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 1,732 13.4% 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.
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