Anybody else concerned about the flood of IMGs?

[AtomSmasher19]

IMGs are killing patients and the profession. I can't be the only one who is concerned.

[uwodesperate]

Did something happen?

[medisforme]

IMGs are killing patients and the profession. I can't be the only one who is concerned.

 

Could you please provide the link to the news story and/or research that reports that IMG's are killing patients - I would love to read it.

[every1knewherasnancy]

IMGs are killing patients and the profession. I can't be the only one who is concerned.

 

Let's all just go ahead and not feed the troll...

[BlurstOfTimes]

I also find it extremely unethical to lower standards for the medical care of rural citizens. Importing foreign trained physicians to practice in small towns is a disgrace to the profession, as if the health of the rural lot is less important than that of the urban.

 

I completely agree *but* at the same time, a less-skilled doctor is better than no doctor at all, right? It's an awful choice to have to make, but if there aren't a sufficient number of CMGs willing to work in those areas, what else can be done?

[BlurstOfTimes]

Another way would be to substantially increase pay for those that practice in rural areas. The downside is that this costs money. As a comparison, workers at Fort make six figures, not because they're better qualified than their counterparts, but because it takes that much to entice them to work there. Though the ultimate motive is different(company profit vs patient wellness), the medical society has in my opinion done a poor job of illustrating this point to the respective government agencies.

 

I think this is probably the simplest way to attract more rural docs, but it's an interesting option to consider just because of how lucrative the medical profession is everywhere else. Most people who work at Fort Mac have absolutely no chance of making six figures living/working anywhere else, but doctors in Canada are virtually guaranteed six figure salaries no matter where they are. The appeal of extra money is presumably less enticing for someone who will have a top 1-2% income no matter where they work. That said, I do agree that substantially higher pay would be helpful in attracting more CMGs to work in rural areas, but it's a complicated question for sure.

 

I also disagree that a substandard doctor is better than none at all, and I vehemently object to substandard physicians being thrust upon rural communities, which sweeps the problem of access to care under the rug.

 

I think this really depends on the actual disparity in skill between CMGs and IMGs, which I admittedly have no sense of whatsoever, so it's difficult for me to comment on. If we're talking about doctors whose interventions are actually worsening patient outcomes, then yeah, that would be terrible. But if we're talking about doctors who simply have limited competency compared to their CMG counterparts, then I'd still say that *some* help is better than *no* help. I agree 100% that this substandard care being thrust on rural communities is largely unacceptable, but I'm not sure I agree that being left completely alone and in the dark when it comes to medical help is better than having access to a doctor, as long as that doctor isn't making things worse for his or her patients than they would be on their own.

[Slipstream]

IMGs are killing patients and the profession. I can't be the only one who is concerned.

 

Hey, at lest they're only killing people in rural Canada. We city folk are safe.

 

OK, I think it's ridiculous to assume that they're really killing people, come on guys.

 

Im not going to get into the debate of why we shouldnt assume IMGs are inferior to our god like, perfect, training in Canada. Theres an entire 8 page thread about that from a couple of weeks ago. With regards to increasing the number of CMGs in rural areas, I don't think that what was suggested is enough, really. I mean Saskatchewan already pays you $15,000 a year more to work there, unless you mean like $50,000+ more to work rurally, which might be unaffordable. On the other hand, I think distributed medical education is the way to go. Lets stop only training physicians in cities, and recruit people from rural areas who will continue to practice there - so like UBC with its northern, island, and southern campus or Northern Ontario. McGill also offers the chance for rural clerkships, but that means that students from Montreal would have to pick the rural option. IMO, the best thing to do is to make these satellite campuses and train physicians right in the rural areas to practice there. This is more of a long term goal, but I think it's the most sustainable.

[r-bot]

My province offers pretty huge incentives (enough to cover tuition and some) per year in exchange for time worked in a rural area after residency. I think financial incentives (particularly during med school) are incredibly problematic, and definitely target those of us without financial help outside of LOCs and loans.

 

I'm also a bit skeptical about selecting students from rural areas with the end goal of having them work there (I think it's an interesting idea for other reasons, sometimes academic opportunity and encouragement is seriously lacking in rural areas) ... if the stats show it works I can accept that, but as someone who lives in a small town driving distance from a city, I can't wait to live in an urban setting.

 

The hugest incentive for me to work in a rural/northern area is a genuine interest in Indigenous health because of the intersections of colonial history/race and health, and the social factors that impact care for Indigenous folks (also why I'm super interested in LGBTQ* and women's health). I wonder if teaching this more effectively would have a positive impact?

[Slipstream]

My province offers pretty huge incentives (enough to cover tuition and some) per year in exchange for time worked in a rural area after residency. I think financial incentives (particularly during med school) are incredibly problematic, and definitely target those of us without financial help outside of LOCs and loans.

