Over the past five years, the number of Canadians studying medicine abroad has more than doubled.
Almost all of these medical students want to practice in Canada.
Is it good for Canada to rely on foreign medical schools to train our future doctors?
David Li, a family doctor in Oshawa, is one of Ross University’s success stories. Li graduated from Ross, a medical school in the Caribbean West Indies, in 2006. “I went to Ross because I couldn’t get into medical school in Canada,” said Li. “I applied in November 2002 and started the program in January 2003. When I graduated in 2006 I was one of the few lucky ones to match for a residency position back in Canada.” Li’s story is prominently featured in advertisements promising that after training at Ross, Canadians can “come home to practice.”
Li is just one of a growing number of Canadians going to medical school abroad, in places like Bahrain, Australia and the Caribbean.
Who are these Canadians who study medicine overseas? What drives them? What are the costs and who pays? And most importantly, is it good for Canada to rely on medical schools in other countries to train our doctors?
The facts behind the numbers
A recent survey found that there are 10,500 medical students in Canada and about 3600 Canadians studying medicine abroad – enough to fill about 6 Canadian medical schools.
The same survey found that more than 75% of Canadians studying medicine abroad say that they did so because they were not able to obtain a spot in a Canadian medical school. Competition here in Canada is fierce. Although there has been an expansion in medical school spots across Canada in recent years, about 25% of applicants are accepted. In the United States, 43% of applicants get into medical school.
| Medical School Region | Average Yearly Tuition ($CAD) |
| Ireland | 49,800 |
| Caribbean | 25,608 |
| Australia | 42,334 |
| Canada | 12,214 |
Source: CaRMs 2010 report Canadian Students Studying Medicine Abroad
Canadians who study medicine abroad are not assured of a residency training spot in Canada – required for a license to practice medicine in Canada. Rikin Patel, who went to medical school at St. George’s University in Grenada, reflects on the “long road” that he took prior to obtaining his current pediatrics residency position at Memorial University in Newfoundland. Patel went through multiple cycles of medical school applications in Canada before deciding to study medicine abroad. He then competed against hundreds of doctors for his residency position and considers himself lucky to have obtained a spot. Many of his colleagues from St. George’s were unable to secure coveted residency positions in Canada, and completed their training in the United States.
There are many steps and years in the journey to becoming a doctor, shown in the graphic below.
Joshua Tepper, who until recently was Assistant Deputy Minister for Health Human Resources Strategy in Ontario, notes that the formal selection process assesses all individuals from foreign medical schools equally regardless of what country they lived in before attending those schools. Patel, however, suggests that Canadians who are competing for spots have a significant cultural advantage, being more familiar with the norms of Canadian medical practice and health care system. Tepper does not disagree.
Is training Canadians abroad good public policy?
Getting the number of doctors right is a major issue in Canadian health care, with data showing that many Canadians experience long waits for specialist care and have difficulty finding a family doctor. In response to these problems, provincial governments have not only increased the number of medical school spots in the last decade, they have also made it easier for internationally-trained physicians to practice in Canada by opening up additional residency training positions. In the short-term, this move alleviates physician shortages here at home. But some feel that it is unfair to Canadian students. For example, Peter Walker, the former Dean of the University of Ottawa Faculty of Medicine notes that the high cost of medical schools abroad, combined with the low acceptance ratio in Canada, make it difficult for many able and qualified Canadians to pursue a medical education. Walker believes that a better solution would be more medical schools in Canada, and has been advising York University on how to go about starting a new medical school in Toronto.
Is it shortsighted for Canadian governments to rely on internationally-trained physicians? Will physicians trained in Ireland or Grenada know what they need to practice here in Canada? “If you are trying to change and improve the [Canadian] health care system, why are people being educated in another environment?” asks Walker. And is it fair for some Canadians to pursue a backdoor route to a career here in Canada while qualified Canadians give up on their dreams of becoming a doctor?
The comments section is closed.
I am looking to contact a canadian student who went abroad to study medicine. I am looking at various options, particularly Poland. I have some questions about programs abroad and process once I return. Thanks in advance.
My question is WHY CANT CANADA JUST GIVE MORE OPPORTUNITIES TO STUDENTS WHO ARE CANADIAN TO JUST STUDY IN CANADA? whats wring with opening up more schools? Its ridiculous when you see how many of these student’s dreams get crushed wheb they get that rejection letter despite all the hard work they put it! Then they have to leave home and suffer and study and still they are not guranteed a spot to come back and work. Okay fine if you dont want foreigners, why not give us more opportinities to just study here? Is it such a bad thing to want to provide service to the public? Please give some consideration for applicants in the near future!
