A few weeks ago, I had dinner with two leaders of our resident physicians, Martin Bernier, the president of the Fédération des médecins résidents du Québec, and Yael Kushner, vice-president of FMRQ and president of the McGill Residents Association. He is a francophone cardiology fellow; she is an anglophone pathology resident in the McGill training programs. They are both fluently bilingual, bright, engaging and dedicated to careers in medicine in Montreal. The conversation was all about possibility -- they are the future of medicine in Canada.
My young colleagues' career paths are in high contrast to those described in a new study published last week in the Canadian Medical Association Journal that has revived the public debate about how to stanch the reported migration of medical school graduates and physicians southward to the United States. The CMAJ study, conducted by a team of Canadian and American researchers, found that one in nine Canadian-educated physicians practises in the United States and nearly half of those graduated from the University of Manitoba (8 per cent), the University of Toronto (15.2) or McGill University (24.7).
As an expatriate American and the new dean of the McGill faculty of medicine, the numbers gave me pause, but there is nothing simple about their meaning. McGill enjoys a reputation internationally that continues to draw exceptional students and members of the faculty from around the world, the United States included. When those students graduate, some of them choose to practise in the United States, where a McGill degree represents the same quality of education and training as those from the top U.S. schools. As a former vice-dean for education, faculty and academic affairs at New York University School of Medicine, I was less surprised by the numbers in the report. Anyone working in the health education or health service sectors in the United States works side-by-side with Canadian graduates.
But I have been in Canada for seven months, just long enough to also understand the justifiably affronted nationalism that informs the shock at the notion that Canadian-educated doctors are beating a path to the U.S. That concern is made worse by the knowledge that Canada's increasingly overburdened health system is further stretched by a shortage of physicians, and that the 10 to 30 U.S. graduates who cross the border the other way each year do little to balance the deficit. The better news is that on average, 200 to 300 physicians return to Canada from abroad each year and, as the article reports, in 2004, for the first time, more returned than left.
In McGill's case, there is no doubt that local work-force conditions play a role in our ability to compete with the lure of the newer, better-funded facilities, the higher salaries and the more flexible working conditions offered by U.S. institutions. And, as Nick Busing of the Association of Faculties of Medicine of Canada reports in an accompanying editorial, it is important to remember that the United States faces a daunting doctor shortage as well. So the pressure will not lessen.
For more than a decade, the core teaching hospitals of the McGill University Health Centre network (the Royal Victoria, the Montreal General, the Montreal Children's, the Montreal Neurological Institute and the Montreal Chest Institute) have operated at best in a state of suspended development due to the delays surrounding construction of the new MUHC hospital project. As long as the status quo maintains, we will continue to produce exceptional doctors who have to choose between treating patients in superb, modern conditions elsewhere and delivering excellent care locally in lesser surroundings.
On this front, McGill continues to be blamed by opponents of the facility, particularly those who argue that Montreal does not need a new "anglo" hospital, a position that willfully ignores the city's evolving demographics and the patient base of the McGill teaching hospitals, where francophones comprise an increasingly significant component. We are blamed for training doctors who leave the province at the same time as we are begrudged the option of providing the academic hospitals that would help retain them.
In a world that grows more connected every day, in a public health environment where global is local, the reality that McGill graduates are treating patients, conducting research and formulating public health policy in as many countries as were represented in their classrooms here is surely as much a source of pride and benefit for most Quebeckers as it is for us. They know Montreal, they stay in touch and one day, if we give them a place to come back to, they may return.
Dr. Richard I. Levin is vice-principal (health affairs) and dean of the McGill faculty of medicine.
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