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Do You Think The Licensure Process For Img's In Canada Is Fair ?


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Hey,

 

We all know that there is a shortage of doctors in Canada in most specialties. One of the short term solutions for this problem is the recruitment of IMG's into the system. However, when one looks into the licensure process for IMG's, it seems a little bit unfair. Foreign doctors have to start from scratch.

 

An IMG is required to take the MCC exams first where he/she are tested in all disciplines of medicine. They not only have to pass, but they have to excel in those exams to have a chance to compete for a residency position. Then they have to do residency all over again. If someone is say a neurosurgeon in his country of origin for more than 10 years, comes to Canada and wants to work as a neurosurgeon here. How is it reasonable that this person is required to excel in exams that cover all the disciplines of medicine ? Then do residency all over again (probably in family medicine not neurosurgery) in order to be able to practice in Canada. Wouldn't it be better if he had to pass an exam that assesses a candidates readiness to practice neurosurgery ? And if he passes the exam he should be allowed to work as a neurosurgeon directly ?

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I can't really comment on the IMG licensure process, since I am not personally familiar with the complex process.

 

I personally don't believe that there is a shortage of doctors in Canada in most subspecialties. Mostly in primary care in underserved areas, but the majority of CMGs intend to practice in urban areas after a few years of locum positions; and IMGs sign a return of service contract typically for 3-5 years. In Quebec, we don't ask IMGs to sign return of service contract. So the need for rural primary care physicians is alarmingly high. In a rural setting, you need a family physician, a general internist, a general surgeon (who can do emergency C&S), and you could keep a hospital running!

 

Knowing quite a few residents in surgical & IM subspecialties who switched to FM due to scarce job market in Canada, I think that the demand for physicians is there; but the government can't keep up with the public health care spending. I.E, can't afford more OR time, can't purchase more dialysis machines, CATH lab, etc. So it explains the ridiculously 1 year waiting list for knee replacement, even though a lot of ortho residents are worried about their future employment plight.

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First, as LittleDaisy says, we do not have a shortage of physicians in Canada in most specialties. Quite the opposite in some cases, especially in fields like Neurosurgery. We don't need more Neurosurgeons these days.

 

Second, the system you describe exists, just not for all IMGs. Training in certain countries, in many disciplines, is recognized by the Royal College or the CFPC and are eligible to write the licensing exams directly. These countries tend to be developed, English-speaking nations, so it's restrictive, but it does exist. Yes, they also have to take the general-knowledge exams for the MCC - where passing is the only requirement -  which is no doubt a pain. Yet, it's a pain we all have to go through. CMGs who are headed into specialized training have to write those as well, even though they'll probably never use much of that knowledge.

 

What about all the IMGs from non-approved jurisdictions who don't qualify for the above fast-track system? Well, in some provinces, they can still become certified through various pathways those provinces have set up. For example, Saskatchewan has set up a route for family physicians who do not qualify to write the CFPC exam to nevertheless get certified in Saskatchewan. These programs are starting to disappear, however, as the need for additional physicians in Canada shrinks, leaving IMGs with the main option of re-doing residency.

 

So, is this fair? Before getting to that question, I'd argue that for many IMGs in Canada, parts of the current system are necessary. Medicine is not the same everywhere. A physician moving from a place like India into Canada will be moving into an environment with a different system of practice, different legal requirements, different standards, different cultures, different technologies, even different diseases. They might be qualified to practice in their home country, but that does not make them qualified here. Some checks are necessary, beyond a simple evaluation of knowledge restricted to their specialty. Undergoing the same basic licensing exams as Canadian-trained physicians seems appropriate, even if the ultimate value of those exams is questionable, and some period of supervised practice I believe to be essential. In medicine, it's easy to be unaware of what you don't know and once independent practice starts, supervision is minimal. I don't think this necessarily has to be a full residency, but given the variability in IMG practice-readiness and the difficulty setting up new, robust training systems, there's some logic to requiring a full residency. There are definitely some countries with training, cultures, and health care systems close enough to that of Canada's that arguably could be included on the fast-track certification system (eg Scandinavian countries), but this wouldn't help most IMGs in Canada.

