Poaching Foreign Doctors

Forty-nine percent of Canada’s Ph.D.s were born elsewhere, and the rules and regulations outlined in our immigration statutes — particularly the points system — tilt strongly toward enticing more foreign nationals with money, skills, and education. According to the minister for citizenship and immigration, Diane Finley, this is precisely what Canada must do — it’s a global competition, after all — and the Harper government’s March budget implementation bill included a provision giving the minister discretion in hand-picking certain immigrant applicants from the large backlog and accelerating their passage into Canada. Identify the need, and then fill it; so much the better that the people come relatively free of charge because their education was obtained elsewhere. Critics argue that this politicizes the immigration and refugee system, but few have raised concerns about the effects of talent recruiting on the developing world.

South of the border, the situation is similar. When the poor spill over the borders into America, as they do from Mexico, alarm bells go off. But, less noticeably, the US has become home to 30 percent of Mexico’s doctoral graduates; and over 60 percent of immigrants from the British Commonwealth Caribbean arrive in America with college or university degrees. In 2005, reporting for the UN, Arno Tanner, visiting Fulbright Scholar at the Migration Policy Institute in Washington, DC, determined that 88 percent of immigrants from non-industrial countries to oecd countries have at minimum secondary school education, and that “global labour migration is increasingly becoming a movement of the educated with their families, which means that, at least initially, the sending country loses a considerable part of its vocational elite upon emigration.” While this global migration creates a temporary vacuum for giants like India and China, it is “more permanent and occasionally life threatening in sub-Saharan Africa or in politically and demographically more vulnerable countries, such as Pakistan and Turkey.” Africa, Tanner states, “has lost a third of its skilled professionals in recent decades, and has had to replace them with 100,000 expatriates from the West, at a cost of $4 billion [US] a year.”

Cited in the Tanner report, Philip Emeagwali — a renowned Nigerian computer scientist who now lives in the US — says that this out-migration makes it nearly impossible for most African countries to build a middle class. He describes Africa as having “a massive underclass that is largely unemployed and very poor, and a few very rich people that are mostly corrupt military and government officials.” This slow but inexorable strangulation of the continent is doubly ironic, given Western leaders’ embrace of the “African renaissance,” and their commitment to helping the continent find “African solutions to African problems.”

Siphokazi Phillip, international relations coordinator for denosa, the professional association of South Africa’s nurses, told me that the recruitment of “all categories of health workers, with nursing being the most affected” continues apace in South Africa. He emphasized that Western health care associations recruit overtly through regular newspaper and magazine advertising campaigns. The biggest offenders, he says, are the US, Canada, Saudi Arabia, and the UK — apparently notwithstanding the efforts of the nhs and Britain’s parliament — and such actions have dire “implications for the country, because they further deepen the staff shortages we have had for many years. The gap is getting wider.” When I ask him about the mitigating effects of remittances, he is skeptical.

On a wall of the Odette Cancer Centre at Toronto’s Sunnybrook Health Sciences Centre, a large world map identifies the countries of origin of the 140-member radiation therapy staff. Doctors, radiologists, and counsellors speak thirty-one languages, the display says, and have come from such diverse places as India, Iran, Tanzania, and Taiwan. This, you might say, is a picture of modern Canada, of multiculturalism in practice, and in many respects it is.

Twenty years ago, Khama Hanson moved from Jamaica to London, England, to study to become a radiation therapist. She returned to Jamaica, which had given her scholarship monies, for a three-year stint to repay her obligation, but packed her bags again, this time for Ottawa and then Toronto. She now works at Sunnybrook. “I always wanted to travel,” she says, “and with this profession you can get a job anywhere in the world.” She tries to believe that some good derives from Jamaicans being one of “the best in the world when it comes to sending remittances,” but cannot deny that one of the Caribbean’s major exports is its workforce.

Sheila Robson, a Brit, came to Canada in 1977. “Princess Margaret Hospital in Toronto was experiencing a desperate shortage of radiation therapists,” she says. “They advertised in the UK, and nineteen of us answered the call.” For Robson, it was both an adventure and a serendipitous financial move: her salary quintupled instantly. Still, like many back then, she intended to stay in Canada only a short time; thirty years later, she’s still here, now as head of radiation therapy at Sunnybrook. In the early days, international recruitment as a strategy to address labour shortages tended to be from one First World country to another — Robson was trained in Newcastle, England — and for Canada, Australia, and England, significant immigration also occurred within the Commonwealth, which explains how Khama Hanson moved easily from Jamaica to England and then here. In the 1990s, as globalization knocked down walls, developing nations became fair game in the hunt.

During that hyper decade, for instance, Robson’s own department at Sunnybrook participated in two mad scrambles to address shortages, both times sending officials on worldwide searches with the full support of two levels of government. Cancer Care Ontario, the provincially funded umbrella organization that oversees strategies to address cancer treatment needs, mounted the overseas campaign of advertisements and interviews. The federal immigration department recognized the campaign and “made us a desired profession,” Robson says. On both occasions, the Canadian delegations found themselves in hot competition with other countries on the prowl for skilled personnel, especially the UK and the US. The Americans, Robson says, always offered great bonuses and higher salaries.

Today, while medical school enrolments are back to their pre-1993 levels, the pressure on Canada to take advantage of the developing world’s skills is enormous. With our population aging rapidly and baby boomers starting to retire, medical needs and costs are rising dramatically. Provincial and territorial health care budgets in 1993 accounted for 32.7 percent of total expenditures. By 2006, they were soaking up nearly 40 percent. The trend lines and expectations are clear. Extended wait times remain a major problem — and private health care, everything from hip replacement clinics in Montreal to the new for-profit hospital in Vancouver, is stepping in to fill the breach. But a major part of the strategy is to go for the foreign trained. In Ontario, for instance, the Liberal government says that it has “doubled the number of international medical graduates to improve access to health care,” and Michael Decter, former chair of the Health Council of Canada, confirms that the province has programs in place to speed up the process of accreditation for foreign-trained medical professionals already here. The question, of course, is whether such efforts simply amount to giving the green light to those wanting to leave their Third World situations.

Many health services across Canada fear that foreign-trained professionals are the only staff they are going to get. In the Yukon, for instance, keeping medical staff is a perpetual challenge, according to Stuart Whitley, the territory’s deputy minister of health and social services. In no small measure, it manages by attracting young international medical graduates (imgs). “We have arrangements for them to practise here,” says Whitley. “Special licences allow doctors who have come from other countries to practise, subject to such conditions as our medical council imposes. Sometimes those are supervisory — shadowing and so on.” The territory has recently licensed doctors from Pakistan, Britain, and South Africa, but, Whitley acknowledges, the problem remains, and “we can never get enough nurses.”