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

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.

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?

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.