 

Alright, so is the system fair? Not really, no. Canada does a terrible bait-and-switch with foreign-trained physicians. Our immigration system encourages them to move to Canada with the promise of being able to practice, then our medical licensing system throws up a number of hurdles to doing so. The hurdles get blamed as being unfair, but they're largely a result of the need to provide protections for Canadian patients, an oversupply of uncertified IMGs, and the lack of pressing demand for more physicians overall. Therefore, I think the fault lies with the immigration system that over-promised the ability to practice in the first place.

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There actually is a short cut as I understand it - if you come over to Canada and do 4 years of fellowships at one institution in your area you can apply to write the exam for that field. Sure you have to write general knowledge exams as you point out but all Canadian doctors do - including those that already know perfectly well the knowledge required for that test doesn't apply to them (although for sure the actual score on those exams doesn't matter as much to us).  Let us all share in the joy of learning a psych examination for a radiologist to be :) At least it ensures a knowledge base.

 

Plus I think LIttleDaisy is right - since we doubled out enrollment in medical school we aren't running into the same doctor shortages as before. In many fields it is the other way around. IN some places we may need more doctors in some areas we cannot afford to actually have, which adds an awkward spin to things for the government. 

 

The ugly not talked about part of this is if there was some easier process as well then Canada - a very small country on the world level but one with excellent income for doctors - would be overwhelmed immediately with licensed doctors from everywhere else, as there are  ton of people qualified for many fields that could work here (ok, neurosurgery is pretty high end, but what about even family medicine - there are millions literally that could even if it required more study qualify under that). Part of our medical associations would oppose that for obviously reasons (just like every other union or association would - we could make all of these arguments about having a teachers license I would think as an example). 

 

One big argument I suppose is the exam simply isn't enough - you can know the book knowledge cold, but actually doing it is a skill that requires more than that. You have to see some one in action for quite some time to be sure they are skilled (to go back to your neurosurgery example - there is no test anyone that could write that would convince me on that test alone they could operate on people. I want them to spend a long time with a Canadian licensed neurosurgeon watching them NOT kill people to make sure they are skilled). 

 

Interesting this goes both ways as well. I cannot practice in the vast majority of the world as a radiologist despite passing my exams (hopefully, gah here comes year five) . Since I am actually a British citizen as well that is actually a bit disappointing in a sense (prior to the mess over there it would if true a gateway to the entire EU for me. That is a lot of freedom to locum ha). Why would any country allow trainees coming in from one direction when your cannot go the other way?

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First, as LittleDaisy says, we do not have a shortage of physicians in Canada in most specialties. Quite the opposite in some cases, especially in fields like Neurosurgery. We don't need more Neurosurgeons these days.

 

Second, the system you describe exists, just not for all IMGs. Training in certain countries, in many disciplines, is recognized by the Royal College or the CFPC and are eligible to write the licensing exams directly. These countries tend to be developed, English-speaking nations, so it's restrictive, but it does exist. Yes, they also have to take the general-knowledge exams for the MCC - where passing is the only requirement -  which is no doubt a pain. Yet, it's a pain we all have to go through. CMGs who are headed into specialized training have to write those as well, even though they'll probably never use much of that knowledge.

 

What about all the IMGs from non-approved jurisdictions who don't qualify for the above fast-track system? Well, in some provinces, they can still become certified through various pathways those provinces have set up. For example, Saskatchewan has set up a route for family physicians who do not qualify to write the CFPC exam to nevertheless get certified in Saskatchewan. These programs are starting to disappear, however, as the need for additional physicians in Canada shrinks, leaving IMGs with the main option of re-doing residency.

