Canada has an acute shortage of doctors — a staffing crisis that is expected to get much worse in the years ahead as the number of residency positions on offer fails to keep up with rapid population growth.
According to a review of medical school data by CBC News, approximately 1,000 Canadian doctors who received their education abroad are rejected each year due to the unavailability of residency positions in Canada. Residency is a mandatory requirement for obtaining a license to practice medicine.
Canadian doctors who desire to return to their home country for employment often receive the response that it is infeasible due to limited resources and a restricted number of available residency positions.
However, the residency programs administered by medical schools still reserve spots for individuals from countries such as Oman, Kuwait, and Saudi Arabia, even though these individuals often do not plan to remain in the country for an extended period of time to work.
All of this is done with Ottawa’s blessing. The federal government has exempted medical schools from immigration laws that require Canadians get priority for a job.
Critics argue that eliminating the foreign “visa trainee” program, which grants hundreds of residency positions to individuals from outside Canada, would create more opportunities for domestic doctors to practice in Canada and contribute to reducing the physician shortage.
According to data from the Canadian Resident Matching Service (CaRMS), a total of 1,810 international medical graduates (IMGs) from Canada applied for a residency in the current academic year. These IMGs consist of doctors who have studied medicine in countries such as Australia, Ireland, and the United Kingdom.
Due to a preference for Canadian graduates and a strict limit on international medical graduates (IMGs), only 370 IMGs were successfully assigned residencies to fulfill their mandatory post-graduate training.
Many highly skilled Canadian doctors are compelled to move to the United States due to a scarcity of residency positions in their own country, resulting in a significant loss of talent.
Dr. Joshua Ramjist is originally from Pickering, Ont.
He attended St. George’s University in Grenada, a Caribbean island nation, for medical school.
He felt anxious when attempting to return home and practice.
Ramjist expressed to CBC News that there were certainly some nights without sleep and a hint of uncertainty.
“There exists a vast reservoir of skilled and committed international medical graduates who have a strong desire to provide healthcare services to their fellow Canadians.”
Ramjist secured a coveted residency and now works as a pediatric surgeon at the Hospital for Sick Children in Toronto.
However, the challenging encounter has transformed him into a supporter for aspiring residents who are struggling to navigate the complex system.
“He stated that it reduces the number of individuals entering the medical profession, which poses a risk as we are in need of doctors. It is crucial to eliminate obstacles in order to utilize the skills and expertise of internationally trained professionals.”
According to federal data, Canada is projected to face a shortage of approximately 44,000 physicians by 2028. This shortage will specifically affect the availability of over 30,000 family doctors and general practitioners.
While Canada is cutting loose some native-born and naturalized doctors who went to medical school overseas, hundreds of foreign trainees are routinely admitted to residencies here, despite an apparent scarcity of resources. Saudi Arabians make up the largest single national group among foreign residents.
The count of these trainees from abroad is on the rise.
In 2019, the year before COVID hit, 87 foreign trainees started the first year of a residency position in Canada, according to data from the Canadian Post-MD Education Registry (CAPER), the body that tracks IMG data.
In 2022, there was a 70 percent increase in the number of individuals who did the same compared to three years ago.
According to CAPER, the number of international trainees in medical residencies in Canada last year was 727.
During the same time period, there was no change in the number of Canadian doctors who received their training outside the country and were accepted into residency programs here.
According to CaRMS, a total of 326 International Medical Graduates (IMGs) secured a residency position in Canada in the year 2019.
In the year 2022, a total of 331 IMGs were successfully placed in these highly desirable entry-level positions, representing a 1.5 percent rise.
Foreign trainees are usually obligated by their contracts to return to their home countries after their residency ends. Both the Saudi government and the state-owned oil company, Saudi Aramco, which sponsor some visa trainees, insist that they depart from Canada upon completion of their residencies.
Critics argue that this implies valuable Canadian residency positions are being squandered.
