Isn’t it in the public interest to make sure that our medical school graduates get jobs?
Some people think that enabling CMGs to get postgraduate training is necessary to capitalize on tax payers’ investment. This argument may appear appealing at first glance but careful consideration will likely lead to a conclusion that a merit based selection process involving all qualified medical graduates best serves the public interest.
- The issue must start with the fact that Canadians who took a different path are still Canadians. Public interest can only be served if the process or rules are consistent with the fundamental principles of a free and democratic society. Canada recognizes that Canadians are entitled to the following rights: a. Liberty including the right to make fundamental personal choices without penalty or interference of the state; b. Mobility including the right to enter and leave Canada as one chooses; c. Equal opportunity; d. Justice. Thus in answering this question it is necessary to consider whether preferring Canadian medical school graduates to Canadians who by choice or birth studied medicine in international schools is consistent with these fundamental principles. If protecting entry level jobs to Canadians who studied medicine in Canadian schools restricts the freedom, mobility, and equal opportunity of other Canadians who did not, that protection is contrary to public interest.
- If “taxpayer investment” was an acceptable argument, all professions that require postgraduate training should be preferring Canadian university graduates over all others. All professional education programs cost the taxpayer money. Most professional graduates require postgraduate training before being eligible for independent practice. Selection for postgraduate training positions is based on merit in all professions but medicine. Canadians who chose to study overseas are free to compete against Canadian school graduates in all professions but medicine. Nobody fusses over the Canadian university legal graduate or accounting graduate who cannot get an articling position. Similarly with architecture, engineering, geoscience, veterinarian medicine, and every other profession but medicine. The taxpayer wants the best Canadian candidates to advance, regardless of what school they attended. When the taxpayer’s loved one needs medical attention, a taxpayer wants the best medical doctor. The reason that medicine stands apart from any other profession, is not because of any public policy interest, but because the universities which were put in control of postgraduate training in medicine have chosen to promote their own interests.
- The public interest is best served by hiring the most qualified Canadians for the job. The current system does not allow the most qualified Canadians to be hired as resident physicians. The problem is best exemplified by a quote from Wikipedia in reference to Rhodes scholars, “For more than a century, Rhodes scholars have left Oxford with virtually any job available to them…. They have reached the highest levels in virtually all fields.” Not in Canada. Canadian Rhodes scholars are not welcome back to compete for the “highest levels” in medicine. They are delegated to the second rate IMG stream where, in B.C., for instance, they can aspire to only 4 of 65 medical disciplines.
- A system which is not merit based results in compromised quality of care and is inconsistent with what is fair.
- A system that entitles CMGs to enter the practice of medicine, and discriminates against IMGs, is inconsistent with the principles of a free and democratic society. A free and democratic society does not limit the ability of qualified Canadians to advance in the most prestigious calling in Canada, because they did not study at a local school. Determining advancement and opportunity on the basis of the school one attended is a throwback to the old English class system which has long ago been rejected.
- Protecting jobs for Canadians who studied in local schools at the expense of Canadians who chose or came by a different path infringes on a Canadian’s right to mobility and the right to make fundamental life choices without state interference.
- Having a two class system of access to the medical profession breeds a sense of entitlement among some and prejudice against others. This is harmful to society and to the medical community.
- The value of an international education is recognized as an asset to society in today’s globalized world. For example, the B.C. Ministry of Advanced Education’s current Service Plan has an objective to develop a highly internationalized education system which includes expanding “opportunities for B.C. students to participate in study and work abroad experiences to gain knowledge and build relationships that will enable them to be successful in an increasingly global society.” The Plan goes on to state: “The province is also becoming more culturally diverse. We need to expand our international focus in B.C. to remain competitive in an increasingly globalized world. This will lead to greater understanding and tolerance, enriching personal connections between British Columbians and other people around the world. It will also help create and maintain key international pathways for commerce, research and innovation.”
- The current system which allows the universities to make the rules and select resident physicians has implications for public safety.
- Failure to require the standard national examinations for all medical graduates, allows CMGs who may not have the requisite knowledge and skills to enter the practice of medicine as resident physicians.
- It is consistent with public safety to require that all IMGs prove their medical knowledge and clinical skills before being allowed to compete for medical residency positions. The universities in charge of residency training do require all Canadian IMGs to write these national examinations.
- Canadian universities sell residency positions to foreigners from oil rich country. UBC, for example, charges up to $75,000 per year per resident position, for a total of $7.13 million in sales in the 2012/2013 year. UBC does not require these foreigners to pass the national medical knowledge and clinical skills exams to be allowed to practice medicine on the B.C. public. (Canadians cannot buy their way into residency positions in B.C.; only foreigners from Middle East countries can.)
- The current system which allows the Canadian universities to make the residency selection rules to serve their own interests is a barrier to solving the medical doctor shortage in Canada.
- The universities use Canadian doctors to train foreigners, reducing capacity to train more Canadian doctors who have medical degrees.
- Access to inexpensive medical care provided by resident physicians is not being capitalized upon.
- Highly skilled and educated CSAs are being forced to emigrate resulting in a brain drain of a much needed resource.
- The inability or refusal to train more Canadian doctors results in increased government spending recruiting foreign doctors, attempting to relocate and redistribute practicing doctors, and restructuring and increasing fees in an attempt to retain doctors who may be enticed to leave Canada for better pay.