 

I'm also a bit skeptical about selecting students from rural areas with the end goal of having them work there (I think it's an interesting idea for other reasons, sometimes academic opportunity and encouragement is seriously lacking in rural areas) ... if the stats show it works I can accept that, but as someone who lives in a small town driving distance from a city, I can't wait to live in an urban setting.

 

The hugest incentive for me to work in a rural/northern area is a genuine interest in Indigenous health because of the intersections of colonial history/race and health, and the social factors that impact care for Indigenous folks (also why I'm super interested in LGBTQ* and women's health). I wonder if teaching this more effectively would have a positive impact?

 

This is a very good point. I like the idea of having distributed sites, but yes they should train people from rural areas WITH the intention of practising rurally. Being from rural Sask myself, I also understand that not all of us want to do that, and we should have every option to apply to larger centres and move there if we desire. But I like that the option to work rurally for people who desire living in rural communities, even if they're from larger cities, is there. They also have a lot of rural initiatives for family doctors from larger cities to go to smaller centres for a few months every year and work on the issues you're talking about. It's a really great idea, and I think it helps the community a lot. But of course it would be best to have permanent physicians who are part of the community as well .

[schmitty]

I do want to say that they already do offer much more pay in many rural areas. I saw a posting looking for a fam doc to work at a federal clinic in a remote First Nations town in northern Ontario (not fly-in, but very remote north of thunder bay) and it paid over $400K for a family doc with 8 weeks vacation. These sort of positions came up quite often...they are filled sometimes for a while (new docs mostly) but are often left unfilled.

[BlurstOfTimes]

They also have a lot of rural initiatives for family doctors from larger cities to go to smaller centres for a few months every year and work on the issues you're talking about. It's a really great idea, and I think it helps the community a lot. But of course it would be best to have permanent physicians who are part of the community as well .

 

I hadn't heard about that sort of thing before - that's really interesting. I have no desire to live in a rural setting but I could definitely see myself doing it for a few months a year - I'm actually really intrigued by the variety and scope of practice of rural family docs (vs. their urban counterparts) but I would hate to live somewhere remote full-time, so this is the first rural incentive I've heard of that would really appeal to me. Of course as you said, having a revolving door of urban doctors coming and going is still far from optimal for the rural population, so I can't see this working as a long-term solution... but still really interesting. Do you know where I can find more info about this, just to satisfy my own curiosity?

[holiday1001]

after some clinical time... yes

[kmartelli]

IMGs are killing patients and the profession. I can't be the only one who is concerned.

IMGs are only a small part of the problem. There's not many in this country to really cause a problem. There are far, far more CMGs killing patients and the profession in this country.

 

The admissions system here is mediocre at predicting who will do well in medical school. Some of them are *not* cut out at all. Then you suddenly let all these medical students go through a very lax curriculum and give them multiple chances to pass their exams, virtually never expelling any students. Then you make all their grades Pass/Fail, don't require a scored licensing exam prior to residency selection, and expect them to have any motivation to work hard if their only aspiration is a CO2 residency. Then you administer a ridiculously easy licensing exam and send these people out to be our family doctors.

 

IMGs are not the problem at all. If we want to improve patient safety, we have to toughen up the evaluation exams and start failing more people (both CMGs and IMGs). We also need to either toughen the standards at Canadian medical schools, or we have to find better ways of selecting the best candidates.

[Fresh fry]

IMGs are only a small part of the problem. There's not many in this country to really cause a problem. There are far, far more CMGs killing patients and the profession in this country.

 

The admissions system here is mediocre at predicting who will do well in medical school. Some of them are *not* cut out at all. Then you suddenly let all these medical students go through a very lax curriculum and give them multiple chances to pass their exams, virtually never expelling any students. Then you make all their grades Pass/Fail, don't require a scored licensing exam prior to residency selection, and expect them to have any motivation to work hard if their only aspiration is a CO2 residency. Then you administer a ridiculously easy licensing exam and send these people out to be our family doctors.

 

IMGs are not the problem at all. If we want to improve patient safety, we have to toughen up the evaluation exams and start failing more people (both CMGs and IMGs). We also need to either toughen the standards at Canadian medical schools, or we have to find better ways of selecting the best candidates.

 

 

Sorry you didn't make the cut and couldn't get accepted in Canada, you are obviously excessively bitter about it. The only thing that is even more painfully obvious is that you have no idea how things work here. You may not work very hard if you were in a pass/fail system (maybe that is why you didn't get selected who knows?) but I can tell you that everyone at my school, and at all the schools I know people at, the students work just as hard as they do down south. We just aren't trying to screw each other over during the process and instead we work together. There are tons of studies and threads dedicated to the topic of the superiority of the pass/fail system that you can look up on your own. I won't bore you by telling you anecdotal stories of people I have met on the wards from other schools who may or may not have answered a question incorrectly when put on the spot, personally I don't care what you think on the matter.

