Bulletin
Physician Movement of Graduates from Canadian Medical Schools and
International Medical Graduates
Mobility of physicians was explored using the Canadian Medical Association (CMA) multiyear masterfile.
With over ten years’ worth of physician data, the ability to look at a cohort of Canadian physicians over a
period of time and determine their habits with respect to movement both inter-provincially and out of
country was made possible.
Updated and compiled on a daily basis, the CMA masterfile includes all physicians in Canada holding a
medical license. The multiyear masterfile is a compilation of annual snapshots of the masterfiles
beginning with the 1994 version. It contains all physicians active as of 1994 as well as any who have
since become active. It is useful in historical analyses as it allows simplified tracking over time, especially
with respect to movement.
A time period for a study of movement was selected, 1998-2006, and the applicable cases were grouped
according to a set of criteria that placed them in one of the following categories:
(1) International medical graduate (IMG) who did not complete a medical residency1 in Canada who first
became active in 1998 or later,
(2) International medical graduate (IMG) who completed a medical residency in Canada who first became
active in 1998 or later,
(3) Graduate of Canadian medical schools (GCMS) who first became active in 1998 or later and,
(4) All those who became active prior to 1998.
Those in the fourth group were removed from the database for the purpose of this study.
A methodological decision was made to backfill for records where the province/territory of practice was
missing in the middle of the time series. It was assumed that blanks in these cases were a result of the
physicians moving and therefore the more recent province should be filled into the blanks. 2 There were
52 cases where backfilling of provinces for missing years was not done as there were more blanks than
information available. These cases were removed from any analysis completed on the file which means
that the total number of cases analyzed was 18,009. The 18,009 physicians who became active in 1998
or later were grouped as follows: 3,648 IMGs who completed residency outside of Canada, 1,307 IMGs
who completed residency in Canada and 13,054 GCMSs.
This file can be used to evaluate the likelihood of an interprovincial or international move. In addition, it
can show whether or not these movers began practice in an urban or rural setting prior to their first move
(see Appendix A). Twenty-two percent (22%) of IMGs became active for the first time in a rural setting
while 6% of GCMSs did the same. Of those becoming active for the first time in a rural setting, 32% of
IMGs and 15% of GCMSs have since moved out of province/territory at least once. When IMGs and
GCMSs who first became active in an urban setting were compared, they were equally likely to have left
the province/territory: 16% of physicians starting in urban practice have left their initial province/territory
for another province or country. Between 1998 and 2006, nearly 5,000 IMGs became active and 20% of
them moved at least once while 13,054 GCMSs became active and 16% moved.
1
Activity status is tracked and updated in masterfiles. It is possible to identify if physicians were in medical
residency in Canada at any point during period of the study (1998-2006). As our count of residency in
Canada is based on residency status between 1998 and 2006, the count for those IMGs with residency in
Canada may be slightly understated. In other words there might be cases where physicians had
completed residency in Canada prior to the time period in the study but because they became active for
the first time during the study time period, they are counted as not having completed residency in
Canada.
2
For example, if a physician’s province was Saskatchewan in 2002, blank in 2003 and Ontario in 2004,
the blank for 2003 was coded to Ontario under the assumption the missing data resulted from their move.
Length of time spent in the province of first activity was considered with respect to moving to another
jurisdiction as well as moving to another country. Depending on the region and on the type of physician
(IMG with Canadian residency, IMG without Canadian residency, and GCMS) the length of time spent
before moving abroad versus changing inter-provincially differed (see Appendix B for Canada, NL & SK
results). Among all of those who have moved, the mean length of time before moving for the first time was
2.18 years. For physicians moving between jurisdictions, an average of 2.20 years were spent in the first
province/territory of activity before a move was made and for physicians moving abroad it was 2.12 years.
After first becoming active in Canada, IMGs who completed a residency program in Canada worked 2.28
years on average before a move abroad was made and 2.14 years before a move to another province
was made (with a mean length before either type of move being 2.18 years). IMGs that did not do a
residency in Canada stayed longer before an international move (2.48 years) as well as before an
interprovincial move (2.76 years). For GCMSs, regardless of whether the move was made abroad or to
another province, the length of time before the first move was made was 1.99 years. The longest staying
cohort was experienced in Newfoundland and Labrador where IMGs without postgraduate training in
Canada stayed, on average, 3.19 years. These findings suggest that IMGs tend to stay in their first
province of activity longer than Canadian medical graduates when looking at those who have moved at
least once from their first province of activity.
