Here is link for this morning’s AGM Time: Dec 16, 2023 09:00 AM Vancouver Join Zoom Meeting https://us02web.zoom.us/j/82883192702?pwd=cU92WGFIbTBGRWJaOWRRQXNiSllEUT09 Meeting ID: 828 8319 2702 Passcode: 806276 One tap mobile +13462487799,,82883192702#,,,,*806276# US (Houston) +13602095623,,82883192702#,,,,*806276# US Dial by your location +1 346 248 7799 US (Houston) +1 360 209 5623 US +1 386 347 5053 US […]
NOTICE of ANNUAL GENERAL MEETING for CANADIANS STUDYING MEDICINE ABROAD , IMGs, FAMILIES AND FRIENDS. Date: Saturday, December 16, 2023 Time: 9:00 a.m. PACIFIC TIME (Vancouver) or noon Eastern time Place: Zoom: SEE LINK BELOW This is an opportunity to get the latest in what is happening with the structure of the Match. In addition, […]
SOCASMA is looking for IMGs who are qualified and prepared to work in the Associate Physician categories that have been enacted in BC. HPA-Bylaws.pdf (cpsbc.ca) sections 2-25, 2-26, and 2-27. The associate physician enactment of 2020 has only resulted in one registrant to January 2023. More and more licensed physicians are coming to realize that […]
RCPSC Exams? Please complete this survey. Just 5 minutes of your time! The quality, effectiveness, and efficacy of the process and the RCPSC exams themselves is an issue that needs to be considered, not just by those who design them, but through the experience of those who take them. We need the input of CMGs, CSAs, […]
STUDENT INFORMATION MEETING FOR CANADIAN AND AMERICAN MATCHES. December 28, 2022 at 9 a.m. Pacific; 10 a.m. Mountain; noon Eastern Via Zoom SOCASMA will be hosting an information/strategy meeting for IMGs looking to get and share information and strategies for the Canadian and American Matches. Before the meeting we will send you information which you […]
A big part of SOCASMA’s work is advocating for equality for IMGs. We advocate in the public sphere, in the political sphere, in administrative fairness organizations, and in the courts. There is increasing awareness and concern about the inequality IMGs face in Canada in accessing the medical profession. MOSAIC, BC’s largest immigrant services organization and […]
Summary of Discrimination IMGs face in the Medical Profession Canadians who graduated from international medical schools are oppressed and by any objective definition second class citizens in Canada. The government in a free and democratic country such as Canada, by law, must treat all its members equally. While it is fair to require Canadian citizens […]
How the System Works. CMG: graduates of Canadian and American medical schools IMGs: graduates of international medical schools To become licensed to practice medicine one must: Have a medical degree from a school on the World Directory of Medical Schools; 2. Worked in entry level job in medicine called residency training or postgraduate […]
Physician Shortage Is there a doctor shortage in Canada? About 5 million Canadians cannot find a family physician. We wait months to see a specialist. People experiencing severe mental illness generally wait months and in some cases over a year to see a psychiatrist. We wait months and even years for surgery. However, it is […]
STRATEGY and TIPS INFORMATION for Residency Matching. Everyone welcome. It is vital to start figuring out how you are going to get a residency position sooner rather than later. The meeting will take place on Wednesday, December 29, 2021 at 9 a.m. Pacific Time. A professional NAC OSCE coach, Dr. Vahid Nilforushan will be […]
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NOTICE of ANNUAL GENERAL MEETING for CANADIANS STUDYING MEDICINE ABROAD , IMGs, FAMILIES AND FRIENDS.
Date: Saturday, December 16, 2023
Time: 9:00 a.m. PACIFIC TIME (Vancouver) or noon Eastern time
Place: Zoom: SEE LINK BELOW
This is an opportunity to get the latest in what is happening with the structure of the Match.
In addition, to conducting the business meeting, we will update you on matters of concern related to
becoming licensed in Canada including:
Updates in the CaRMS Match process
Updates in the court challenge to the discrimination we face in access to licensing.
Planning an information meeting in late December: Strategizing to Match in Canada or the US
Facilitating return home after training in another country including RCPSC certification exams
The 2023 Directors Report is available to IMGs and their families on request from socasma@outlook.com.
MEDICAL STUDENTS- PLEASE SHARE THIS INFORMATION AT YOUR SCHOOL AND OTHER SCHOOLS AND FORWARD IT TO YOUR CANADIAN CLASSMATES. ENCOURAGE YOUR FAMILY AND FRIENDS TO ATTEND THE MEETING.
Please RSVP socasma@outlook.com or message us on Facebook (Society for Canadians Studying Medicine Abroad) if you plan to attend the meeting, together with any questions or requests that you would like discussed at the meeting.