 

This thread is about the well documented incidents of IMGs struggling here in Canada and not your petty ad hoc rationalizations of why you are not a CMG.

[A-Stark]

IMGs are only a small part of the problem. There's not many in this country to really cause a problem. There are far, far more CMGs killing patients and the profession in this country.

 

The admissions system here is mediocre at predicting who will do well in medical school. Some of them are *not* cut out at all. Then you suddenly let all these medical students go through a very lax curriculum and give them multiple chances to pass their exams, virtually never expelling any students. Then you make all their grades Pass/Fail, don't require a scored licensing exam prior to residency selection, and expect them to have any motivation to work hard if their only aspiration is a CO2 residency. Then you administer a ridiculously easy licensing exam and send these people out to be our family doctors.

 

IMGs are not the problem at all. If we want to improve patient safety, we have to toughen up the evaluation exams and start failing more people (both CMGs and IMGs). We also need to either toughen the standards at Canadian medical schools, or we have to find better ways of selecting the best candidates.

 

Agreed. Although I don't think there are really that many CMGs who are truly not "cut out" for medicine, I can think of at least a couple of examples of students failing exams repeatedly and given more than one "second" chance to make it up. I have no idea how failing exams affects outcomes in CaRMS (no doubt negatively for the most part), especially when it occurs at the clerkship level. The only saving grace is that Royal College (and, relatedly, POS) exams are hardly the cakewalks that are the LMCCs, but that means an awful lot of time wasted for no gain.

 

The major problem with failing out students is that the debtloads are now so high that it becomes practically difficult. If med school were less financially onerous, this would not be an issue, but I at least understand the dilemma faced when deciding to kick out a student whose sunk costs are already tens of thousands of dollars. It still needs to be done, though, from time to time.

[leviathan]

As an IMG and resident in Canada, I can't really see a problem. We all go through the same residencies which is where the vast majority of our real training comes from. If there are any glaring problems with any graduates, Canadian or otherwise, I hope they would be identified early on. Those deficiencies can then either be rectified, or worst case scenario the individual is exited from the program. After that, the Royal College or CCFP should be rigorous enough to ensure only quality graduates make it out to independent practice.

 

I am curious as to these alleged reports of IMGs struggling in Canada, though. The only report I ever saw was out of UBC, where the failure rate of the grads was higher. In that case, UBC has been known to exclusively train immigrant IMGs who still struggle with English, and have been out of medical school for a long time. I've never heard of any problems with IMGs passing exams who are recent graduates and fluent in English, in the rest of the country.

[bloh]

Most of the provinces are doing a ****ty way of exposing medical students to rural medicine.

 

Ever try to book a rural FM elective?

 

Good. ****ing. luck.

 

You have to do it all by yourself. Am I going to sit there and dial lousy and incompetent administrative assistants all day or just submit an application and get something in any other urban place? It's a pretty easy decision.

[Fresh fry]

Most of the provinces are doing a ****ty way of exposing medical students to rural medicine.

 

Ever try to book a rural FM elective?

 

Good. ****ing. luck.

 

You have to do it all by yourself. Am I going to sit there and dial lousy and incompetent administrative assistants all day or just submit an application and get something in any other urban place? It's a pretty easy decision.

 

Another RD RPAP fan

[medisforme]

In my opinion, the doors should completely shut for anyone who has not completed medical school at an lcme accredited institution. Full stop.

.

 

That seems awfully strong considering how ridiculously competitive med school admission in Canada is at present. Often the only thing seperating a succesful and not succesful applicant is luck.

One thing I have heard before in regards to CSA's applying to CaRMs is to require proof that they attempted to apply for med school admissions in Canada at least 3-4x before applying overseas.

This would likely cut down on the number of CSA's (given the perserverence that is required to continually apply) and the ones that do apply would arguably be of higher caliber.

[medisforme]

Hey, at lest they're only killing people in rural Canada. We city folk are safe.

On the other hand, I think distributed medical education is the way to go. Lets stop only training physicians in cities, and recruit people from rural areas who will continue to practice there - so like UBC with its northern, island, and southern campus or Northern Ontario. McGill also offers the chance for rural clerkships, but that means that students from Montreal would have to pick the rural option. IMO, the best thing to do is to make these satellite campuses and train physicians right in the rural areas to practice there. This is more of a long term goal, but I think it's the most sustainable.

 

I read that of the first cohort of residents from the UBC Northern Medical Program - 33% chose to practice in a rural area - I think the BC gov't was likely hoping for a higher number, but it is a start.

 

Also, being a current student in the Southern Medical Program, the majority of students in my class are not from a rural area though that may change as the program becomes more established.

