Opinion

The residency match needs to change—but not at the expense of international medical graduates

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51 Comments
  • Mouse says:

    Most IMGs immigrated to Canada via the Federal Skilled Worker Program, and most had to quit medicine or re-train as paramedics, RNs, etc. It is time to remove “specialist physicians” and “general practitioners” from the Skilled Worker list. According to the report on IMG selection for postgraduate medical training (available on the MOH website), the more experience IMG has, the fewer chances he/she has to get a residency position. Most programs do not consider candidates who graduated from a medical school more than five years ago. While CMGs had interviews with individual faculty members, IMGs were interviewed for 30 min by a group of people. All family medicine programs in Ontario collectively review each IMG. Once the decision has been made NOT to proceed with an IMG’s application, he/she has no chance even if they applied to each family med program in the province. The list goes on and on.
    Unlike the States, Canada lacks community residency programs with university affiliation, and there are no plans to change the system. The number of positions in the US is much higher as they have both community and university-based programs.
    The bottom line is that IMGs are not welcomed into Canadian postgraduate medical training. They face discrimination at each step of the process. The only viable solution is to train in the US and move back. Even that route is full of obstacles. An IMG with the US training MUST have the American Board certification and independent license in the US, AND most provinces/employers require a Royal College exam.
    After three years of practice in Canada, an IMG has to undergo an assessment of practice to maintain his/her restricted license. IMGs with dual certification and an independent license in the States work within the same scope of practice as their Canadian-trained colleague, sharing the same responsibilities and workload, but they will always be discriminated against based on their restricted license.

  • James murphy says:

    The issue of Saudi Md residency is disturbing allowing money as the pivotal factor to access as you see the profession and country groveling for dollars issued from sporting oil wells and rainstorm of cash in favor over citizens access to positions. MONEY TALKS WHINING WALKS IT SEEMS IS THE REAL POLITIC IN TRAINING un this nation. The message is clear and has been of seats for sale but only in group travel for those with cash. Others can dream for free and there it is.

  • James murphy says:

    I sympathize with graduates who have gone through the process then fail to match one of the coveted residency spots. Before undertaking international studies think hard about your chances , a life driving taxi with an MD degree might be a disturbing thought and lead to great unhappiness , no reflection on Taxi drivers. There are only so many residencies and this fact supports high Medical salaries by lowering numbers in practice and considering the huge population of med students migrating to the Caribbean to mostly profit making schools this presents a scary picture for the profession as a whole a well as for the migrating students.Perhaps many of those not fortunate to match could be shunted to practice to areas of need in lesser developed countries in underserved areas as medical volunteers.In many poor countries most practicioners cluster in large cities with fewer in rural and provincial areas with great need. In the united states a similar situation prevails. College + Medical School = Taxi driver is a very upsetting outcome . I have seen it happen and to those living it tragic

  • Nara says:

    I was the top medical student in my country. Unfortunately, I came to Canada to be trained, be a doctor and serve Canadians. Canada wasted my time, ruined my dreams. Doctors and other professionals from other countries, please don’t come to Canada. You will work as cashiers, taxi drivers, construction workers and will ruin all your career and will have mental disorder. I am planning to move out. Canada, you won’t get anything by lying and attracting many IMGs!

    • James murphy says:

      I am sorry for your experience life is seldom fair but it seems always for sale to the very rich in powerful groups. ACCESS IS THE KEY BIG INVESTORS WELCOME

  • Mohamed elbanna says:

    Great article.thank you

  • Toussents Worth says:

    Canada lied. They don’t need IMGs.

  • Ri A. says:

    I can’t believe most of the comments here. So basically the system as it is now is equating the Internationally trained Canadian graduate (just fresh out of med school with no experience at all) and an internationally trained medical doctor with years and years of training and experience. Both those two are way less favored in the current system than a fresh new Canadian medical graduate.
    If you are an international trained doctor with lets say 20 years of experience in a specialty, it does not matter and the system does not care you have less than 1 percent getting a residency even after passing two exams and all those years of experience. you basically compete with Fresh medical graduates either internationally trained or even the more privileged locally trained. And you are usually a lot older in age which decreases your chances even more.

