Many of these media accounts of the brain drain problem facing Canada illustrate their point by focusing on doctors as an especially vulnerable profession (Durkan: p. 27; Singh, 1997, p. A19;). Canadians, who have consistently placed their concerns regarding the country's health care system at the top of the list, would most likely be swayed by brain drain pundits' emphasis on the role of brain drain in the deterioration of health care. Happily, doctors also present an excellent opportunity for the academic study of brain drain.

It is my contention that Canada has experienced a drain of emigrating doctors to the United States since 1993 and that these doctors have been motivated less by the pull factors of increased income potential in the U.S. (whether due to higher salaries or lower taxes) than they have by the push factors of shrinking public funding for health care in Canada. Furthermore, I contend that those who emigrate will tend to be doctors at earlier stages in their careers, with fewer familial ties and responsibilities, who are seeking better research opportunities. However, I expect to find two countervailing trends compensating for any loss of emigrating doctors: an increase in enrollment at Canadian medical schools (part of an overall trend of increasing educational attainment by Canadians) and an increase in the number of doctors immigrating to Canada, if not from the U.S., then from other countries.

Brain drain is considered a problem for many countries, particularly for those less-developed. The United States is the destination country for most emigrating skilled workers from practically every country, developed or otherwise. The United States "is the largest market for human capital and is the country which has received the largest number of highly-trained immigrants." (Cheng and Yang, 1998: 627). Canada, while not a developing nation, is much more tied economically to the United States and shares cultural elements that extend beyond the two countries' mutual border.

The problem of Canada's "best and brightest" migrating to and working in the United States has much to do with wasting Canada's resources. Universities are subsidized by Canadian taxpayers. If the training they provide turns out to benefit another country, much of that money is wasted, typically for the benefit of the United States. Alejandro Portes has noted, by way of illustration of this phenomenon's impact on Latin America, that 20,000 highly-skilled emigrants from the region over a five-year period went to work in the United States. The professional training they embodied represented a windfall of $60 million dollars. (Portes, 1976: 489). In the age of cutbacks to the Canadian education system, we can hardly afford to be so generous to our wealthy neighbours to the South.

This problem only gets worse should the skills in question be in short supply in the origin country. Brain drain then has real potential to have a negative impact on the origin country's economy, stunting growth in sectors dependent upon highly-skilled labour. This in turn creates a domino effect, resulting in lower employment in those sectors, which begets less revenue in business, consumer and income taxes for the government. This in turn results in less money for government programs. Thus, a brain drain migration pattern can have far-reaching consequences for a country. If the occupation in question should play a crucial role in providing an essential service, such as health care, the consequences can be even more drastic.

Skilled migration is a complex migratory phenomenon, which cannot be explained by just one theory or typology. (Iredale, 1999: 94). Three theoretical schools have dominated the academic discourse on brain drain thus far.

Human capital theorists explain skilled migration as being motivated by a desire to seek out employment and/or compensation more appropriate to one's level of skill/training. Doctors "invest" more in their training than most professions, in that their profession is one of the costliest to train (Portes, 1976: 497; Singh, 1997: A19). In addition, the training period can last several years longer than with other professions, so doctors must also evaluate the greater costs of deferred wages when assessing their "investment" decision. The result is that doctors are highly-motivated to seek out the best opportunities to reap the highest rewards for their investment.

Canada's medical schools are publicly-subsidized, whereas the medical schools of the United States are privately-funded. This means that it is less expensive to receive medical training in Canada than in the United States. Logically, then, there should be higher per capita enrollment in Canada's medical schools, where costs are less of a barrier than in the U.S. This situation, perhaps further exaggerated by an overall increase in educational attainment in Canada, would lead to a much less-competitive labour market for doctors in the U.S. than in Canada, where more doctors would presumably train. And where there is less competition, there are higher wages to be earned, irrespective of the tax differences between the two countries. Moreover, even if the U.S. attempted to compensate for this discrepancy by increasing enrollment in U.S. medical schools, the length of the training period would guarantee that the labour market would feel not feel any impact for several years.