I am a current graduate of University of Toronto in Molecular Biology looking to study medicine. For about 3 years not I have sat on the fence and listened to both sides place forth their arguments. For the sake of my argument international schools represents the US, Australia, Caribbean, UK, Ireland, and Bahrain.
Here’s what I have realized: those against international education are a large part uneducated on the undertakings of a doctor’s requirements to become licensed in Canada. The reason I say this is because the overwhelming argument posted by them is that they would rather receive a diagnosis from a Canadian medical doctor because they are somehow superior in their knowledge compared to the internationally-trained doctors.Those for the international schools are for the large part people with insight in seeing the value they bring. Maybe just from a supply and demand perspective, but it should be mentioned that countries fare well when their population is educated and the more educated the better. In fact a report (I can’t recall who for all those citation dependent) published found that in order to move 3rd world countries to the 1st world position the only way of doing so is through education. The more educated the population the better decisions they will make in raising their family (a safe home for children to live and learn in), they will have fewer children, they will have higher incomes and thus pay more taxes back to the State, they will commit less crimes, take better care of their health, make more informed decisions as voters and tax payers, and exemplify this behavior in their communities.
Now to address the question which was probably never a burning in a single person’s mind when they criticized international schools: How well educated is an undergraduate student who went to an international school? Let me summarize it real quick. After becoming an astronaut, applying to medical school is the most difficult type of professional educational program to apply to. The GPA required is a minimum of a 3.0 (75%) or higher at practically every single school except 2 or 3 which represents at most 5% of the schools outside Canada. Now keep in mind that undergraduates applying for medicine aren’t just busting their backs to study for good grades. Medical schools have another requirement a lot of people don’t know about – life experiences / community service. While studying, kids are spending their weekends volunteering at hospitals, then their summers shadowing doctors, and their evenings marking tests or reports if they are Teaching Assistants, then contributing to organizing events to usually at least 2 societies/clubs a year. Lets not forget about research, which they could spend anywhere from 1 to 3 years on performing experimentation – a contribution which may or may not be recognized on the publishing pending if their professor liked them (yea, even professors get emotional). All that work (usually 80hr weeks), but it doesn’t stop there. Compound it with the MCAT. A grueling 5.5 hour exam which requires expertise in physics, chemistry, biology, organic chemistry, essay writing, and literacy. This exam usually takes 2.5-3 months to study for during their summers and requires 4/5 hours a day, 6 days a week of their attention. In addition to those school year jobs, now they can kiss those summer jobs goodbye. For those who think they still have 20 hours a week available to work, try and find me even 5 employers willing to bend to that hourly schedule with the summer saturated with non-medical aspirants flooding the job market. Ever wonder why the majority of premeds seem a little more work stressed than the majority of working people? Because they’re 20 years old, have spent the last 3 years making little to no money for travelling or indulging in things that 20 years like. Lets not forget about medical school applications which usually require about 2-4 essays per school, multiplied by the 3-5 schools applied to, written during their school year amongst all the other stuff aforementioned. And then guess what happens. After 4 years of sacrificing their youth to pure work, instead of “enjoying the university experience” many others seem to find, they get rejected from medical school. Why? Well maybe 20% (an awfully huge estimate looking at my competition) were never cut for it right from the get go. Of the 80% remaining, only 25% will even get accepted because that’s the max capacity of the glorified Canadian medical school. What about the remainders? Should they go apply for jobs and give up? No, many will get a masters and even advance to a PhD if they need to become more distinct, another 2-7 years. Then they may reapply and still be rejected because of the indecisive excuse about health care costs limiting our medical school capacity. So guess what? You’re going to tell me that the undergraduate, masters, or even doctoral student is not qualified to read medical literature and diagnose illnesses? For those still skeptical with no reason, here’s more. During medical school, REGARDLESS OF WHERE YOU STUDIED (that means australian, caribbean, us, uk, ireland, bahrain graduates), it is mandatory to write 3 more board examinations which are even more brutal than the MCAT and test you on everything that a doctor must know to practice medicine in Canada. Then comes the residency match, a process which takes 2-5 years. After that more education can still ensue if the person decides to.
To summarize, there is no difference in the competency of a student regardless of what school they come from. They are all filtered through a 3 step examination process for coming back to Canada (the same applies for the US). The only way I can describe it is: have you ever seen a medical student? The answer for the majority is no, because they’re always studying and the little time they do have they will spend with other medical students. I mention this because the people you surround yourself with has an impact on your aptitude and ambition. So whether your doctor came from St. Georges Medical School (even Windsor School or Medicine for those who understand this point) or University of Toronto, it doesn’t matter. Not to mention their ability to diagnose will further with experience. What we need are not doctors from Canada. We need all the best talent we can get. But we need emotional intelligence. Someone who doesn’t just pump out prescriptions that their pharma rep “educates” them on, but intervenes in that patients life and explains what they need to do to get their life back on track. We need doctors who will empathize and solve the often deep rooted reason for the manifestation of disease in a patient.
