Physicians who have practiced in both the United States and Canada compare the systems. (2024)

PMCID: PMC1694903

G J Hayes, S C Hayes, and T Dykstra

Author information Copyright and License information PMC Disclaimer

Abstract

OBJECTIVES. The aim of this study was to examine the US and Canadian systems from the unique perspective of physicians who have practiced in both Canada and the United States. METHODS. Questionnaires were sent to 355 Canadian physicians who graduated from US medical schools and 347 US physicians who graduated from Canadian medical schools. RESULTS. The overall response rate was 59% (65% of US-graduated Canadian physicians and 54% of Canadian-graduated US physicians). Thirty-six percent of the respondents were "dual experience" physicians; that is, they had practiced medicine in both countries after completing their medical training. Physicians who left Canada were more likely than those who left the United States to indicate dissatisfaction with the health care system as a reason for leaving. Respondents expressed greater professional satisfaction with their current country of practice, but overall, dual-experience physicians in the United States favored that system only slightly more than the Canadian system, whereas those in Canada rated the Canadian system significantly better than the US system. CONCLUSIONS. The comparatively weak rating of the US system by dual-experience physicians underlines the need for health care reform.

• Iglehart JK. Canada's health care system (2). N Engl J Med. 1986 Sep 18;315(12):778–784. [PubMed] [Google Scholar]
• Iglehart JK. The United States looks at Canadian health care. N Engl J Med. 1989 Dec 21;321(25):1767–1772. [PubMed] [Google Scholar]
• Blendon RJ, Leitman R, Morrison I, Donelan K. Satisfaction with health systems in ten nations. Health Aff (Millwood) 1990 Summer;9(2):185–192. [PubMed] [Google Scholar]
• Himmelstein DU, Woolhandler S. A national health program for the United States. A physicians' proposal. N Engl J Med. 1989 Jan 12;320(2):102–108. [PubMed] [Google Scholar]
• Todd JS, Seekins SV, Krichbaum JA, Harvey LK. Health access America--strengthening the US health care system. JAMA. 1991 May 15;265(19):2503–2506. [PubMed] [Google Scholar]
• Holahan J, Moon M, Welch WP, Zuckerman S. An American approach to health system reform. JAMA. 1991 May 15;265(19):2537–2540. [PubMed] [Google Scholar]
• Butler SM. A tax reform strategy to deal with the uninsured. JAMA. 1991 May 15;265(19):2541–2544. [PubMed] [Google Scholar]
• Evans RG, Lomas J, Barer ML, Labelle RJ, f*cks C, Stoddart GL, Anderson GM, Feeny D, Gafni A, Torrance GW, et al. Controlling health expenditures--the Canadian reality. N Engl J Med. 1989 Mar 2;320(9):571–577. [PubMed] [Google Scholar]
• Iglehart JK. Canada's health care system faces its problems. N Engl J Med. 1990 Feb 22;322(8):562–568. [PubMed] [Google Scholar]
• Hughes JS. How well has Canada contained the costs of doctoring? JAMA. 1991 May 8;265(18):2347–2351. [PubMed] [Google Scholar]
• Fuchs VR, Hahn JS. How does Canada do it? A comparison of expenditures for physicians' services in the United States and Canada. N Engl J Med. 1990 Sep 27;323(13):884–890. [PubMed] [Google Scholar]
• Linton AL. The Canadian health care system. A Canadian physician's perspective. N Engl J Med. 1990 Jan 18;322(3):197–199. [PubMed] [Google Scholar]
• Orford RR. Reflections on the Canadian and American health-care systems. Mayo Clin Proc. 1991 Feb;66(2):203–206. [PubMed] [Google Scholar]
• Access to health care. American College of Physicians. Ann Intern Med. 1990 May 1;112(9):641–661. [PubMed] [Google Scholar]
• Hadley J, Steinberg EP, Feder J. Comparison of uninsured and privately insured hospital patients. Condition on admission, resource use, and outcome. JAMA. 1991 Jan 16;265(3):374–379. [PubMed] [Google Scholar]
• Himmelstein DU, Woolhandler S. Cost without benefit. Administrative waste in U.S. health care. N Engl J Med. 1986 Feb 13;314(7):441–445. [PubMed] [Google Scholar]
• Woolhandler S, Himmelstein DU. The deteriorating administrative efficiency of the U.S. health care system. N Engl J Med. 1991 May 2;324(18):1253–1258. [PubMed] [Google Scholar]
• Coyte PC, Dewees DN, Trebilco*ck MJ. Medical malpractice--the Canadian experience. N Engl J Med. 1991 Jan 10;324(2):89–93. [PubMed] [Google Scholar]
• Kirkman-Liff BL. Health insurance values and implementation in The Netherlands and the Federal Republic of Germany. An alternative path to universal coverage. JAMA. 1991 May 15;265(19):2496–2502. [PubMed] [Google Scholar]
• Iglehart JK. Germany's health care system (1) N Engl J Med. 1991 Feb 14;324(7):503–508. [PubMed] [Google Scholar]
• Dukakis MS. The states and health care reform. N Engl J Med. 1992 Oct 8;327(15):1090–1092. [PubMed] [Google Scholar]
• Miles SH, Lurie N, Quam L, Caplan A. Health care reform in Minnesota. N Engl J Med. 1992 Oct 8;327(15):1092–1095. [PubMed] [Google Scholar]