Rational Choice theorists would posit that doctors are likely to immigrate to the United States from Canada when their self-interests are served by doing so. Current labour market conditions in both countries, along with tax rates, the costs involved in moving to the United States, and other factors, are calculated and weighed by Canadian doctors. If the wages and tax rates compensate for the costs of moving, as brain drain/tax cut pundits are quick to claim, the rational actor will be compelled to emigrate.

Herbert Grubel and Anthony Scott developed very detailed formulas for calculating a decision to emigrate in their book, The Brain Drain: Determinants, Measurements and Welfare Effects (1977: 13-18). Some of the factors they listed included expected real income in both country of origin and country of (potential) destination; the "psychic income" of both countries (determined by such things as climate, architecture, scenery and other non-quantifiable factors that nevertheless impact an individual's happiness); rates of discount applied to future real and psychic income; and the cost of moving.

However, it becomes obvious that most will not be able to calculate all the variables that compose psychic or even real potential income when arriving at a decision. The computations involved are simply too complicated. Another criticism of rational choice theory (and a criticism often used to rebut human capital theory as well) is the emphasis it places on the individual, at the expense of a thorough examination of macro-level factors that influence the decision to migrate.

Combined with either Human Capital or Rational Choice theory, Structuration theory yields a more complete picture of migration patterns. It is Structuration theory's emphasis on agents of recruitment which is particularly adept for the introduction of macro-level processes into, for example, rational choice analysis. (Iredale: 92)

Structuration theorists hone in on the information-gathering processes involved in coming to a rational decision about potential real and psychic incomes in origin and destination countries. The emphasis is on the communication channels and interpersonal networks and contacts used by the highly-skilled to receive the information about wages, living conditions, occupational opportunities, etc. that they require in order to arrive at a decision. This may, in fact, be precisely the reason why foreign training (i.e. through foreign exchange programs between universities) is such a key way for the highly-skilled (or to-be highly-skilled) to become familiarized "with incomes, opportunities and working and living conditions elsewhere." (Grubel and Scott: 62). Through foreign training, the skilled migrant comes in face-to-face contact with agents of recruitment, studying and working under their tutelage. Iredale believes this process "alters the 'mental maps'" of the highly-skilled (101). The agent of recruitment is therefore placed in an excellent position to provide information about the very things that will come under consideration of the highly-skilled when deciding to migrate.

Structuration theory also provides a useful framework for explaining the importance of professional relations with colleagues across international borders, the tight-knit nature of highly-skilled professional labour markets and the lesser reliance on other social/kinship ties for the highly-qualified, who often harbour a "broad and deep commitment to their profession." (Ibid.: 21-25).

However, which theoretical school one chooses to explain brain drain is important mainly if one is able to establish that a brain drain exists, something that may not be as easy to do as it might appear to be.

PROBLEMS WITH CURRENT BRAIN DRAIN LITERATURE

Problems with studying brain drain are encountered as soon as it becomes necessary to lay down definitions of "highly-skilled" or "brain drain" itself. While there is no shortage of academic research on brain drain, the operational definition of the highly-skilled often differs substantially, creating ambiguity and uncertainty. (Wihtol de Wenden, 1995: 90; Bhagwati, 1976: 694). One study can define highly-skilled persons as those in possession of a university degree (Termote, 1995: 35); or those with a degree plus extensive experience in a given field (Iredale: 90); or simply as "professional, technical and kindred workers." (Guha, 1977: 3). As definitions vary from paper to paper, so does the data, making comparative analysis impractical. However, the selection of a specific occupation to study serves as an excellent way around this definitional conundrum. By focusing solely on the migration patterns of doctors, any definitional ambiguities are resolved.

A more difficult definitional problem comes when defining brain drain. First used to describe the migration of British scientists to the United States in the 1960's (Fakiolas, 1995: 218), it has since been defined as "the flow of professional, technical and kindred workers" (Guha: 3); someone educated to a (undetermined) high level who intends to hold permanent employment in another country (Grubel and Scott: 49); and also as a very specific five-year stay for highly-skilled immigrants (Ahmad, 1970: 217-218). For the purposes of this paper, we will define "brain drain" as the emigration of Canadian doctors to the United States for the duration of their medical careers.

