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.
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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?