While the analyses conducted on this file are not 100% accurate given assumptions and missing data, it
is believed the results are a reliable reflection of physician migration in Canada. One limitation that should
be noted, especially in relation to the rural/urban dynamics, is that movement is only captured when a
move is made outside a province. Therefore, there are also moves that occur inter-provincially that are
not captured at all by this study.
Of particular interest in this study is the ability to examine movement of IMGs with and without Canadian
postgraduate training. It would appear that regardless of residency background, IMGs stay longer with
their first jurisdiction of practice than do GCMS. This is no doubt in part due to return of service
requirements that are in place in some provinces and territories even when an IMG has completed a
Canadian residency program.
Melanie Comeau
Canadian Collaborative Centre for Physician Resources
July 15, 2009
Rural/urban Practice and Likelihood to Move
Appendix A
Physicians by location of first activity & place of MD graduation
Subtotal: IMGs
GCMSs
Count
%
Count
%
First Active
First Active in Rural
1083
21.9%
752
5.8%
First Active in Urban
Total
Total
Count
%
1835
10.2%
3872
78.1%
12302
94.2%
16174
89.8%
4955
100.0%
13054
100.0%
18009
100.0%
Physicians by location of first activity, type of first move & place of MD graduation
Subtotal: IMGs
First Active in Rural
First Active in Urban
Total
Moved out of country or
province/territory *
Didn't move
Total
Moved out of country or
province/territory *
Didn't move
Total
Moved out of country or
province/territory *
Didn't move
Total
Total
Count
350
%
32.3%
Count
115
%
15.3%
Count
465
%
25.3%
733
1083
67.7%
100.0%
637
752
84.7%
100.0%
1370
1835
74.7%
100.0%
636
16.4%
2003
16.3%
2639
16.3%
3236
3872
83.6%
100.0%
10299
12302
83.7%
100.0%
13535
16174
83.7%
100.0%
986
19.9%
2118
16.2%
3104
17.2%
3969
4955
80.1%
100.0%
10936
13054
83.8%
100.0%
14905
18009
82.8%
100.0%
Notes:
Includes only physicians who became active for the first time between 1998 and 2006.
* Into either a rural or urban setting; refers to first move made by a physician during this period.
Source: CMA Multiyear, 2006
GCMSs
Length of Time Before First Move by Place of MD Graduation
(Canada, Newfoundland & Labrador and Saskatchewan)
Appendix B
Place of first activity: Canada
Length of
(years) before
first move
Moved to another
province
Moved to another country
Total: Moved
Count (total who moved)
IMGs with residency
elsewhere
2.76
IMGs with residency
in Canada
2.14
2.48
2.71
2.28
2.18
761
Subtotal:
IMGs
2.63
GCMSs
2.43
2.59
225
986
Total
1.99
2.20
1.99
1.99
2118
2.12
2.18
3104
Place of first activity: Newfoundland & Labrador
IMGs with residency IMGs with residency Subtotal:
GCMSs
Total
elsewhere
in Canada
IMGs
Length of
Moved to another
2.72
2.77
2.72
1.88
2.48
(years) before province
first move
Moved to another country
3.19
n/a
3.19
1.38
2.58
Total: Moved
2.76
2.77
2.76
1.84
2.49
Count (total who moved)
174
30
204
86
290
Place of first activity: Saskatchewan
Length of
(years) before
first move
Moved to another
province
Moved to another country
Total: Moved
Count (total who moved)
IMGs with residency
elsewhere
2.92
IMGs with residency
in Canada
2.43
2.19
2.80
1.00
2.39
197
Notes:
Includes only physicians who became active for the first time before 1998 and 2006.
Source: CMA Multiyear, 2006
36
Subtotal:
IMGs
2.83
GCMSs
1.90
2.58
2.16
2.74
2.29
1.94
2.18
2.53
313
233
Total
80