More Canadian Health Workers Licensed in the U.S.

REGINA, SK: New data obtained by SecondStreet.org shows that California, Texas, Florida, Illinois and Massachusetts have issued 8,237 licenses to nurses and doctors with Canadian mailing addresses. This research builds on SecondStreet.org’s previous examination into licenses issued by nine states along the Canada/U.S. border, bringing the total number to at least 18,025.

“Picture a sold out NHL-sized arena. That’s how many Canadian health care workers we’re talking about,” said SecondStreet.org Communications Director Dom Lucyk. “One might think that Canadian workers are choosing to work in the U.S. because of money. Sometimes that’s true, but when we surveyed Ontario nurses who work in Michigan, the top reason they decided to work abroad was actually availability of work. Many wanted full-time jobs like the ones they found in Michigan, not part-time jobs in Ontario.”

SecondStreet.org looked into California, Texas, Florida, Illinois and Massachusetts as they are popular U.S. destinations. Readers should note that some of the 18,025 workers may not actively be working in the U.S. Some of these workers may have retired, returned to Canada or haven’t yet moved to the U.S. Conversely, not captured in this research are workers who have moved to the U.S. and no longer use a Canadian mailing address.

Key highlights from SecondStreet.org’s new research include:

  • Texas attracted the most Canadian health care workers (6,063) among the states examined. However, 4,468 of those licenses did not specify which Canadian province.
  • Ontario health care workers were most likely to obtain licenses in the five U.S. states (1,905). 
  • U.S. states issued a low number of nursing licenses (304) to Quebec workers. This may be due to the province’s large private health care sector providing workers with more choice and helping to retain them in Canada. Alternatively, the language barrier may play a role.
Nursing Licenses by State and Canadian Mailing Address
 CATXFLIL*MA 
BC14813224509363
AB1342364110017528
SK23414370105
MB2135623287
ON303584295101741,357
QC235633416159
NS104017445116
NB81573437
NL3856022
PE0408113
NT200103
YT210306
NU000000
SUBTOTAL6771,1524324171182,796
Unspecified04,4680014,469
TOTAL6775,6204324171197,265

CA = California, TX = Texas, FL = Florida, IL = Illinois, MA = Massachusetts
*Illinois’s public state registry accessed September 19, 2023

Physician Licenses by State and Canadian Mailing Address
 CATX*FLIL**MATOTAL
BC764785N/A136
AB412673N/A77
SK2500N/A7
MB91502N/A26
ON16625011319N/A548
QC4080223N/A145
NS31030N/A16
NB3720N/A12
NL2200N/A4
PE0100N/A1
NT0000N/A0
YT0000N/A0
NU0000N/A0
Subtotal34244315532N/A972
Unspecified0000N/A0
TOTAL34244315532N/A972

CA = California, TX = Texas, FL = Florida, IL = Illinois, MA = Massachusetts
*The data shows Texas has also issued 947 licenses to doctors born and educated in Canada who provided a U.S. mailing address
** Illinois’s public state registry accessed September 19, 2023

“While these workers rejected working for Canada’s government-run health care system, new private clinics that are popping up may be able to offer these workers the type of work environment they’re looking for,” added Lucyk. “One thing is certain, the status quo isn’t working for thousands of doctors and nurses. Ultimately, Canada’s health care worker shortage harms patient care.”

To view the raw data for each state, see below:

California – click here for nurses (file 1 and file 2) and here for doctors

Texas – click here for nurses and here for doctors

Illinois – click here to see their public state registry

Florida – click here

Massachusetts – click here

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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.