To my considerable surprise, I found myself agreeing with everything that Barer and colleagues1 wrote in their CMAJ salon article. The authors are right in describing Canadian health care as an “essentially unmanaged system where physicians can practise what they want, where they want, when they want.”
It was not always thus. I came to British Columbia with my wife and three children 50 years ago and was told by the College of Physicians and Surgeons of British Columbia that I would have to work in an underserviced town or city in northern BC. This seemed perfectly reasonable, and so, I went to work in Prince Rupert, BC.
All this has been changed by the Canadian Charter of Rights and Freedoms, which guarantees all Canadians and permanent residents freedom of mobility within Canada to pursue their occupation. Ironically, the same charter offers no “right to health care,” although most Canadians assume it does. Until these two conflicting aspects of the charter are dealt with, we shall continue to see a very disturbing maldistribution of doctors throughout Canada, with rural Canadians, who produce much of the nation’s wealth, being shortchanged.
To open the gates to all Canadian medical graduates from overseas would offer no guarantee of better health care to those Canadians living in rural and isolated areas.
We have a politicized health care system, and it seems that no federal government has the courage to address its problems.