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Canadian Physician Statistics - 2016

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8 minutes ago, goleafsgochris said:

The standout for me tbh is that seems like too many IMGs. Also that family physician salary is not great considering overhead.

I agree.. this seems very high.

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Its not that much of a surprise, if you look at it, Canada recruited boatloads of British, South African and Australian physicians in the past. Even now, academic centers regularly hire international candidates that have done a fellowship here over locally trained Canadians because they like them better. We are competing on a global market whether we like it or not. 

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IMGs play a larger role in the system than most people realize, and the figures given here aren't that surprising. In the US, they make up a similar proportion - about 26% of the total physician population. Today, just by numbers alone, it would be a bit unusual if a doctor didn't have any colleagues that are international grads. 

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US has surplus residency spots that it partly uses IMGs to fill, which accounts for some of their numbers.  

In Canada, there's at least four sources:  the historical recruiting of physicians (commonwealth - England, S.A., etc..), IMG entry into CaRMS, Canadian-born IMGs returning after US or other residency, and some academic physicians.  There's probably about 1000 Canadian-born IMGs graduating every year - the ones that make into the US on J-1 visa have to come back to Canada (some rare exceptions), and most of them want to come back anyway.

When health Canada published the number of SONs for J-1 visas it was issuing, the number was at least around 500/yr (size of 2 to 3 med schools).  When you add the 350 dedicated IMG quota positions, that's already a substantial number - and simplifying things works out to be 500+350=850/(3000 [CMG quota] + 850), which gives at least about 22% IMGs/yr in Canadian workforce.  

So for a year to year basis, that IMG proportion should hold fairly steady (could increase with SON J-1 restrictions lifted).  There's going to be some loss through US waivers, but not much.  Only 9 CMGs matched to the US in 2018, so they don't account for a substantial proportion of the SONs being issued.

It does mean that governments don't have to rely on Canadian trained physicians as much (and are less beholden to them) and it's another way try to bring down unit labor costs (increased supply -> new supply/demand equilibrium and many IMGs have to do RoS -> less negotiating power).  Also it saves governments from spending money on training CMGs - basically "outsources" medical education to IMG schools and to US residency programs.  

Here's a graphic showing the number of CSAs applying to CaRMS by year (up to 2014).   Many will also be trying to match into the US - accounting for that at least 500 year J-1s being issued, who will almost all ultimately come back to Canada.  

Edit: In 2017, Health Canada issued 519 SONs for J-1s (including 5 for Canadian CMGs).
 

resized_CSA.jpg.149a060c40df2c10d80092984714a02f.jpg

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4 hours ago, goleafsgochris said:

The standout for me tbh is that seems like too many IMGs. Also that family physician salary is not great considering overhead.

Well, traditionally most of those are GPs from South africa, UK, Ireland and Australia that have come over. 

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On November 9, 2018 at 1:00 AM, JohnGrisham said:

Well, traditionally most of those are GPs from South africa, UK, Ireland and Australia that have come over. 

In the next 5-10 years, I think there's going to be a IMG "wave" as more CSAs-IMGs finish US residencies and come back to Canada.  Canadian MD education is being outsourced to IMG schools and US residencies.   In 2017, there were 519 SONs issued for J-1s by Health Canada - and the graphic above shows that the number of CSAs has been growing strongly since 2008.  I think most will be in primary care (FM especially)  even though some will stay in the US using J-1 waivers.

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On 11/10/2018 at 10:08 AM, tere said:

In the next 5-10 years, I think there's going to be a IMG "wave" as more CSAs-IMGs finish US residencies and come back to Canada.  Canadian MD education is being outsourced to IMG schools and US residencies.   In 2017, there were 519 SONs issued for J-1s by Health Canada - and the graphic above shows that the number of CSAs has been growing strongly since 2008.  I think most will be in primary care (FM especially)  even though some will stay in the US using J-1 waivers.

Is it pretty easy to come back to practice in Canada after completing a US residency?

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14 minutes ago, JohnGrisham said:

Specialty dependent, but takes a few extra steps and its doable for most things. Trouble is finding a job if you're super specialized and/or picky on region.

So is all the fuss with IMGs mainly those who want to be super specialized in Canada? Because there seems to be a lot of lobbying for IMGs to have more access to Canadian residencies, but if they just did a US residency it sounds like they could still end up in Canada. It's a bit more time away, but seems better then doing an ROS here...

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3 minutes ago, jfdes said:

So is all the fuss with IMGs mainly those who want to be super specialized in Canada? Because there seems to be a lot of lobbying for IMGs to have more access to Canadian residencies, but if they just did a US residency it sounds like they could still end up in Canada. It's a bit more time away, but seems better then doing an ROS here...

The main issues they have are exactly that, being away from Canada for even longer, and having to do the numerous extra steps necessary for US residencies etc etc

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2 hours ago, jfdes said:

So is all the fuss with IMGs mainly those who want to be super specialized in Canada? Because there seems to be a lot of lobbying for IMGs to have more access to Canadian residencies, but if they just did a US residency it sounds like they could still end up in Canada. It's a bit more time away, but seems better then doing an ROS here...

Many would like to come home sooner, plus, it will be easier finding jobs coming from a Canadian residency due to connections you build while here. Also, you can get into Canadian residencies as an CSA without high USMLE scores.

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The CSA-IMG argument strikes me personally as a little bit entitled.  A lot of premeds don't get accepted to med school: either they try to improve and re-apply or pursue a different career.  Already going to Aus/UK/Ireland is not a path most pre-meds can take due to the financial cost (80k/yr in tuition alone), but not necessarily ability or merit.  CSAs are currently benefitting from quota IMG positions created initially for immigrant physicians - now they're looking for the CMG residency positions, despite not being CMGs.  The Canadian med school admissions process is far from perfect - but there's no way in my mind, that Canadian med students wouldn't overwhelmingly be able to be accepted to the IMG schools (maybe not be able to afford it), but the reverse doesn't hold true.    

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