Paging Canada: Your future doctors are fleeing the U.S.

Well before the Nov. 5th U.S. presidential election, my wife and I had talked about moving to Canada. Two days after the vote, we put the wheels in motion.

I’m a physician, and she’s a newly minted nurse practitioner. We were greeted with mutual enthusiasm, and we both secured jobs rather quickly. Now we live in Canada, and we’re incredibly pleased and grateful. 

It’s not a shock that a country that collectively decided the health and well-being of its citizens is essential to social cohesion has an abundance of friendly people. I believe these things are connected.

In return for my appreciation, I’d like to share an important secret with all Canadians: American physicians, especially those under 45, are smart, dedicated, ethical, and desperate to escape a system that not only fails to respect these values but actively undermines them. They are looking for a way out. 

With Trump’s reelection, and a deafening silence from medical leadership, now is the time for Canada to recruit the best and brightest young American doctors.

The rapid decline of medical ethics in the U.S. has been devastating for younger physicians who still believe that medicine should be about, you know, helping people. Many don’t realize just how little control younger physicians in America have over the internal workings of the system or the larger sociopolitical environment in which they practice.

And no one, particularly those who trained us, is telling these doctors that it doesn't have to be this way. We wouldn’t be in this situation if older, mostly retired physicians hadn't sold the practice of medicine to corporations and private equity. It was never theirs to sell but with their endless arrogance, self-importance, and desperate desire to be part of an anointed medical aristocracy, they did it anyway.

It doesn't have to be this way.

“It,” meaning the horrific, amoral, unethical system of profiteering that defines American healthcare. Maximizing profit has become the primary focus of U.S. medicine. 

The Institute of Medicine once identified six crucial domains of healthcare quality: safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness. But for all their good work, in practice this amounts to little more than a PR campaign — empty rhetoric meant to reassure the public while protecting the status quo.

Let’s be honest, American healthcare is a business first. Everything else comes second. The days when it even pretended to be about anything more than maximizing profit are long gone. 

Today, the system exists to enrich grossly overpaid C-suite executives and their sycophantic middle-management foot soldiers, who deliver nonsensical productivity demands, blame the victim, and silence anyone who dares point out the obvious.

This isn’t a mistake. These executives were hired to oversee this racket, and they, in turn, hire waves of yes-men and yes-women who have no integrity to speak of. Everyone is replaceable. Don’t like it? There’s the door. Their moral compasses don’t just break, they spin wildly, disoriented by the sheer scale of the grift.

I’ve met and worked closely with hundreds of these people. Their total lack of interest in patients, refusal to listen, and their inability to empathize aren’t flaws in the system — they’re job-requirements.

Any tangible, meaningful effort to change things — especially if it threatens the financial interests of older, mostly retired physicians — is actively destroyed. But these physicians understand the power of movements, so they don’t just destroy the idea, they destroy the person who had it. They kill careers, discredit reputations, and destroy futures.

There’s an entire internal apparatus built around neutralizing the most demoralized and outspoken among us. The pathways are many, but the goal is the same: Get “well” or get out.

Enter the modern hospital “Wellness Committee,” where physicians (yes, physicians) lead kangaroo courts designed to silence dissenters. “Wellness” has absolutely no connection to its historical meaning. In corporate newspeak, it means: Shut up and work. Or get out.

The last thing discussed in these so-called wellness conversations is patient care, because frankly, it’s not relevant to the people in charge. In fact, physicians who actually violate medical ethics — those who peddle quack cures, defraud the public, and repeatedly harm patients — are often protected, as long as they don’t interfere with the flow of profits. As long as they stay in their lane and don’t disrupt the money-printing machine, they’re safe.

Meanwhile, private institutions and public-sector entities, both of which are controlled by corporate interests via lobbying and campaign contributions, negotiate backroom deals that enrich the powerful while demanding ever-increasing productivity from frontline doctors. 

One particularly nasty cost-cutting measure is intentional understaffing. It has led to an epidemic of burnout, moral injury, and even suicide.

Dr. Lorna Breen and Nurse Tristin Kate Smith are just two of many who could no longer reconcile their deep moral convictions with a system designed to undermine and exploit them. They dedicated their lives to helping others, only to realize that the entire enterprise was a giant, grotesque lie. 

Here’s the key takeaway: There is no healthcare without us.

Without physicians, the entire medical billing operation grinds to a halt. And unlike other industries, there is no reserve workforce of doctors waiting to cross a picket line. Another thing we can thank those older physicians for: intentionally restricting the supply of doctors to keep wages artificially high. Classic supply-and-demand economics.

However, for the younger doctors who aren’t yet financially secure, and for those shackled by hundreds of thousands of dollars in student loan debt, organizing a collective response is nearly impossible. So, the ones who still care — who see medicine as a calling instead of a business — are looking for a way out.

And here’s where Canada comes in.

Younger American physicians don’t have to stay in a country where the medical system is designed to strip-mine their souls for profit. The price of staying is clear: participation in a morally bankrupt, predatory business model that Americans call “healthcare.”

Canada, this is your chance, should you choose to take it.

A serious, well-funded, and strategic recruitment campaign to bring young American physicians to Canada could be exactly what the doctor ordered. Many of us want out. With the right incentive structure — streamlined licensing, credentialing support, and competitive compensation — a significant number would make the move.

The doctors reading this and nodding along? They’re ready to come.

The doctors reading this and fuming with indignation? Trust me, you don’t want them.

As for me, I could no longer be a public face of an extortion racket — one that limits access to care, medicalizes social problems, and prevents me from actually helping people.

Ultimately, this effort will require something that’s increasingly rare in American healthcare: honesty.

An honest discussion between muzzled younger doctors and the public is long overdue. But there is one thing that is not up for debate: The  U.S. medical establishment must be excluded from this conversation. Their endless record of bad-faith negotiations, exploitative practices, and thin-skinned authoritarianism renders them utterly unfit to lead.

They have nothing to contribute — except, perhaps, an apology.

And a promise, to get out of the way.

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Code Black is a physician now practicing in B.C. after immigrating from the U.S. last year. He writes under a pseudonym due to fear of further retribution from members of U.S. medical leadership and U.S. government officials.