#socasma; #Canadians Studying Medicine Society for Canadians Studying Medicine Abroad; #IMG
Topic: SOCASMA AGM
Time: Dec 16, 2023 9:00 a.m. Vancouver or noon time Eastern time
Join Zoom Meeting
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Comments Off on Associate Physician Position in BC
SOCASMA is looking for IMGs who are qualified and prepared to work in the Associate Physician categories that have been enacted in BC. HPA-Bylaws.pdf (cpsbc.ca) sections 2-25, 2-26, and 2-27.
The associate physician enactment of 2020 has only resulted in one registrant to January 2023. More and more licensed physicians are coming to realize that they personally must take action to help applicants become registered to overcome barriers.
A group has been formed in southeastern British Columbia (Elkford and Sparwood) and Northern Vancouver Island (Port Hardy) which is prepared to sponsor IMGs who meet the requirements for these classifications. SOCASMA has agreed to help with the location of qualified IMGs. The group has organized physicians who are prepared to supervise and mayors who are prepared to facilitate sponsorship letters from Health Authorities and put in place necessary infrastructure. CSAs, refugees, and immigrant physicians are welcome to apply.
Currently, these classifications are not pathways to full licensure. However, through these associate physician positions the group hopes to advance a concept to integrate the structure and requirements of Practice Ready Assessment (PRA) into the experience of associate physicians so the group will be positioned to encourage the CPSBC and the Ministry of Health to allow this experience to stand as a type of PRA which will lead to full licensure and provide these communities with fully licensed physicians.
Please refer to the CPSBC bylaws sections 2-25, 2-26, and 2-27 for the necessary qualifications.
Please email socasma@outlook.com with your CV if you meet the qualifications and are interested in working as associate physician in Elkford, Sparwood, or Port Hardy, BC.
RCPSC Exams? Please complete this survey. Just 5 minutes of your time!
The quality, effectiveness, and efficacy of the process and the RCPSC exams themselves is an issue that needs to be considered, not just by those who design them, but through the experience of those who take them.
We need the input of CMGs, CSAs, and other IMGs, those who are just preparing and those who have taken them, those who have succeeded and those who have not, those who recently took the exams and those who took them a long time ago…
Please take 5 minutes to complete the attached anonymous survey. Please also distribute this survey to any colleagues who you know who prepared for, took, or are otherwise involved with RCPSC exams.
Click below to complete the survey. Click the “Submit” button at the end of the survey to submit. Thank you for your help and support.
This survey is being conducted by the Society for Canadians Studying Medicine Abroad. If you have questions, please contact us at: socasma@outlook.com.
Click HERE to take the survey. https://docs.google.com/forms/d/e/1FAIpQLSfOhI10btGhZ8iCQQs63g-HSMBYk8lgW-VY8IY-6aTYItx0cw/viewform?vc=0&c=0&w=1&flr=0
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STUDENT INFORMATION MEETING FOR CANADIAN AND AMERICAN MATCHES.
December 28, 2022 at 9 a.m. Pacific; 10 a.m. Mountain; noon Eastern
Via Zoom
SOCASMA will be hosting an information/strategy meeting for IMGs looking to get and share information and strategies for the Canadian and American Matches.
Before the meeting we will send you information which you will likely find helpful to the match processes. This meeting is relevant to students at all levels in the process.
CSAs who have negotiated the Canadian and American Match will provide their advice and answer questions.
We hope that everyone present will share their concerns, experiences, and advice.
We invite those who have navigated the match to join us as well to pass on your wisdom. Supporters of IMGs are also welcome.
TO ATTEND, please message us on Facebook or email us at socasma@outlook.com. We need your name and email address to send you the resource material and Zoom link prior to the meeting.
Your year of medical school or PGT would also be helpful in our planning. Please send any issues you would like us to focus on or questions you wish addressed.
Comments Off on IMGs are not alone in their quest for equality
A big part of SOCASMA’s work is advocating for equality for IMGs. We advocate in the public sphere, in the political sphere, in administrative fairness organizations, and in the courts.
There is increasing awareness and concern about the inequality IMGs face in Canada in accessing the medical profession.
MOSAIC, BC’s largest immigrant services organization and Association of Doctors Denied by Degree (SOCASMA is a member of ADDD) have forwarded Recommendations to BC’s Ministry of Health seeking equitable access to medical licensing for all Canadian citizens and permanent residents. Here is what they say and recommend:
The purpose of ADDD is to build strategic alliances to address systemic issues related to (a) exclusion of
graduates of international medical schools from becoming licensed to practice medicine before and
after they have proven equivalency and had their credentials recognized, (b) barriers to career
advancement, and (c) equitable access of newcomers to the health care system.
MOSAIC hosts and convenes the ADDD meetings. There are currently 5 organizations who are members
of the Alliance. The Alliance has been engaged in: public education about the discrimination facing
graduates of international medical schools; building alliances with other organizations engaged in
advocacy related to graduates of international medical schools; and developing documents describing
the discrimination and its impact. ADDD has also supported qualitative research undertaken by other
organizations such as SFU.