 

So, is this fair? Before getting to that question, I'd argue that for many IMGs in Canada, parts of the current system are necessary. Medicine is not the same everywhere. A physician moving from a place like India into Canada will be moving into an environment with a different system of practice, different legal requirements, different standards, different cultures, different technologies, even different diseases. They might be qualified to practice in their home country, but that does not make them qualified here. Some checks are necessary, beyond a simple evaluation of knowledge restricted to their specialty. Undergoing the same basic licensing exams as Canadian-trained physicians seems appropriate, even if the ultimate value of those exams is questionable, and some period of supervised practice I believe to be essential. In medicine, it's easy to be unaware of what you don't know and once independent practice starts, supervision is minimal. I don't think this necessarily has to be a full residency, but given the variability in IMG practice-readiness and the difficulty setting up new, robust training systems, there's some logic to requiring a full residency. There are definitely some countries with training, cultures, and health care systems close enough to that of Canada's that arguably could be included on the fast-track certification system (eg Scandinavian countries), but this wouldn't help most IMGs in Canada.

 

Alright, so is the system fair? Not really, no. Canada does a terrible bait-and-switch with foreign-trained physicians. Our immigration system encourages them to move to Canada with the promise of being able to practice, then our medical licensing system throws up a number of hurdles to doing so. The hurdles get blamed as being unfair, but they're largely a result of the need to provide protections for Canadian patients, an oversupply of uncertified IMGs, and the lack of pressing demand for more physicians overall. Therefore, I think the fault lies with the immigration system that over-promised the ability to practice in the first place.

 

This part I completely agree with. Immigrating under false promises is just wrong. We need to be upfront about someone's chances immediately. 

 

I suspect Canada likes immigrant doctors even if they cannot practice. They are smart, often come over with more money than most, educated and they have educated children (statistically speaking)....... That is all great but we STILL shouldn't take someone if we are not complete honest about it. 

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I have talked to some IMG's and the biggest problem they face is passing the MCC exams. Someone who is 35, has a wife and 2 kids simply doesn't have the physical or mental capability to start studying everything from scratch nor find the time for it.  It's like telling someone in PGY7 that they have to do the MCAT again !

 

CMG's do have to pass the MCC exams, but they do it right after medical school when their knowledge is still fresh and typically spend less than a month brushing up on the most common topics because all they need to do is simply pass.

 

The end result is a disappointed ex-neurosurgeon who is working as a taxi driver because he couldn't remember the diagnostic criteria of SLE or how to manage bronchial asthma. And the problem is once an IMG passes the MCC exams he can't take them again to improve his score. So basically they are stuck for the rest of their lives.

 

I just think if someone is good enough to pass the Royal College exams in his/her specialty then they should be able to practice directly. It is reasonable to say that they should be also required to pass a language test and perhaps have a course on how the Canadian medical system works. But to start all over, it is just impossible.

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I did an ACLS course with a fully certified IMG internist. It was beyond terrifying. He was a lovely man but was honestly at the level of a clerk (like, a first rotation clerk). There needs to be a be a basic level of knowledge required. Even neurosurgeons should, as you mention, know the very basic management of common conditions. As for the diagnostic criteria of SLE, I'm not sure where you are in training, but that certainly wasn't on the MCC.

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I did an ACLS course with a fully certified IMG internist. It was beyond terrifying. He was a lovely man but was honestly at the level of a clerk (like, a first rotation clerk). There needs to be a be a basic level of knowledge required. Even neurosurgeons should, as you mention, know the very basic management of common conditions. As for the diagnostic criteria of SLE, I'm not sure where you are in training, but that certainly wasn't on the MCC.

Fully certified from Canada ?

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I have talked to some IMG's and the biggest problem they face is passing the MCC exams. Someone who is 35, has a wife and 2 kids simply doesn't have the physical or mental capability to start studying everything from scratch nor find the time for it.  It's like telling someone in PGY7 that they have to do the MCAT again !

 

CMG's do have to pass the MCC exams, but they do it right after medical school when their knowledge is still fresh and typically spend less than a month brushing up on the most common topics because all they need to do is simply pass.

 

The end result is a disappointed ex-neurosurgeon who is working as a taxi driver because he couldn't remember the diagnostic criteria of SLE or how to manage bronchial asthma. And the problem is once an IMG passes the MCC exams he can't take them again to improve his score. So basically they are stuck for the rest of their lives.

