Three male doctors reviewing x-ray results. One has an olive skin tone wearing royal blue scrubs and a stethoscope, one has a black skin tone wearing teal scrubs and one has a fair skin tone wearing white scrubs.
Canada contributes to the global medical brain drain by recruiting doctors from developing countries to deal with its health-care crisis that is, in large part, a staffing crisis. (Photograph by EVG Kowalievska,

Topics: Ethical Living, March 2024 | Ethics

Is it ethical for Canada to recruit health-care workers from countries with worse healthcare crises?

Canada is trying to solve its staffing crisis by luring doctors who are essential to their own countries' medical care


A number of years ago, I helped shoot a video that aimed to make northern Manitoba appealing to physicians in South Africa. Northern Manitoba, like much of outlying Canada – then and now – suffered a chronic shortage of doctors. Wouldn’t some South Africans enjoy setting up in the crisp fresh air of Churchill or Norway House? Neither I nor my employers questioned the ethics of trying to seduce health-care workers who had both been trained at the expense of their home country and were sorely needed in its health services. We had only ourselves in mind.

Canada continues in this vein. Recently, our government has designed appeals to health-care professionals around the world. In a program launched last June, 2,000 foreign health workers were encouraged to apply for permanent residency in Canada. According to a CBC report, invitations were sent to “foreign doctors, nurses, dentists, pharmacists, physiotherapists and optometrists as part of a push by the federal government to deal with a health-care crisis that is, in large part, a staffing crisis.”

Here’s the rub: we may have a health-care crisis, but is it right to lure trained people away from places that have worse health-care situations? South Africa – the focus of my recruiting video – has about 80 physicians for every 100,000 people. Canada has 228. Meanwhile, it costs South Africa around C$120,000 to educate each one of those doctors. Still, there are worse situations: Bangladesh has only 67 physicians for every 100,000 people, while 65 percent of the young physicians it trains leave the country.

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The British are alert to the contradictions. In March 2022, a study in the medical journal The Lancet concluded that “recruiting an ever-increasing number of doctors from low-income countries to plug gaps in the UK National Health Service (NHS) is unethical. These doctors are needed to maintain essential services in their own countries.” In other words, a Sri Lankan physician lured to the United Kingdom is one less physician working in Sri Lanka.

In Canada, we operate outside a tension and a contradiction. The tension is our belief that we have a needy health-care system, which we then couple with the right of free movement for people seeking to better their lives. The contradiction involves the ethics of recruiting persons trained at the expense of much poorer countries, thereby depriving those countries of much needed skills.

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This goes beyond health care, too, as our immigration strategies as a whole mandate accepting only skilled immigrants in all fields.

In 1999, the World Bank warned that the brain drains from developing nations to higher-income ones would shape the landscape of the 21st century. Later, Philip Emeagwali, a noted Nigerian computer scientist who served in the Biafran army as a teenager, cautioned that the out-migration of skilled people was making it nearly impossible for many African countries to build a middle class. Follow that thread and you get another kind of immigration: impoverished refugees from failed states.

On the health front, the Canadian government subscribes to the United Nations’ Sustainable Development Goals, which were established in 2015. One of the goals is universal health care. We might want to ask ourselves how seriously we take such commitments when we reach out to nurses trained in Morocco or doctors from Mali and lure them to New Brunswick or Quebec.


Larry Krotz is a writer and author in Toronto. His latest book, Nothing Ordinary, recounts the history of the Northern Ontario School of Medicine.

This article first appeared in Broadview’s March 2024 issue with the title “Medical Brain Drain.”

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