Background
Throughout Canada, an integral part of fiscal management of health care spending is controlling the
number of physicians who are licensed to practice medicine which in turn controls public access to
health care. Controlling the number of physicians is accomplished through policies designed to create
insurmountable barriers to licensing for most international medical graduates (IMGs). There are two
gateways to licensing for IMGs: individualized assessment and residency training. Individualized
assessment of IMGs, called Practice Ready Assessment, is not available at all in some provinces (eg.
Ontario), unavailable in most provinces for specialty practice, and available in only small numbers in
some provinces for family medicine. The only other route, in fact the only route in provinces like
Ontario, is re-training. Re-training means that an IMG must obtain one of a limited number of residency
training positions. Only immigrant physicians from a few, primarily white Commonwealth countries, can
avoid having to undertake residency as a condition of licensing.
Restricting access to residency training to IMGs is the primary method by which Canadian provinces prevent the vast majority of IMGs from ever becoming licensed to practice in Canada.
It is a myth that IMGs are not licensed because their credentials are not recognized, and they are a
threat to public safety as described below.
To control the number of IMGs who can become licensed the provinces set a quota for IMGs preventing
them from competing for 90% of the resident physician positions despite being qualified to work and
train in these positions. These restrictions which prevent IMGs from becoming licensed are unfair and harmful, not only to the IMGs, but to the public as well.
Below is a description of the discriminatory system of access to residency training, hence medical
licensure that IMGs face.
Resident physician jobs are segregated
Access to residency training for citizens and permanent residents of Canada (Canadians) is segregated
into two streams based on place of education in all provinces except Quebec:
a) The CMG Stream is for Canadian citizens or permanent residents who are graduates of Canadian
and American medical schools called “CMGs”; and
b) The IMG Stream is for Canadian citizens or permanent residents who are graduates of medical
schools located outside of Canada or the United States called “IMGs”.These streams have significantly different opportunities which will be described below.
Discrimination #1 Access to Number of Residency Positions
Both the CMG and IMG Streams are subject to what CaRMS calls a “quota”. The CMG Stream has more
positions than there are CMG applicants.
In 2021 there were 3043 residency positions for 3003 active applicants who are CMGs (2985 graduates
of Canadian schools and 18 graduates of American schools)—40 more jobs than CMG applicants
protected in the CMG stream for CMGs. Only 33 (33/3003 = 1%) CMGs did not get a residency position.
.
In 2021 there were 1831 IMG active applicants for 322 positions. A total of 410 IMGs received a
residency position in 2021. Thus, 1421 IMGs who met the Canadian standard and were qualified to
work as resident physicians (1421/1831 = 78%) did not get a residency position.
In the CMG Stream, CMGs have complete mobility consistent with section 6 of the Charter of Rights.
They are eligible to compete for positions in the province or program of their choice across Canada. This
is not the case for IMGs who face additional requirements which limit their ability to compete even
further. Alberta and Quebec do not allow IMGs from other provinces to apply. British Columbia
mandates an additional assessment but limits the number of assessments to less than 30% of IMGs who
have proved they meet the Canadian standard. Almost all programs have a cut-off point for IMGs well
above a passing grade for scores on the NAC OSCE and MCCQE1 such that if that score is not reached,
the IMG is eliminated from competition before anyone sees their curriculum vitae and full application.
Discrimination #2 Area of Practice
In the CMG Stream, all base specialties are available. There are more than 70 medical disciplines (base
specialties and sub-specialties) recognized by the provincial Colleges of Physicians and Surgeons across
Canada. The IMG Stream does not have positions in all the base disciplines. In most provinces IMGs are restricted to the general disciplines: family medicine, with only a few positions in specialties, mostly in psychiatry, pediatrics, and internal medicine. Ontario has more variety of specialties, but even this large province does not offer IMGs the opportunity to be licensed in all the base disciplines. Thus, there is literally no avenue for some immigrant specialists to become licensed in their discipline in all of Canada. By contrast, CMGs are provided with a complete selection of recognized disciplines. Some provinces, like
British Columbia, do not allow IMGs to subspecialize. In British Columbia, IMGs are limited to 4 of more than 70 recognized medical disciplines.
Discrimination #3 Fair Access to Licensing, Freedom, and Mobility Rights
Positions in the CMG Stream are unconditional. The CMG Stream imposes no restrictions or obligations
before or after a CMG becomes certified and licensed to practice after completing their residency
training. CMGs are free to work if and where they want after becoming certified and licensed.
