WINDSOR, Ontario — To a young cardiologist like Amr Morsi, Canada seemed a medical wasteland not too long ago.
Toronto, a city of 2.5 million, had just three hospitals doing angioplasties and open-heart surgery. Catheterization labs and advanced imaging equipment were not widely available. Patients might be dead before they ever received their results from angiograms or other tests.
In 2001, at the peak of frustration over Canada's government-funded health care system, Morsi moved to Orlando and joined a private group practice.
"We even had a cath lab in our office,'' he says. "I thought I'd died and gone to heaven.''
But now Morsi, 40, is back in Canada, impressed by how far his country has come. And critical of a U.S. system he once admired so much.
He found that American doctors tend to order more testing, partly for fear of being sued but also because "patients demand it and doctors and hospitals want to do it because it's more money. It's a positive feedback loop.''
But in Morsi's view, "the most evil part of the system'' was the insurance companies.
"Every year the insurance premiums go up and your deductible goes up so you're paying more for less. On the other side of the coin, the insurers are saying to the physicians, 'We're renegotiating and paying you less.' Then they collect the difference in profits. They're a big drain on the U.S. system.''
In Canada, meanwhile, change was afoot. At one time, more than 500 heart patients a year from Windsor had to go to Detroit, Toronto or other cities for angioplasty, a procedure to diagnose or widen blocked arteries. Then Hotel Dieu-Grace, one of Windsor's two hospitals, beefed up its cardiac care program and in 2007 performed its first angioplasty.
Last year, the hospital recruited Morsi to be medical director of its catheterization lab.
"I came back and found substantial improvement,'' he says. "The government has invested in infrastructure and now we can do an angiogram on a patient in 48 hours.''
In returning to Canada, Morsi joined a reverse flow of the "brain drain'' that saw thousands of doctors and nurses go to the United States between 1997 and 2003. Enticed by signing bonuses, they helped ease shortages in speciality fields and parts of the country like Florida with large numbers of elderly people and winter visitors.
Since then, 541 doctors have returned to Canada, including two urologists that Windsor Regional Hospital recently lured back. In the last 18 months, the hospital has also hired 54 nurses who once worked in nearby Detroit.
For the nurses, tighter border controls after 9/11 made commutes longer, and a strong Canadian dollar nearly negated any pay advantages. But they were also frustrated with the insurance-heavy U.S. health care system.
"The Canadian system isn't driven on revenues, so when we're caring for patients we don't itemize the cost of everything,'' says Karen McCullough, chief nursing executive at Windsor Regional. "Nurses that come back from the States really like the pureness of patient care here.''
For Morsi, factors in his return were the breakup of his group practice — "the older guys didn't want to work as hard'' — and a desire to be closer to family. But he is also glad to be free of the insurance burden — in Orlando, 160 people were needed to handle paperwork for 16 physicians.
Now Morsi is in practice by himself with a single assistant.
Physicians' gross pay in Canada is less than in the States, ranging from about $106,000 for some family doctors to over $600,000 for specialists. But Morsi says he takes home about the same as he did in Orlando because of much lower overhead and malpractice insurance costs.
"The U.S. health care system is incredibly complicated. If you're trained in Canada, the attitude is: I just want to be a doctor.''
Susan Taylor Martin can be contacted at firstname.lastname@example.org.