This doctor education is a silly debate for largely uninformed people. We need doctors and Canada can’t produce them. And as I have just explained, the other sources are well educated. What we need to debate about now is the ways in which they can help us. That means instead of putting an end to the patient’s complaining, learning how to revitalize them to normal health.
I am a current graduate of University of Toronto in Molecular Biology looking to study medicine. For about 3 years not I have sat on the fence and listened to both sides place forth their arguments. For the sake of my argument international schools represents the US, Australia, Caribbean, UK, Ireland, and Bahrain.
Here’s what I have realized: those against international education are a large part uneducated on the undertakings of a doctor’s requirements to become licensed in Canada. The reason I say this is because the overwhelming argument posted by them is that they would rather receive a diagnosis from a Canadian medical doctor because they are somehow superior in their knowledge compared to the internationally-trained doctors.Those for the international schools are for the large part people with insight in seeing the value they bring. Maybe just from a supply and demand perspective, but it should be mentioned that countries fare well when their population is educated and the more educated the better. In fact a report (I can’t recall who for all those citation dependent) published found that in order to move 3rd world countries to the 1st world position the only way of doing so is through education. The more educated the population the better decisions they will make in raising their family (a safe home for children to live and learn in), they will have fewer children, they will have higher incomes and thus pay more taxes back to the State, they will commit less crimes, take better care of their health, make more informed decisions as voters and tax payers, and exemplify this behavior in their communities.
Now to address the question which was probably never a burning in a single person’s mind when they criticized international schools: How well educated is an undergraduate student who went to an international school? Let me summarize it real quick. After becoming an astronaut, applying to medical school is the most difficult type of professional educational program to apply to. The GPA required is a minimum of a 3.0 (75%) or higher at practically every single school except 2 or 3 which represents at most 5% of the schools outside Canada. Now keep in mind that undergraduates applying for medicine aren’t just busting their backs to study for good grades. Medical schools have another requirement a lot of people don’t know about – life experiences / community service. While studying, kids are spending their weekends volunteering at hospitals, then their summers shadowing doctors, and their evenings marking tests or reports if they are Teaching Assistants, then contributing to organizing events to usually at least 2 societies/clubs a year. Lets not forget about research, which they could spend anywhere from 1 to 3 years on performing experimentation – a contribution which may or may not be recognized on the publishing pending if their professor liked them (yea, even professors get emotional). All that work (usually 80hr weeks), but it doesn’t stop there. Compound it with the MCAT. A grueling 5.5 hour exam which requires expertise in physics, chemistry, biology, organic chemistry, essay writing, and literacy. This exam usually takes 2.5-3 months to study for during their summers and requires 4/5 hours a day, 6 days a week of their attention. In addition to those school year jobs, now they can kiss those summer jobs goodbye. For those who think they still have 20 hours a week available to work, try and find me even 5 employers willing to bend to that hourly schedule with the summer saturated with non-medical aspirants flooding the job market. Ever wonder why the majority of premeds seem a little more work stressed than the majority of working people? Because they’re 20 years old, have spent the last 3 years making little to no money for travelling or indulging in things that 20 years like. Lets not forget about medical school applications which usually require about 2-4 essays per school, multiplied by the 3-5 schools applied to, written during their school year amongst all the other stuff aforementioned. And then guess what happens. After 4 years of sacrificing their youth to pure work, instead of “enjoying the university experience” many others seem to find, they get rejected from medical school. Why? Well maybe 20% (an awfully huge estimate looking at my competition) were never cut for it right from the get go. Of the 80% remaining, only 25% will even get accepted because that’s the max capacity of the glorified Canadian medical school. What about the remainders? Should they go apply for jobs and give up? No, many will get a masters and even advance to a PhD if they need to become more distinct, another 2-7 years. Then they may reapply and still be rejected because of the indecisive excuse about health care costs limiting our medical school capacity. So guess what? You’re going to tell me that the undergraduate, masters, or even doctoral student is not qualified to read medical literature and diagnose illnesses? For those still skeptical with no reason, here’s more. During medical school, REGARDLESS OF WHERE YOU STUDIED (that means australian, caribbean, us, uk, ireland, bahrain graduates), it is mandatory to write 3 more board examinations which are even more brutal than the MCAT and test you on everything that a doctor must know to practice medicine in Canada. Then comes the residency match, a process which takes 2-5 years. After that more education can still ensue if the person decides to.
