President George Bush wants Congress to approve tax cuts worth $1.6 trillion over 10 years, and he wants income tax rates slashed. Will this persuade yet more Canadian physicians to move south?
Not likely, says Jeffrey Simpson, author of Star-Spangled Canadians: Canadians Living the American Dream (Harper–Collins, 2000). “Bush's tax cut may make a marginal difference,” says the Globe and Mail columnist, “but it won't drive people's behaviour. The brain drain to the US is triggered by a variety of more complex pressures.”
Simpson's book offers an interesting look into the history and consequences of Canadian emigration to the US, where about 660 000 Canadians currently live. Moreover, he argues that Canadians are becoming more and more American in their cultural preferences and political and economic choices.
Increasingly, the most important divider between the 2 nations is the way their citizens regard their health care services: in Canada they are a right, in the US they are a privilege.
In his book, which took 2 years to research and involved mostly face-to-face interviews with 250 Canadians in 13 states, Simpson carefully explores the reasons for physician emigration in the 1990s. He looks at both “push factors” — capped incomes, excessive workloads — and the “pull factors,” such as the growing US need for family doctors.
His analysis will not surprise anybody who follows physician work patterns, but he was surprised by a recent report from the Tommy Douglas Research Institute that contested evidence of a physician shortage (see CMAJ 2001;164[6]:857). “It's out of line with every other study I've seen,” he says. “I wonder whether their analysis isn't wishful thinking, reflecting a planner's conceit that [planners] can always anticipate pressures and allocate resources sensibly.”
The kaleidoscope of attitudes among doctors who have moved south surprised Simpson. “I anticipated ardent devotees, but I found plenty of misgivings about the system and a real dislike of HMOs. Many of the doctors I talked to went south to join a free-market system, and now they find the regulation and paperwork just as bad there.”
Simpson has now turned his attention to the future of the Canadian system. “I'm struggling with attitudes within Canada about medicare. The polls say we are still wedded to universality and hostile to the idea of a parallel private system, but we are also open to some private service delivery if the integrity of the system can be maintained.”
Simpson says some public discussion on the issue is beginning, but serious debate won't start until Canadians realize that change is essential “if we want to keep what we've got.”