These foreign residents are not being permanently deployed to physician-starved rural and remote areas or hanging their shingles in a province like Nova Scotia — where 142,000 people, roughly 14 per cent of the population, are on a waiting list for a family doctor.
IMGs, in contrast, are individuals who either possess Canadian citizenship or are permanent residents and typically aspire to reside and work within their home country.
The Society for Canadians Studying Medicine Abroad (SOCASMA), an advocacy group that fights for the rights of IMGs, wants to dismantle the regime.
Rosemary Pawliuk, the president of the group, informed CBC News that there is a severe shortage of doctors in our country. Surprisingly, there are numerous Canadians who are not only ready and qualified to perform the job they were trained for, but also eager and desperate to do so. However, their own government prioritizes individuals from oil-rich nations over them.
She mentioned that a Deloitte study reveals that numerous Canadians lose their lives annually due to the prolonged wait for medical treatment. Additionally, she expressed concern about the training of foreign individuals, as it diminishes the opportunities available for Canadians aspiring to become doctors.
In 2010, a policy called Bulletin 230 was put into effect by Immigration, Refugees and Citizenship Canada (IRCC). This policy granted Canadian medical schools an exemption from performing labour market impact assessments (LMIA).
According to federal regulations, Canadian citizens or permanent residents are given priority for jobs and training opportunities. An employer can only hire a foreign national if no suitable Canadian candidate is available.
The federal government eliminated the need for medical schools to provide evidence that no Canadian doctors are available for residency positions by removing the LMIA requirement. This decision was made despite the fact that over 1,000 Canadian doctors are unable to secure residency positions each year.
These foreign nationals have benefactors that pay much more for medical residencies than the sums offered by provincial governments for Canadian residents.
Pawliuk stated that the reason why the current system persists is because foreign trainees serve as a lucrative source of income for the medical schools overseeing the residency program.
She mentioned that Saudi interests not only offer higher payments but also take care of the salaries of certain teaching staff members.
“Canadians trained abroad get very poor and limited options and they are subject to a quota. These foreign nationals can just buy their way in,” she said. “It’s all about the money. Money talks.
“We need to revoke Bulletin 230 so foreigners can only come if there isn’t a Canadian or permanent resident to fill those jobs. Until then, there are thousands of Canadian doctors who are sitting unlicensed.”
The Canadian Medical Facilities Association did not provide a response to CBC’s inquiry for a comment.
Ivy Lynn Bourgeault holds expertise in human resources in the field of health care and is currently serving as a professor at the University of Ottawa.
She’s studied the visa trainee issue and has found that Canadian taxpayers actually foot part of the bill for foreign residents.
According to the data provided by Bourgeault, approximately 70 percent of the funding originates from foreign sources, with the remaining portion being obtained from public funds.
“She stated that there is undoubtedly a crisis in the health workforce. The occupation of spots in Canada by visa trainees should be examined and included in a comprehensive review of the system.”
The system should be designed to prioritize the health needs of our own population, she said — and that requires giving the existing trainee program a hard look.
However, Bourgeault cautioned that a sudden alteration might cause disruption.
While they are present, foreign residents do perform important roles.
“She stated that we should adopt a gradual approach to implementation, ensuring that it does not exacerbate the existing instability.”
An IRCC representative stated that foreign medical residents gain valuable hands-on experience in Canadian healthcare facilities and make a positive impact on Canada’s healthcare systems and the well-being of Canadians by offering their time and expertise.
The federal department has indicated that there are no intentions to dismantle the regime.
The spokesperson stated that IRCC consistently monitors its programs and will openly disclose any updates to existing policies.
Pawliuk claimed that the given response is deceptive.
“How can IRCC possibly claim that foreigners displacing Canadians is a benefit? If Canadians filled these positions, they would stay to serve Canadians,” she said. “In the meantime, Canadians are dying from a lack of access.”