Immigrant Doctors and the Transnational Roots of Canadian Medicare

Abstract

Immigrant Doctors and the Transnational Roots of Canadian Medicare Alex Myrick (bio) IN A RECENT FRONT-PAGE STORY published by the Telegram in St. John’s, Newfoundland, journalist Peter Jackson observed that only one 2021 Memorial University of Newfoundland medical school graduate has agreed to establish a practice in the province. Jackson states that this news comes at a time when “several existing family physicians” are reducing their practices or are retiring all together.1 According to Jackson, the lack of new doctors, and the retirement of the older ones, are adding to the province’s impending doctor shortage. During a recent visit to St. John’s, federal Immigration Minister Marco Mendicino stated “One of the ways that we can provide reinforcements to the front lines of the health care sector is through immigration.”2 Mendicino’s comment reflects the current federal government’s recognition of a much publicized doctor shortage, and that immigration may provide a solution.3 But while journalists are helping to raise awareness of this issue, the historic root causes are left unexamined. Fortunately, two of Canada’s most accomplished historians of medicine, Sasha Mullally of the University of New Brunswick and David Wright of McGill University, have published Foreign Practices: Immigrant Doctors and the History of Canadian Medicare. The central purpose of their text is to examine the immigration of foreign-trained doctors to Canada following the Second World War and the vital role they played in the delivery of health services during the transition to Medicare during the late 1960s and early 1970s.4 To frame this narrative, Mullally and Wright focus on the years between 1957 [End Page 117] and 1984 as immigrant physicians established themselves throughout Canada. Mullally and Wright primarily argue, as a result of their study of the links between immigration and health care, that universal health insurance in Canada was able to survive because of the influx of foreign-trained doctors, who bolstered the nation’s ability to deliver health services to an expanding population. Without immigrant physicians, Canada would have been unable to provide the number of doctors needed to make Medicare a success. By examining the statistics, the authors show that in the two-and-a-half decades after the passage of the 1957 Hospitalization Insurance and Diagnostic Services Act (HIDS Act) more than 15,000 foreign-trained doctors arrived in Canada. With this figure in mind, one of the authors’ goals is to observe the routes taken by international medical graduates as they migrated to and within the country.5 Because it concentrates mostly on Canada, Foreign Practices is also a national history as certain provinces and regions were affected by physician immigration more than others. According to Mullally and Wright, their text focuses, in particular, on the disparities that existed in the delivery of health services in “marginalized, rural, and remote communities,” the private or incorporated group practices, and the community health centres that were popular throughout these decades, as well as the growth of new Canadian medical schools. In analyzing these facets of health service delivery, the authors describe how immigrant physicians “fit into and exerted an influence on the economic and corporate structures” of Canadian health care. For example, as Mullally and Wright explain, the influx of foreign-trained doctors influenced the upper echelons of Canadian health care’s corporate structure as “a notable few of this generation of doctors” became “presidents of medical associations, heads of clinical departments, and deans of medical schools.” Yet, further down the corporate stratum, in rural or remote resource communities, “physicians’ health care practices” were restructured from “hierarchical to collaborative group practices” as a more democratic and equal working environment between physicians ensured higher rates of doctor retention in these difficult-to-service areas.6 Another contribution Mullally and Wright make is their analysis of the complex moral dilemmas surrounding the “brain drain,” which saw foreign-trained physicians leave developing nations in favour of opportunities in the developed world.7 And Mullally and Wright also present the problem of doctor [End Page 118] maldistribution that the Canadian federal and provincial governments tried to solve from time to time; this was done by forcing physicians to practise in...