Nick Busing's recent guest editorial on physician shortages raised many important issues that need to be addressed.1 I am concerned, however, that Busing did not discuss the interprovincial migration of physicians, a key issue that may become the downfall of health care in many parts of the country. As a practising physician in St. John's, I see the effects of the physician shortages that Newfoundland suffers in all specialties. We lose Newfoundland physicians not only to other nations but also to other provinces.
Under the current funding formula for health care, the provinces bear a large portion of the responsibility for physician salaries. Provincial economies are obviously not all equivalent. Without a federal program guaranteeing uniform salary levels for all specialists across the country, I worry that some of the smaller provinces, such as Newfoundland, will continue to lose physicians to other regions of the country. I agree with Busing that we need to keep our physicians at home in Canada, but we also need federal measures that will free us as professionals to decide where to practise on the basis of our personal desires and community needs, without having to contend with varying remuneration scales from region to region.
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