Retention in Healthcare: Migration Costs and Systems Perspectives
Over the past several decades, Canada’s healthcare systems have delivered remarkable advances, with healthcare workers implementing life-extending and life-saving interventions that have transformed patient outcomes across the country. These advances have introduced new pressures. As demand for care increases, the pressures shaping the future of the system are also intensifying.
Of the pressures facing the system, addressing workforce shortages is among the most immediately actionable solutions. Governments have several policy levers available, including expanding training pathways, supporting improvements to international credential recognition, modernizing the scope of practice, and strengthening retention. However, not all solutions produce results at the same pace. This means the system must act along two tracks at once: deliver results where the impact is immediate, while also strengthening the foundations that enable the health workforce’s long-term sustainability.
In this context, we undertook an examination of the cost of turnover and out-migration among Canadian healthcare workers, as well as how regulatory bodies and training organizations monitor and respond to workforce exits. Our approach combined a quantitative cost-consequence analysis with qualitative insights from interviews with 18 representatives from national associations and provincial and territorial regulatory bodies and seven focus groups involving 32 participants from educational organizations.
Key Insights
Health workforce migration—within and between provinces, and internationally—has measurable impacts on health systems. Data confirm that health professionals do move across jurisdictions, creating cost and capacity pressures. However, limited data availability and fragmented, inconsistent collection practices restrict understanding of the scale, patterns, and drivers of this movement.
Workforce instability generates considerable system-level costs, driven primarily by turnover rather than migration alone. Each health professional who leaves a role triggers replacement costs—estimated at $118,000 to $158,000 per physician and $38,000 to $140,000 per nurse—regardless of whether the move occurs within a province, between provinces, or internationally.
Decisions to migrate are driven by a consistent set of structural and workplace factors. Compensation differences, variation in scope of practice, access to professional development, job availability, and workplace culture materially influence whether health professionals remain in place, relocate within Canada, or leave the country.
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