The country’s healthcare system suffers from acute doctor shortages — even as hundreds of qualified Canadian doctors trained abroad are turned away each year due to bureaucracy and bias, experts say.
Canada is missing out on the chance to enroll hundreds of these Canadian doctors in a strained system because, critics say, tight-fisted provincial governments have restricted places — and because the system explicitly privileges students who went to Canadian medical schools.
According to census data, there is no shortage of doctors in Canada. What we have is a shortage of licensed doctors.
While estimates vary, there may be as many as 13,000 physicians in Canada who do not practice because they have not completed a two-year residency position – a requirement for licensing.
Critics of the system say discrimination is pervasive.
“There’s a ‘don’t come home’ attitude in Canada,” said Rosemary Pawliuk, president of the Society for Canadians Study Medicine Abroad.
“They have cute slogans like ‘You are wanted and welcome in Canada,’ but when you look at the barriers, it’s very clear that you shouldn’t come home. Their message is essentially ‘go away’. And they do.”
Under Canadian regulations, medical schools decide for themselves who receives residency. Critics say these schools have a vested interest in Canadian-educated students getting as many of these positions as possible — putting Canadians educated at respected schools abroad at a serious disadvantage.
Critics say the system is designed to ensure that every graduate from a Canadian medical school – no matter how competent – is licensed to practice medicine. Only a relatively small number of underperformers are singled out each year.
The same does not apply to local doctors who go abroad.
A prejudice built into the system
“The doctors who run these departments want the best – but that’s not allowed. You’re not allowed to choose from the full pool of qualified applicants,” Pawliuk said.
About 90 percent of all residencies are reserved for Canadian medical graduates each year. Internationally trained doctors get the rest.
In some provinces, domestic medical graduates and foreign-educated cannot compete – there are two separate pools, and the pool reserved for international medical graduates is much smaller.
According to the Canadian Resident Matching Service (CaRMS), 1,661 international medical graduates (IMGs) applied for residency in Canada last year. Only 439 were matched with the required postgraduate education. That’s a “match rate” of just 26 percent.
And these aren’t aliens — you must be a Canadian citizen or permanent resident to even apply for residency in Canada.
“The Canadian public should be entitled to the best qualified Canadian applicant. Whether they have a degree from a Canadian school or an international school, whether they are native Canadians or immigrants, they should measure their individual merit,” Pawliuk said.
The functioning of the residence system has consequences. For example, according to CaRMS data, 115 resident physicians nationwide — mostly in family medicine — remained vacant because Canadian medical school graduates were not interested in them.
These foreign-educated Canadians also face a number of other hurdles.
For example, unlike Canadian medical graduates, international medical graduates must pass the MCCQE Part 1 exam administered by the Medical Council of Canada before they can apply for residency.
Canadian medical graduates can do so after they’ve already secured a place, and each year about 5 percent of them fail the exam, according to Pawliuk, but still continue their residency training.
Lack of space in medical schools
Canada’s internship rate compares poorly to reports from other countries.
In the US, for example, 61.6 percent of US-born or naturalized citizens who attend foreign schools receive a residency position, according to US National Resident Matching Program data.
Many medical students go abroad for education as there are very few medical college places available in Canada.
Tens of thousands of medical students compete for just 2,800 first-year places at the country’s 17 medical schools. According to the university, their acceptance rate is only about 5.5 percent.
Each year, about 1,000 Canadian trainee doctors enroll in schools in countries such as Australia and Ireland, where first-year places are more plentiful.
Toronto-born Jake Portnoff is one of those students.
Portnoff, a Queen’s University medical graduate, was not accepted into his Canadian medical school – partly because of a spate of applications after years of COVID-related postponements.
He is now at the University of Queensland with about 100 other Canadian students who have also been excluded from what he calls “very competitive and discouraging” Canadian medical school selection processes.
Portnoff said most Canadian students there wanted to return home – they were just worried about what looks like an uphill battle.
“There are so many qualified and educated medical students that I really think should be given a chance. The currently available amount of assistant places is such an obstacle. It’s certainly hard to hear that many qualified Canadians are being turned away by what we’re witnessing,” he told CBC News.
“Increasing the number of residence places would be a huge benefit for Canadians, especially when the system there is in crisis.”
With some emergency rooms closing due to staff shortages and a shortage of family doctors across the country, it’s obvious that Canada needs to increase the number of housing places it offers, Portnoff said.
“We are doing everything we can to promote the best healthcare outcomes for our patients. That doesn’t change whether I’m in Australia or Canada. I would take all my skills and clinical acumen home and put them all in the Canadian system,” he said.
The number of international residence applicants is shrinking
In addition to calling for more residency positions, Portnoff called for other creative solutions — like an international exchange program so students in Australia can return home to Canada for experience before diving into the cutthroat residency-matching process.
Portnoff co-founded the Canadian-American-Australian Medical Student Association, an advocacy group dedicated to helping students transition when it became known that returning to Canada was difficult.
The number of international applicants for residency has steadily declined from 2,219 in 2013 to 1,661 in 2022 – a 25 percent drop in just a decade.
Some foreign-trained doctors are abandoning Canada because the process is so difficult, Pawliuk said.
“If you tell people to stay away long enough, they will,” she said.
This is a problem because Canada relies in part on foreign-trained physicians to fill the ranks of departing physicians.
According to data from the Canadian Institute for Health Information, foreign-trained physicians account for about 25 percent of all physicians.
In family medicine, almost a third of all doctors have international medical degrees.
This week, the federal Liberal government announced an offer to the provinces of about $46 billion in new healthcare spending.
In exchange for that money, critics say Ottawa should demand that provinces do more to streamline the recognition of foreign credentials.
As part of his health plan, Conservative leader Pierre Poilievre has suggested working in the provinces to speed up the process.
“It’s outrageous that my little girl has to sit in the emergency room for six hours with a migraine because there aren’t enough doctors and nurses,” he told reporters Wednesday after Trudeau unveiled his health plan.
“I think we should work with the provinces to come up with a simple system that says ‘yes’ or ‘no’. It should be done in sixty days, not six or seven years.”
The Royal College of Physicians and Surgeons of Canada oversees the accreditation of residency residency training in Canada.
In a statement, the Royal College said it considers residents who have completed medical school outside of Canada to be “important contributors to a robust educational environment and future health workforce” and is currently considering some “alternative avenues” to streamline the system.
“I think five years from now, internationally trained physicians, regardless of their medical specialty, will be admitted into the system within a year or two, as opposed to five to seven years,” said Glen Bandiera, executive director of standards and assessment at the Royal College .
