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la marzocco

Canadian doctors trained overseas petition court to end 'system of exclusion'

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https://www.cbc.ca/news/canada/british-columbia/canadian-doctors-trained-overseas-petition-court-to-end-system-of-exclusion-1.4838439

The petitioners claim their charter right to leave Canada temporarily and to return to work and study has been violated.  They also cite equality rights and liberty rights, including the choices of where to reside, education and occupation.

"It never occurred to me or my parents when I left to study medicine in Poland that in Canada, Canadians would be denied the opportunity to compete for education or training," says Kostanski.

 

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21 hours ago, la marzocco said:

https://www.cbc.ca/news/canada/british-columbia/canadian-doctors-trained-overseas-petition-court-to-end-system-of-exclusion-1.4838439

The petitioners claim their charter right to leave Canada temporarily and to return to work and study has been violated.  They also cite equality rights and liberty rights, including the choices of where to reside, education and occupation.

"It never occurred to me or my parents when I left to study medicine in Poland that in Canada, Canadians would be denied the opportunity to compete for education or training," says Kostanski.

Saw this too.  A couple small thoughts - it seems as if the lawsuit is possibly trying to draw a distinction between CSA and immigrant-IMG in their petition ("right to leave .. and to return"), but I'm not sure if legally that could be or would be the case.  Historically it seems that IMG positions were originally created with the immigrant IMG in mind - but of course CSAs are eligible for those positions by virtue of being Canadian and having obtained a MD outside of US/Can.   When I read this, there's a jump  from "rights" to "apply to CaRMS".  I associate "right to return to work and study" and "liberty rights" as not being a strong enough to imply CaRMS  - i.e. separate questions since for example they clearly have no restriction on being able to return to Canada.  But constitutional arguments can be unexpected winners - it seems Ford was stopped momentarily in his city council downsizing b/c of a constitutional case (lost on appeal).

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4 hours ago, la marzocco said:

https://www.cbc.ca/news/canada/british-columbia/canadian-doctors-trained-overseas-petition-court-to-end-system-of-exclusion-1.4838439

The petitioners claim their charter right to leave Canada temporarily and to return to work and study has been violated.  They also cite equality rights and liberty rights, including the choices of where to reside, education and occupation.

"It never occurred to me or my parents when I left to study medicine in Poland that in Canada, Canadians would be denied the opportunity to compete for education or training," says Kostanski.

 

Should have done his research. Ignorance isn't always bliss.

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Also the other person who is the key person in the law suit, did a bogus MD in some ultra low tier school in the carribean. Not even one of the remotely good ones. And still couldn't find a spot in the US, so obviously their application was not strong at all. 

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How is a selection process exclusionary? Ah, the candidate has the right to demand entry! Immigrants to Canada who practiced Mediicine for years, who were educated and practiced as physicians in the former Soviet Union or elsewhere, cannot practice here, cannot simply enter a residency program, yet some dufus who was not qualified for entry into medical school here, expects as a right to be accepted into any residency program in Canada - just because he is Canadian! I don’t think so. He should be suing the pro I;iCal government that funds residency programs to demand funding. He had a choice to remain in Canada and to apply year sfter year to try to attain admission for entry to a Canadian medical school, but he found a shortcut and now wants equal access for entry at the next level. The winners here are his lawyers, big time, with the fees they will be paid for a losing process through each stage of appeal. Lawyers have to make a living too. Not all IMGs are a dufus for sure. They understood the risk they took to possibly becoming taxi drivers in Canada when they chose that route. 

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Kostanski's motivation for choosing Poznan was "mainly to connect to his roots and spend time with his grandfather", but I'm fairly certain that could have been accomplished without attending medical school there. That's what summer vacations are for. Bottom line, I don't think he understood the difference between CMGs and IMGs at the time he went abroad. He thought simply being a Canadian citizen would give him the same application status as a CMG, then discovered that wasn't the case, and then got outcompeted in the IMG pool.