 

I just think if someone is good enough to pass the Royal College exams in his/her specialty then they should be able to practice directly. It is reasonable to say that they should be also required to pass a language test and perhaps have a course on how the Canadian medical system works. But to start all over, it is just impossible.

 

Presumably, any qualified physician won't have to learn the MCC material from scratch, as they should have already learned much if not all of it before. The part that IMGs likely don't have prior knowledge of concerns how the Canadian medical system works, which as you say, is fair to test them on. Regardless, an IMG will have to do some studying, but shouldn't have to start from scratch. If they are starting from scratch, there are bigger problems.

 

There are definitely some topics on the MCC exams that are not relevant for all writers. That's true of CMGs as well. But I think it's important to distinguish between problems with the test itself and problems with the requirement to write it. IMGs should be able to demonstrate ability up to the same level as CMGs, and CMGs have to write the MCCQEs, even the parts that have no real bearing on their future practice. Especially with Part 2 of the MCCQE, it's not uncommon for CMGs to be evaluated on topics they haven't looked at in years. And while the MCC exams are far from perfect evaluations - that I will fully agree on - they do at least test clinical knowledge. It's not quite like the MCAT or the USMLE step one, testing arcane knowledge of biochemical processes, or obtuse specifics of physiology. There is a degree of relevance here. I'd be a little concerned with a Neurosurgeon who couldn't recognize SLE, given that it often has neurological manifestations. I also think it's worth keeping in mind that the areas who could potentially use IMGs, and for where there are some residency spots, are in generalist specialties, particularly Family Medicine, where that broad, generalist knowledge on the MCCQE is most useful.

 

I completely agree that the need to score highly on the MCC to obtain one of a limited number of residency spots, and being unable to rewrite the exam to get a better score, shows how the process we have in place unfairly limits IMGs. However, that's a direct consequence of the over-abundance of IMGs in Canada. The reason residency programs insist on those high scores is because they have to stratify a large number of applicants quickly and that's an easy way to do it. The MCC gets blamed as the proximal choke-point to practicing for IMGs, but if it were gone, the next choke-point would arise quickly. No MCC means residency is the next choke-point. Remove the requirement for residency and the job market becomes the next barrier. To pick up on your example, if we implemented the exact system you're proposing, that Neurosurgeon would still be working as a taxi driver because there's virtually no jobs for Neurosurgeons in Canada and no one is going to hire an IMG with zero Canadian clinical experience ahead of the dozens of underemployed, over-qualified Canadian-trained Neurosurgeons.

 

Again, I will fully disagree that passing the Royal College or CFPC exam is sufficient to certify a physician to work in Canada, unless they are from a very similar country to Canada. That's an insufficient safeguard for the patients those physicians would treat, and is an unnecessary risk to take given the current state of physician supply relative to demand for their work.

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I have talked to some IMG's and the biggest problem they face is passing the MCC exams. Someone who is 35, has a wife and 2 kids simply doesn't have the physical or mental capability to start studying everything from scratch nor find the time for it.  It's like telling someone in PGY7 that they have to do the MCAT again !

 

I just took the MCC as a 3rd year medical student, and with a basic understanding of medical foundation, 4-6 weeks of part-time study is perfectly adequate to do well on the exam. I don't believe there are neurosurgeons driving taxis because they cannot pass the MCC unless they have some core deficiencies elsewhere.

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Presumably, any qualified physician won't have to learn the MCC material from scratch, as they should have already learned much if not all of it before. The part that IMGs likely don't have prior knowledge of concerns how the Canadian medical system works, which as you say, is fair to test them on. Regardless, an IMG will have to do some studying, but shouldn't have to start from scratch. If they are starting from scratch, there are bigger problems.

 

 

I just took the MCC as a 3rd year medical student, and with a basic understanding of medical foundation, 4-6 weeks of part-time study is perfectly adequate to do well on the exam. I don't believe there are neurosurgeons driving taxis because they cannot pass the MCC unless they have some core deficiencies elsewhere.

I think the whole situation is unfortunately a moot point since neurosurgery in particular given the inherent risks and the possible over-supply of Canadian-trained neurosurgeons, there's no reason to even really strongly consider IMGs.  