To summarize, there is no difference in the competency of a student regardless of what school they come from. They are all filtered through a 3 step examination process for coming back to Canada (the same applies for the US). The only way I can describe it is: have you ever seen a medical student? The answer for the majority is no, because they’re always studying and the little time they do have they will spend with other medical students. I mention this because the people you surround yourself with has an impact on your aptitude and ambition. So whether your doctor came from St. Georges Medical School (even Windsor School or Medicine for those who understand this point) or University of Toronto, it doesn’t matter. Not to mention their ability to diagnose will further with experience. What we need are not doctors from Canada. We need all the best talent we can get. But we need emotional intelligence. Someone who doesn’t just pump out prescriptions that their pharma rep “educates” them on, but intervenes in that patients life and explains what they need to do to get their life back on track. We need doctors who will empathize and solve the often deep rooted reason for the manifestation of disease in a patient.
This doctor education is a silly debate for largely uninformed people. We need doctors and Canada can’t produce them. And as I have just explained, the other sources are well educated. What we need to debate about now is the ways in which they can help us. That means instead of putting an end to the patient’s complaining, learning how to revitalize them to normal health.
From a supply and demand perspective, graduating/licensing more MDs could give patients more choice when it comes to deciding who they see for medical or surgical care. This could raise physician quality (i.e., better MDs would be sought after) and lower out-of-pocket costs (i.e., non-OHIP procedures would have to be priced competitively). However, we might see OHIP over-utilization (e.g., excessive diagnostics).
I don’t see any major ethical issues with training MDs overseas. Countries will develop policies to benefit themselves when offering this education (e.g., increased international student fees). Summary: Enough bright people want to become MDs, so whichever scenario is cheaper for the Canadian taxpayer, is best.
One of the major issues raised here is the difference in cost of medical education in Canada vs. other countries. While the current situation already shuts out those of lower socioeconomic status (not to mention the general education system in which a student having a part-time job is automatically at a disadvantage being unable to focus only on education). Medicine is more and more becoming a profession of the upper middle class, and this creates problems in finding physicians willing to serve marginalized populations. Medical education overseas is certainly not accessible to anyone of a low income, and if this is the new paradigm, it is creating yet another barrier for those wishing to have a career in medicine.
Canadian medical schools stopped their natural growth after the infamous Barer-Stoddart report of 1990. Medical school enrolments were artificially decreased in an effort to reduce the number of physicians and theoretically the costs of Medicare that are physician-driven. The architects of this failed concept did not factor increased population, increased longevity, new medications, increased patient demands and expectations, acccelerating technology, and decreased work commitment by young physicians to purse their lifestyles. The physician shortage in Canada is an artificial famine created by government. That will be solved when proper funding and expansion of medical schools will be a cross-Canada priority. Our talented young men and women can then be educated in Canada to serve Canadians.
Thanks for that comment. Here is a link to the Barer Stoddart report. http://www.chspr.ubc.ca/node/522
For those not familiar with the Barer Stoddart report, it was written by health economists at the University of British Columbia, and made recommendations around physician training and resources in Canada. One important comment on the first page of the report is :
“the ‘optimal’ number of physicians cannot be defined by purely technical means. Ultimately, this is a social rather than technical judgement.”
I think it is unethical for the government to rely on foreign trained physicians, whether they are Canadian or not. First it places a higher burden on the individuals; more debt and more stress for individuals hoping to be able to practice in Canada could be avoided. Second the school systems in many of the UK are government subsidized and we are effectively stealing resources they are trying to build for themselves. I don’t deny there are many physicians from other countries that want to come to Canada, but we need to consider how the countries we take them from are compensated in terms of money or support for educating further healthcare professionals.
The other issue with medical education within Canada is wee need more schools of rural medicine. Physician migration is also an issue within Canada, many students apply to school in other provinces with no intention to stay there to practice. Having universal healthcare does not do a lot of good if you have no healthcare providers in your area. I think schools like the Northern Ontario School of Medicine are a great start and should be replicated where possible.
Thanks for bringing up the Northern Ontario Medical School Robert, which is a unique model of medical education. The Northern Ontario Medical School was the first new medical school Canada in 30 years, and they started accepting students in 2005, with 64 places in the first year class, and a mandate to provide health care to communities in Northern Ontario. 91% of students come from communities in Northern Ontario. To learn more about the Northern Ontario Medical School visit their website http://www.nosm.ca/