    Just the idea that all those years of experience don’t matter is a joke. It is a joke that Canada is literally wasting millions of dollars that were spent in training those doctors not to mention all the years it takes to reach that level of skill.
    Most of those international doctors have active licenses in other countries but still Canada could not come out with a better way to evaluate them other than to put them in the same process as Fresh medical grads.
    And to that person who says Canada can’t accept every third world degree, you are so mistaken most doctors in 3rd world countries are way much better doctors than most doctors here, the reason is that they need to depend on their high skills to treat their patients instead of doing a bunch of medical test and sometimes unnecessary procedures just to figure out (or not) the issue with their patient.
    When it comes to the health care system in Canada, the wait times and the amount of wrong treatments is way much more than in many 3rd world countries that you look at very low. The healthcare system here is so inefficient with all the resources they have.

    • Vesna says:

      Just google
      Stewart: Saudi Arabian medical trainees in Canada mask a problem
      and lots of issues will be much more clear to you as to why is so hard to get residency in Canada.
      Been there

  • Tanny says:

    Every CMG should get residency first before anything is given out, period.

  • psoas major says:

    This is a completely biased article throwing all the mistakes and misfortunes towards IMG. Those IMGs who successfully passed all the screening set by MCC are undoubtedly more qualified doctors. I have witnessed the patient care set forth by so-called non IMG doctors who are sucking up billions of dollars of government money by giving substandard care. Remember this country cannot survive without immigrants. It is the right of every IMG or CMG to get the residency position if he/ she has successfully completed all the exams and criteria.
    CaRMS definitely needs to be restructured. Closed house document review process by faculty members is a big junk of bias process which needs to be addressed. open house counselling in terms of score and achievements could be an alternative source.

  • John Doe says:

    To those of you who think that studying in Eastern Europe costs $250 000. You are highly misinformed. I went to a medschool in romania and tuition was 7500$ per year which was also paid by my student loans. that being said, I completely agree that Canada should have quality control but too much is darn expensive and ridiculous. MCCQE1 and NAC are more than sufficient and considering 40% imgs fail the first time I think to not allow at least 40% of passing IMGS to enter is mean and puts our country back… we bring in immigrants and refugees who have no educational backgrounds yet our healthcare system is understaffed!! Canada has one of the longest waiting times in the world, averaging to about 6hrs. if you think that just because you got into medschool in Canada that you’re better than other doctors who studied abroad, you’re absolutely wrong. the average scores for mccqe1 between imgs and cmgs is a difference of 10 points. there are some people who are also not canadian citizens and absolute geniuses. so please educate yourselves before you call imgs entitled or privileged. you’re a dr. you should be sympathetic and kind to others even if they are not your patients. arrogance is not a quality of a good dr.

    • Maria says:

      Hello JD, I have heard this scenario from many of my students in Canada. IMGs are the among the most resilient professionals I have ever worked with. Many patient newcomers and ethnically diverse Canadians need IMGs, not only for better language communication, but also understanding of their cultural practices and lifestyle which helps in the creation of effective management plans that patients can adhere to. We need IMGs. Would you be interested in discussing this issue in more detail with me?

  • JR says:

    A lot of the people replying here have no idea what they are talking about.

    A lot of the people who study abroad are not wealthy. They get huge lines of credits/bank loans and rely on matching post-medical school into residency in order to eventually pay it back, taking on a lot of risk and uncertainty to follow their dreams. There are easily 3-4X the number of candidates each cycle who would be fully qualified (people who reach the interview stage) to study medicine at Canadian schools but the number of spots are so limited and small differences/minute weaknesses in an application can essentially eliminate someone from getting into Canadian medical school either permanently or only after many application cycles. The Canadians studying abroad have to outperform the students studying at Canadian medical schools to get a lesser residency…it is way more competitive for them as it is already. They are Canadian citizens too and them or their parents paid taxes for decades in the country and in fact, they effectively paid for a large proportion of their education rather than tax dollars. Also, certain provinces require CSA to sign return-of-service agreements if they do residency in the province, committing to practice in the province for a certain period of time (Canadian medical school grads don’t have to). As it is, many of them fail to match in Canada and go to the US instead as a back up.