Positions in the IMG Stream are conditional. Even after overcoming significant odds, IMGs who match
to a residency position will only be allowed to keep that position if they “agree” to sign a “return of
service” contract in most provinces. The Ministries of Health in all provinces except Quebec and Alberta
will only permit IMGs access to residency jobs if they sign these contracts. The contract obligates IMGs
to work where the Ministry of Health directs them to work for up to 5 years upon being certified and
licensed. If an IMG wants to subspecialize, another return of service contract of up to an additional five
years may be required by some provinces. In the case of other provinces, such as British Columbia, sub-specialization for IMGs is simply not permitted. These contracts, which an IMG has no choice but to sign
to become licensed in the medical profession, cause financial, social, and emotional hardship.
Discrimination #4 Proving Competency: Two different standards
To compete in the CMG Stream of CaRMS, a student in a Canadian or American medical school must
simply be poised to graduate from medical school.
To compete in the IMG Stream of CaRMS a Canadian who has graduated from a medical school outside
of Canada or the USA must first establish that (s)he has, in the words of the Medical Council of Canada,
“the critical medical knowledge and clinical decision-making ability of a candidate at a level expected of
a medical student who is completing his or her medical degree in Canada” by passing the Medical
Council of Canada Qualifying Examination Part 1 (MCCQE1). In addition, he or she must pass the
National Assessment Collaboration Objective Structured Clinical Examination (NAC OSCE) which is in the words of the Medical Council of Canada “designed to evaluate an IMG’s clinical skill at the level of a
Canadian medical graduate entering postgraduate training.” Realistically, to avoid being electronically
eliminated from competition without an interview, IMGs must not just pass, but must excel in their
MCCQE1 and NAC OSCE exams.
To compete in the CMG stream, CMGs are not required to demonstrate they meet this standard. CMGs never have to take the NAC OSCE. Their competency in clinical skills is assumed. CMGs do take
the MCCQE1 but only at the end of medical school, by which time all but a few of these prospective
CMG graduates have already secured a resident physician position. In most provinces CMGs are free to
fail the MCCQE1 and still work as resident physicians.
Discrimination # 5 Representation and Recognition
Although the Ministry of Health, Faculties of Medicine, and other professional organizations involved in
the process of access to medical licensing state that they have collaborated or engaged with
stakeholders, and although decisions made by these bodies regarding postgraduate medical education
affect IMGs, IMGs are excluded for the most part from these consultations and from the tables where
decisions affecting access to residency and hence licensing are made.
Recommendations
To stop the systemic discrimination where the Ministries of Health/regulatory colleges/medical faculties have imposed a system that excludes graduates of international medical schools from accessing residencies and hence medical licensure, and perpetuates conscious and unconscious prejudice, we recommend:
1. Opening up all residency positions (including speciality and sub-speciality) to competition by all Canadian citizens and permanent residents who have passed the Medical Council of Canada exams which establish that they have the critical medical knowledge, decision-making ability and clinical skills expected of a graduate of a Canadian medical school and as such are qualified to work as resident physicians.
2. Increasing the number of residency positions to accommodate more candidates.
3. Implementing Practice Ready Assessments (PRA) of all graduates of international medical schools, including specialists, who meet simple eligibility criteria to determine if retraining is necessary, and if so to what degree.
4. Ending the requirement that graduates of international medical schools sign a return of service contract as a condition of working as resident physicians where they “agree” to work in the community and clinic where the government directs them for a specified number of years after they are fully licensed.
5. Removing exclusive responsibility for the selection of residents from Faculties of Medicine and putting in place oversight to overcome the bias embedded in the system.
6. Implementing and/or increasing existing oversight and accountability including enforcement powers (such as Fairness Commissioners) of all aspects of the entry to the medical profession to ensure admission to the profession is: (i) fair and free of discrimination, i.e., inclusive and consistent with the principles of a free and democratic society; (ii) impartial; (iii) objective; (iv) flexible and (v) transparent as defined in the Health Professions Review Board’s Best Practices on pages 18-21. Best Practices Report.doc (gov.bc.ca)
7. Requiring representation of graduates of international medicals schools on all committees and other forums which make decisions which affect graduates of international medical schools’ access to the medical profession.
8. Creating opportunities for meaningful dialogue with all partners and stakeholders to address the discrimination facing graduates of international medical schools.
9. Addressing the physician shortage by taking immediate steps to provide increased assessment and training opportunities for eligible graduates of international medical schools.
Consider sending these recommendations to your federal and provincial political representatives in all provinces.
Comments Off on The Discrimination that IMGs face in the Medical Profession
Summary of Discrimination IMGs face in the Medical Profession
Canadians who graduated from international medical schools are oppressed and by any objective definition second class citizens in Canada.
The government in a free and democratic country such as Canada, by law, must treat all its members equally.
While it is fair to require Canadian citizens and permanent residents who are international medical graduates to prove that they meet the Canadian standard of medical education, it is illegal and oppressive to deny them the right to compete for jobs, especially government-funded jobs, once they have met the Canadian standard by passing the requisite exams.
