Quebec has long benefited from unofficial linguistic protectionism; if skilled French-speaking Quebecers wanted to live, raise children, and work in their own language, there were few places in Canada outside this province where they could settle.
So Quebec could offer lower pay and poorer working conditions and still retain talent.
According to the most recent information from the Canadian Institute for Health Information, this province spent 11 per cent less per capita on health care than Ontario, and paid its doctors an average 25 per cent less. Even so, it had 23 per cent more doctors per 100,000 of population than its neighbour.
The effect of the protective language barrier can be seen in the accompanying table; doctors who graduate from McGill University are far more likely to leave Quebec to practise within two years of completing their training than are graduates of the province's French-language medical faculties.
The brain drain of McGill medical graduates trained at Quebec's expense has become an argument against building the new McGill teaching hospital in addition to that of the Université de Montréal. In each of the past three years, more than three-quarters of doctors graduating from the U de M two years earlier were still here.
But while it's the McGill exodus that attracted attention when the figures in the accompanying table were reported last month, a closer look at them suggests that the language barrier keeping skilled French-speaking Quebecers isn't entirely effective.
It's hardly surprising that, in each of the past three years, doctors graduating from McGill left Quebec in about the same proportion as those graduating from Memorial in St. John's or Dalhousie in Halifax were practising outside the Atlantic region.
What is surprising is that nearly a quarter of doctors graduating from the Université de Sherbrooke in 2006 were practising outside the province two years later. And the proportion was similar for each of the two previous graduating classes.
In fact, in each of the last three years Quebec, even with its linguistic advantage, had retained a slightly smaller proportion of doctors graduating from the U de S than Ontario from the University of Toronto.
Over the three years, 44 doctors from the U de S had left this province for the rest of Canada, and 25 were practising in other countries or were not located.
The registry from which the figures were taken did not say where the graduates came from. But while some of them might have gone home, there are probably others who left in search of better practice conditions and better pay.
And now the language barrier is about to face a new test. Last week, the Quebec college of physicians signed an agreement with its Ontario counterpart that, as of Aug. 1, would allow a doctor with a full practice permit in one province to obtain an equivalent permit in the other within 24 to 48 hours.
The president of the college, Dr. Yves Lamontagne, said he didn't expect the increased mobility to result in an exodus of doctors to Ontario, because "Quebecers are very attached to their province."
But others in this province's medical community seemed to hope that it would put pressure on the Quebec government to improve doctors' pay and practice conditions.
The president of Quebec's medical specialists' federation, Dr. Gaétan Barrette, said that among doctors, the low pay in this province makes it "the laughingstock of Canada." And the spokesman for the province's medical residents' federation, Dr. Jonathan Spicer, complained about the requirement that young doctors start practice in the hinterland and hoped the agreement would force Quebec to be "competitive in terms of recruiting."
That will depend upon how many French-speaking doctors use the agreement to jump the language barrier.
Percentages of Quebec medical graduates completing training in 2006 and practising in this province in July 2008:
Université Laval 84
Université de Sherbrooke 78
Université de Montréal 91
McGill University 48
source: Association of Faculties of Medicine of Canada