His story is a cautionary tale for those considering the IMG route, and direct evidence against the notion that it's a shortcut, or somehow "easier". It's also a lesson about due diligence, and the need to be truly informed before going abroad. Lots of people know successful IMGs who matched and now work in Canada, but most simply don't see the other side, namely what happens when things don't work out.

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https://www.vancourier.com/2.2067/canadian-doctors-educated-abroad-file-suit-say-limits-on-training-in-b-c-unfair-1.23442538

 

Another article, names Harris falconer. Who is obviously not qualified. Sure he passed through a very low tier carribean school. Yet he didnt match any residency in the US, but somehow thinks hes qualified for Canada? His case would have been helped if he at least matched in the US.

 

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The legal perspective: 
"Health lawyer Lisa Feldstein noted discrimination in law can be permitted in some instances, but discrimination that violates the Charter or human rights codes is not allowed.

“There are examples where making decisions to treat groups differently may be lawful,” she said. “One thing I would note is the College of Physicians and Surgeons, in our model of self-regulated health professions, [is] actually there for the benefit of the public, not the physicians. Their duty is to solely protect the public interest — I think the college may fall back on its duty to the public.”

Feldstein said, if the petitioners are successful, she would expect the decision to be appealed, but added that CSAs in other provinces would likely follow suit."

https://www.thelawyersdaily.ca/articles/7468/discrimination-claimed-in-british-columbia-medical-residency-placements-

 

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20 hours ago, la marzocco said:

https://www.cbc.ca/news/canada/british-columbia/canadian-doctors-trained-overseas-petition-court-to-end-system-of-exclusion-1.4838439

The petitioners claim their charter right to leave Canada temporarily and to return to work and study has been violated.  They also cite equality rights and liberty rights, including the choices of where to reside, education and occupation.

"It never occurred to me or my parents when I left to study medicine in Poland that in Canada, Canadians would be denied the opportunity to compete for education or training," says Kostanski.

Let's assume for a moment that this argument has merit and the court will agree. Do these guys really think that competing directly with CMGs will be to their benefit? They will still be at an automatic disadvantage. I don't think many PDs or program committees will be interested in taking students from Polish Medical University NYD or No Name Brand Caribbean med school. If anything, this is likely to be a worse situation for IMGs - in fact, that's why the separate spots were created. 

All that aside, there is no right, Charter or otherwise, to leave Canada and return to work in a particular occupation or study in a particular field. Similarly there is no positive right to live in a certain location contingent on also gaining particular employment or admission to an educational program. Residencies are postgraduate education programs and a form of employment. It is entirely legal for educational institutions and provincial legislation to define criteria for admission to such programs. Certainly such criteria cannot include such things as ethnicity or language or gender but it seems that medical school of graduation is a fairly relevant criterion. 

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1 hour ago, A-Stark said:

Let's assume for a moment that this argument has merit and the court will agree. Do these guys really think that competing directly with CMGs will be to their benefit? They will still be at an automatic disadvantage. I don't think many PDs or program committees will be interested in taking students from Polish Medical University NYD or No Name Brand Caribbean med school. If anything, this is likely to be a worse situation for IMGs - in fact, that's why the separate spots were created. 

All that aside, there is no right, Charter or otherwise, to leave Canada and return to work in a particular occupation or study in a particular field. Similarly there is no positive right to live in a certain location contingent on also gaining particular employment or admission to an educational program. Residencies are postgraduate education programs and a form of employment. It is entirely legal for educational institutions and provincial legislation to define criteria for admission to such programs. Certainly such criteria cannot include such things as ethnicity or language or gender but it seems that medical school of graduation is a fairly relevant criterion. 

QC doesn't have separate streams and the number of matching IMGs, even at McGill (where language wouldn't be as much of an issue) is much lower than ON, suggesting that the parallel streams do increase the number of IMG matches.  

It's been previously speculated that familial influence could be more of an issue in resident selection for CSAs whose parents are prominent physicians.  I'm not sure that it would be any different than the current selection procedures for CMGs with such parents, though.  

A number of CaRMS programs do have language criteria, but I think they're within their rights to look for that kind of qualification in some cases (although there's not that much switching between the two official language groups from med school to residency).  