Working as a resident physician is for Canadians who studied abroad and for many immigrants the only route to becoming licensed in medicine.
The Discrimination
After proving themselves qualified to work as resident physicians, graduates of international medical schools (IMGs) across Canada are:
Segregation
The segregation of Canadian citizens and permanent residents based on where they went to medical school and prohibiting them from competing for entry level jobs to medicine which are a pre-requisite of licensure AFTER proving themselves qualified is the antithesis of equal opportunity for which Canada prides itself.
2. Denied the ability to compete for 90% of resident physician jobs in Canada
There are more residency positions for CMGs than there are CMG applicants. In 2021 there were 3043 positions protected for 3003 applicants who were graduates of Canadian and American medical schools. By comparison, there were 325 positions for 1831 fully qualified Canadians who were IMGs.
There is usually less than one position per 6 qualified IMG applicants with thousands of IMGs who have given up.
In BC, there are 349 positions. IMGs are prohibited from competing for 85% of these.
3. Denied the ability to access most disciplines in most provinces.
40 disciplines are available to CMGs. Only 25 disciplines are available to IMGs. (See carms.ca data Tables 12 and 14)
More than half of the positions designated for IMGs are in family medicine. The other positions designated for IMGs are in the general specialties which are underserviced disciplines: internal medicine (53 positions), pediatrics (18 positions) and psychiatry (20 positions). These tend to be the lower paid specialties.
In BC IMGs are restricted to applying for only 4 disciplines: 52 in family medicine; 3 in internal medicine; 2 in psychiatry; and 1 in pediatrics.
4. Denied the ability to subspecialize in some provinces.
There are over 70 specialty/subspecialty medical disciplines recognized in Canada.
Inability to access specialties, prevents sub-specialization in those specialties.
All CMGs are free to apply to subspecialize.
While Ontario allows IMGs to apply to subspecialize, some provinces like BC do not.
Subspecialties tend to be higher paid.
5. IMGs can only work as resident physicians if they sign a contract where they “agree” to work where the government directs them for a specified number of years after they are fully licensed.
In other words, they must “volunteer” to sign a contract to give up their section 6 Charter mobility rights, if they want to become licensed in their profession. An IMG’s choice is “give up your profession or give up your right to choose the region in which you work for up to 5 years work”. In BC the return of service is 3 years.
In Ontario IMGs are prohibited from working in designated urban areas, but in BC, the government dictates not only which community, but also which clinic. IMGs are forced to work by paying a greater percentage of their billings to the clinics than CMGs, even in the same clinic.
If IMGs fail to comply with the terms of this “agreement” there are penalties ranging from about $70,000 in Ontario to between $480,375 (family medicine) and $897,581 (psychiatry) in British Columbia.
CMGs whose education is subsidized by up to $300,000 each are not required to sign this contract as a condition of working as resident physicians. CMGs are free to take their education and leave the country.
6. IMGs must meet a higher standard of medical knowledge than CMGs or visa trainees to work as resident physicians.
IMGs must pass two national examinations (MCCQE1 and NAC OSCE) to prove that they meet the Canadian standard of medical education to be eligible to apply for residency training jobs. CMGs do not have to pass either to apply.
The NAC OSCE is designed to determine whether the candidate has the clinical skills expected of a graduate of a Canadian medical school ready to enter residency training.
CMGs and visa trainees never have to take the NAC OSCE to be eligible for residency training (working as resident physicians).
The MCCQE1 is designed to determine whether the candidate has the critical medical knowledge and decision-making ability expected of a graduate of a Canadian medical school.
CMGs do take the MCCQE1 after they have received residency training positions. They are free to fail the MCCQE1 and work as resident physicians except Dalhousie which requires CMGs to pass prior to beginning residency training and Alberta which requires CMGs to pass within one year of beginning work as a resident physician.
Considering that the MCCQE1 is designed to determine whether a graduates has the medical knowledge expected of a graduate, allowing candidates to practice as resident physicians despite failing the MCCQE1 has implications for public safety.
CMGs failing the MCCQE1 is foreseeable considering Canadian and American medical schools have a policy against failing students. Between 2% and 5% fail the MCCQE1 each year.
Why is discrimination government-sanctioned?
Those in the medical system who created and enforce systemic discrimination in access to medical licensing benefit from this system.
Only international medical graduates and the public fail to benefit from this system.
The system prohibits licensed physicians who select who will be hired to work as a resident physician, from considering all qualified applicants and choosing the best.
The system is designed to ensure that every graduate of a Canadian medical school, no matter how weak, is licensed to practice medicine.
This is accomplished by privileging and protecting CMGs by prohibiting competition which prevents strong graduates of international medical schools from displacing weak graduates of Canadian and American medical schools.
