The Canadian contribution to the US physician workforce.
BACKGROUND
A physician shortage has been declared in both Canada and the United States. We sought to examine the migration pattern of Canadian-trained physicians to the United States, the contribution of this migration to the Canadian physician shortage and policy options in light of competing shortages in both countries.


METHODS
We performed a cross-sectional analysis of the 2004 and 2006 American Medical Association Physician Masterfiles, the 2002 Area Resource File and data from the Canadian Institute for Health Information, the Canadian Medical Association and the Association of Faculties of Medicine of Canada. We describe the migration pattern of Canadian medical school graduates to the United States, the number of Canadian-trained physicians in the United States in 2006, the proportion who were in active practice, the proportion who were practising in rural or underserved areas and the annual contribution of Canadian-trained physicians to the US physician workforce.


RESULTS
Two-thirds of the 12 040 Canadian-educated physicians living in the United States in 2006 were practising in direct patient care, 1023 in rural areas. About 186, or 1 in 9, Canadian-educated physicians from each graduating class joined the US physician workforce providing direct patient care. Canadian-educated physicians are more likely than US-educated physicians to practise in rural areas.


CONCLUSIONS
Minimizing emigration, and perhaps recruiting physicians to return to Canada, could reduce physician shortages, particularly in subspecialties and rural areas. In light of competing physician shortages, it will be important to consider policy options that reduce emigration, improve access to care and reduce reliance on physicians from developing countries.
Phillips
Robert L
RL
The Robert Graham Center, Policy Studies in Family Medicine and Primary Care, Washington, DC 20036, USA.
Petterson
Stephen
S
Fryer
George E
GE
Rosser
Walter
W
D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D019992:Databases as Topic; D004641:Emigration and Immigration; D005550:Foreign Medical Graduates / Q000706:statistics & numerical data*; D006801:Humans; D008511:Medicine / Q000706:statistics & numerical data; D010560:Personnel Selection; D010820:Physicians / Q000706:statistics & numerical data* / Q000600:supply & distribution; D011365:Professional Practice Location; D019035:Rural Health Services; D013038:Specialization; D014481:United States / Q000453:epidemiology; D000078329:Workforce