Brain drain studies are reliant on statistical and aggregate data from government agencies like the United States Department of Immigration and Naturalization Service and Immigration Canada. However, these agencies do not collect data with the notion of utilizing it for analysis of brain drain. Typically, the data is gathered for other purposes and does not fit the operational parameters of brain drain studies (Grubel and Scott: 51).

Countries do not tend to keep track of how many of their citizens return after working abroad, making return migration extremely difficult to quantify. (Ibid.). Immigration data can overstate brain gain by not including return-migration figures and by not specifying where training was received. (Ibid.: 3). Immigration data in general refers only to "gross" flows, ignoring the likelihood of migrants' returning to their countries of origin or even moving back and forth in a more-or-less continual pattern. Finally, immigration data typically includes the country of last permanent residence for immigrants, assuming that it will be the same as their nationality, which if often not the case. (Bhagwati: 693).

Even when useful data is gathered by government agencies, it is often grouped together in unwieldy aggregate categories for the purposes of making graphs more palatable. Neither the Immigratin and Naturalization Service in the United States nor Statistics Canada keep records on the specific migratory patterns of doctors, for example. The INS does have a "medical profession" occupational category, but it is impossible to tell what proportion of this category are doctors, as opposed to nurses, paramedics, medical technicians or other occupations. The aggregate category in which Statistics Canada includes doctors is the even-broader "highly-skilled" one, which also includes lawyers, teachers, engineers, librarians and several other occupations.

Fortunately, most professions have professional associations that make it their business to keep information on the migratory patterns of the members. The Canadian Medical Association, for example, has kept data on emigrating, returning and immigrating doctors for several years.

The vast majority of research done on brain drain migration has been done on flows from developing to developed nations, with China-U.S. or India-U.S. being the two prominent examples. Contrasted with this is the relatively little work done on what could be described as "horizontal" brain drain - a migratory pattern of skilled workers from one developed nation to another. It would be illogical to simply assume that the research and findings developed from work based on LDC-DC migratory patterns would automatically apply to DC-DC migration of the highly-skilled. Unless one is willing to take a position similar to that argued by Wallace Clement (1978) and others, that Canada, a developed nation, in actuality resembles the developing countries of Latin America in terms of economic structure and other key ways. Is it reasonable to argue that any brain drain migration from Canada to the United States is further evidence of Canada's resemblance to developing nations? Perhaps an examination of the differences between the brain drain of developing and developed nations will produce a conclusive answer.

Brain drain is often blamed on developing nations themselves, who create a "push" factor by developing more skilled workers than they can employ (Grubel and Scott: 8). A classic case study of this phenomenon is Portes' look at how the Argentine education system created more doctors than it could employ, thus creating a brain drain (Portes, 496).

Is it possible that similar circumstances can arise in developed nations? Portes notes a brain drain flow from Britain to the United States, due to a lack of opportunities available relative to levels of training (499). With recent cutbacks to the Canadian health care system, is it possible that more Canadian doctors are graduating than could possibly hope to find employment? Statistics do not bear this argument out. Canada's medical schools graduated the fewest number of doctors in 1999. Just 1,516 doctors graduated that year, 4% less than the year before and fully 17.3% less since the class of 1985. (Canadian Medical Forum Task Force on Physician Supply, 1999: 8). Canada, with the second lowest doctor to population ration of fourteen OECD countries (Ibid.: 19), clearly has enough of a need for doctors to employ all of its medical school graduates. Whether or not there are funds to employ them all may be another matter.

Portes argues that:

However, this may be dependent on the perceptions of the professionals in advanced Western countries. It is entirely conceivable that Canadian doctors, faced with crises engendered by health-care cutbacks, perceive their working conditions as suddenly and drastically declining. If these doctors did not foresee an end to the decline in work conditions in the future, they may be just as tempted as doctors from developing nations to emigrate.

But again, statistics fail to support this theory, with the number of emigrating Canadian doctors remaining quite stable between 1992 and 1998, with the exception of a decline in emigrating doctors beginning in 1997. (Canadian Medical Forum Task Force on Physician Supply, 1999: 22).