Selection is based on place of education, not individual knowledge, skills, nor characteristics best suited to the positions.
Provincial Ministries of Health
In Canada health care is universal and provincial ministries of health have complete control over Canadian citizens and permanent residents seeking residency training jobs, and hence licensure. The provincial ministries’ goals are:
To control health care spending by controlling access to health care by controlling the number of physicians (Barer Stoddart economic policy);
To provide medical physicians in all parts of the provinces. It is more efficient and economical to have a subordinate class of Canadians who can be coerced to work in these underserviced regions rather than providing free-market incentives.
To provide physicians in the general disciplines which are generally lowest paid and underserviced: family medicine, internal medicine, psychiatry, and pediatrics. It is more efficient and economical to have a subordinate class of Canadians who can realistically only choose from these medical disciplines rather than responding to supply/demand realities of a free market which would require providing free-market incentives.
Faculties of Medicine. The goals of the Faculties of Medicine are:
To protect their graduates. This is accomplished by preventing other Canadians such as immigrant physicians and Canadians who chose to study abroad from competing against their graduates. Competition on the basis of an individual’s knowledge, skills, and characteristics relevant to best practice of medicine would displace the weaker graduates of Canadian medical schools.
To maintain and further a position of power and prestige. Successful protection of power and prestige is accomplished by pronouncing one’s graduates to be the “best and the brightest” and preventing competition which may serve to contradict this powerful sound bite. Proclamation of graduates of Canadian medical schools being “the best and the brightest” has the benefit of raising prestige and perpetuating the historic and persistent prejudice of inferiority which tars international graduates, especially those from racialized countries.
To sell residency training positions to oil rich Gulf State sponsors which pay higher rates than the Ministries of Health. Filling residency positions with Canadians would help address the physician shortage but has the disadvantage of reducing revenue to the Faculties of Medicine. Canadian municipalities, community groups, and corporations are not allowed to purchase these positions for Canadians to meet their physician shortage needs. The disadvantage of accepting funding from Canadian sources is that the funder and amount of need would vary from year to year which requires more administration and provides less certainty than Gulf State sponsors who can and do fill all the training positions the Faculties of Medicine of Canada are prepared to offer.
Medical Profession in General
The profession is primarily comprised of graduates of Canadian medical schools and immigrant physicians from white British Commonwealth countries (United Kingdom and Ireland) who tend to consciously or unconsciously perpetuate a system of prejudice against international medical graduates especially those who graduated from racialized countries.
Fewer physicians equal greater demand which serves to keep the profession fully employed and physician income high.
Comments Off on Understanding Access to Licensing in Medicine
How the System Works.
CMG: graduates of Canadian and American medical schools
IMGs: graduates of international medical schools
To become licensed to practice medicine one must:
Have a medical degree from a school on the World Directory of Medical Schools;
2. Worked in entry level job in medicine called residency training or postgraduate medical training for a designated number of years depending on the specialty. Postgraduate training is imposed by regulatory authorities to ensure that medical graduates have enough practical experience to ensure public safety before being fully licensed. In all countries except Canada and the USA, postgraduate medical training is administered by medical institutions such as hospitals overseen by the regulatory authorities. In Canada and the United States since 1993 postgraduate training has been administered solely by Faculties of Medicine of universities. It was when Faculties of Medicine were granted a monopoly over postgraduate training that they imposed rules which protected graduates of Canadian and American medical schools from competition. (Conflict of interest?)
3. Pass the certification examinations of the national colleges to ensure that their knowledge, skills, and experience meets the national standards. For family physicians the College of Family Physicians of Canada determines the process and standards necessary to be certified. In the specialties, it is the Royal College of Physicians and Surgeons.
4. Licensure by the provincial regulatory authorities, i.e., Colleges of Physicians and Surgeons or in the case of the territories, Medical Councils.
All developed countries have a similar process for licensing.
Canadians who study medicine abroad generally want to come home, but they need to work as resident physicians in order to be licensed. They are denied a fair opportunity to compete for resident physician jobs due to discrimination described in the discrimination document. As a result, the majority do their postgraduate training in other countries, primarily Australia, the United States, the UK, and Ireland. Barriers are set up at the certification level to prevent CSAs from coming home.
Immigrant physicians have generally graduated, completed postgraduate training, been certified and licensed and practiced medicine in their country of origin.
By rules established by the regulatory authorities, immigrants from countries such as UK, United States, Ireland, Australia, and New Zealand do not have to retake their postgraduate training. Their postgraduate training is recognized.
However, the training and experience of immigrants from all but a few countries is not recognized. So they must obtain postgraduate training positions. The system of discrimination attached prevents most of them from ever becoming licensed.
