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For decades, there have been fluctuations in the movement of physicians across the Canadian-American border, but since the 1990s the net movement has been close to zero. But perhaps we are now entering new times: the Medical Council of Canada recently reported a nearly 600 per cent increase in U.S.-educated doctors signing up for its physician application portal.

Recent cuts to services that support the care of vulnerable populations, concerns about potential cuts to safety net programs like Medicaid, and defunding of research and global health initiatives signal a shift that likely does not align with many doctors鈥� values. The realities of providing reproductive health care when doing so could result in the loss of one鈥檚 medical license or even criminal proceedings might have a similar impact.

But there are other reasons that predate the politics of this moment. We all know the stories of Americans experiencing personal bankruptcy due to medical costs. What is less well-known is the distress of their doctors.

As one American colleague puts it, 鈥淲hile we may see patients who are uninsured or underinsured in our practice, if we want lab, imaging, or a referral to a specialist, we sometimes can鈥檛 get it done.鈥�

This moral injury is compounded by administrative burden in a system where over 34 per cent of every dollar is spent on administration (compared to 17 per cent in Canada overall and less than 3 per cent in our public insurance plans). That administrative burden plays out in the 鈥渄emoralizing and insulting鈥� processes of trying to get pre-authorization before giving care and decoding different requirements and fee schedules across a multitude of insurance plans.

Add to that the rise in the consolidation of hospitals by private equity firms and for-profit companies, a trend that prioritizes patient volume over clinical judgment, leading to decreased physician autonomy, declining job satisfaction and patient mistrust.

We should be concerned for American patients who can鈥檛 access the health care they need. And we should take no pleasure when colleagues feel that their work lives have become so untenable that they would consider leaving the country.

Having said that, we could use their help.

At a time when 6.5 million Canadians don鈥檛 have a family doctor, we shouldn鈥檛 say no to any qualified health-care worker who wants to move here, whether from the U.S. or anywhere else.

In recent years and months, governments across the country have launched concerted efforts to recruit U.S. doctors, nurses and other health-care professionals and to make it easier for internationally trained health-care workers from any country to practise in Canada.

For example, in 2023 the Ontario College of Physicians and Surgeons (CPSO) simplified the registration process for U.S.-trained and board-certified doctors, enabling them to begin to practise in Ontario without extra exams. Similarly, hospitals and universities have made bold announcements declaring their intention to actively recruit young medical researchers from the U.S.

While these approaches could help alleviate some of our health-care shortages, there are legitimate concerns around the ethics of pursuing physicians from other countries as a solution to our human resources challenges in Canada.

Still, if people see fit to move, we should make it as easy as possible. As we witnessed during the Vietnam War era, significant societal shifts can prompt people to seek new beginnings elsewhere.

We can offer our U.S. colleagues a safe place to practise medicine while benefiting from their invaluable skills and expertise. We should do so while investing Canadian resources in growing the Canadian workforce for a time in the future when we hope the U.S. will offer a supportive environment for all patients and all doctors alike.