Other push and pull factors salient for developing countries do not appear to be salient for developed countries, and vice versa. Ahmad (1970: 221-222) illustrates this by pointing out that most British skilled migrants left for reasons other than compensation, while this was the primary pull factor for their Indian counterparts. A major push factor missing from DC-DC flows is political instability (Wihtol de Wenden: 92; Portes: 492). On the other hand, other factors formerly salient only in LDC-DC flows may now be relevant to the Canadian situation, such as greater research opportunities offered in the U.S. and no longer found in post-cutback Canada. But it seems premature to be arguing that Canada has come to resemble a developing nation in terms of the highly-skilled labour market and migration patterns within that market. Conclusive evidence that would make the case has yet to be presented.

A brain drain can only be attributed to the country that has invested in the training of highly-skilled labour and then loses those whose training it has invested in. It is one thing, brain drain, for Canadian doctors trained in Canadian schools to then migrate to the U.S. to work. But it is entirely another matter if Canadian doctors trained in the United States then choose to remain in the United States to work. The reason comes down to human capital and where it should be credited. Grubel and Scott (128) insist that the credit must go to the country where the education occurs, which is not necessarily the same as the country of origin. They also note that Canadian scientists working in the U.S. are more likely than any other nationality to have received their Ph.D. in the U.S. (93).

How often do brain drain studies take this into account when assessing the gravity of the situation? It is difficult to discern if this is taken into account very often, as very little mention is made of it in the literature. Further complicating matters is the lack of good aggregate data on the subject. Few, if any, countries maintain statistics on how many foreign students decide to stay on as workers. Likewise, few countries (if they keep track of emigration rates at all) appear to know how many "emigrants" of a particular profession were actually trained in other countries to start with. Even if the countries of interest (in this case, Canada and the United States) did have such data readily-available, it is likely that the data would only be available in the form of aggregate occupational categories, which would reveal little for the purposes at hand.

Some may argue that students who train in another country, then do not return to the country of origin, nevertheless qualify as brain drains, because the country of origin loses the potential benefits they carry with them. A Canadian medical student studying in the United States, for example, has the potential to become a doctor. If she chooses to do so in a country other than Canada, then Canada has lost that potential doctor. The problem with this argument is that it would be impossible to quantify. Where, for example, would the line be drawn as to what constitutes "potential"?

Although the only foreseeable short-term gain for origin countries is remittances from brain drain emigrants (Fakiolas, 1995: 219), much more can be gained, in terms of accumulated human capital, should they return to the country of origin. The problem is that no country seems to keep track of returning migrants, let alone returning highly-skilled migrants. The available statistical data on migration all refers to gross flows, ignoring return or even continual back-and-forth migration (Bhagwati: 693). Most researchers agree that this is one of the weakest points in brain drain data (Ahmad: 217; Bhagwati: 693; Grubel and Scott: 4).

Fortunately, the Canadian Medial Association has been able to keep track of returning doctors, and has maintained statistics on return flows for at least the past seven years. (Canadian Medical Forum Task Force on Physician Supply: 21). The numbers have remained very steady, at an annual average of 265 returning doctors, with a standard deviation of 36.6 (Ibid.).

Another factor which can skew brain drain data is what kind of information immigration data contains. The Department of Immigration and Naturalization Services in the United States asks all immigrants to name their last country of residence, and this information is used to determine the loss or gain of certain professions from respective countries. For example, immigrants to the U.S. who list "doctor" as their intended profession and "Canada" as their last place of residence will be counted as part of the brain drain of doctors from Canada.

The problem with this is that they are not all necessarily Canadians. The highly-qualified often reside in another country before migrating again to the United States. Canada is a particularly attractive way station for highly-skilled migrants from Britain, Ireland and Australia, before they re-immigrate to the United States. (Grubel and Scott: 78). While they are undoubtedly counted as part of the Canadian brain drain, they should not be.