The explanation commonly given by the medical establishment for IMGs not being licensed is that their credentials are not recognized, and they would be a public safety risk. However, Medical Council of Canada for more than a decade has delivered examinations which enable these immigrants to prove that they have the medical knowledge and clinical skills expected of a graduate of a Canadian medical school. Thousands of IMGs in Canada have proven their credentials and that they meet the Canadian standard but are unable to practice due to pathways of licensure being designed to restrict the number of physicians who can be licensed in Canada.
In some provinces, a small number of some immigrant physicians, depending on the length of training in their country of origin, can apply to work under a Practice Ready Assessment program. Ontario does not have a Practice Ready Assessment program.
How do medical graduates apply for residency training positions?
Canadian citizens and permanent residents can only apply for residency position positions through a national match called the CaRMS Match. This method of selection was requested by the graduates of Canadian medical schools. At first the Match was open to all qualified Canadians. But in 1993 when the Faculties of Medicine across Canada became the only institutions authorized by the College of Physicians and Surgeons to administer residency positions, they immediately set up segregation to protect access to these entry level jobs mandatory for licensing for CMGs with only leftover positions being available to IMGs.
Who Makes the rules that segregate and restrict IMGs from competing for jobs for which they are qualified?
The official answer is that it is a collaboration between various organizations in the medical establishment. However, when all these entities were recently were sued in British Columbia, everyone denied responsibility for the rules which marginalize IMGs. Only the Ministry of Health did not deny responsibility. Thus, it is the Ministry of Health which makes the rules.
Legally the only legislative body with authority to make these rules in a province is the College of Physicians and Surgeons in respect to standards necessary to be licensed to practice medicine.
Data re Physician shortage
The number of residency training positions has been decreasing for IMGs. In 2013 there were 348 positions dedicated for IMGs in all of Canada. In 2021, there were 322, a decrease of 26 positions. Although CMG positions have been increasing over time for the most part, in 2021 there was a decrease from 3072 to 3043 for CMGs and from 325 to 322 for IMGs.
In BC there were a total of 349 residency positions. IMGs can only apply for 58 of those despite meeting the Canadian standard.
In BC, in the 2020/21 year there were 515 resignations, but only a total of 349 resident physician positions plus approximately 30 PRA positions in family medicine which means in BC there were 136 more resignations than new physicians.
Shortfalls such as this have been filled in the past by hiring physicians from approved jurisdictions such as UK, Ireland, South Africa, USA, Australia, and New Zealand. But on November 30, 2021, the RCPSC advised us that they would be eliminating the approved jurisdiction route. This has significant repercussions to an already critical physician shortage. The RCPSC states that they are working to create an alternative.
Training IMGs puts junior physicians in place immediately.
Fiscally, it is 10 times less expensive to train IMGs than to educate and train CMGs. (University of Canada Economics Department)
Canada trains twice as many visa trainees who are under contract to leave the country when they complete postgraduate training than they train Canadian citizens and permanent residents who are IMGs. The data is set out below.
Comparing Access to Licensing in Canada for Canadian IMGs vs. Gulf State IMGs
Overview of resident physicians in residency training in Canada in 2018/19 (published by the CMA)
Resident physicians in training (all years with programs 2-7 years in length) 16,508
Ministry-funded positions for Canadians 12,906
Canadian CMGs 11,174 86.6% of Canadians
Canadian IMGs 1,73213.4% of Canadians
12,906 100% of Canadians
Non-Canadians (visa trainees) in residency training (2X+ as many as Canadian IMGs) 3,602
Non-Canadians (visa trainees) who return to Canada within 5 years of completing training 53.6%
CAPER and CaRMS Data for last 2 years
In 2019/20 in Canada there were 640 visa trainees. In 2020/21 there were 699 visa trainees, an increase of 59 visa trainees. YearOverYear_Compare_EN.pdf (caper.ca)
In 2019/20 there were 325 residency positions allowed for Canadian IMGs. In 2020/21 this was reduced to 322. Between 2013 and 2021 there was a reduction of 26 positions for Canadian IMGs. PowerPoint Presentation (carms.ca) Slide 19.
Comments Off on Is there a doctor shortage in Canada?
Physician Shortage
Is there a doctor shortage in Canada? About 5 million Canadians cannot find a family physician. We wait months to see a specialist. People experiencing severe mental illness generally wait months and in some cases over a year to see a psychiatrist. We wait months and even years for surgery.
However, it is an uncontroversial fact that there are literally thousands of medical doctors in Canada who have met the Canadian standard by passing the Medical Council of Canada examinations. The problem is that our government has erected barriers which prevent them from becoming licensed to practice.
These barriers accord with the government’s fiscal policy. In the early 1990s Canadian provinces adopted the Barer Stoddart economic theory of health care management: If we control the number of physicians, we control public access to health care, and thus we control health care spending.
In Canada, the correct number of physicians is not related to public need. It is a simple matter of dividing the provincial allocation of the health care budget for physicians by the average cost of a physicians.
