U.S. Attracting Thousands of Canadian Health Workers

  • States along the Canada/U.S. border have issued nursing and doctors licenses to nearly 10,000 staff with Canadian addresses
  • 2,550 Canadian nurses had their credentials confirmed in U.S. in 2022 alone

REGINA, SK: SecondStreet.org released new research today that shows states along the Canada/U.S. border have issued nearly 10,000 licenses to nurses and doctors with Canadian mailing addresses. Data suggests many of these workers are commuting regularly to work in nearby states, while some are likely moving to, or considering a move to the U.S.

SecondStreet.org obtained the data from state licensing bodies along the border. Data was also obtained from a national body that confirms credentials for foreign nurses who want to work in the U.S. 

“There’s a big opportunity for government-run hospitals to improve and convince some of these health care staff to work in Canada instead of commuting to the U.S. or moving there altogether,” said SecondStreet.org President Colin Craig. “However, there’s also a big opportunity for new private clinics in Canada to recruit some of these workers and provide the compensation and working arrangements that government-run hospitals in Canada don’t offer.” 

Highlights from the research paper include:

  • States along the Canada/U.S. border have issued licenses to 8,909 nurses and 879 doctors (who have Canadian mailing addresses) for a total of 9,788 workers. It is unclear how many actually commute to the U.S. for work, but prior research into Canadian nurses working in Michigan found 63% of licensees commute for work. 
  • The totals above are underreported, as data was unavailable for North Dakota, Minnesota and New Hampshire, while Washington State only had data for nurses. 
  • Border states had issued the most licenses to doctors and nurses with mailing addresses in Ontario (6,655), British Columbia (901), Alberta (851) and Quebec (510). Even if these workers do not work in the U.S., it’s clear they’ve shown a strong interest in leaving Canada’s health care system.   
  • Strictly looking at nurses, SecondStreet.org obtained data that showed in 2022 alone, 2,550 Canadian nurses applied to have their credentials approved to work in the U.S. (any state).

“Canada’s health care system is failing for many reasons and a staff shortage is one of them. It’s clear that we need to find ways to keep more doctors and nurses within our borders,” added co-author Dom Lucyk. “Some staff are leaving for money, but many others are leaving because of poor working conditions in Canada and the availability of full-time jobs with stable schedules in the United States.”

To view Policy Brief: Thousands of Health Care Workers Leaving Canadian Systemclick here.

Data responses (organized by state):

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Prevention – reduce demand in the first place

If Canadians lived healthier lives, we could reduce demand for emergency services, orthopaedic surgeries, primary care and more. 

For instance, if you visit the Canadian Cancer Society’s website, you’ll read that “about four in ten” cancer cases are preventable. The Heart and Stroke Foundation notes that “almost 80 percent of premature heart disease and stroke can be prevented through healthy behaviours.” A similar number of Diabetes cases are also preventable. 

Many joint replacements and visits to ERs and walk-in clinics could also be avoided through healthy living. 

To be sure, not all health problems can be avoided through healthy living – everyday the system treats Canadians with genetic conditions, helps those injured in unavoidable accidents and more.  

But there is an opportunity to reduce pressure on the health care system through Canadians shifting to healthier lifestyles – better diets, more exercise, etc. 

To learn more, watch our Health Reform Now documentary (scroll up) or see this column. 

Partner with non-profits and for-profit clinics

European countries will partner with anyone who can help patients. 

It doesn’t matter if it’s a non-profit, a government entity or a private clinic. What matters is that patients receive quality treatment, in a timely manner and for a competitive price.  

In Canada, governments often delivery services using government-run hospitals instead of seeing if non-profit or private clinics could deliver the services more effectively. 

When governments have partnered with non-profit and private clinics, the results have often been quite good – Saskatchewan, Ontario and British Columbia are just a few examples of where partnerships have worked well. 

Canada should pursue more of these partnerships to reduce wait times and increase the volume of services provided to patients.  

To learn more, watch our Health Reform Now documentary (scroll up) or see the links above. 

Make cross border care more accessible

In Canada, citizens pay high taxes each year and we’re promised universal health care services in return. The problem is, wait times are often extremely long in our health system – sometimes patients have to wait years to see a specialist or receive surgery. 

If patients don’t want to wait long periods, they often have to reach into their own pocket and pay for treatment outside the province or country. 

Throughout the European Union, we also find universal health care systems. But a key difference is that EU patients have the right to go to other EU countries, pay for surgery and then be reimbursed by their home government. Reimbursements cover up to what the patient’s home government would have spent to provide the treatment locally. 

If Canada copied this approach, a patient waiting a year to get their hip operation could instead receive treatment next week in one of thousands of surgical clinics throughout the developed world. 

Governments benefit too as the patient is now back on their feet and avoiding complications that sometimes come with long wait times – meaning the government doesn’t have to treat those complications on top of the initial health problem. 

To learn more, watch our Health Reform Now documentary (scroll up) or this shorter video. 

Legalize access to non-government providers

Canada is the only country in the world that puts up barriers, or outright bans patients from paying for health services locally. 

For instance, a patient in Toronto cannot pay for a hip operation at a private clinic in Toronto. Their only option is to wait for the government to eventually provide treatment or leave the province and pay elsewhere. 

Countries with better-performing universal health care systems do not have such bans. They allow patients a choice – use the public system or pay privately for treatment. Sweden, France, Australia and more – they all allow choice. 

Why? One reason is that allowing choice means some patients will decide to pay privately. This takes pressure off the public system. For instance, in Sweden, 87% of patients use the public system, but 13% purchase private health insurance. 

Ultimately, more choice improves access for patients. 

To learn more, watch our Health Reform Now documentary (scroll up) or watch this short clip on this topic. 

Shift to funding services for patients, not bureaucracies

In Canada, most hospitals receive a cheque from the government each year and are then asked to do their best to help patients. This approach is known as “block funding”. 

Under this model, a patient walking in the door represents a drain on the hospital’s budget. Over the course of a year, hospital administrators have to make sure the budget stretches out so services are rationed. This is why you might have to wait until next year or the year after for a hip operation, knee operation, etc. 

In better-performing universal health systems, they take the opposite approach – hospitals receive money from the government each time they help a patient. If a hospital completes a knee operation, it might receive, say, $10,000. If it completes a knee operation on another patient, it receives another $10,000. 

This model incentivizes hospitals to help more patients – to help more patients with knee operations, cataract surgery, etc. This approach also incentivizes hospitals to spend money on expenses that help patients (e.g. more doctors, nurses, equipment, etc.) rather than using the money on expenses that don’t help patients (e.g. more admin staff). 

To learn more about this policy option, please watch our Health Reform Now documentary (scroll up) or see this post by MEI.