Though it is widely-acknowledged that the emigration of highly-skilled workers ultimately impacts many others through stunted economic growth, lost tax revenues and less funds for government programs, such effects are extremely difficult to quantify. (Ibid.: 47). It would require an exhaustive listing of all possible government services a doctor may benefit from, which would then be subtracted from, say, the average amount of tax revenue contributed by doctors. Any surplus amount could then be considered the welfare effect. However, the exhaustive listing of ways in which a doctor may benefit from government spending is an inconceivably complicated undertaking. And the effects of lost tax revenue due to stunted economic growth would still lie waiting to be addressed. So for the most part, brain drain literature lets sleeping dogs lie when it comes to welfare effects.

Doctors are an excellent occupational category for academic study for a variety of reasons. Very few occupations are more costly to train, with estimates reaching as high as a million dollars worth of training per doctor. (Singh: A19). With so much human capital invested into each doctor, their migration patterns are of great importance and will be felt more profoundly on an economic level. Selecting doctors greatly decreases the definitional ambiguities that so often confound examinations of brain drain, because the criteria to be considered is so

clearly-defined: the possession of a license to practice medicine, which first requires graduation from a recognized medical school and the passing of an exam. The issue of licensing also brings an interesting additional element to the issue of brain drain, to be discussed later. Finally, doctors are among the few professions whose skills are truly transferable from country to country. While lawyers, for example, are limited to working in those countries whose legal systems they are familiar with, doctors are limited only to those countries inhabited by human beings. The high degree of transferability of a doctor's skills make it one of the few truly globalized professions.

However, looking at doctors as a professional aggregate will not reveal much concerning brain drain without the addition of distinguishing qualifiers. Only those emigrating doctors who were trained in Canada can be considered to be part of any brain drain, because only their human capital can be rightfully credited to Canada. Further still, only those doctors trained in Canada that emigrate and do not return (or intend to return) for at least five years can be counted as drains. Otherwise, if they return within five years, their accumulated experience, training, status and credentials from their foreign (U.S.) work will be credited as a human capital gain for Canada. The time they spend practicing medicine elsewhere is not enough of a loss for Canada to compensate for the enormous benefits the country will receive upon their return, in the form of accumulated experience, training, status and credentials.

Media reports have told of doctors leading the way of Canadian professionals being "lured south by higher pay and dramatically lower taxes", (Durkan: 27). Does the evidence support the existence of a brain drain of Canadian doctors to the United States?

There is a clear annual loss of doctors in Canada, currently at a rate of 3.5%. (Canadian Medical Forum Task Force on Physician Supply: 15). However, the cause of this loss is in dispute. While the president of the Canadian Medical Association states that "active physicians are being lost to the United States," (Scully, 1999: 2) the report from the task force he co-chaired on the topic attributed just 30% of this loss to emigration (Canadian Medical Forum Task Force on Physician Supply: 16). The estimated 600 doctors who emigrated in 1998 comprised just 1% of the 56,000-strong physician workforce in Canada. (Ibid.: 3). Moreover, the report does not specify how many of those 600 doctors they estimate are lost to emigration were trained in Canada.

The majority of the doctor-shortage problem seems to be related to Canada's aging population: while Canada's aging population "significantly impacts the health care system including the demand on physicians," (Ibid.: 12), the physicians themselves are also aging, and retiring in greater numbers. In 1998, 51% of physicians no longer working in Canada had retired, not emigrated. (Ibid.: 16).

This discrepancy between what the president of the Canadian Medical Association (CMA) says is the situation and what his own task force's report says is the situation may be indicative of the socioeconomic implications of the brain drain. Many newspaper accounts of the so-called "brain drain" of health care professionals quote "experts" who prescribe tax cuts for high-income professionals as a cure. (Chwialkowska: A1; Durkan: 27). It would only make sense that the CMA, as the body representing Canada's doctors, would strive to come up with evidence supporting the theory of a brain drain of doctors, if that evidence could then be used as political ammunition to press the federal government for tax breaks for its members. It is therefore telling that the CMA-commissioned task force did not find brain drain to be the main culprit in the doctor shortage facing Canada. Nor did the task force recommend tax breaks as a solution, despite what could be construed as real incentive to arrive at such

conclusions. For this reason, the data presented in the task force report is all the more convincing.

