Strengthening Canada’s Physician Workforce Through Targeted Loan Forgiveness and Student Financial Support

Rosemary Pawliuk, Executive Director

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Dear Minister Hajdu,

I am writing on behalf of the Society for Canadians Studying Medicine Abroad (SOCASMA), a national organization that advocates for the removal of barriers that prevent Canadians who studied medicine abroad from returning home to practice. Our members are Canadian citizens and permanent residents who remain committed to serving patients in Canada but face structural, financial, and policy obstacles that make returning increasingly difficult.

I am writing to advocate for targeted enhancements to the Canada Student Loan Forgiveness program and the Canada Student Financial Assistance Program to better address Canada’s growing physician workforce shortages. As you know, the Canada Student Financial Assistance Program plays an important role in shaping the health workforce by incentivizing service in areas of need. Recent expansions to include a broad range of professions—including dentists, dental hygienists, early childhood educators, midwives, personal support workers, pharmacists, physiotherapists, psychologists, social workers, and teachers—reflect a welcome recognition of workforce gaps across sectors.

However, I respectfully submit that the program should be further expanded to include specialist physicians in high‑demand fields, such as pediatrics, anesthesiology, emergency medicine, and internal medicine, in addition to family medicine.

While the shortage of family physicians is widely recognized, reputable national data demonstrate that Canada is also facing critical shortfalls in pediatrics, anesthesiology, emergency medicine, and internal medicine, among other specialties. These shortages are contributing to emergency department overcrowding, surgical backlogs, delayed access to specialist care, and poorer health outcomes for Canadians.

The Canadian Institute for Health Information (CIHI) reports that several hospital‑based specialties—particularly emergency medicine—have seen little growth relative to population needs, while system pressures continue to rise.¹ In parallel, independent workforce analyses identify anesthesiology, internal medicine, pediatrics, and emergency medicine as among the most in‑demand medical specialties nationwide.²

Leading national organizations have repeatedly warned that shortages across these specialties are particularly acute outside major urban centres, exacerbating inequities in access to care.

Given this reality, it would be prudent to explicitly include physicians practicing in these high‑need specialties within federal loan forgiveness and retention programs.

Canada is home to many citizens who, despite strong academic qualifications chose to pursue medical education abroad. Due to systemic barriers to obtaining Canadian residencies through the Canadian Residency Matching Service (CaRMS), many of these physicians go on to establish careers in other jurisdictions, particularly the United States, where financial incentives, training pathways, and loan structures are more competitive.

Canada already relies heavily on international medical graduates (IMGs)—who now comprise approximately 27% of the physician workforce—because domestic medical education capacity is insufficient to meet current and projected needs.³ Leading medical organizations and peer‑reviewed research emphasize that Canada cannot meet physician demand through domestic training alone and must better attract and retain internationally trained physicians.⁴

Targeted loan forgiveness—covering Canadian undergraduate education as well as medical school completed abroad—would represent a powerful, cost‑effective incentive for these physicians to return to Canada and commit to practice in areas of need.

Recent expansions of loan forgiveness eligibility to include professions such as dentists, dental hygienists, pharmacists, physiotherapists, psychologists, social workers, teachers, early childhood educators, midwives, and personal support workers reflect a commendable recognition of workforce shortages across the health and social sectors.

However, given the length, cost, and intensity of medical training, and the central role physicians play in maintaining access to essential health services, extending comparable—or greater—support to physicians in shortage specialties is both logical and equitable. Expanding eligibility to include specialist physicians in shortage areas would be consistent with—and arguably more urgent than—the recent inclusion of other professions. The return on investment, in terms of patient access, system sustainability, and reduced downstream costs, is substantial.

Multiple authoritative reports confirm that Canada is not educating enough physicians to meet future demand. The Royal Bank of Canada estimates that Canada could face a shortage of approximately 44,000 physicians by 2028, even after accounting for current training levels.⁵ Similarly, the Canadian Medical Association and Health Canada have concluded that domestic training capacity alone will not close the gap.⁶

Despite this reliance on internationally trained physicians, financial support for Canadians studying medicine abroad remains inadequate. Tuition at many accredited foreign medical schools commonly exceeds USD $60,000 per year, excluding living expenses. Yet Canada Student Loans often provide approximately $10,000 CAD annually, an amount that is insufficient and uncompetitive.

In contrast, U.S. federal loan programs frequently provide access to financing in the hundreds of thousands of dollars for medical training, including for students attending international schools. As a result, Canadian students abroad often accumulate substantial debt without meaningful Canadian financial support.

In an increasingly competitive global environment—where physician shortages are widespread and countries actively recruit internationally trained doctors—Canada must position itself strategically to attract and retain talent. Increasing CSL limits for CSAs—particularly when paired with return‑of‑service or loan forgiveness commitments—would be a practical and fiscally responsible policy choice aligned with this goal.

Expanding loan forgiveness to include physicians in high‑need specialties, enhancing incentives for Canadians trained abroad to return, and modernizing student loan support for medical education are practical steps that align with Canada’s long‑term health workforce needs.

I respectfully urge the Government of Canada to consider these measures as part of a comprehensive strategy to strengthen physician supply, improve patient access, and ensure the sustainability of our publicly funded health care system. I would welcome the opportunity to provide further input or discuss these proposals in more detail.

Thank you for your attention to this critical issue.

Sincerely,

Rosemary Pawliuk
President, SOCASMA