  • Gordon says:

    I agree with a lot of these comments. Certainly, Canadians who go to medical school overseas are a privileged group. Many of my physician colleagues have sent their children overseas to medical schools, at great expense. The IMG program was originally intended as a pathway for immigrant physicians to become licensed to work in Canada. Instead, it has become a backdoor method for Canadians to get into medical school who could not gain acceptance within Canada. These Canadian IMGs tend to get residency positions at greater numbers than true IMGs not only because of their better understanding of the language and culture, but also because they often have family members who are on medicine and can help with the process. This is not fair and not why this program was created. What is most ironic is that my colleagues who immigrated to Canada as true IMGs and benefited from the original intention of the program are now using it to help their children through the back door of medical schools abroad, often at the expense of true IMGs. One last question that needs to be asked – these foreign medical schools do not care if Canadians are qualified or not for their schools – they only want their tuition money. So why is Canada the only country that accepts so many IMGs, sometimes at the expense of their own CMGs?

    • Anonymous says:

      I disagree with your comment on accepting the student on the basis of money. I go to a school in UK, I was interviewed (MMI Style) and they only take 150 student (that includes student from UK as well as international). My friend did not got in because she didn’t meet the criteria. If that medical school just cared about tuition they should have readily accept anyone!? She had about good marks as me just few point less on GPA than me. Please educate yourself before stating facts which have no validity!!

  • Sam serbane says:

    IMGs should Inly be given access to the match after all Canadian graduates have matched . I don’t see the increase numbers if IMGs in Canada as a good thing . Rather it speaks to the artificial restrictions placed on Canadians who want to go to med school due to the hyper competitiveness of the process . Canada’s medical establishment is shooting itself in the foot . While making it increasingly difficult for Canadians it is making it much easier for IMG to get in to the system in many ways eg after fellowships and working in academia . Making it increasingly difficult for Canadians to get these staff positions . The very fact that there are so many IMGs in Canada speaks to a system stacked against Canadian graduates . Look at any teaching hospital faculty list . Often once the IMGs gatbinto positions of power and influence they hire countrymen or friends of friends , by subtly discouraging other Canadian applicants of course in a way that is impossible to prove .Its time for Canadian graduates to organize and push back

    • JA says:

      I fail to understand on where exactly did you find your information so that you can claim that the system is designed to help IMGs and make it easy for them. Ever since I came here nothing has been easy. I am an IMG and I qualified for a PR based on a skilled program offered by Canada, that was attracting only physicians by stating that Canada has shortage of doctors. We had to wait for 6 years to get a PR and once we landed here the first thing we got is being attacked by people like you that we are taking your spots. You have no idea how we have been fooled into this process and the stress that we are going through and the amount of expenses that we are exposed to. Make an in-depth research to understand on where the real problem is and stop blaming the IMG, as we are the biggest losers in this whole process.

      • Maria says:

        I have heard this scenario from many of my students in Canada. In fact, by the time newcomer IMGs get into residency they are Canadian citizens and in major financial debt. They are among the most resilient professionals I have ever worked with. I am creating a course for newcomer IMGs in Canada to help with linguistic skills and patient-centered communication skills in Canada. Would you be interested in discussing this issue in more detail with me? I am an accredited ESL educator in Canada. I have been working with IMG newcomers since 2015 to help with interviews, applications and oral exams.

    • psoas major says:

      Get well soon.

  • Victim As Accomplice says:

    For so called skilled occupations, Canada is not very welcoming to foreign trained professionals. Canada is a great country in terms of human rights, social welfare, tolerance, etc but if you are overachiever, being a foreigner or having foreign experience is always going to prevent you from moving up. I was an Analyst at the Canadian subsidiary of one of the largest Global Financial Institutions. Later on, I got transferred to our overseas subsidiary and in 3 years moved up to becoming a Senior Vice President. In Canada, that would have been impossible. My prior foreign experience and non Caucasian race would disqualify me from advancing to the senior management roles on a hidden rule basis.

    • Sam says:

      System here just made a false dream for IMG physicians to emigrate here only because of their money to buy houses, cars and much more basics needs in order to run the economy of the country!!!

      • Ana Gutierrez says:

        I’m a general doctor in Argentina. I will move to Canada And I will take the exams what could be the best pathway? thanks in advance!

