More Canadian Brain Drainage

Sir: The article entitled “The Canadian Plastic Surgery Workforce Survey: Interpretation and Implications” (Plast. Reconstr. Surg. 119: 2299, 2007) showed a perceived shortage of Canadian plastic surgeons because 8 percent of respondents were within 5 years of retirement, 3.2 percent were planning to emigrate by 2010, and 21 percent of residents who graduated over the past 10 years now practice outside of the country.1 Based on these findings, an estimated 14 percent attrition rate will lead to a projected significant shortage of Canadian plastic surgeons in the next 5 years. The article did not mention several factors that will likely further increase the flow of Canadian-trained plastic surgeons to the United States. First, the recent agreement with the American Board of Plastic Surgery now makes all Canadian-trained plastic surgical residents eligible for American Board of Plastic Surgery certification.2 Second, over 40 percent of surveyed Canadian plastic surgeons have completed fellowship training (33 percent in hand/wrist/upper extremity surgery and 24 percent in cosmetic surgery).1 There is a preference to complete these fellowships in the United States because (1) Canadian hand fellowships are not accredited by the Accreditation Council for Graduate Medical Education and, thus, a Certificate of Added Qualifications in Hand Surgery is not possible3; and (2) there are limited aesthetic fellowship opportunities in Canada.4 Third, the high quality of Canadian plastic surgical training, which emphasizes early operative independence and requires oral and written board examinations that must be passed during the chief resident year, likely enables graduates to match to excellent American fellowships. Having completed a U.S. fellowship, all these factors contribute to the increased likelihood that Canadian-trained and now American Board of Plastic Surgery–eligible plastic surgical residents will be invited to practice south of the 49th Parallel after completion of their fellowship training. “The Canadian Plastic Surgery Workforce Survey” suggested several incentives to keep graduates in Canada and to practice in underserviced rural areas (e.g., retention bonuses, support for practice overhead, retirement plans, and spousal support).1 Nonetheless, research has shown that these incentives are not wholly effective in retaining Canadian physicians to practice in rural areas.5 In addition to the aforementioned strategies, the Canadian health care system might offer more aesthetic fellowships and make necessary moves so that Canadian hand fellowships are recognized by the Accreditation Council for Graduate Medical Education, which would allow their graduates to obtain a Certificate of Added Qualifications in Hand Surgery. Julielynn Wong, M.D., M.P.H. Division of Plastic Surgery University of Pittsburgh School of Medicine 3550 Terrace Street 683 Scaife Hall Pittsburgh, Pa. 15261 [email protected]

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