Are CSAs less qualified to practice medicine than CMGs?

In all probability some are less qualified, some are equally qualified, and others are more qualified.

  • National medical knowledge and skills (MCCEE) and clinical skills (NAC OSCE) examinations are designed to ensure that IMGs including CSAs have the knowledge and skill necessary to work as resident physicians.  A passing grade establishes that the IMG’s knowledge and clinical skills “are at the level of a Canadian medical graduate entering postgraduate training.”  Thus every IMG who passes the NAC OSCE and the MCCEE has proven that they have the medical knowledge and clinical skills of CMGs.
  • Comparing how any individual CSA compares to a CMG is more difficult.
    • In the USA, everyone, regardless of the medical school attended, regardless of citizenship, has to take the U.S. medical licensing exams.  (SOCASMA has members who have scored in the top 2% of all medical graduates writing these U.S. licensing examinations.)
    • Canadian and American medical school graduates are not required to take medical licensing exams, which makes it difficult to compare CSAs and other IMGs to CMGs.    In the current system the knowledge and skills of medical graduates need not be examined as Canadian universities have designed a system that virtually guarantees their graduates training jobs as resident physicians regardless of how well or poorly they did in medical school.
    • Canadian medical schools do not all issue grades.  UBC courses, for instance, are pass/fail.  Thus it is not possible to compare CSAs and CMGs by their grades or how they ranked in their class because CMGs do not necessarily get anything more than pass/fail grades.
    • A comparison of the reputations or international ranking of a school is another way of evaluating the quality of the medical graduate.  This, of course, is a poor substitute for evaluation of the medical graduate on individual merits.  Assuming a reputable school in a developed country, how well a student masters the education (s)he accesses is more a function of individual motivation, aptitude, and work ethic than the medical school itself.
      • A review of the international ranking of medical schools demonstrates that Canada does not have any medical schools ranked in the top 10.  Some CSAs attend medical schools that are ranked internationally higher than any Canadian school. Most CSAs attend medical schools that are ranked higher than the lowest ranked Canadian medical school.
      • The quality of medical education in Canada is controlled by a Canadian (CACMS) and American (LCME) accreditation organization.  Canadian medical schools have been put on probation by the American accreditation organization on various occasions.  Currently the University of Saskatchewan is at risk of losing accreditation.
      • The Colleges of Physicians and Surgeons of Canada in determining registration qualification recognize medical degrees that are awarded by medical schools recognized by FAIMER (Foundation for Advancement of International Medical Education and Research).  All CSAs attend medical schools recognized by FAIMER.
      • Some people, often Canadian medical school students, claim superiority to CSAs on the basis that CSAs were not accepted into a Canadian medical school.  To quote one who posted on a medical chat line:  “IMGS should be treated as second class medical graduates.  That is by definition what they are. They could not get into a Canadian school because they were not good enough.  That is why they went abroad and bought their degree.   Why in the world should they be on the same playing field as CMGS?  They are not in the same league?”
        • 63.7% of CSAs never applied to a Canadian medical school or applied just once.  26.7% never applied at all.  The average CMG applied 2.59 times before being admitted to a Canadian medical school.
        • Even if a student was not accepted by a particular university, it does not mean that they would not make an excellent physician.  University admissions do the best they can, but they hold no crystal ball.  The best measure of success is success itself.  Each level of challenge helps separate those who wilt from those who thrive, the less skilled and mediocre from the best.
        • Canadian universities do not have a uniform admissions policy.  Students were admitted into UBC medical school with grade point averages as low as 70% and poor MCAT scores.  UBC admissions determined that lower scores were warranted in students that they identified as good candidates for rural practice.  CBC reported that only 25% of the students who were accepted into medical school as rural candidates in fact stayed to open practices in rural areas. Thus, UBC’s success rate in identifying good rural candidates was 25%.  CSAs have entered medical schools with GPAs as high as the 90s.  SOCASMA is unaware of any CSA accepted into an international medical school with a GPA as low as 70%.  SOCASMA members have had MCAT scores as high as the 99.7 percentile.
        • Doctors who have served on UBC Admissions have advised SOCASMA that there are many more excellent applicants for medical school than there are positions, and there is a point in the selection process as it narrows where it is basically arbitrary as to who is accepted and who is not.
        • As volunteering is an important part of medical school admissions criteria, some Canadians from financially challenged families had to work, with no time left for volunteering.  Similarly some Canadians who had disabled or otherwise dependent family members could not volunteer.  These Canadians were disadvantaged in the medical school competition process where volunteering is heavily weighted.
        • Some Canadians also find it necessary to find medical schools that are reputable, but more affordable to realize their dreams and aspirations.  A medical degree can be obtained more quickly and cost effectively through medical programs that are designed to begin after high school.  Some reputable international medical schools offer lower tuition fees than Canadian medical schools.
        • An objective examination of the facts suggests that there is no basis for concluding that CMGs will make better doctors than CSAs.  A substantial number of licensed Canadian doctors are IMGs.  Of the 72,368 physicians in Canada in 2012, 17,407 (24.1%) obtained their medical degree outside of Canada. [CMA Masterfile, 2012]  In 2 provinces and one territory, IMGs comprise almost half of the physician workforce.  [CIHI, 2011]
        • What an examination of the facts shows is that when Canadian universities exercised their control to bar IMGs from competing against CMGs, they created a breeding ground for a sense of entitlement on the part of CMGs, and prejudice against IMGs.  Forcing someone into a second rate competition stream, results in an assumption that the competitor in that stream is second rate.
        • By refusing IMGs the opportunity to compete against CMGs, and reducing them to a second class stream, the universities have put a ceiling on how high Canadians who exercised their freedom to experience the world, and immigrant physicians who came here to find a better life, can aspire in the medical profession.  This enforced constraint should not be confused with aptitude, knowledge, skills and abilities.

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