However, it appears that even the task force was not immune to pressures encouraging the propping-up of the brain drain myth with inflated data. Page 16 of the report lists the "approximate" number of emigrating Canadian doctors as 600 for 1998. But a table on page 22 of the same report gives an exact number of 569 for that year - which would mean that the figure was "rounded upwards" by just over 5% of the "approximate" figure.

Even if the number of Canadian doctors emigrating is not enough to be considered the torrent read about in the newspapers, it is still useful to take a closer look at which of the 56,000 doctors in Canada do emigrate. Unfortunately, little data is collected on the topic, or at least made available for research purposes. The best available data comes from the CMA, which reports that emigrating physicians tend to be under the age of 40. (Scully: 2). This is consistent with the contention of rational choice theorists that emigrating doctors will tend to be younger, as younger doctors are less likely to have started families and subsequently do not have as many fiscal responsibilities or family members to move. The lower the real and psychic costs of emigration for younger doctors makes them the most likely candidates for emigration.

However, emigrating doctors tend to be split evenly between family physicians/general practitioners and specialists. (Ibid.). This finding is inconsistent with the hypothesis that emigrating doctors are motivated by the pull factor of greater research opportunities. If that was the case, it would be expected that a majority of emigrating doctors would be specialists, who are more likely to be involved in research. Instead, other motivations must be salient for emigrating doctors.

A factor for which data is lacking is the quality of those Canadian doctors who choose to emigrate. This is a point of heated debate in brain drain literature. One side posits that the best and brightest will have the most opportunities to accept better positions in other countries, and since it would make little sense to move to another country to accept an inferior position, it must be the best and brightest who emigrate. Portes' study of emigrating Argentine doctors found them to have better academic records and more prolific publishing careers than their non-emigrating peers, who also accepted inferior salaries compared to the emigrants. (502-503). Likewise, he found that emigrating British doctors tended not to be those "whose low qualifications bar them from the job market, but rather those whose qualifications, professional self-image and goals tend to exceed what the occupational structure can offer." (499).

On the other hand, securing employment or admission to a foreign institution does not necessarily rely on merit alone. Structuration theorists would caution that personal contacts and sheer luck may be just as salient, if not more so. So, it would not be prudent to assume that the best and brightest are the ones who migrate. In fact, the worst and dimmest may turn out to be the ones emigrating, having been pushed out of the domestic labour market by more competent competition. (Ahmad: 218).

Unfortunately, data on the quality of emigrating Canadian doctors is unavailable, making any assessment of their professional merit extremely difficult to assess.

What is missing from media accounts of brain drain (and even from some academic treatises on the subject) is any acknowledgment of the multidirectional nature of highly-skilled migration, or of the gains a country may make from immigrating highly-skilled workers. On this, the literature is in agreement: the treatment of brain drain as a unidirectional migration flow is one of the gravest errors that can be made when assessing the situation. (Ahmad: 220; Bhagwati: 693; Grubel and Scott: 76).

If Canadian doctors are thought to be drawn to emigrate to the United States by the "pull" of various advantages of working there, surely Canada's "pull" factors draw doctors from other countries. Overall, immigrants represent a greater level of human capital than found in the general populace. Immigrants tend to have more schooling (Grassmuck and Pressar, 1999: 10) and are more likely to have a university degree (Termote: 36), a trait that some studies have considered to be the defining characteristic of highly-skilled individuals. In fact, immigration of highly-skilled individuals to Canada accounted for 20% of the "production" of the country's university degrees (Ibid.: 39), at no investment cost to Canada - a significant gain in human capital.

If the number of emigrating Canadian doctors is small relative to the size of the physician workforce, the number of doctors Canada receives as immigrants is even smaller. In 1998, the same year that an estimated 600 doctors emigrated from Canada, just 100 were estimated to have immigrated to Canada. At first glance, this low figure seems a certain refutation of the universality of what rational choice or human capital theory would predict. Surely, there are countries whose doctors are envious of the working conditions and rewards their Canadian counterparts enjoy. Yet they do not seem to be immigrating here. Some might even argue that Canada's health care system has actually eroded to the point that doctors from developing nations see no advantage in practicing medicine here.

