The “Brain Drain”: Factors influencing physician migration to Canada


Context: Higher income countries have an average physician density of 300 physicians per 100,000 people. In stark contrast, lower income countries have an average physician density of 17 physicians per 100,000 people. A major cause of this discrepancy is the migration of healthcare professionals from lower income to higher income countries, a phenomenon colloquially known as the “brain drain”. Objective: To explore factors that led International Medical Graduate (IMG) physicians to leave their home countries and migrate to Canada. Methods: An anonymous questionnaire with a mix of open- and close-ended questions was sent to 500 randomly selected IMG physicians practicing in Ontario, Canada. Results were analyzed using a mixed-method design utilizing both descriptive statistics and a thematic analysis approach. Results: 39 physicians met inclusion criteria and completed the survey. The majority were 50 years or older, and over 60% were male. The most common reason for emigration from their home country was the socioeconomic and/or political situation, and the most common reason for selecting Canada was family issues. Suggestions for how brain drain could be stemmed fell into three broad categories: 1) more accurate information about lack of opportunities in Canada, 2) more continuing medical education opportunities in home countries, and 3) address issues such as safety and quality of life in home countries. Conclusions: This survey provides insights into the reasons for emigration and immigration for international medical graduates. The results of this survey can assist stakeholders in working toward appropriate and acceptable solutions to the brain drain.

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Lofters, A. , Slater, M. and Thulien, N. (2013) The “Brain Drain”: Factors influencing physician migration to Canada. Health, 5, 125-137. doi: 10.4236/health.2013.51017.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] World Health Organization (2008) Do most countries have enough health workers? WHO.
[2] Dovlo, D. (2005) Taking more than a fair share? The migration of health professionals from poor to rich countries. PLOS Medicine, 2, e109. doi:10.1371/journal.pmed.0020109
[3] Lopes, C. (2008) Restrictions on health worker migration proving problematic. CMAJ, 178, 269-270. doi:10.1503/cmaj.071818
[4] College of Physicians and Surgeons of Ontario (2010) Request for Information Form.
[5] Akl, E.A., Gaddam, S., Mustafa, R., Wilson, M.C., Symons, A., Grifasi, A., et al. (2011) The effects of tracking responses and the day of mailing on physician survey response rate: Three randomized trials. PloS One, 6, e16942. doi:10.1371/journal.pone.0016942
[6] World Health Organization (2008) 10 facts on health workforce crisis. WHO.
[7] World Health Organization (2010) Migration of health workers: Fact sheet No. 301. WHO.
[8] Connell, J., Zurn, P., Stilwell, B., Awases, M. and Brai-chet, J.M. (2007) Sub-Saharan Africa: Beyond the health worker migration crisis? Social Science & Medicine, 64, 1876-1891. doi:10.1016/j.socscimed.2006.12.013
[9] Mullan, F. (2005) The metrics of the physician brain drain. The New England Journal of Medicine, 353, 1810-1818. doi:10.1056/NEJMsa050004
[10] Mills, E.J., Kanters, S., Ha-gopian, A., Bansback, N., Nachega, J., Alberton, M., et al. (2011) The financial cost of doctors emigrating from sub-Saharan Africa: Human capital analysis. BMJ, 343, d7031. doi:10.1136/bmj.d7031
[11] Hooper, C.R. (2008) Adding insult to injury: The health- care brain drain. Journal of Medical Ethics, 34, 684-687. doi:10.1136/jme.2007.023143
[12] Morison, L. (2001) The global epidemiology of HIV/ AIDS. British Medical Bulletin, 58, 7-18. doi:10.1093/bmb/58.1.7
[13] Fortson, J.G. (2011) Mortality risk and human capital investment: The impact of HIV/AIDS in Sub-Saharan Africa. The Review of Economics and Statistics, 93, 1-15. doi:10.1162/REST_a_00067
[14] Schuchman, M. (2008) Economist challenges recruiting hyperbole. Canadian Medical Association Journal, 178, 379-380.
[15] Scott, M.L., Whelan, A. and Dewdney, J. (2004) “Brain drain” or ethical recruitment? Solving health workforce shortages with professionals from developing countries. Medical Journal of Australia, 180, 174-176.
[16] Aly, Z. and Taj, F. (2008) Why Pakistani medical graduates must remain free to emigrate. PLOS Medicine, 5, e2. doi:10.1371/journal.pmed.0050002
[17] Syed, N.A., Khimani, F., Andrades, M., Ali, S.K. and Paul, R. (2008) Reasons for migration among medical students from Karachi. Medical Education, 42, 61-68. doi:10.1111/j.1365-2923.2007.02904.x
[18] Kaushik, M., Roy, A., Bang, A.A. and Mahal, A. (2008) Quality of medical training and emigration of physicians from India. BMC Health Services Research, 8, 279. doi:10.1186/1472-6963-8-279
[19] Hagander, L.E., Hughes, C.D., Nash, K., Ganjawalla, K., Linden, A., Martins, Y., et al. (2012) Surgeon migration between developing countries and the United States: Train, retain, and gain from Brain Drain. World Journal of Surgery, 37, 14-23. doi:10.1007/s00268-012-1795-6
[20] Grava-Gubins, I. and Scott, S. (2008) Effects of various methodologic strategies: Survey response rates among Canadian physicians and physicians-in-training. Canadian Family Physician, 54, 1424-1430.
[21] Field, T.S., Cadoret, C.A., Brown, M.L., Ford, M., Greene, S.M., Hill, D., et al. (2002) Surveying physicians: Do components of the “Total Design Approach” to optimizing survey response rates apply to physicians? Medical Care, 40, 596-605. doi:10.1097/00005650-200207000-00006
[22] Viera, A.J. and Edwards, T. (2012) Does an offer for a free on-line continuing medical education (CME) activity increase physician survey response rate? A randomized trial. BMC Research Notes, 5, 129. doi:10.1186/1756-0500-5-129
[23] James, K.M., Ziegenfuss, J.Y., Tilburt, J.C., Harris, A.M. and Beebe, T.J. (2011) Getting physicians to respond: The impact of incentive type and timing on physician survey response rates. Health Services Research, 46, 232-242. doi:10.1111/j.1475-6773.2010.01181.x
[24] Hawley, K.M., Cook, J.R. and Jensen-Doss, A. (2009) Do noncontingent incentives increase survey response rates among mental health providers? Administration & Policy in Mental Health, 36, 343-348. doi:10.1007/s10488-009-0225-z
[25] Camunas, C., Alward, R.R. and Vecchione, E. (1990) Survey response rates to a professional association mail questionnaire. Journal of the New York State Nurses Association, 21, 7-9.
[26] No authors list (2008) A global dialogue on a global crisis. Lancet, 371, 1138.
[27] Pagett, C. and Padarath, A. (2007) A review of codes and protocols for the migration of healt workers. The Regional Network for Equity in Health in East and Southern Africa (EQUINET) with the Health Systems Trust.

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