  • Adam smith says:

    You only seem to focus on IMGs who are originally from Canada but have gone abroad to study. About them I don’t really have much sympathy. They knew the score when they emigrated to study. Like everyone else in society, they have no right to simply come back to Canada and demand a position and a high income. That’s not “privilege”, that’s a sense of entitlement.

    O the stent that the match system and education system churns out graduates who can’t get positions, then that’s a separate issue. We know ttechnology will drive down demand for certain specialities, so universities need to course correct.

    As for immigrant physicians, I have sympathy but they too knew the score. And they are in the same boat as immigrants who are lawyers, dentists, engineers, accountants etc in their original countries. And it’s not an either or where they drive for Uber vs become a physician. Let’s not be melodramatic.

    • Zahra Take says:

      No actually, many immigrants didn’t. The way that immigration into Canada works is that points are given for high education and professions such as doctors and engineers are especially sought out under the theory that they will fill in shortages in that portion of the labour market – the government gives the idea that they want them to practice their professions in Canada. There seems to be a disconnect between immigration policy, labour market needs, and access to professional licensing. If we don’t need doctors to immigrate here, why are we prioritizing their degrees? If we are having family physician shortages in rural areas, why are we not providing residency opportunities for IMG’s there (with a caveat that they need to serve those communities for some minimum number of years)? I personally am not a doctor and don’t want to be one, but in my line of work these two questions are often asked but no one can come up with a clear answer, let a lone a solution to the problem.

      • Tanny says:

        I agree the immigration point system is flawed but don’t expect that Canada will accept any degree from any third world university at par.

      • Tanganga says:

        Canada is not accepting “any degree from any third world university at par” as you are saying. As an immigrant physician, you are required to take certification exams that are very Canadian focused and quite difficult to excel in (90th percentile or above), in order to be able to apply for residency and get interviews. That is fair. Even after you do exactly that, endless other factors are used to filter out applicants based on quality. Which is also fair (even though some of these factors are really crushing and often conflict with one another). Now the residency programs have filtered out all the baddies with degrees from third world universities.

        Then comes in the ‘real’ make it or break it factors. “Who you know” and “luck”. Many specialties have only 1 or 2 residency spots across the entire country reserved for IMGs. If a university professor’s son or daughter (who studied medicine abroad) is applying to the same position during the same cycle then too bad, so sad. And the professors’ kids are not few. If the immigrant physician is lucky enough that nobody’s kid is applying, then it all depends on whether the person (physician) you made a connection with has more influence than the connections of the other candidates or not (i.e., the politics of the department).

        The process is way more complex than “Canada accepting degrees from any third world university at par”. Essentially Canadians have created a system where they can send their kids to study medicine abroad and then come back to take the majority of the IMG positions while luring in immigrant physicians with that points system and “Oh! this country needs more doctors :)”

      • Maria says:

        Hello Zahra, I have heard this scenario from many of my students in Canada. In fact, by the time newcomer IMGs get into residency they are Canadian citizens and in major financial debt. They are among the most resilient professionals I have ever worked with. I am creating a course for newcomer IMGs in Canada to help with linguistic skills and patient-centered communication skills in Canada. Would you be interested in discussing this issue in more detail with me? I am an accredited ESL educator in Canada.

  • FKA says:

    Hi Tarun, Thank you for speaking on behalf of the IMG community. I just wanted to add that in 2019 second iteration, there are 21 seats in the competitive stream, 20 seats for CMGs and only 1 seat for IMGs The disproportionate numbers of seat is pretty obvious. Yet again the deficit is being filled at the cost of IMGs. IMGs that reside in Canada are also tax payers, some consideration should be given to the fact that they too deserve to train in Canada and excel in their profession and not just drive an Uber or deliver pizza for the rest of their lives

  • Cynthia says:

    Thanks for bringing this topic up. I too have thought about the impact of IMG as the CARMS made changes to not allow IMG to match in 2nd iteration. My husband was a refugee and IMG who is now a practicing cardiologist. It was a long journey filled with many moments of doubts, sacrifice and many other challenges that “Canadian” IMG may not understand. It is already a very competitive process. This new change will almost render it almost impossible for these IMGs to get into the system. How can Canada say we offer new comers equal opportunities?