Such arguments are overly-presumptuous. Like brain drain, this aspect of brain gain is a complicated affair. Prior to 1975, the number of immigrating doctors to Canada was significant, indeed. But in that year, the National Committee on Physician Manpower recommend that the government remove the "preferred status" bestowed upon immigrating physicians, in the name of self-reliance. (Ryten et. al., 1998: 732). This result in an immediate and steady drop in the numbers of immigrating doctors to Canada, a demographic trend whose impact is clearly still felt today. For, while only 100 doctors managed to immigrate to Canada from elsewhere, hundreds more had to be provided with "temporary employment authorization" permits to work in Canada to compensate for the shortage of doctors - fully 790 such permits were granted to foreign doctors in 1997. (Canadian Medical Forum Task Force on Physician Supply: 10).

This is a common practice for occupations where the skills are in short supply in Canada. (Iredale: 99). It is difficult to imagine why any foreign doctor willing to work temporarily in Canada on a special work permit would not be just as willing to work permanently in Canada, if given the same opportunity offered her counterparts prior to 1975.

The acquisition of a license to practice medicine may also serve as a barrier against foreign doctors immigrating to Canada. Obtaining a medical license is often a difficult process for immigrating doctors, and failure to do so results in underemployment (Boyd and Taylor, 1990: 44), which has a negative impact both on the immigrant, whose earnings and opportunity potential are severely curtailed, and on Canada, which is unable to capitalize on imported human capital. Robyn Iredale notes that this is a "major issue" in Canada (99). The CMA reports that "international medical graduates challenging the Canadian Qualifying Examinations have a considerably lower success rate than Canadian graduates;" (Canadian Medical Forum Task Force on Physician Supply: 21). While 95% of Canadian medical school graduates pass the exams, only 21% of foreign-trained medical school graduates manage to. The CMA is confident that this reflects the Canadian graduates' superior "ability to practice medicine," (Ibid.).

The only short-term gain origin countries can hope for from brain drain is in the form of remittances from their emigrants, (Fakiolas: 219) something that none of the literature suggests has made much of an impact if the country of origin is a developed nation. However, long-term gains can be much greater, should the emigrants return to the country of origin, bringing with them accrued experience, status, credentials, advanced skills, and often, infusions of capital (Ahmad: 216; Grassmuck and Pressar: 82).

Investigation of return migration patterns is hampered by the shortage of reliable data pertinent to the topic. Countries rarely keep track of their own returning citizens or of immigrants returning to their countries of origin. The INS, for example, has scant data available on returning Americans, or on where immigrants who later leave the United States go to. (Grubel and Scott: 51). Immigration Canada and Statistics Canada offer even less. This is terribly unfortunate, as the migration patterns of the highly-skilled have been called a "yo-yo effect," with movement back and forth between origin country and receiving country quite common. (Ibid.: 4). As Iredale notes, "a large amount of temporary movement has become a phenomenon of the late 1980's and 1990's and may exist on top of permanent migration or where there is no permanent migration." (95).

Luckily, highly-skilled occupations invariably come with their own professional associations, and these associations tend to keep much better data on the comings and goings of those who ply their particular trade than do government agencies, who must concern themselves with all occupations.

The Canadian Medical Association is a prime example of just such an association. The CMA's Canadian Medical Forum Task Force on Physician Supply report provides exact numbers of returning Canadian physicians for the years 1992-1998. The data reveals an average annual return rate of 40% of the annual emigration rate. The year 1998, however, reports a return rate of 56% of the emigration rate, perhaps indicating an upswing in numbers of returning doctors.

However, once again the authors of the report appear to be fudging numbers to make a "brain drain" more plausible. The number of returning Canadian doctors - 321, as reported on page 22, shrinks 22% when it is reported six pages earlier that the "approximate" number of returning doctors is 250. The 71 missing doctors may not seem like a large enough number to take issue with, but when they would explain away 12% of the brain drain of doctors from Canada for 1998, it is a significant point.

