After months of agony -- and it was nothing short of that -- David Ross decided to move across the country. His was no ordinary relocation: Politicians pressured him to stay and newspapers printed stories.

Before Dr. Ross and his family moved to Edmonton, he was the only surgeon in Atlantic Canada who could slice open children's chests and repair their tiny hearts.

"We were very torn in leaving and there wasn't anything really wrong [in Halifax]. This was just an opportunity that we felt we probably couldn't afford not to take," he said.

Now in Edmonton, Dr. Ross has a colleague. He is no longer constantly on call. He can take holidays. And he'll never have to rush home because a newborn needs him. The 46-year-old's move last year was one of seizing a prospect that would come only once, given the slim ranks of pediatric heart surgeons -- there are only about 15 in Canada -- as well as the lure of getting in on the ground floor of a cardiac institute that is slated to open in 2005.

But to add insult to injury to Nova Scotia's health-care system -- or at least that's the way some portrayed it -- pediatric brain surgeon Vivek Mehta followed the same migration route as Dr. Ross just a few months later. One Edmonton hospital manager called it a "one-two punch."

Like Dr. Ross, Dr. Mehta was deeply conflicted about leaving Halifax. His departure, too, left a hole in Atlantic Canada's medical field: He was one of just two physicians skilled in the delicate field of children's cranial surgery. But his decision was one of family; Edmonton offered better career opportunities for his wife, who is a kidney specialist.

"It was good out there [in Halifax] as well, but overall it wasn't great for both of us together and we're sort of a team, so it had to be a good job for her and opportunities for me," said Dr. Mehta, who is 35.

The relocations of Dr. Ross and Dr. Mehta -- highly skilled experts in ultra-specialized fields -- are extreme examples of the mobility of human health resources, and the impact upon hospitals and whole regions when professionals pick up and leave. More common, of course, is the rural family physician who can no longer take the never-ending hours and the nurse who is sick of treadmill-like, understaffed hospital wards.

The Canada Health Act's principle of portability is usually thought of in terms of patients being able to get similar health care wherever they live, rather than in relation to the mobility of health workers. But when employees are wooed away by a province or a country -- often the United States -- offering better work conditions and more money, medicare can suffer.

"Competition between provinces and territories is intense and, in many ways, counterproductive," says the report on health care released last week by Roy Romanow.

To counter this problem, the report recommends that resources be used "to improve the supply and distribution of health care providers, encourage changes to their scopes and patterns of practice, and ensure that the best use is made of the mix of skills of different health care providers."

Mr. Romanow also recommended that the proposed Health Council of Canada report on relevant information about the work force, including education, recruitment, distribution and pay. He said the agency should recommend more integrated education programs, especially relating to primary health care.

And perhaps most important, he said it should develop a plan to manage the work force.

The idea, which would be designed to ensure supply was at an adequate level to prevent crisis-like shortages, is favoured by Nova Scotia Health Minister Jamie Muir -- who was one of the people who asked Dr. Ross to stay in Halifax -- and other politicians who are weary of having their skilled health workers pack up and leave.

The strategy would involve monitoring and making decisions from a national perspective on a variety of issues, including demographic trends and the number of spots in training programs for doctors, nurses and technologists.

"It's a supply thing," Mr. Muir said. "If you have enough supply, then you don't worry so much about somebody taking one person."

But Mr. Muir is pragmatic about the current situation facing not-so-wealthy provinces.

"If it comes to a battle of bucks, we aren't going to win, I guess," he said. "Alberta has been extremely fortunate; they've been resource-rich compared to any other province in Canada."

However, work-force mobility is a reality for any province, have or have-not, said Mr. Muir, who boasts that his province does better than some of its richer cousins in terms of the number of physicians per capita.

"We're playing in the big leagues," he said. "Sometimes people move from team to team, this is not unusual . . . We would like to have the very best people come here and never move, but in this day and age mobility is a fact of life and we think we're competitive in every way."

Alberta Health Minister Gary Mar defends Alberta's recruitment of health professionals as a short-term solution to staffing its hospitals, clinics and labs. The real answer, he argues, is for provinces to train and retain their own workers, which could be fostered with a national strategy.

However, such a plan has not yet gotten off the ground, so Alberta, and other provinces, have gone it alone.

"Is there a way that we can recruit better by co-ordinating ourselves among each other? The answer is probably yes. But efforts to do that have, in my estimation, been too slow and so that leaves each province to make their own best efforts and Alberta is no different than any other jurisdiction. We have been aggressive in recruiting health professionals from other places."

And Mr. Mar points out that while Alberta may gain health workers from other provinces, it also attracts a sizable number of people who move to Alberta and need health care.

"We have had a significant increase in the number of physicians in this province. It has been at a rate faster than the growth of our population, but keep in mind that people continue to come to Alberta, all kinds of people, from all over Canada and that we have a population growth that is higher than most provinces," he said.

Back at Edmonton's Stollery Children's Hospital, Dr. Mehta and Dr. Ross have ideas of their own to cure the nation's staffing ailments.

Dr. Mehta said it is the federal government's responsibility to provide the most level playing field possible by providing the provinces with enough funding for the basics of medicine: high-tech equipment, research and, of course, stable and adequate funding for general health care.

"I think that just makes common sense."

Dr. Ross concurs. Normally soft-spoken, he gets upset about what he considers the federal government's inadequate funding of the medical system.

"There is such a discrepancy in economic well-being of different parts of this country, that for it to have totally backed out of funding the medical system as it has, has really led to extreme difficulty in the less-well-off parts of the country," he said. "Canadians want medicare, we can afford it, we're a rich country, but the federal government has to be a leader, not just a mouthpiece."