Canada’s health-care system stands at a critical juncture, facing an alarming shortage of doctors that has left entire communities without adequate medical care. In rural and underserved areas, this crisis is profoundly felt as families wait months for appointments or travel hours to see a doctor. Projections underscore the urgency – by 2028, Canada is expected to face a shortfall of more than 44,000 doctors, with more than 30,000 of those being family doctors and general practitioners.
Amid this critical need, highly skilled and qualified internationally trained physicians – known as International Medical Graduates (IMGs) – stand by, ready yet unable to contribute their expertise to a system in need. IMGs are Canadian citizens or permanent residents who studied medicine abroad; immigrants who have become Canadian citizens or permanent residents but trained as doctors in their home countries; and individuals on temporary visas, awaiting residency status or opportunities to practice.
For some IMGs like Irma Faruqi, the journey to Canada was fuelled by a desire to serve, contribute, and reconnect with family. Faruqi, an experienced emergency physician, poignantly describes her frustration: “It is here, in the belly of the whale, with my fingers tightly guarding the caduceus around my neck, that I await the return to my calling.” Her words reflect the painful reality facing many IMGs, stalled by bureaucratic barriers.
Can we continue to overlook these trained professionals, or is it time to address the barriers keeping them from contributing to our health-care workforce?
The physician shortage is not merely a statistic; it’s a harsh reality for countless Canadians. In rural and remote areas, finding a family doctor or accessing specialist care is a struggle that deeply impacts families and communities. As Canada’s population grows and ages, the strain on health care will only intensify. In this context, there are more than 13,000 IMGs already living in Canada. These highly trained professionals remain unable to practice due to a rigid residency system that favours domestically educated doctors.
The World Health Organization’s Global Strategy on Human Resources for Health: Workforce 2030 highlights the need for adequate health-care workforce planning to meet global demands, particularly in times of crisis. Canada’s exclusion of IMGs from practice is more than a missed opportunity; it’s a systemic inefficiency that deprives Canadians of accessible care, especially in underserved areas. IMGs could readily fill roles as family doctors and specialists in these communities, yet current policies prevent them from reaching the very people who need them most.
Many of these professionals, like Faruqi, bring years of experience from high-pressure environments and come to Canada with the hope of continuing to serve. Yet, securing a residency – an essential step for licensure – is often an insurmountable hurdle. In the 2020 residency match, IMGs faced a success rate of less than 23 per cent, while Canadian graduates nearly reached 98 per cent. To be eligible for a residency match, physicians must be Canadian citizens or permanent residents, yet Canadian IMGs face the same barriers as their foreign counterparts despite their strong ties and commitment to Canada.
Canadian IMGs face the same barriers as their foreign counterparts despite their strong ties and commitment to Canada.
This disparity is largely due to quotas that limit IMGs’ access to residency positions and restrict the specialties available to them. Studies on IMG career development reveal that such barriers not only stifle IMGs’ professional growth but also rob Canada of skilled health-care providers. Meanwhile, Canada continues to rely on temporary visa trainees – foreign nationals who fill residency slots but are often required to return to their home countries upon completion. This practice raises uncomfortable questions: Is this reliance driven by cost-saving measures or systemic inefficiencies that prioritize short-term solutions over long-term workforce planning?
Beyond filling physician shortages, IMGs hold unique skills that could help bridge cultural and linguistic gaps within our health-care system. For many immigrant communities, seeking health care can be a daunting experience, often complicated by language barriers, cultural misunderstandings, and unfamiliarity with Canada’s health-care landscape. Research shows that these barriers lead to significant unmet health-care needs among immigrants, with poorer health outcomes as a result.
IMGs are uniquely positioned to address these gaps, bringing with them both medical expertise and cultural awareness. Their linguistic skills and deep understanding of diverse health practices make them invaluable assets in fostering a health-care environment that is inclusive, accessible, and responsive to our evolving demographic.
While Canada continues to overlook the potential of IMGs, other countries have recognized their value. In the United States, for example, IMGs are actively recruited to fill vital roles, particularly in rural and underserved areas, where their diverse skills and experiences are highly valued. This stark contrast raises an uncomfortable question: Why is Canada failing to integrate its internationally trained doctors while other nations eagerly welcome them?
A significant obstacle for IMGs is Canada’s residency system, which is structured to disadvantage them. Policy Bulletin 230, for instance, exempts medical schools from proving that no Canadian resident is available for a residency slot before admitting foreign nationals. This reliance on temporary visa trainees highlights systemic biases that create financial and institutional barriers, effectively shutting out Canadian IMGs from practice.
Unlocking the potential of IMGs requires targeted reforms to reduce barriers and increase residency opportunities. Expanding the number of residency slots specifically allocated for IMGs – particularly in high-need and rural regions – would provide these skilled professionals a clear path to practice. Additionally, reducing reliance on temporary visa trainees could open more positions for Canadian IMGs, ensuring that our health-care workforce is sustained by those committed to Canada’s future.
Reforming residency quotas, prioritizing Canadian IMGs, and creating accessible pathways for practice in underserved areas are steps we must take to transform this health-care crisis into an opportunity for growth.
