title: Shifting tides in the emigration patterns of Canadian physicians to the United States: a cross-sectional secondary data analysis.
abstract: The relative ease of movement of physicians across the Canada/US border has led to what is sometimes referred to as a 'brain drain' and previous analysis estimated that the equivalent of two graduating classes from Canadian medical schools were leaving to practice in the US each year. Both countries fill gaps in physician supply with international medical graduates (IMGs) so the movement of Canadian trained physicians to the US has international ramifications. Medical school enrolments have been increased on both sides of the border, yet there continues to be concerns about adequacy of physician human resources. This analysis was undertaken to re-examine the issue of Canadian physician migration to the US.
  
  
  
  We conducted a cross-sectional analysis of the 2015 American Medical Association (AMA) Masterfile to identify and locate any graduates of Canadian schools of medicine (CMGs) working in the United States in direct patient care. We reviewed annual reports of the Canadian Resident Matching Service (CaRMS); the Canadian Post-MD Education Registry (CAPER); and the Canadian Collaborative Centre for Physician Resources (C3PR).
  
  
  
  Beginning in the early 1990s the number of CMGs locating in the U.S. reached an all-time high and then abruptly dropped off in 1995. CMGs are going to the US for post-graduate training in smaller numbers and, are less likely to remain than at any time since the 1970's.
  
  
  
  This four decade retrospective found considerable variation in the migration pattern of CMGs to the US. CMGs' decision to emigrate to the U.S. may be influenced by both 'push' and 'pull' factors. The relative strength of these factors changed and by 2004, more CMGs were returning from abroad than were leaving and the current outflow is negligible. This study supports the need for medical human resource planning to assume a long-term view taking into account national and international trends to avoid the rapid changes that were observed. These results are of importance to medical resource planning.
authors.affiliation: Department of Family Medicine, Centre for Studies in Family Medicine, Western University, London, ON, Canada. tfreeman@uwo.ca.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Freeman
authors.affiliation: The Robert Graham Center for Policy Research in Family Medicine and Primary Care, Washington, D.C, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Petterson
authors.affiliation: The Robert Graham Center for Policy Research in Family Medicine and Primary Care, Washington, D.C, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Finnegan
authors.affiliation: The Robert Graham Center for Policy Research in Family Medicine and Primary Care, Washington, D.C, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bazemore
mesh_terms: D002170:Canada; D003430:Cross-Sectional Studies; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005550:Foreign Medical Graduates / Q000706:statistics & numerical data* / Q000600:supply & distribution; D006801:Humans; D010820:Physicians / Q000706:statistics & numerical data* / Q000600:supply & distribution; D012189:Retrospective Studies; D012577:Schools, Medical / Q000706:statistics & numerical data; D014481:United States
keywords: Medical human resources; Physician migration; Physician supply