FACTORS INFLUENCING THE EMIGRATION OF PHYSICIANS FROM CANADA TO THE UNITED-STATES

Objective: To determine whether location of postgraduate medical train ing and other factors are associated with the emigration of physicians from Canada to the United States. Design: Case-control study, physici ans were surveyed with the use of a questionnaire mailed in May 1994 ( with a reminder sent in September 1994), responses to which were accep ted until Dec. 31, 1994. Participants: Physicians randomly selected fr om the CMA database, 4000 with addresses in Canada and 4000 with curre nt addresses in the United States and previous addresses in Canada. Ou tcome measures: Sex, age, location of undergraduate and postgraduate m edical training, qualifications, practice location, opinions concernin g residence decisions, current satisfaction and plans. Results: The ov erall response rate was 49.6% (50.0% among physicians in the United St ates and 49.2% among those in Canada). Age and sex distributions were similar among the 8000 questionnaire recipients and the nearly 4000 re spondents. Physicians living in the United States were more likely to be older (mean 53.2 v. 49.6 years of age), male (87% v. 75%) and speci alists (79% v. 52%) than those practising in Canada. Postgraduate trai ning in the United States was associated with subsequent emigration (o dds ratio 9.2, 95% confidence interval 7.8 to 10.7). However, in ratin g the importance of nine factors in the decision to emigrate or remain in Canada, there was no significant difference between the two groups in the rating assigned to location of postgraduate training. Professi onal factors rated most important by most physicians in both groups we re professional/clinical autonomy, availability of medical facilities and job availability Remuneration was considered an equally important factor by those in Canada and in the United States. Six of seven perso nal/family factors were rated as more important to their choice of pra ctice location by respondents in Canada than by those in the United St ates. Current satisfaction was significantly higher among respondents in the United States. Most physicians in each group planned to continu e practising at their current location. Of Canadian respondents, 22% i ndicated that they were more likely to move to the United States than they were a year beforehand, whereas 4% of US respondents indicated th at they were more likely to return to Canada. Conclusions: Factors aff ecting the decision to move to the United States or remain in Canada c an be categorized as ''push'' factors (e.g., government involvement) a nd ''pull'' factors (e.g., better geographic climate in the US). Facto rs can also be categorized by whether they are amenable to change (e.g ., availability of medical facilities) or cannot be managed (e.g., pro ximity of relatives). An understanding of the reasons why physicians i mmigrate to the United States or remain in Canada is essential to plan ning physician resources nationally.