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14 hours ago, JohnGrisham said:

Also the other person who is the key person in the law suit, did a bogus MD in some ultra low tier school in the carribean. Not even one of the remotely good ones. And still couldn't find a spot in the US, so obviously their application was not strong at all. 

 

Agreed. That being said plenty of Canadians who study at reputable medical schools in Ireland, the UK or Australia for instance which are on par with Canadian/US quality of education do have difficulty returning sometimes and generally speaking don't match to many residencies outside of family med.

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We establish and fund residency positions for the same purpose that we train Canadians in Canadian undergraduate medical programs. They don't exist so that Canadian citizens and permanent residents having trained *anywhere* can obtain a Canadian residency. That IMG seats exist reflects provincial policies aimed at recruitment, generally for underserviced areas with ROS contracts attached. These are legitimate policy choices and I very much doubt the courts will take any of these "rights" claims seriously. 

Then again, I also thought that talk of using the Notwithstanding Clause for something as trivial as ensuring Toronto City Council has 25 not 47 members was unlikely...

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Nonsense. I have a lot more sympathy for actual IMGs - those who grew up in other countries and had little choice but to train there - than Canadians who decided to circumvent the system by going abroad. 

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5 hours ago, vino said:

 

Agreed. That being said plenty of Canadians who study at reputable medical schools in Ireland, the UK or Australia for instance which are on par with Canadian/US quality of education do have difficulty returning sometimes and generally speaking don't match to many residencies outside of family med.

RIght, but the key part is the ones who are competent generally dont have any difficulty getting a residency in the US. If you dual apply and do it properly, and still dont get anything in the US in rural nebraska, then you aren't likely to be anywhere near as competitive of an applicant as you think for Canada. 

Canada yes, is very difficult purely on a numbers game of minimal spots. US, not nearly as much if youre flexible with where youre willing to go.

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13 hours ago, JohnGrisham said:

RIght, but the key part is the ones who are competent generally dont have any difficulty getting a residency in the US. If you dual apply and do it properly, and still dont get anything in the US in rural nebraska, then you aren't likely to be anywhere near as competitive of an applicant as you think for Canada. 

Canada yes, is very difficult purely on a numbers game of minimal spots. US, not nearly as much if youre flexible with where youre willing to go.

 

That's fair enough but it's a tough spot to be in. The reality is individual circumstances really do play a key part to getting into a Canadian medical school. Not everyone can work, take care of their family, volunteer, do research and maintain a 3.8+. Even people who do have stellar grades sometimes get rejected. So going overseas after you've applied a certain number of years (let's say 3-4 years) is understandable in my view if you can't see yourself doing anything besides medicine. I agree with you though in the context of this news story. Going to an ultra low tier Caribbean school and not even matching in the US is maaajor red flag and at that rate competency to even practice medicine should really be considered.  Additionally for the guy who opted to go to a 6 year European medical program right away instead of even attempting to apply to Canadian programs...well if you don't do your research on the numbers and factors of going overseas, come back and face this dilemma, well I also have a hard time having much sympathy. There are no shortcuts into Canadian med.  However for people who had decent grades and attempted to get into medical school in Canada a few times, didn't make the cut and went to Ireland or Australia instead then that is a sad spot to be in, and going overseas is not a shortcut in that sense. And not everyone wants to go to the USA where it's easier for IMG's to get a residency. People want to be near their families, home, etc. The matching system is just a lottery and inefficient. Wasn't there a sad story of a Canadian medical grad from McMaster I believe who could not match for 3 years in a row and took his own life because of the impact that had on his mental health? I know that's not something very common for CMG's but it does happen and if that's not a sign that there is something seriously flawed with the system then I don't know what is.

