Canada is short of doctors — and it's turning away hundreds of its own physicians each year

The country's health-care system is suffering from an acute shortage of doctors — even as hundreds of qualified Canadian physicians trained abroad are turned away each year because of a tangle of red-tape and bias, experts say.

Canada is passing up a chance to add hundreds of these Canadian doctors to a strained system because, critics say, tight-fisted provincial governments have restricted the number of residency spots — and because the system explicitly privileges students who went to Canadian medical schools.

According to census data, there's no shortage of doctors in Canada. What we have is a shortage of licensed doctors.

While estimates vary, there may be as many as 13,000 medical doctors in Canada who are not practising because they haven't completed a two-year residency position — a requirement for licensing.

Critics of the system say discrimination is pervasive.

"There is a 'don't come home attitude' in Canada," said Rosemary Pawliuk, president of the Society for Canadians Studying Medicine Abroad.

"They have cute slogans like, 'You're wanted and welcome in Canada,' but when you look at the barriers, it's very clear that you should not come home. Their message is essentially, 'Go away.' And so they do."

Under Canadian regulations, medical schools themselves decide who gets a residency. Critics say those schools have a vested interest in seeing Canadian-educated students get as many of those positions as possible — leaving those Canadians trained at reputable schools abroad at a serious disadvantage.

Critics say the system is designed to ensure that every graduate of a Canadian medical school — no matter how competent they are — is licensed to practice medicine. Only a relatively small number of underperformers are weeded out each year.

The same cannot be said for Canadians who attend medical school overseas.

A bias built into the system

"The physicians running these departments want the best — but that's not allowed. They're not allowed to pick from the full pool of qualified applicants," said Pawliuk.

About 90 per cent of all residencies are set aside each year for Canadian medical graduates. Internationally trained doctors get the rest.

In some provinces, domestic medical school graduates and those educated abroad can't compete against one another — there are two separate pools, and the one reserved for international medical graduates is much smaller.

According to data from the Canadian Resident Matching Service (CaRMS), 1,661 international medical graduates (IMGs) applied for residency positions in Canada last year. Just 439 were matched with the necessary post-graduate training. That's a "match rate" of just 26 per cent.

And these are not foreigners — you must be a Canadian citizen or permanent resident to even apply for a residency in Canada.

"The Canadian public should be entitled to the best qualified Canadian applicant. Whether they've graduated from a Canadian school or an international school, whether they're a Canadian by birth or if they're an immigrant, they should be competing on individual merit," Pawliuk said.

The way the residency system works has consequences. For example, 115 residencies nationwide — mostly in family medicine — went unfilled last year because Canadian medical school graduates weren't interested in them, according to CaRMS data.

These Canadians trained abroad also face a series of other hurdles.

Unlike Canadian medical graduates, for example, international medical graduates have to sit for the "MCCQE Part 1" exam administered by the Medical Council of Canada before they can apply for a residency.

Canadian medical graduates can do it after they've already secured a spot and, each year, about 5 per cent of them fail the exam but continue with their residency anyway, according to data from Pawliuk.

A shortage of space in med schools

Canada's residency placement rate compares poorly to what's been reported in other countries.

In the U.S., for example, 61.6 per cent of American-born or naturalized citizens who go to school abroad are matched with a residency position, according to data from the U.S. National Resident Matching Program.

Many medical students go abroad to train because there are very few medical school spots available in Canada.

Tens of thousands of pre-med students are competing for just 2,800 first-year openings at the country's 17 medical schools. Their acceptance rate is only about 5.5 per cent, according to university data.

Every year, about 1,000 would-be Canadian doctors go to school in countries like Australia and Ireland, where first-year spots are more plentiful.

Toronto-born Jake Portnoff is one of those students.

A pre-med graduate of Queen's University, Portnoff wasn't accepted at his Canadian medical school of choice — in part because there was a flood of applications after years of COVID-related deferrals.

He's now at the University of Queensland with about 100 other Canadian students who were also shut out of what he calls a "very competitive and daunting" Canadian medical school selection process.

Portnoff said most of the Canadian students there want to return home — they're just worried about a residency process that looks like an uphill battle.

"There are so many qualified and educated medical students who I believe really should be given a chance. The amount of residency seats available right now is just such a barrier. It's certainly hard to hear that many qualified Canadians are being turned aside in the face of what we're experiencing," he told CBC News.

"Increasing the amount of residency spots would be a huge benefit to Canadians, especially when the system there is in a crisis."

With some emergency departments closing due to staff shortages and a dearth of family doctors nationwide, Portnoff said it's obvious Canada needs to increase the number of residency spots on offer.

"We do all we can to promote the best health-care outcomes for our patients. That doesn't change, whether I'm in Australia or Canada. I'd take all my skills and clinical acumen home and all apply them in the Canadian system," he said.

Number of international residency applicants dwindling

Beyond adding more residency positions, Portnoff called for other creative solutions — such as an international exchange program so that students in Australia can go home to Canada to gain experience before diving into the cutthroat residency matching process.

Portnoff co-founded the Canadian-American-Australian Medical Student Association, an advocacy group designed to help students make the transition at time when word has gotten out that it's difficult to come back to Canada.

The number of international applicants to residency positions has fallen steadily from 2,219 in 2013 to 1,661 in 2022 — a drop of 25 per cent in just a decade.

Some foreign-trained doctors are giving up on Canada because the process is so difficult, Pawliuk said.

"If you tell people to stay away long enough, they will," she said.

That's an issue because Canada depends in part on foreign-trained doctors to fill the ranks of departing doctors.

Foreign-trained physicians historically account for about 25 per cent of all doctors, according to data from the Canadian Institute for Health Information.

In family medicine, nearly a third of all doctors have international medical degrees.

This week, the federal Liberal government announced an offer to the provinces of about $46 billion in new health-care spending.

In exchange for that cash, critics say Ottawa should demand that the provinces do more to streamline foreign-credential recognition. 

As part of his health-care plan, Conservative Leader Pierre Poilievre has pitched working the provinces to fast-track the process.

"It's outrageous that my little girl has to sit in the emergency room with a migraine for six hours because there's not enough doctors and nurses," he told reporters Wednesday after Trudeau unveiled his health-care plan.

"I think we should team up with the provinces to come up with a simple system that gives a 'yes' or a 'no.' It should happen within sixty days, not six or seven years."

The Royal College of Physicians and Surgeons of Canada oversees the accreditation of medical resident training in Canada for specialists.

In a statement, the Royal College said it considers residents who completed medical school outside of Canada to be "important contributors to a robust education environment and future health workforce," and it is currently considering some "alternate pathways" to streamline the system.

"I think five years from now, internationally trained physicians would be getting into the system within one or two years, regardless of their medical specialty, as opposed to five to seven years," said Glen Bandiera, executive director of standards and assessment at the Royal College.