Physicians are considering leaving Canada, or have already left, due to an increasingly difficult landscape for practising medicine, experts say.
“Up to a third of physicians are talking about decreasing their hours or retiring or leaving the country in the next two years,” said Dr. Joss Reimer, president of the Canadian Medical Association, which advocates for physicians across the country.
“We’re going to lose health-care providers [while] more people than ever need those services.”
Many doctors across Canada are expressing a desire to relocate or leave Canada entirely.
A 2024 Doctors Manitoba survey reveals almost half of existing doctors are considering relocating to another province, retiring or reducing their hours in the next three years. The province is at risk of losing a fifth of their physicians in the next three years, the survey shows.
An Alberta Medical Association survey from 2024 also shows almost half of Alberta family physicians are considering moving out of the province.
And the situation is not different in British Columbia, says Dr. Ahmer Karimuddin, president of Doctors of BC, the province’s association for doctors.
Beginning in 2020, we started “seeing more and more family doctors closing down their offices and … either retiring or leaving, or changing their practice patterns, because they felt they couldn’t provide the care that they were used [to providing],” said Karimuddin, a colorectal surgeon who has practiced for the past 17 years.
Sources point to lower earnings, poor tax policies, unsustainable work hours and excessive administrative work as factors pushing physicians to consider changing their work, or moving out of the country entirely.
Ability to save
One of the main reasons many physicians move to the US is a higher salary, says Reimer, who used to run a community medical practice but moved into hospital work due to being overloaded by paperwork.
The median gross income of a family physician in Canada was C$298,600 in 2021/2022, according to the Canadian Institute for Health Information. For family physicians in the US, the average wage was about C$330,000 in May 2023, according to the US Bureau of Labor Statistics.
However, most physicians in Canada are self-incorporated and work as small business owners. They incur their own office and employee expenses and bill the government for the medical services they provide.
“[Physicians] who set up practices can spend as much as 40 per cent of their gross clinical revenue on office space, equipment and staff,” the Canadian Medical Association website says. Using the 40 per cent estimate, a physician grossing $298,600 would have net income of $179,000.
Many doctors keep some of their income in their corporations. That money is then invested and subject to taxes on any gains.
In June, the Liberal government increased taxes on capital gains incurred by corporations.
“These capital gains changes affect every dollar of capital gains that I earn in my corporation,” said Reimer. “[They’re] affecting… my ability to save for retirement because most physicians don’t have pensions.”
The Ontario Medical Association’s website says “Ontario doctors that realize a capital gain in their professional corporation will pay approximately 9.65 per cent more income tax on capital gains realized on or after June 25, 2024.”
The Canadian Medical Association met with the government to discuss the proposed inclusion rate increase. It also sent a letter to Finance Minister Chrystia Freeland urging the government to repeal the increase or exempt medical professional corporations from it.
Officials did not follow their recommendations, says Reimer.
The Canadian Medical Association has warned the inclusion rate change will “exacerbate the ongoing access to care crisis affecting millions of Canadians.” Already, 6.5 million Canadians do not have access to a family doctor, according to a survey released earlier this year.
Easy to move
In addition to the attraction of better earnings, the US medical industry can offer better research opportunities, says Reimer. There is greater access to state-of-the-art facilities and large funding pools that are not widely available in Canada.
“They do more creative and advanced interventions that may not be possible in some of the systems in Canada,” she said.
Canadian medical credentials are recognized in the United States. The Liaison Committee on Medical Education, a US-Canada accreditation body, treats physicians who graduate from one of Canada’s 17 accredited medical schools as equivalent to graduates of US medical schools.
Canadian physicians are not required to complete a certification process that establishes the equivalency of their medical education or board examinations, according to the US immigration law firm Murthy Law Firm. Canadian citizen physicians are also eligible for a TN visa, which is not subject to quotas and can be applied for at the border upon entry to the US.
The departure of physicians may be part of a broader trend. In May, CBC News reported that more than 126,000 Canadians moved to the US in 2022, an increase of nearly 70 per cent from 2012. Their reporting identified high cost of living and dissatisfaction with Canada’s political culture as driving factors behind the increase.
Rather than leave the country, Reimer would prefer Canada look to other countries for ways to improve the health-care system and decrease the stress on doctors. New Zealand offers paid vacations for doctors, while Sweden offers pensions, she says.
“Can we look at some of the countries … and recreate?”
She also says the profession needs to do a better job of understanding what physicians need.
“We really need to be looking at the younger generation, and talking to them about what are the things they need to see in the workplace, to make it worth it for them,” she said.
“To make it so that they can contribute in an efficient and effective way … so that it’s an attractive place for them to thrive and be able to provide a service to Canadians.”
Leave a comment