When Canadian-trained doctors look to the American medical system, they see more money, more opportunity and fewer bureaucratic hassles. So they head south. Meanwhile, U. S. physicians are lured to swanky, high-tech hospitals in tropical countries to fill the rapidly-growing needs of medical tourism. Finally, doctors from less-developed countries eagerly travel anywhere—just to pursue a better quality of life.
It’s all part of “the circle of life” for today’s doctors. But South Africa says it consistently gets the short end of the stick, and it’s now pointing the finger of blame at Canada.
Dr. Abraham Sokhaya Nkomo, South Africa’s high commissioner to Canada, recently told us to stop recruiting its doctors because our aggressive practices have caused “grave health outcomes” in his country.
The appeal is dramatic, but it isn’t new. In 2001, South Africa’s former high commissioner issued an almost identical message that was supposedly an unprecedented appeal to cease the targeting of South African physicians. But the complaints have been around since the 1990s and, given that the number of South African doctors here continues to grow, the messages seem rather futile.
There are about 2,100 South African physicians in Canada; about one quarter of them (560) work in Alberta and comprise eight per cent of its physician population. They are primarily located in the rural communities that Canadian doctors continue to shun because of greater responsibilities (on-call and hospital duties) and fewer resources. But is it poaching?Whether or not doctors are actively or even passively recruited, the decision to leave South Africa is theirs alone.
Like everyone else, doctors have the human right to move freely about the world and live/work in a setting of their choice. No country can compel doctors to stay unless they establish special agreements whereby medical education is fully funded in exchange for a period of compulsory service. Canada’s military has such a program, and it might be something for both Canada and South Africa to consider.
Canada is a logical choice for South African doctors because there are no language barriers and it is relatively easy to transfer their credentials within fellow Commonwealth countries. Most can start work immediately and write their exams over a period of time. In contrast, the U. S. may require a two-year residency program and the completion of all regulatory exams before they even begin to work.
Beyond the convenience, a key reason driving the migration of South African doctors is safety. The country has one of the world’s highest rates of violent crime (murder, rape) and those who have the opportunity to attain a more secure and better quality of life for their families are eager to do so. Other negatives are hospitals plagued by theft, corruption and a lack of equipment, and a poor economy. Prior to the mid-1990s, many doctors left to escape compulsory military service for a racist government.
In other words, there are plenty of reasons for young doctors to leave South Africa, and that’s why only half of the physicians it has trained over the past decade have stayed.
South Africa’s problem isn’t that they are losing physicians, but that they are failing to create reforms and incentives that will give them a reason to stay.
Canada’s problem exists because former Jean Chretien screwed up.
In 1993, his Liberal government made the erroneous determination that Canada had a surplus of doctors. In their mad rush to reduce health care expenses, they neglected to consider future trends. So they cut enrolments at medical schools and offered retirement incentives to physicians. Then things changed: Not only did fewer doctors graduate, but only 45 per cent wanted to be general practitioners, no one wanted to work in rural communities and increasing numbers of female doctors only worked part-time. All these factors culminated in a significant doctor shortage for an aging Canadian population that requires increasing amounts of care.
That shortage still exists, so we need to actively recruit doctors. Our governments can’t apologize for that because their role is to ensure that Canadians have adequate health care.
But recruiting isn’t the long-term solution; providing the required number of Canadian-trained doctors is. That means cash for increases in medical school enrolments and the availability of hospital positions. It means building a reliable medical system for the future —something Chretien forgot to do.