When we try to explain to people who are not familiar with how the medical residency selection process works, most people do not understand or believe it. Most think that there must be a misunderstanding, or that some piece is missing. It is difficult to understand why we would be forcing Canadians who studied medicine outside North American at reputable schools to leave Canada if they want to practice medicine, while we pay Health BC to recruit foreign doctors. It is difficult to understand why we would exclude some of Canada’s best and brightest medical graduates from competition for jobs as resident physicians. It is difficult to understand how the government could allow a system of medical residency selection that is inconsistent with Canadian values of freedom, fairness, and equal opportunity.
But the reality is that medical resident jobs in Canada are not filled on the basis of merit. Qualified Canadians do not have equal opportunity to compete for medical resident jobs. In fact, in B.C., Canadians who have international medical degrees cannot access residency positions in 61 out of 65 medical disciplines.
Medical residency selection has created two classes of Canadians: those with unlimited opportunity, and those with limited opportunity and whose access to competition can only be gained by entering into contracts of servitude. The determining factor of who can enter the practice of medicine is not based on medical knowledge, clinical skills, the international ranking or quality of the medical school, or any other consideration that we as members of a free and democratic society would consider important and relevant.
About 20 years ago, the Canadian universities gained full control over medical resident selection. They used the power that they obtained, to further the opportunities and success of their graduates by excluding international medical graduates, including Canadians who were born and raised in Canada, from competing against their graduates. Even those young Canadians who were smart enough to be accepted into international medical schools, which rank above any Canadian medical school, cannot return to Canada to compete against their peers for resident physician jobs in this country. Read Understanding Residency to get an overview of how the system came to be and how it works.
In a time when we are desperately short of doctors, Canadian universities place barriers in front of Canadians who studied overseas, preventing them from coming home to serve Canada’s health needs. The current system forces Canadians who earned an international medical degree to leave Canada to practice medicine. We are spending hundreds of millions of dollars to recruit foreign physicians, redistribute the licensed doctors we have, and pay doctors more to keep them from going to other jurisdictions that pay more. Ministries of Health pay to recruit foreign doctors but severely restrict new Canadian physicians and immigrants who are already here from training jobs as resident physicians. Canadian Rhodes scholars who study medicine are turned away. Families are separated. The medical residency system makes no sense ethically, economically, socially, professionally, or legally. It only serves the universities.
The most fundamental principles of admission into the profession have been ignored as selection of residents is determined by the conflict-fraught universities, instead of the Colleges who were statutorily designed to fulfill this function. The most fundamental principles of a free and democratic society have been ignored as selection is determined by universities, who have used the monopoly they have on medical residency training to put their interests above all else. The most fundamental principles of fairness have been ignored as selection is determined by universities, who seek to promote their own graduates at the cost of other graduates. This is why SOCASMA exists.