 

But, to be fair to the OP - supposing this weren't the case, selecting IMGs based on MCC scores seems to be missing part of the picture.  A fully-trained and practicing IMG would be bringing a different set of skills than someone finishing medical school - the latter who which would likely have an advantage on a more general test.  Maybe this is partly why in practice CSAs tend to do much better in the IMG-specific  matches (not to mention other cultural and linguistic differences).  

 

The problem then becomes sufficient similarity to Canadian training, which seems like it could be a grey area.  

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I just took the MCC as a 3rd year medical student, and with a basic understanding of medical foundation, 4-6 weeks of part-time study is perfectly adequate to do well on the exam. I don't believe there are neurosurgeons driving taxis because they cannot pass the MCC unless they have some core deficiencies elsewhere.

 

I get there are family pressures - and easy is always a relative term. Yet there are many, many 35 year olds studying for their royal college exams learning vastly more material (and if in family medicine learning the same material in more detail than MCC) often with families etc as well. Thus I am surprised they view it as a barrier like that - maybe I am missing something.  

 

If it is I think then we should probably encourage having the test written before coming here. Having more support in the home country (in many but not all cases) may make it easier. 

 

The fellows I know doing the 4 years route of fellowships here have to study for the US USMLE all parts and ABR exams during their fellowships, and all of them have families etc that I know. They made it work for a relatively small sample size of 4-5 :)

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Physicians who have practiced outside of North America receive varied training. And even on a current practice level, if you look through any clinical practice guidelines and compare European vs. American vs. Canadian practice guidelines, and you are BOUND to find differences. Differences in level of recommendation, differences in adjudication of grade of evidence. 

So, I actually do think the medical-licensing standards and training is fair.
 

I understand that IMG's tend to be older and have developed other priorities in their lives, but truly, would you care that your physician has a wife and children? I don't. And if family was the reason they couldn't score high on the MCC, which is considered fundamental knowledge and skills of a physician in Canada, I have high suspicions of their ability to be self-directed learners and stay up-to-date in their future practice.

If I had a family member requiring surgery (as I currently do) I want to know and have confidence that my surgeon has been through the ringer and succeeded in every check and balances of physician training.

From a personal experience working in the OR and on the ward, I've worked with fellows from Saudi who were great, sharp as nails. I also worked with fellows who everyone had genuine concern letting them take care of patients. So for those fellows who are ready to be independent attendings, I sympathize with their frustration. But for those fellows who everyone double checks their work, I am really glad that such a rigorous process is in place.

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The fellows I know doing the 4 years route of fellowships here have to study for the US USMLE all parts and ABR exams during their fellowships, and all of them have families etc that I know. They made it work for a relatively small sample size of 4-5 :)

 

 The fellowship route seems to be fairest to all parties involved (especially possible future patients and incoming IMGs with advanced skills).  

 

Initial clarity with IMGs I think is imperative (ethically and practically speaking).  I think that IMGs that wish to immigrate to Canada, should still possibly be advantaged for immigration but be informed of their actual chances of succeeding and gaining licensure to practice.  

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 The fellowship route seems to be fairest to all parties involved (especially possible future patients and incoming IMGs with advanced skills).  

 

Initial clarity with IMGs I think is imperative (ethically and practically speaking).  I think that IMGs that wish to immigrate to Canada, should still possibly be advantaged for immigration but be informed of their actual chances of succeeding and gaining licensure to practice.  

 

I completely agree with this. There should be very transparent and mutual agreement regarding the immigrant IMG's between the medical licensing board and the ministry.

 

I also think a bigger ethical problem that complicates the IMG positions and IMG applicants is the differentiation of CSA's (Canadians Studying Abroad) and immigrant IMG's and how they all fight for the smaller portion of IMG positions.

 

CSA's have an easier time than immigrant IMG's when it comes to securing the select number of IMG positions available. I'm not going to get into whether it's fair or not, because this the reality regardless of what the general consensus is. 