There is a good deal of evidence to indicate a large number of doctors return to Canada, or intend to. Canadians in the United States are one of the least likely immigrant groups to take out U.S. citizenship. (Schmidley and Gibson, 1999: 19-21). It is plausible that such reluctance to become a citizen of the country of residence could indicate an intention to return to the country of origin at some juncture. A stronger indicator for doctors would be the percentage practicing medicine in the U.S. who nonetheless go to the trouble to maintain active licenses to practice medicine in Canada - 31% of the 8,000 Canadian doctors working in the U.S. (Canadian Medical Forum Task Force on Physician Supply: 23). One would be hard-pressed to come up with an explanation for this besides the notion that these doctors in all likelihood intend to return to Canada to practice medicine. What other reason could there be to go through the trouble to maintain one's professional standing in a country of origin besides a desire to return to the country of origin? In fact, many predict increasing numbers of returnees to Canada when doctors working in the U.S. contrast their ability to practice medicine in a country with no nationalized health care plan and in which medical decisions are often dictated by a patients "Health Maintenance Organization" (HMO) and its nickel-and-dime prerogatives which the situation back in Canada. The human capital costs of practicing medicine in an environment where the dollar is the main consideration, as dictated by U.S. HMO's will override any rational choice calculations of personal economic benefit. Indeed, the structure of the U.S. health care system may preclude research and skills acquisition opportunities for emigrant Canadian doctors, who may then find themselves thinking fondly of their previous professional careers in Canada.

Despite the best efforts of the Canadian media, the Canadian government, and the Canadian Medical Forum Task Force on Physician Supply to make it seem otherwise, all available evidence demonstrates that the shortage of doctors in Canada is not attributable to a brain drain. While the task force summarizes the net emigration loss as approximately 350 doctors for 1998, their own report later provides an exact figure of 248 doctors lost to emigration for that year. And this figure does not take into account the "approximate" 100 doctors who immigrated to Canada that same year to practice medicine, further reducing the 1998 brain drain of Canadian doctors to just 148, or .2% of Canada's physician workforce. Furthermore, the high number of Canadian doctors who practice medicine in the U.S. yet maintain active licenses to do so in Canada indicates that for many, their time in the U.S. is temporary.

Still, migration can explain a greater proportion of the doctor shortage than brain drain has been able to. The loss of preferred immigration status for foreign doctors in 1975 was immediately followed by a sharp and steady decline in the number of immigrating doctors to Canada. The likelihood of barriers to licensing in Canada, only augment this decline. Indeed, while only 100 foreign doctors were able to immigrate to Canada in 1998, 790 accepted temporary employment here through special "temporary employment authorizations" (Canadian Medical Forum Task Force on Physician Supply: 10). It is apparent that, were the opportunity to immigrate to Canada and practice medicine available, our physician shortage problems could be resolved overnight.

For those doctors who do immigrate, better research opportunities do not appear to be a major "pull" factor. This would tend to discredit human capital theory. Furthermore, the relative youth of emigrating doctors may indicate lower real and psychic costs of emigration for them, which would support a rational choice based on the projected costs and benefits of emigration. However, the fact that younger doctors are more likely to emigrate might also be caused by stronger social network ties with agents of recruitment in U.S. medical schools, supporting structuration theory's view of the situation. Unfortunately, the lack of data concerning the country in which Canadian doctors receive their training prevents an investigation of this.

Whatever theoretical view properly explains why the few Canadian doctors who do emigrate choose to, other motivations appear to be driving the brain drain myth itself. Just a week before the federal government unveiled their budget for the year 2000, complete with generous cuts to corporate taxes, The National Post ran a front-page story suggesting that cuts to corporate taxes were the only sure-fire solution to the brain drain malady allegedly plaguing Canada. (Chwialkowska: A1). Perhaps all the evidence refuting the existence of a brain drain of Canadian doctors is irrelevant if government fiscal policy requires a brain drain to justify tax cuts.

Nonetheless, given the available facts, the question posed by Alejandro Portes in 1976 remains as valid today: "the real question is often not why some professionals migrate but why so few, in fact, leave." (490).

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