| This really isn’t a Canadian versus internationally trained doctor issue — it is in the public interest to ensure we train more doctors through residency positions, and that we ensure we attract the most qualified doctors into these residency positions by including internationally trained doctors. We should be putting our votes behind parties that commit to increasing residency and fixing the system that prevents us from getting the most qualified doctors into our system.
Unfortunately we don’t have system today that ensures that the most qualified doctors – judged by their knowledge, skills and competence for each field of medicine – will get the limited number of residency positions available. Instead we have a system today that judges mainly by where your degree was obtained, by giving preferential access to those educated in Canada, even above other Canadians at the top of their class but trained internationally! We have talked to so many Canadians who agree that it is more important to select the most competent doctors for these competitive residency positions than to support a system that instead focuses first on where they went to school, and thus excludes many highly skilled doctors from entering most fields of medicine.
Today almost 25% of Canada’s doctors received their medical degree abroad – and with almost 40% of doctors within 10 years of retirement age we need both CMGs and IMGs. If we turn away internationally trained Canadian doctors now they may never return to Canada. We have a primary physician shortage today in Canada. Not only this, earlier this year the CD Howe Institute and Canada’s largest think tank, the Commonwealth Fund, compared Canadian health care to other developed countries. We came dead last in waiting times to see specialists.
The old formulas for replacing retiring doctors doesn’t work anymore. We need to plan for a replacement rate that is greater than 1 for 1. Today’s doctors aren’t willing to work 80 hour weeks because they seek a healthier work-life balance for their families.
All of this means that we need more residency positions today to prepare for tomorrow. To ensure that we have the best and brightest doctors practicing in Canada, we need to put an end to the protectionist system we have today that basically tosses away valuable Canadians who earned their medical degrees abroad.
Why are governments blocking Canadians from taking residency training in the U.S.A.?
| To train as a resident physician, the US requires Canadian medical graduates to obtain a document from Canada called a Statement of Need confirming Canada has a need for more doctors. The provinces direct Health Canada to severely limit the number of Statements of Needs it will approve. This is done to ration healthcare. Controlling the number of physicians controls public access to health care which controls health care costs. What this means for families is that they don’t have a family physician and they wait a long time to see specialists. Our waitlists are ranked very badly compared to other developed countries according to a study by the CD Howe Institute–dead last.
We should be casting our votes for a party that ends this rationing and puts the health care needs of Canadians first.
Consider these facts:
a. Governments deny Statements of Need because they claim they don’t need many specialists – but the shortage of physicians and long wait lists suggest that our governments are very wrong and not planning into the future.
b. Ontario and other provinces claim not to have the money to train more physicians but refuse to allow Canadians to train in the US at no cost;
c. The US is predicting a physician shortage of more doctors than we have in all of Canada by the year 2020. They are way ahead of us in being able to recruit and attract our highly trained doctors;
d. Almost 40% of Canada’s physician will be at retirement age in 10 years;
e. A study this year demonstrates that physicians are no longer willing to work 80 hour weeks as both men and women take time to raise their families and seek work / life balance;
f. No other developed country in the world actively prevents their citizens who have matched to a training position the ability to train.
There is little doubt that denial of SONs is about rationing access to health care.
As a direct consequence to students, Canadians who are refused a SON see their career jeopardized as a result of action taken by their own government. They may end up never serving Canadians or other people around in world with their care needs. |
| Why do so many IMGs go abroad when they know they can’t get back into Canada – shouldn’t they be better informed before they go? Isn’t this their own fault?
The fact is that most people don’t know that they cannot get back to Canada. Like most students choosing their future career path they make a reasonable assumption that they are free to choose their education and, once qualified, they will be able to fairly compete for a job in their home country. In a free society it is shocking that the universities have been allowed to protect their own graduates by being the gatekeeper on access to the postgraduate training which is the doorway to medical licensing in Canada. Medicine is the only field where governments protect and ensure licensing for those Canadians who graduate from Canadian medical school to the detriment of those who studied in other schools The regulatory Colleges are failing in their duty to protect the public and the profession by allowing a two class system of access to the medical profession. Once people get the facts they tend to agree that all Canadians should have equal access to career opportunities.
Canadians study medicine abroad for many reasons. Some choose to enter medical school right from high school – common in most countries but not an option here in Canada. Others decide that going to school outside of Canada is an exciting opportunity – like many Canadians in many fields of study.
Aren’t IMGs just those who couldn’t get into medical school in Canada?
Our universities, acting in unison, have been able to create this false idea that there are two classes of Canadian doctors – those trained in Canada and those trained abroad – and have created a two-tier system of access to postgraduate training that is discriminatory. They have fostered the misleading perception that Canadians study medicine abroad only because they could not get into medical school. Many go abroad because most countries allow them to go straight into medicine whereas Canadian medical schools require undergraduate education even if it is totally unrelated to medicine. Canadians may also choose to study abroad because they want to study in the country of their roots, for adventure, and some because they are brilliant enough to get into the world’s top ranked medical schools such as Oxford in the UK. Did you know that this system prevents a Rhodes scholar who studies at Oxford from applying to 66 out of 70 medical disciplines in BC?
Why should we let IMGs compete for residency spots?
| First because we have a moral and legal responsibility to ensure that, as Canadians, they have free and equal opportunity to advance their education and their careers on the basis of individual merit.
But it is also a huge economic advantage to us. Canadians really get such a good deal from IMGs – as taxpayers we save over $250,000 per medical student if they train abroad. A University of Calgary economics study called this “Picking $1000 bills off the street”, because for the 600 IMGs we bring back to Canada each year we save over $150 million! We don’t lack qualified medical graduates in Canada – we just need our politicians to fix the system to make sure we bring them home to Canada.
Why do you say the current match system isn’t fair to IMGs, or that it is discriminatory?
| People need to understand that the current system is a segregated two class system: for some it is a gold plated “guaranteed job” entitled stream, and for others it is a “take the leftovers” stream. I don’t know any other training that guarantees you a job – Canadians expect to work hard and to have to demonstrate that they are the best candidate for the job. They expect to have an equal opportunity to succeed or fail on their abilities. Those are the hallmarks of a free and democratic society.
The public has been tricked into believing they should fund the continued training, and pretty much guarantee a medical license, to any medical school graduate just because they received a medical degree in Canada. They haven’t had to demonstrate they are superior to all other available candidates or most suitable to their field. Not only this, for those few who do earn one of the few residency spots for IMGs, despite the fact taxpayers have not subsidised their degree at all – a saving of over $250,000 – IMGs are required to sign a return of service contract which prevents their future subspecialization and prohibits them from future freedoms to choose to work or not work and even move across the country.
We have been looking at this issue for many years, and unfortunately have concluded that the current system is not driven by the health care needs of Canadians, but instead is the result of a misuse of power by universities who protect their own students at the expense of other qualified Canadians and at the expense of the public who are not getting physicians selected primarily on the basis of individual competence relevant to the practice of medicine.
We know of no other profession where the academic institution from which a person graduated is allowed to protect their graduates at the expense of other Canadians.
What message would we like the publicto send to the government / politicians / candidates?
Our politicians need to stand up more strongly for the health care needs of Canadians by ending the two tier / two class system for residency training. They need to fund adequate numbers of residency positions and ensure that all qualified Canadian doctors have equal and fair access to these positions. They need to end the abuse of power the universities wield when they use access to residency positions as a way to unfairly protect their own graduates. |
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