 

I think that it is really important for the government to define who these IMG positions are really for and make it clear to both CSA's and immigrant IMG's. If it actually is for CSA's then they should make it clear that these X number of positions are for CSA's, and the remaining is for immigrant IMG's. What we shouldn't do is say, "hey we have X number of IMG's positions that immigrant IMG's can compete for" when in actuality a majority of those positions go to CSA's.

 

Canadians Studying Abroad and Immigrant IMGs

  • Of the matched group of IMGs across Canada, the percentage of positions matched to CSAs rose from 26.9% in 2008 to 47.9% in 2011. The percentage matched to immigrant IMGs dropped from 73.1% in 2008 to 52.1% in 2011.

    Source: CaRMS National Match Results for Active IMGs, 2008-2011

  • In 2011, CSAs represented approximately 1/4 of the IMG applicants and obtained just over 1/2 of the first-year residency positions filled by IMGs at the Ontario faculties of medicine

    Source: CaRMS Data Tables, 2011 Main Residency Match (R-1) 

Full report: http://www.health.gov.on.ca/en/common/ministry/publications/reports/thomson/v1_thomson.pdf

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But, to be fair to the OP - supposing this weren't the case, selecting IMGs based on MCC scores seems to be missing part of the picture.  A fully-trained and practicing IMG would be bringing a different set of skills than someone finishing medical school - the latter who which would likely have an advantage on a more general test.  Maybe this is partly why in practice CSAs tend to do much better in the IMG-specific  matches (not to mention other cultural and linguistic differences).  

 

No arguments on that point, though it begs the question as to why we're training medical students and testing them to have a set of knowledge and skills that aren't required to be an attending physician. Kinda gets to what I was trying to touch on, that the problem with IMGs writing the MCC is the MCC itself, not the requirement to write it, and that the problematic parts of the MCC apply to everyone, not just IMGs. I don't doubt this affects experienced physicians more than fresh graduates when writing the MCC, but the preference for more recent grads goes a lot deeper, and is a lot more explicit, than biases in MCC performance. For example, Ontario FM programs which do their interviews together and represent the largest block of IMG spots in the country, often screen applicants based on year of graduation alone.

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Even though many doctors become specialized, they still require, or at least benefit from, a basic working knowledge of general medicine. That's why generalist knowledge is tested on the MCC, as well as all 3 steps of the USMLE. A good general knowledge is a bellwether of the quality of your overall medical education. That's why the results of these exams are taken seriously by those who make admission decisions for IMGs. Yes, it's easier for new grads, however, the material tested should not be beyond the ability of an "experienced" physician. For those who do struggle, the chances are high that their basic medical training was not up to Canadian standards to begin with.

 

The seeming preference for fresh graduates is likely based on several reasons, most of which should be self-evident. Not only are these individuals usually younger (and therefore likely to have longer careers), but the blank slate is also easier to mold. A physician who has already completed their residency training, +/- several years of practice outside Canada, will be more difficult to re-train, because this person has likely developed attitudes, habits and tendencies, some or many of which may not necessarily be consistent with how medicine is usually practiced in this country. This person is also usually older, with a family and responsibilities that's not typical for most incoming residents. Lastly, as expected, those more recently graduated also have a better chance of getting through the standardized exams with less difficulty.

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 The fellowship route seems to be fairest to all parties involved (especially possible future patients and incoming IMGs with advanced skills).  

 

Initial clarity with IMGs I think is imperative (ethically and practically speaking).  I think that IMGs that wish to immigrate to Canada, should still possibly be advantaged for immigration but be informed of their actual chances of succeeding and gaining licensure to practice.  

 

and to be clear while you would not be staff for at least 4 years you are earning a fellows income, which is not an low sum of money (particular compared to say a taxi driver which was the comparison job someone mentioned). It is also time spent specifically in the area of interest of the trainee. 

 

I really don't think a single test along that grants someone to work as a physician for the rest of their life in a particular area is enough regardless of where they came from. This is a master apprentice style training system for a reason. Somethings just cannot tested well in a 3 hour exam. 

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None of this is new. Those who immigrate should know the risks of being unlicensed and never practicing again. It has been decades like this. I know extended family who understand it but choose to immigrate anyways because being a health care professional makes it easier to gain PR and then they have a better quality of life for their family and children, even if they never practice as a doctor again.