When the Barer Stoddart economic theory was adopted by provincial ministries of health, the number of physicians that Canada trained dropped dramatically.
Because we have a government controlled universal health care system, it is a simple thing for the government to control the number of physicians by controlling the gateways to licensing.
Allow me to explain: Most immigrant physicians and all new medical graduates must work in entry level jobs as resident physicians before they can become fully licensed to work in Canada.
The provincial ministries of health control the number of these residency positions for the purpose of controlling the number of physicians who can become licensed to practice.
The provincial ministries of health have a monopoly over the residency training required for Canadians (whether born or immigrated here) to become licensed. There is a government report which states that there are municipalities, community groups, and large corporations who are so desperate for physicians that they would fund residency training positions. But this is not allowed. If it were, the government would lose control of being able to control the number of licensed physicians.
I would like to provide you with some data. I am going to use BC as my example.
Last year (2020/2021 year), 515 physicians stopped practicing medicine in BC.
Last year BC funded the training of 349 new resident physicians. In addition, about 30 immigrant physicians were individually assessed to practice as family physicians. This allows licensing of 379 new physicians. Thus, BC was short by 136 if our only goal was to replace those physicians who stopped practicing last year.
Because of additional demand caused by COVID, logically we would expect the ministries would be training more physicians considering physician burnout and physicians and other health professionals predicting the collapse of our medical system because of professional shortages.
But that did not happen. For the year before last (2019/2020 year) (with the decision-making being before COVID) BC funded 352 resident physician positions. So, after COVID, the BC Ministry of Health decided to cut 3 residency training positions. Across Canada last year, the number was reduced by 32.
This is predictable, when viewed from the fiscal management theory from which Canadian health care operates. Although the government presents a narrative that it is working to meet Canadian health care needs, this narrative is created to assuage the public for political reasons. The narrative in fact is contradicted by facts.
Last year across all Canada there were 1831 Canadian citizens and permanent residents who met or exceeded the minimum Canadian standard who applied to work as resident physicians in Canada. Because the ministries of health and faculties of medicine segregate and restrict Canadians who graduated from international medical schools to a small number of positions, only 410 are working as physicians today. Working as a resident physician is a pre-requisite to becoming fully licensed for all new graduates and most immigrant physicians. In 2021, 1421 Canadian citizens and permanent residents who are qualified and applied to work are not practicing because of government fiscal policy to restrict the number of physicians who can be licensed. Many other qualified applicants have given up trying to get these entry level positions because the costs related to application are great and the chances of success slight. This barrier is not related to competence; it is a function of the government only allowing a trickle of physicians into the licensing pathway. Studies report that many of these physicians who have met the Canadian standard to work as resident physicians are literally driving taxis.
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The fact is that our health care system is grossly mismanaged, and the glaze the government puts on this subject is political, not factual.
It is not accurate that immigrant physicians and Canadians who studied medicine abroad are not licensed because they have not had their credentials recognized nor that they are a threat to public safety. Objective evidence demonstrates that graduates of Canadian and American medical schools are held to a lower standard when applying for entry level jobs than those who graduated from international schools.
The fact is that the physician shortage Canadians experience is a function of the government barricading the door to thousands of qualified physicians. The barricades are a function of the fiscal management policy practiced by our government.
Canada’s health care system consistently ranks at or near the bottom of developed countries. We are the 4th last in number of ICU beds out of 36 developed countries. We ranked 7th last in ratio of physicians to population. We consistently have the longest waiting lists.
Despite “universal” health care 17% of Canadians report that the cost of health care is a barrier to care.
For comparison, Germany is a country that spends about the same amount as Canada on universal health care. Germany has about 75 million people (compared to Canada’s 38 million) and is one of the top-rated health care systems in the world compared to Canada which is consistently rated as having one of the worst systems in the world. Canada has 2.7 physicians and 1.4 government administrators per 1000 people. By comparison Germany has 4.25 physicians and 0.15 administrators per 1000. Although Germany and Canada spend essentially the same, Germany has more family physicians, more specialists, more acute care beds, more psychiatric beds, and far surpasses Canada in its inventory of diagnostic equipment. Where Canada excels is in the number of administrators: we have 10 times as many administrators as Germany.
STRATEGY and TIPS INFORMATION for Residency Matching. Everyone welcome. It is vital to start figuring out how you are going to get a residency position sooner rather than later. The meeting will take place on Wednesday, December 29, 2021 at 9 a.m. Pacific Time.
A professional NAC OSCE coach, Dr. Vahid Nilforushan will be there to provide information and answer questions;
We will send you a PowerPoint presentation with information and advice in advance of the meeting;
If you want to attend this meeting, please email us at socasma@outlook.com. Please set out any questions that you are interested in.
We will send you a Zoom invitation, and the PowerPoint presentation.
