Does Canada Have Too Many Doctors?: Why Nobody Loves an Immigrant Physician

Abstract

A consensus seems to be emerging among health service planners and administrators in Canada that the rapid influx of foreign-trained physicians should be slowed down, if not stopped.' Most physicians seem to agree. On the other hand, a 'consumerist' position has tended to emerge in response which opposes 'monopolistic' restrictions on the supply of medical services with consequent limitations on the availability of medical care and increases in cost. The consumerist position is sometimes linked to a simplistic economic model of the medical care 'market'; the anti-immigrant view is not in general related to any abstract underpinnings. It appears, however, that both positions can in fact be traced back to fundamentally different economic and behavioural models of how pricing and resource allocation take place in the health care industry. In this paper I will try to articulate somewhat more clearly what I believe to be the technical and behavioural assumptions underlying these alternative views of the foreign physician (or indeed of health care economics), in the hope that the extent of common or contested ground may be more readily observed. In particular, the pro-foreign physician position seems to rest on the consumer sovereignty assumption that so long as people are willing to consume more medical care then more is 'a good thing,' on the technical assumption that more medical care and more physicians are equivalent, and on the market assumption that increases in supply tend to drive down prices and supplier incomes. By taking the converse of each of these propositions one can arrive at the restrictionist position at least if one views domestic physician supply