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39 minutes ago, vino said:

 

That's fair enough but it's a tough spot to be in. The reality is individual circumstances really do play a key part to getting into a Canadian medical school. Not everyone can work, take care of their family, volunteer, do research and maintain a 3.8+. Even people who do have stellar grades sometimes get rejected. So going overseas after you've applied a certain number of years (let's say 3-4 years) is understandable in my view if you can't see yourself doing anything besides medicine. I agree with you though in the context of this news story. Going to an ultra low tier Caribbean school and not even matching in the US is maaajor red flag and at that rate competency to even practice medicine should really be considered Additionally for the guy who opted to go to a 6 year European medical program right away instead of even attempting to apply to Canadian programs...well if you don't do your research on the numbers and factors of going overseas, come back and face this dilemma, well I also have a hard time having much sympathy. There are no shortcuts into Canadian med.  However for people who had decent grades and attempted to get into medical school in Canada a few times, didn't make the cut and went to Ireland or Australia instead then that is a sad spot to be in, and going overseas is not a shortcut in that sense. And not everyone wants to go to the USA where it's easier for IMG's to get a residency. People want to be near their families, home, etc. The matching system is just a lottery and inefficient. Wasn't there a sad story of a Canadian medical grad from McMaster I believe who could not match for 3 years in a row and took his own life because of the impact that had on his mental health? I know that's not something very common for CMG's but it does happen and if that's not a sign that there is something seriously flawed with the system then I don't know what is.

Most of my posts only address the bolded.

As for "not wanting to go to the US where its easier for IMGs to get a residency" well, that again is a conscious choice, and if one chooses to opt against that, then you're making that choice(a very stupid one) and you should live with the consequences.  If you've already been away for 4-6 years abroad, whats another 3-5. If thats where you draw the line, then that person shouldn't have gone abroad in the first place.

None of this is new, being an IMG is tough, so people need to take ownership of their decisions. 

The matching system is not a lottery, and by definition it s not "inefficient" it is actually extremely efficient and noble prize material behind its origination.  I think you maybe meant that the process itself is perhaps less defined and vague in selection criteria. Hence why one should apply to the US where scores will nearly guarantee you something, somewhere.

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1 hour ago, JohnGrisham said:

Most of my posts only address the bolded.

As for "not wanting to go to the US where its easier for IMGs to get a residency" well, that again is a conscious choice, and if one chooses to opt against that, then you're making that choice(a very stupid one) and you should live with the consequences.  If you've already been away for 4-6 years abroad, whats another 3-5. If thats where you draw the line, then that person shouldn't have gone abroad in the first place.

None of this is new, being an IMG is tough, so people need to take ownership of their decisions. 

The matching system is not a lottery, and by definition it s not "inefficient" it is actually extremely efficient and noble prize material behind its origination.  I think you maybe meant that the process itself is perhaps less defined and vague in selection criteria. Hence why one should apply to the US where scores will nearly guarantee you something, somewhere.

 

Yes, less defined and vague in terms of selection criteria is probably a more accurate description. That being said, Canada has a doctor shortage. We should not be sending Canadian IMG's down to the USA when our own population needs care (notably First Nations) especially in rural areas. 

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4 minutes ago, vino said:

 

Yes, less defined and vague in terms of selection criteria is probably a more accurate description. That being said, Canada has a doctor shortage. We should not be sending Canadian IMG's down to the USA when our own population needs care (notably First Nations) especially in rural areas. 

Shortage doesn't matter unless you increase residency spots. In the current situation with no increase in residency spots, it is actually a GOOD thing that Canadian IMGs go train in the US in FM and other primary care specialties and then come back to Canada.   

In this conversation people often conflate multiple different seemingly related ideas.

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On 10/4/2018 at 1:18 PM, JohnGrisham said:

Shortage doesn't matter unless you increase residency spots. In the current situation with no increase in residency spots, it is actually a GOOD thing that Canadian IMGs go train in the US in FM and other primary care specialties and then come back to Canada.   

In this conversation people often conflate multiple different seemingly related ideas.

There should probably be an increase in residency spots then. Obviously that's easier said than done because of rampant bureaucracy and what not but having a person uproot their lives and be away from their families for years and years just because they did not have a good chance at home is not something I support.

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17 minutes ago, vino said:

There should probably be an increase in residency spots then. Obviously that's easier than done because of rampant bureaucracy and what not but having a person uproot their lives and be away from their families for years and years just because they did not have a good chance at home is not something I support.