    • Adam smith says:

      Newcomers do not get equal opportunity. The system is geared to Canadians educated here and financed by taxpayers. System really maintains existing power and privilege structures. Is that right? I don’t know, but most every other job and profession does the same thing.

    • Maria says:

      Cynthia, I am creating a course for newcomer IMGs in Canada to help with linguistic skills and patient-centered communication skills in Canada. Would you be interested in discussing this issue in more detail with me? It’s to assist with the SOOs and OSCE exams. I am an accredited ESL educator in Canada.

      • Annie says:

        Hi Maria,

        Are you still looking for IMGs to discuss ideas? If so, please send me an email.

  • Vlad Milosevic Dgnas says:

    Pretty shallow dive into the subject and rather unconvincing.

    The only IMGs who suffer In the system are the ones who have immigrated here and go round after round without being able to match, ever. This group is seemingly not addressed in this article.

    I would be interested to know the sociodemographic makeup of Canadians who go abroad for medics training – is there such a dataset? In my experience, they have been wealthy, and socially privileged, who went abroad to either do a direct entry 6-yr program or because dripping with privilege made them think it would be too easy to get into Med school in Canada, and they failed.

    Trying to fit all events and decisions into the frame of over/under privilege is a very narrow lense to look at the world.

  • Sabina says:

    I think your opinion warrants further examination and consideration of additional facts.

    The bulk of IMGs coming to Canada are Canadians, and most of them come from privileged backgrounds- from families that can afford to pay the tuition set at international medical schools. Furthermore, many of these students are those who went directly into medical school after high school rather than staying in Canada to study, raising the question of whether they would have been able to meet the academic and extra-curricular standards set by medical schools in Canada. It’s easier to be an excellent student in the grade-inflationary environment of Canadian high schools and get into international medical schools that take just about any international student willing to pay the high tuition that funds their program and subsidizes their students than to go through often demanding undergraduate degrees where grade inflation suddenly disappears and the A+ high school student becomes a B university student.

    Those who didn’t make it into Canadian schools fall into several categories- those who are excellent and simply were unlucky, and those who simply didn’t hack it and didn’t have the marks or qualities to get in. I think it’s worth analyzing whether someone who “gives up everything for their dream” is deserving or just unrealistic. While anecdotes aren’t facts, in my limited experience, many of those who travel overseas after a few failed attempts at med school entry in Canada are often actually deficient and feel entitled to be a physician even if their aptitudes suggest otherwise. Some dreams should be given up if those dreams aren’t realistic or in line with capabilities.

    Finally, the question of privilege. I completely agree that many students who don’t make it to med school may not have the privileges that others do. However, I would argue that this doesn’t apply to the bulk of international medical students- many of whom pay 100s of thousands of dollars to study elsewhere, who still end up doing lots of extra-curriculars, and who, as evidenced by data available from organizations like PARO, tend to come from extremely wealthy and privileged families- perhaps even more so than those admitted to Canadian med schools. There have also been clear scandals (e.g. UBC) of some students getting into residency on the basis of things like family name, or the fact that their parents are physicians known to committees that make decisions about residency spots.

    So are there lots of qualified people who want to get into med school? Yes. Does luck play into it? Yes. Would a bunch of people who get denied entry still make good doctors? Undoubtedly. But should we be protecting spots for internationally trained physicians who may have “jumped the queue” over those trained in Canada, who are extremely privileged, and perhaps unrealistic in their assessment of their capabilities? I would so no. And if we want to have IMG spots, let’s reserve them for actual immigrants who were trained/practicing physicians who want to practice in Canada rather than a bunch of rich people’s kids who decided they wanted to be doctors in high school without really knowing anything or else who are likely to have had mediocre performances in undergrad and yet still felt like they, above all others, were entitled to being physicians.

    • Tom says:

      Really, this whole argument of not allowing non-Canada trained graduates not compete in the first, let alone the second iteration, is purely based in protectionism and regulatory capture.

      If Canadian graduates are so much better than IMGs then they should have no problem beating out IMGs for residency spots. Plain and simple. Success as a physician in Canada shouldn’t be determined by who wins the med school acceptance lottery at age 22.