 

If youre smart enough to be a specialized doctor in your home country, your smart enough to realize that immigration is not tied to professional licensure. Those that dont realize this, well that is unfortunate but they can choose to stay (and still likely have a better quality of life overall) or return to their home countries and continue practicing.

 

Many of my small group tutors have been just that - FMGs who never got relicensed. Some may eventually but most dont and find new means of income.

 

As to fair? Doesn't have an answer. Every country does the same thing. There's a reason people want to immigrate from a developing nation to a developed nation. $$$$$$

 

You can let in easily 1000 FM docs right now but then where is all the money coming to pay them? We can triple the amount of family docs in Canada, but then you'd have to cut the pay drastically to have the same net sum of healthcare dollars.. Sure the CMA would love that.

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None of this is new. Those who immigrate should know the risks of being unlicensed and never practicing again. It has been decades like this. I know extended family who understand it but choose to immigrate anyways because being a health care professional makes it easier to gain PR and then they have a better quality of life for their family and children, even if they never practice as a doctor again.

 

If youre smart enough to be a specialized doctor in your home country, your smart enough to realize that immigration is not tied to professional licensure. Those that dont realize this, well that is unfortunate but they can choose to stay (and still likely have a better quality of life overall) or return to their home countries and continue practicing.

 

I beg to differ for a few reasons.  

 

Just because it's always been like that, doesn't mean it's "right".  While although your extended family made an informed decision to immigrate despite knowing the low chances of gaining licensure, it's not necessarily the case for every IMG.

 

 In fact, in a fairly recent UofT study regarding immigrant IMGs, a " substantial number of respondents reported feeling that they were misinformed as to their actual chances of obtaining a residency position in Canada".  Moreover, "Many reported regretting their decision to migrate to Canada".  

 

Finally, things have changed.  In the "1960s and early 1970s, Canada licensed more IMGs than it graduated physicians domestically" (source).  And more recently CSAs have begun competing for  IMG positions, meaning that immigrant IMGs stand an even smaller chance of getting licensed.  

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CSAs have been competing for IMG spots for the last decade.

 

Again, none of this is new, the data KS freely available. I agree it should be even more clear regarding immigration being a seperate process. But at the end of the day it is still on the individual to do their research.

 

If you spend even 10 minutes you'd know enough. I imagine most people spend weeks or months doing research on their big move.

 

BUT as long as there is even a small chance, people will think "it will be me" and make their decision to immigrate.

 

Again, literally nothing is new nor has changed for the last 15 years at the very minimum.

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Also, I didn't say it was "right". Far from it, but it is what it is.

 

Find me a country that is better by an objective measure and I'll give you credit. But youll be hardpressed. Most either say " stay away, we dont want you" or are even more convoluted.

 

Canada is in the top echelon for immigration practices. It is not perfect, not even close- but it is far better than the vast majority.

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CSAs have been competing for IMG spots for the last decade.

 

Again, none of this is new, the data KS freely available. I agree it should be even more clear regarding immigration being a seperate process. But at the end of the day it is still on the individual to do their research.

 

If you spend even 10 minutes you'd know enough. I imagine most people spend weeks or months doing research on their big move.

 

BUT as long as there is even a small chance, people will think "it will be me" and make their decision to immigrate.

 

Again, literally nothing is new nor has changed for the last 15 years at the very minimum.

 

I think this is being just a little dismissive of the experiences of an IMG.  A testimonial - from the link above:

 

"Just feel pity for those who still will migrate to Canada and make the same mistake as we have. This is bad karma for Canada – so many families are destroyed by this country, so many people gave up their last hopes there. Lie is the basis for this emigration. Canada should make it very clear – doctors are not welcome here, unless you change your profession. [Male, aged 40–49 years]"

 

And the overall result "Respondents overwhelmingly held the view that there are not enough residency positions available in Ontario and that this information is not clearly communicated to incoming IMGs."

 

The sampling was based on 400+ IMG doctors in Ontario - clearly it might not be completely representative, but it suggests at the minimum that the IMGs physicians are not getting or finding the appropriate information.  