? No one forced them to uproot their lives. They can keep re-applying and improve their applications like the rest of us.

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3 hours ago, JohnGrisham said:

? No one forced them to uproot their lives. They can keep re-applying and improve their applications like the rest of us.

 

That's not always realistic and you know that.  If you have a 3.4 cGPA for instance, it's unlikely you can compensate for it with EC's. And time is a factor too. People have life plans. After enough rejections soon enough you find yourself in your late 20's or whatever and that is irritating if someone wants to settle down and have kids by their mid 30's, etc. If you spend 5 or 6 years applying to Canadian schools with no luck but RCSI for instance, accepts you then that is probably your only chance of becoming a doctor. The mentality of "tough luck, that's life" or telling someone to "pick another career" is unfair to those whose life circumstances didn't enable them to solely focus on achieving academic excellence. 

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48 minutes ago, vino said:

 

That's not always realistic and you know that.  If you have a 3.4 cGPA for instance, it's unlikely you can compensate for it with EC's. And time is a factor too. People have life plans. After enough rejections soon enough you find yourself in your late 20's or whatever and that is irritating if someone wants to settle down and have kids by their mid 30's, etc. If you spend 5 or 6 years applying to Canadian schools with no luck but RCSI for instance, accepts you then that is probably your only chance of becoming a doctor. The mentality of "tough luck, that's life" or telling someone to "pick another career" is unfair to those whose life circumstances didn't enable them to solely focus on achieving academic excellence. 

 

It also is unrealistic to assume EVERYONE who wants to be a doctor should be able to become one. The nature of becoming one is in of itself a competitive process. This isn’t just for an MD alone, people go for multiple types of degrees and so you think they ALL get a job in their field? Definitely not. Even my second degree not everyone gets a student position, not everyone gets certified because of that or they fail. Not everyone gets a job POST certification, that’s just the nature of the job market. So just like that, not everyone who acquired an MD is entitled to work as one. It’s an unfortunate truth to the way society works. Sometimes people need to accept that one path for them is closed, but there are many others that can open. The things that help like OSAP, social housing, bursary’s, they are there to help people of lower income. And now we have multiple application streams to help marginalied populations , thensystem is slowly working to help those people. At some point people need to be accountable for their own actions too.

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Just now, IMislove said:

It also is unrealistic to assume EVERYONE who wants to be a doctor should be able to become one. The nature of becoming one is in of itself a competitive process. This isn’t just for an MD alone, people go for multiple types of degrees and so you think they ALL get a job in their field? Definitely not. Even my second degree not everyone gets a student position, not everyone gets certified because of that or they fail. Not everyone gets a job POST certification, that’s just the nature of the job market. So just like that, not everyone who acquired an MD is entitled to work as one. It’s an unfortunate truth to the way society works. Sometimes people need to accept that one path for them is closed, but there are many others that can open. The things that help like OSAP, social housing, bursary’s, they are there to help people of lower income. And now we have multiple application streams to help marginalied populations , thensystem is slowly working to help those people. At some point people need to be accountable for their own actions too.

I feel like if I told someone who took on $300,000 of debt, worked their asses off for 4-6 years and successfully completed an accredited, reputable medical program that they need to now accept one path for them is closed, I would be viewed as a condescending, elitist asshole. 

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1 hour ago, vino said:

I feel like if I told someone who took on $300,000 of debt, worked their asses off for 4-6 years and successfully completed an accredited, reputable medical program that they need to now accept one path for them is closed, I would be viewed as a condescending, elitist asshole. 

Reputable in what way?

 

I would not consider the Caribbean schools particularly reputable as they are first and foremost for profit institutions. Same with the European schools that profit exceptionally from accepting foreigners. 

 

I am not saying that students who matriculate from those schools couldn't make fine doctors, but the bar must be set exceptionally high for them.

 

Those students could also apply to the USA where there are loads more residency spots. This requires decent USMLE scores. If someone didn't get the scores for it, then that's on them.

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