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:

1. 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.