Too Many Doctors? Foreign Medical Graduates and the Debate over Health Care Accessibility in Canada, c.1976–1991

Abstract

Abstract. Although the last decade has been dominated by commentators lamenting the national shortage of medical practitioners, only a generation ago policy makers concluded that most Canadian provinces had too many doctors. As a consequence, provincial ministers of health placed new restrictions on the licensing of foreign-trained health professionals. Assisted by the 1976 Immigration Act, Canada suddenly witnessed a precipitous drop in the number of newly licensed, foreign-trained doctors, a dramatic reversal of the previous decade which had seen over 10,000 physicians immigrate and take up practice in this country. The 1980s was notable for a variety of health care initiatives aimed at relocating the diminishing number of foreign physicians to underserviced areas, some of which were struck down as contravening the new Charter of Rights and Freedoms. This paper will examine the period of 1976-91, when, after two decades of relatively liberal immigration and licencing policies, Canadian provinces introduced new measures to restrict the scope of practice of incoming foreign-trained doctors and to divert them to underserviced areas. The paper will explore these health policy debates in order to understand better the context of the landmark Barer-Stoddart Report (1991), which concluded that a new interprofessional mix of health care practitioners was needed to reform, and make more accessible, the Canadian health care system. Keywords. Medicare, foreign-trained doctors, Immigration Act 1976, BarerStoddart ReportRésumé. Alors qu'on ne parle plus que de pénurie en médecins à l'échelle nationale, il est bon de rappeler que les décideurs en santé canadiens faisaient

Changing Migration Policy from the Margins: Filipino Activism on Behalf of Victims of Domestic Violence in Australia, 1980s–2000

“…Moreover, the timing of departures has been mirrored to some degree in the rhythm of arrivals from Australia, of whom as many as two-thirds are returnees. 44 We can go even further than this. The sheer growth in the numbers of Kiwis in Australia has meant that New Zealanders and their Australian families dominate the flow of migration from Australia to New Zealand.…”

“…43 These migrant doctors were notably deployed in primary care in rural areas away from major conurbations, and in the words of John Clarke and David Wright, 'helped to fill the holes in the emerging system of universal health care.' 44 In contrast to the strong patterns of clustering found in the UK, for instance in cities such as Manchester, 45 the historical evidence from Canada shows, however, that once migrant doctors were in the country, many of them were able to move to more affluent areas and practise there, including in more prestigious and wellremunerated specialties. 46 The effect of the triad of dirty work is nevertheless still in evidence: it was due to the shortages in particular parts of Canada that migrants were able to obtain their first opportunities and they played an important part in the development of care in rural parts of the country.…”

“…Then, like now, many politicians, public commentators, critics, and media organizations have greatly influenced Americans' understanding of immigration and the role that immigrants play in U.S. society. 44 Providing and publicising access to historical scholarship tailored to contemporary concerns, such as border control, racism and nativism, can form an important antidote to misinformed and ill-tempered discourses.…”

“…43 The death of Gene, the light sentence bestowed on her murderer, and the misrepresentation of her character mobilised another group of Filipina activists in Melbourne who campaigned under the general theme of 'Justice for Gene'. 44 Melba Marginson led 30 Filipino Australians in a demonstration to denounce the decision of the Australian legal system for the verdict of manslaughter influenced by the image of the victim as 'a loose woman' who 'used him as a passport to Australia, and who was not morally fit to be a mother to their child'. 45 An organisation called the Collective of Filipinas for Empowerment and Development (CFED) was formed in the wave of the 'Justice for Gene' campaign 'to look for strategies to get Filipino women to engage in discussions of possible victimization'.…”

“…43 Dar al Arqam had organised coffee mornings and sewing lessons for Moroccan-Dutch women who otherwise lived fairly isolated lives. 44 The MGVF had adopted the slogan 'Integration, Emancipation, Participation and Performance' already before the 9/11 attacks and before the escalation of the Dutch integration debate. In 2002 it initiated a large project against domestic violence, a year before the Dutch government started its policy programme for the integration and emancipation of minority women.…”