      I have a vested interest in this as I am a Canadian studying in Australia and hope to practice in the rural area I’m from one day. I have zero family ties to medicine and only got the idea that I would be suitable for medicine after working several years as a paramedic. I went back to university at age 26, paid for everything by working part-time as a paramedic, volunteered, did research, all those things. I was unable to get a spot in Canadian med schools likely because I had a year of Cs and Ds from a misspent year in college right after highschool. Those marks haunted me and drug my application down to the point where I missed UBCs interview cut-off every year despite high non-academic evaluations. So the question is for me – either eat this loss after 4+ years of applying and go back to being a paramedic…or take on a massive debt load and risk of career uncertainty by training in another country in order to pursue my goal.

      Unfortunately this is the route that myself and many other CMGs are forced to take but it shouldn’t preclude us from competing for residency spots in a country where we are competent to and desperately want to give back to as physicians.

  • Matt Strauss says:

    I found this deeply unconvincing. A Canadian who can afford the $250,000 dollars to study abroad probably doesn’t deserve your concern regarding socioeconomic privilege.

    • Adam smith says:

      Exactly. This article throws around the word privilege. The IMGs mentioned in this article are very privileged (usuallly white and always well off) Canadians who studied overseas and expect/demand that they come back here because they think they have a right to work in Canada at taxpayers expense. This isn’t the IMGs who qualified overseas and emigrated here and struggle to adjust and who are not privileged at all.

      Spouting stats like 20 percent of doctors were trained overseas is a red herring. That would include lots who studied in the US and qualified there and who automatically qualify here. And yes lots of IMGs cover rural/remote practices cause that’s a way for them to enter practice here.

      Too much physician entitlement in this article.

    • Adam smith says:

      Right on. Very unconvincing article. Indeed, I would suggest to the publishers that they need some quality control, and this one fails.

    • Gurdy Wolosz says:

      That is a not true. I have saved every penny, not even purchased a home for myself so that my kid go go Poland to study medicine. And now he can not find a RESIDENCY match in his own country. And there are 16,000 Saudi doctors – in -training in Canadian hospitals.

      • Damian O'laire says:

        He probably should’ve studied harder so he could’ve studied medicine in Canada.

      • Tanny says:

        My point exactly. They aren’t smart enough for Canadian Medical schools and then demand they should be treated equal. Every CMG should get the residency spots first before they given out to IMGs

      • Gurdy Wolosz says:

        Like every other institution in any country today, the medical establishment has become a thing run by the people inside, for the people inside. It will have to change.

      • Gurdy Wolosz says:

        How do you know that the students who go overseas are smart or not smart ? A typical and unintelligent response. Look around your. The world is being run by mediocre people.

      • Jacqueline says:

        Dear Gurdy,
        Please ignore the ignorant who thinks only CMG are smart. This is a very superficial thinking. Ironically, I’m a CMG who couldn’t be matched and my cousin who studied in a Caribbean school matched to pediatric residency program in ON this year. There are multi-factors control this.
        Good luck for your kid, he must be proud of his/her devoting, loving dad!

      • Robert says:

        I’m afraid that it’s not that simple. Getting into medical school is as much a function of who you know as it is what you know. Do you really think that the young guy with no connections has the same chance to get the interview or, ultimately, the seat, in a Canadian medical school as does the guy who’s mom or dad are doctors and know people? Think about how many times in life, you rely upon someone to help you get your foot in the door for a job. It’s no different than that in medicine.
        There are a great many doctors who went to Europe or the Caribbean to get their degrees who are very, very good clinicians. My own father’s oncologist went to school in France. We should view these people as potential assets to help us all improve the length and quality of our lives and healthcare.

      • Vesna says:

        Just google
        Stewart: Saudi Arabian medical trainees in Canada mask a problem
        and lots of issues will be much more clear to you as to why is so hard to get residency in Canada.
        Been there

        Reply to Damian O’Laire:…….please don’t be ignorant
        Dr Medical school graduate Robert Chu, took his own life last fall after being passed over twice for medical residency programs.
        and BTW he graduated in CANADA

      • Suhas Nayak says:

        Dear Gurdy , The Canadian government has wrong belief that the average life tenure of Canadians is more than 200yrs

Author

Tarun Rahman

Contributor

Tarun Rahman is a family medicine resident at St. Michael’s Hospital in Toronto who previously worked as a public health epidemiologist. His writing focuses on global and public health, as well as issues of identity and culture.

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