 

And even within the framework of the past decade things have changed, not to mention the last few decades (as your initial assertion).

 

Also, I didn't say it was "right". Far from it, but it is what it is.

 

Find me a country that is better by an objective measure and I'll give you credit. But youll be hardpressed. Most either say " stay away, we dont want you" or are even more convoluted.

 

Canada is in the top echelon for immigration practices. It is not perfect, not even close- but it is far better than the vast majority.

 

While you didn't say it was "right", you appeared to give justification for the state of affairs - a sort of "caveat emptor" with regards to immigration.  Relativism to me isn't a good argument - if Canada is in the top echelon, it could be far and away the best, an exemplary model.

 

Here's an example where there's an obvious deficiency, and at the minimum, a relatively simple fix of greater information could really make a difference in many people's lives and choices.      

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To us it may seem obvious that the rules are very restrictive. It may seem equally obvious that educated intelligent people should be able to figure all this out prior to coming, particularly now with the internet resources and the large body of people that have come before. I would say that is probably true in the strict sense of things. 

 

yet, I continue to encounter just a large number of people coming over as doctors in there home country not adequately made aware of things. So something is going off the rails.

 

Part of it I think it like the average premed - that despite all of this information out there very often doesn't know the rules until late in the game. That doesn't make sense either but it happens all the time to educated people as well (otherwise this very forum would not exist, and I wouldn't keep running into it at every university I give a talk to). We have forums, we have webpages, we have med students.... Still a ton of misinformation. 

 

Part of it is there is an aggressive immigration plan to recruit a lot of professionals that actually cannot use their skills here. Don't think it is restricted to medicine. It is actually very much so more common in engineering. Some of this is because immigration is a federal responsibility, and education is provincial (so is health care for that matter). I ran into this as well prior in my life as a software engineer. On paper these highly educated people are what the government wants, so it is what our civil servants recruit actively (which is kind of silly as we are short a ton of trades that are much easier to transfer over, have shorter retraining if needed, and something we cannot seem to attract enough interest in here.)

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That research study is great and all, but for every angry FMG who was unable to practice - there are many who are satisfied they were able to immigrate at all and gain Canadian citizenship for themselves and their families based on their medical training. Yes they can't practice medicine, but they can give a better life for their kids and future generations. There are millions of others who would kill to do the same, but don't have any education or qualifications to ride their backs on to a 1st world country citizenship. Yet many people with simple MBBS(which in many foreign countries, is much different and less restrictive in terms of academics - and sometimes even corrupt, i.e. you are from a well off family in India and you can pay your way into a seat), can get a huge leg up on immigration into Canada.  

So my point is, not all IMGs/FMGs are of the same opinion. In fact, im sure many who follow the path outlined above - would hate to lose this option, should the immigration system decide to smarten up and tie immigration to medical licensure availability, and tighten up/decrease the number of foreign doctors they allow in. In fact, why would you even allow in so many, if you know they can't practice? The rationale maybe is that because they are educated, perhaps they will then go towards other related professions and "settle" for something less, and thus be overqualified but easy to adapt and gain proficiency.  The next time you see your dental hygenist who's foreign for example, check to see if they were a dentist in their home country. This is VERY common - dentist back home, can't pass exams and/or get licensed here, so retrain in a shorter dental hygeine program. Still end up making very good money in a short amount of time, and have a far better quality of life compared to back home perhaps -if not for the long term prospect of their offspring being Canadian and the enormous potential opportunities.

I'll stand by the assertion that its on the individual to make sure they do their research. It's what expected of us here, and its no different for us should we want to go abroad, and in fact far worse.  There is ZERO reason during this digital age, with by far more information then ever before on the topic, for ANYONE to be entering Canada without understanding the situation and climate. But 100s-1000's still do, because they cling onto that "well only 5-10% make it, may as well be me. And that is their right and I'll defend that choice, based on the framework of immigration allowing them in.  

 

Anyways, just wanted to throw the counterpoint, as people seem to want to constantly berate Canada and its immigration.
 

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