Why are Quebec's doctors leaving?

T Canadian Institute for Health Information (CIHI) recently reported that Quebec shows a net loss in the interprovincial migration of physicians, and this poor performance is compounded by the departure of physicians to other countries. In all, 653 doctors have left Quebec in the past 5 years. Their average age was 40.8 years, so they were at the peak of their productivity. Why are they leaving? The migration of significant numbers of skilled professionals is one of the signs of a society’s total or partial inability to allow those professionals to grow and thrive. While the causes of such an exodus may vary, the message that must be drawn is harsh: such movement almost invariably implies that this society is relatively less capable of supporting — in logistical, technological, scientific or financial terms — the activities of this special workforce. We believe that physicians belong to this special workforce and that their exodus is highly significant. The debate surrounding physicians’ migratory trends is highly charged, but beyond sensationalism and scoring political points we need to take a serious look at the issue because even though the statistics appear to suggest a slight improvement, the exodus from Quebec is real. Beyond mere figures, there is a “qualitative” exodus because highly skilled physicians with special expertise depart, leaving behind hospitals incapable of providing extra-specialized care, surplus work for colleagues who remain and a weakened teaching base. That 653 skilled medical professionals should leave Quebec in 5 years is scandalous. So what can we do to end the scandal? Medical practice in Quebec has to be made more attractive. Coercive measures concerning physician employment must be eliminated. We have to take a fresh look at how our system is managed and find new ways to fund it, while still maintaining the principles embedded in the Canada Health Act. Health care and the biomedical sciences have to aim for excellence. If we do that, then perhaps we will be able to offer our physicians a more attractive environment.