Foreign Practices: Immigrant Doctors and the History of Canadian Medicare by Sasha Mullally and Wright David (review)

Reviewed by: Foreign Practices: Immigrant Doctors and the History of Canadian Medicare by Sasha Mullally and Wright David Heather MacDougall Mullally, Sasha and David Wright–Foreign Practices: Immigrant Doctors and the History of Canadian Medicare. Montréal and Kingston: McGill-Queen’s University Press, 2020. 366 p. Foreign Practices by medical historians Sasha Mullally and David Wright is an ambitious effort to decentre the historiographical focus on politics in making the icon of Canadian health care policy: Medicare. Mullally and Wright focus on the crucial role immigrant doctors played in providing medical services during the early phases of government action in health care, starting with the Hospital Insurance and Diagnostic Services Act (1957) and its successor, the Medical Care Act (1966). As they cogently argue, Canada had always relied on international medical migrants but rapid population growth in the 1950s and the Royal Commission on Health Services’ (RCHS) pointed references to the lack of health care professionals in all disciplines made its recommendation for publicly funded “medically necessary services” the issue at the top of the policy agenda. But the timing of the “socialization” of Canadian health care meant that Canada also participated in the transnational movement of highly trained professionals with its expected and unexpected consequences. But how did health care become so intimately entwined with immigration policy? This important question highlights the second significant component of their analysis and justifies their mixed methodology for the study. In essence, their work is intended to bring social history into current and future discussions of the history of Medicare by examining the impact of both legislation and policy implementation through the lived experiences of migrant practitioners. Placing their work within the field of transglobal migration studies requires Mullally and Wright to describe the complexities of the division of powers between the federal and provincial governments succinctly since the comparator nations, such as the United States, the United Kingdom, Australia, and other western nations, generally have different political approaches to health care policies and the groups being covered. By focusing primarily on the period from 1957 to 1984, Mullaly and Wright demonstrate the way doctors and nurses migrated in response to “push” (rigid hierarchies and racism) and “pull” (better salaries, adventure, opportunity) factors that reflected both personal imperatives and national policies. Using personal recollections to open each chapter also illustrates the gap between accepted sociological interpretations and individual motivations for emigration. The key events in immigration policy include the Fairclough Initiative in 1962, which lifted the restriction on Commonwealth migration and thus contributed to the [End Page 230] arrival of doctors and nurses from India, Pakistan, South Africa, and the Caribbean. World conflicts throughout the period also meant that doctors from Egypt, Hungary, Czechoslovakia, Haiti, Uganda, and Taiwan also joined the Canadian workforce, especially after 1967 when a new Immigration Act introduced the “points system.” This legislation identified training and education as highly desirable criteria for immigrants and was to be particularly important since studies prepared for the provinces in the early 1950s and the Royal Commission on Health Services in the 1960s revealed a significant shortfall in health care personnel despite increasing medical migration from Great Britain and the arrival of nurses trained in the Caribbean and the Philippines in the 1950s. Why was this so important? What did it mean for the implementation of a national medical services program? As the introduction of national hospital insurance between 1958 and 1961 had demonstrated, Canada needed many more doctors, nurses, and allied health care personnel than were currently available. The country also required better distribution of resources rather than the growing concentration of medical education and services in rapidly expanding urban areas. To deal with the pent-up demand that would arise when the national medical services program was implemented, the RCHS recommended not only hiring many more foreign health care workers but also creating seven new medical schools and expanding hospitals and postgraduate specialty training. The Pearson government responded with the Health Resources Fund, which provided federal support for expanding universities and hospitals in all the provinces and funding three new medical schools in Quebec (Sherbrooke), Ontario (McMaster), and Alberta (Calgary). The deans at each school looked overseas as...

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