Submission to the House of Commons Standing Committee on Health, October 24, 2022

Submission to the House of Commons Standing Committee on Health
by the Society for Canadians Studying Medicine Abroad

October 24, 2022

In the aftermath of Covid-19, Canada is experiencing a health care crisis. 1 COVID-19 has exposed
previously existing cracks in our health care foundation 2 including inadequate planning for future
physician needs 3 ; sustainability issues with our current models of family practice 4 and primary care;
overburdened long term care systems 5 ; and recruitment and retention issues in our nursing sector 6 . The
crisis is evidenced by 6 million Canadians being without a primary care doctor 7 , and by closures of
emergency 8 , ICU 9 , and other departments across Canada. The Canadian Medical Association reports over
4,000 excess deaths not related to COVID-19 in 2021 were due to delayed procedures and increased
wait times 10 . This statistic may be just the tip of the iceberg. The President of the Canadian Medical
Association is "concerned about collapse" and "in some places collapse has already happened." 11
To its credit, the federal government has been making efforts through its immigration policies to
address the shortages of health care workers that are a significant part of this crisis. Canada recently
pledged 1.5 million dollars to remove barriers for immigrants who want to work in healthcare. 12 In 2021,
Canada established a permanent residence pathway for health care workers 13 . Canada's immigration
targets also focus on recruiting skilled healthcare workers and removing barriers to permanent
residence for physicians. 14

Despite this federal investment in attracting immigrant physicians and other health care workers,
internationally educated physicians have been sidelined during much of the Covid-19 pandemic by
provincial regulatory authorities’ Canadian experience barriers. 15 Their skills and expertise have been lost
to Canadians.

MacFarlane, 16 in a recent peer reviewed paper, describes these barriers as they relate to internationally
trained physicians accessing residency training jobs through CaRMS which are a pre-requisite to
licensure. Due to a streaming process that likely violates federal and provincial human rights codes and
Charter rights regarding equality, liberty, and mobility, internationally educated physicians, who are
required to be Canadian citizens or permanent residents to participate in CaRMS, are prohibited from
competing for 90% of residency spaces for which they have proven themselves qualified. In 2020, over
1400 international medical graduates (IMGs) who had demonstrated competence to at least the level
expected of a graduate of a Canadian medical school (CMGs) were unmatched because of this
marginalization. Further, a 97.7% match rate for CMGs vs a 22.6% match rate for IMGs is a significant
and substantial discrepancy and represents clear evidence of marginalization and discrimination of
IMGs.

If Canada is to be successful in addressing the current health crisis and addressing the impact and
aftermath of COVID-19, it is critical we use all the human resources at our disposal. Canada cannot
continue to waste the medical skills, talents, and health care human resources we have recruited at
considerable expense. Organizations such as the Canadian Medical Association, the Canadian Nurses
Association, the College of Family Physicians of Canada and the Ontario Medical Association have
recognized the critical role internationally trained physicians have to play in addressing the current
health care crisis and have advocated for improved access to the profession for IMGs. 17, 18
It is important that the federal government take a leadership role with the provinces in addressing and
removing barriers faced by internationally educated physicians and health professions in accessing the
medical profession. To this end, the Society for Canadians Studying Medicine Abroad recommends the
following:
1) The federal government should immediately open dialogue with their provincial health counterparts
with the aim of addressing and removing barriers to practice faced by internationally trained healthcare
providers.
2) The federal government should immediately open dialogue with other stakeholders with the aim of
identifying and removing barriers to practice faced by internationally trained health care providers. Such
stakeholders should include the Canadian Medical Association, various provincial medical associations,
and IMG stakeholders such as the Society for Canadians Studying Medicine Abroad, Canadian on Paper
Society for Immigrants for Physician Equality, and International Trained Physicians of Ontario.
3) The federal government should consider tying funding for COVID-19 recovery and efforts to address
healthcare shortages contributing to the current crisis to provincial commitments and progress in
removing barriers faced by internationally trained health care providers.
4) Removal of barriers should include:
a. Opening all residency positions to competition by all Canadian citizens and permanent residents
who have graduated from Canadian medical schools or 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. A system designed to select for the best candidate as
determined by selection committees comprised of practicing, not academic physicians, will have
the added benefit of adding efficiency, reducing costs, and improving quality of care.
b. Increasing the number of residency positions.
c. Implementing Practice Ready Assessments (PRA) in all provinces for graduates of international
medical schools, including specialists, as an alternative to residency training.
d. Ending the requirement that graduates of international medical schools sign a return of service
contract as a condition of working as resident physicians. If it is considered necessary to have a
commitment for physicians to work in a particular location, such positions should be open to all
candidates. This burden should not be imposed on IMGs alone.
e. Removing exclusive responsibility and unfettered discretion for the system of selection of
residents from Faculties of Medicine and putting in place oversight to overcome the bias
embedded in the system.
f. Implementing and/or increasing existing oversight and accountability including enforcement
powers (by institutions such as provincial Colleges of Physicians and Surgeons and 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.

g. 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.

Thank you for accepting and considering this submission. Should you desire further information
regarding these issues and recommendations, we would be pleased to respond to questions or to
appear in person before the Committee.

1. Canada’s health care crisis: What we need now | CMA
2. COVID-19 exposing cracks in our universal healthcare – Healthy Debate
3. Canada's doctor shortage will only worsen in the coming decade | Fraser Institute
4. Open letter from the CFPC to our Members | The College of Family Physicians of Canada
5. Long-term care reform in Canada will require a massive, multi-year effort (irpp.org)
6. Canada headed for nursing shortage ‘beyond anything we’ve ever experienced’: experts |Globalnews.ca
7. Family doctors scarce across Canada amid health-care crisis: report | CTV News
8. Emergency Rooms Across Canada Close Amid Nursing Shortage – The New York Times(nytimes.com)
9. 'Significant staff shortage' forces ICU closure at Bowmanville Hospital | CBC News
10. Excess deaths, increased mental health disorders and substance use: new CMA report highlightspandemic’s broader impact | CMA
11. 'This is a crisis': Head of medical association warns that the health-care system faces 'collapse' |CBC News
12. Canada to support internationally educated health professionals | Canada Immigration News(cicnews.com)
13. New pathway to permanent residency for over 90,000 essential temporary workers andinternational graduates – Canada.ca
14. Canada removing barriers to permanent residence for physicians | Canada Immigration News(cicnews.com)
15. Despite health-care ‘crisis,’ internationally-trained doctors, nurses face barriers to work -National | Globalnews.ca
16. View of When a Canadian is not a Canadian: marginalization of IMGs in the CaRMS match(ucalgary.ca)
17. Physicians, nurses offer solutions to immediately address health human resource crisis | CMA
18. OMA proposes three immediate solutions for Ontario’s health-care system
Submitted by:
Rosemary Pawliuk
President, Society for Canadians Studying Medicine Abroad
22879 29B Avenue
Langley, BC
V2Z 3B1

604-541-4747
www.socasma.com
socasma@outlook.com