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

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  1. Matt Strauss

    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

      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

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

    • Gurdy Wolosz

      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

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

      • Suhas Nayak

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

  2. Sabina

    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

      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.

  3. Vlad Milosevic Dgnas

    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.

    • Adam smith

      Very unconvincing. Need for quality control. This article fails.

  4. Cynthia

    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

      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.

  5. FKA

    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

  6. Adam smith

    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

      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.

  7. Victim As Accomplice

    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.

  8. Sam serbane

    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

      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.

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