Are medical licensing rules worsening Canada's doctor shortage? Your questions answered

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If you're struggling to find a family doctor in Canada, you're not alone. Health-care professionals we spoke to pointed to the country's complex medical licensing procedures as a major contributor to the problem.

Why is that? And how have other countries solved the same problem? We explore some of the most common questions we heard from you. 

What barriers exist for doctors looking to practise in Canada?

Jurisdictional requirements, access to residency programs and rigid standards all contribute to the obstacles doctors must navigate before being licensed in Canada.

Many of them are not able to practise because they haven't completed a minimum two-year residency position — a requirement for licensing whether they went to medical school in Canada or not. 

Currently, those schools decide which candidates get residencies. Critics say that leaves doctors trained abroad at a serious disadvantage.

Rosemary Pawliuk, president of the Society for Canadians Studying Medicine Abroad, says there are thousands of potential doctors who are not allowed to practise because of a limit on how many seats are offered for medical residencies to international and Canadian graduates.

"It's not a doctor shortage, it's a doctor blockage," she said.

Just 331 residency spots were allocated for international medical graduates (IMGs), of which more than 1,000 applied in the first round of 2022, according to data from the Canadian Resident Matching Service.

When it comes to doctors who are already licensed in Canada, they can not move easily between provinces.

"Traditionally, movement between provinces is possible, but it's not so easy because you have to apply for a licence. There's a cost to it and a lot of paperwork," said Richard Reznick, a past president of the Royal College of Physicians and Surgeons of Canada, and former dean of the Faculty of Health Sciences at Queen's University.

For instance, according to this assessment tool by the College of Physicians & Surgeons of Alberta, the licensing cost for a doctor who is already a licensed practising family physician in another province would be more than $3,500. For international graduates, the cost could be even higher. 

The process could take months. 

"We create these situations where patients are not able to maintain their connections to high quality accessible care because of the way that we limit the mobility of providers," said Alika Lafontaine, president of the Canadian Medical Association.

Are the rules changing?

"Right from the get-go," said Reznick, Canada has largely tried to "populate our medical workforce through homegrown solutions." 

But there are signs of change as some some provinces loosen their rules in a bid to alleviate doctor shortages.

For instance, doctors living and working in the four Atlantic provinces will soon be able to work anywhere within the region without additional licensing. Ontario has said it will also make it easier for health-care practitioners registered in other provinces to work within its jurisdiction. 

How have other countries addressed doctor shortages?

There are 2.8 doctors for every 1,000 Canadians. This is well behind countries like Australia, France and Germany, according to the Organisation for Economic Co-operation and Development..

Australia, like Canada, used to have jurisdictional licensing and has since moved toward a pan-national system with a "whole lot of success," said Lafontaine.

Pawliuk says many other countries have removed their barriers to welcome international graduates. 

The U.S., for one, has "usually been pretty welcoming, especially to Canadians who study medicine abroad," she said.

Canadians who study at Caribbean schools often end up doing their clinical training in the United States, for example, she said.

The U.K. has long relied on IMGs. About 50 per cent of doctors who joined its workforce in 2021 were international graduates, according to a 2022 report.

However, this raises concerns about possible exploitation of medical professionals from low-income countries, said Dr. Danyaal Raza, a family physician at St. Michael's Hospital in Toronto.

Similar concerns have also been raised about nurses from developing countries moving to work in wealthy countries, including Canada.

What steps could be taken?

According to Pawliuk, the first thing should be to eliminate jurisdictional segregation. 

"You should be entitled to apply for the job regardless of your place of education, if you've met the Canadian standards," she said. 

The provinces should also create more residency positions and fund more practice-ready assessments, she added. Such assessments are another path for international physicians who have already completed their residency and practised independently abroad to become licensed.

A national medical license is not going to fix the doctor shortage, but will allow Canada to "distribute doctors … in a little bit more of an equitable or fair way," said Raza.

He says expanding team-based care and team models, which includes training doctors and other health-care professionals, could be a long-term solution. 

"Modern ways of practising family medicine, meaning practising in a team not just with other doctors but also with other health professionals — that's a much better way of taking care of patients, but it's a much more expensive way," Reznick said.

There is capacity to train more doctors both at the undergraduate and postgraduate level and that would require "an extra investment by provincial governments," said Reznick.