[ralk]

That seems awfully strong considering how ridiculously competitive med school admission in Canada is at present. Often the only thing seperating a succesful and not succesful applicant is luck.

One thing I have heard before in regards to CSA's applying to CaRMs is to require proof that they attempted to apply for med school admissions in Canada at least 3-4x before applying overseas.

This would likely cut down on the number of CSA's (given the perserverence that is required to continually apply) and the ones that do apply would arguably be of higher caliber.

 

That seems like it would select for the worst, not the best, CSAs. Applying once and not getting into a Canadian school can happen for any number of reasons, and luck is definitely one. Applying 3-4 times and not getting in makes luck a much less likely reason (though it can still happen). Perseverance is an admirable trait, for sure, but it brings up the question as to why an individual was rejected that many times.

 

Despite the already-powerful disincentive to be a CSA, it hasn't been enough to stem the increasing tide of Canadians going abroad. Closing the door to re-entry into Canadian practice, or at least ensuring that it is open only a crack, would likely be the strongest way to do so. Most CSAs want to return home, and though their chances aren't great, it's still high enough to make people believe that it's an option. Effectively taking away that option would remove a lot of CSAs.

 

Even if these aren't necessarily the most qualified people to become physicians, they're usually still quite intelligent, driven people. We lose many of them to other countries, instead of having them here pursuing other non-physician careers. They, and quite often their families, take on enormous costs. This pushes a lot of money overseas needlessly and encourages a fair bit of nepotism in the system - it's a lot easier for a kid of rich parents to pursue the CSA route than a middle-class or poor kid. Moreover, the individuals that have the best chance of returning home are one with connections, namely those with parents as physicians. CSAs don't even fill the main holes in our health care system - while many get forced into family and may have to do a ROS in a rural area, they're far more likely to want to work in the oversaturated major centres like Toronto or Vancouver.

 

The existence of such a huge and growing pool of CSAs is a major flaw in our system. Before even considering the effect on patients, shutting the door to CSAs, opening up a few more spots at Canadian med schools, and shifting the residency spots from IMGs to CMGs would be much more equitable, reliable, and effective than our current system.

[hamham]

As an IMG and resident in Canada, I can't really see a problem. We all go through the same residencies which is where the vast majority of our real training comes from. If there are any glaring problems with any graduates, Canadian or otherwise, I hope they would be identified early on. Those deficiencies can then either be rectified, or worst case scenario the individual is exited from the program. After that, the Royal College or CCFP should be rigorous enough to ensure only quality graduates make it out to independent practice.

 

I am curious as to these alleged reports of IMGs struggling in Canada, though. The only report I ever saw was out of UBC, where the failure rate of the grads was higher. In that case, UBC has been known to exclusively train immigrant IMGs who still struggle with English, and have been out of medical school for a long time. I've never heard of any problems with IMGs passing exams who are recent graduates and fluent in English, in the rest of the country.

 

I'm a new medical student, so I don't know much about residency. Correct me if I'm wrong, but I think there are 3 main check-points to be a doctor in Canada:

 

1st checkpt: Admissions into Canadian medical school

2nd checkpt: Getting a residency in Canada

3rd checkpt: Getting hired by a hospital after residency

 

While I do respect you for successfully getting Canadian residency (must be tough on you), it's an undeniable fact that you have circumvented the 1st checkpoint by choosing to study medicine at a foreign school. I'm not sure what extenuating circumstances you have at that time, which eventually made u decide to go abroad, but it is clear that you failed to get into a Canadian MD program.

 

Don't get me wrong. I'm not saying you are not qualified to be a Canadian doctor, but it's a fact that you you lost your faith in the Canadian MD programs. Consider yourself fortunate to have make it back against all odds!

 

UBC was training foreign doctors some time ago, before the introduction of the distributed sites program. At that time, there was a severe shortage of doctors in rural BC and there is a need to increase doc supply there. Today, they have greatly reduced the number of foreign doc they trained.

[NikiFM]

I think one of the bigger problems in getting future physician's into rural medicine is their spouse. Particularly, in terms of the partner wanting to live in a community which likely will not give them the career opportunities they want, or the lifestyle. I would guess many physicians of this generation will have partners who may not be very flexible in where they can work, in their chosen field, (with the job market as it is), whereas family physicians can find a community to work in to accommodate their partner without much difficulty. Not that it is a very solvable issue, but I think its important to identify that problem when looking for solutions.

[spontaneouscombustion]

I'm a new medical student, so I don't know much about residency. Correct me if I'm wrong, but I think there are 3 main check-points to be a doctor in Canada:

 

1st checkpt: Admissions into Canadian medical school

2nd checkpt: Getting a residency in Canada

3rd checkpt: Getting hired by a hospital after residency

 

While I do respect you for successfully getting Canadian residency (must be tough on you), it's an undeniable fact that you have circumvented the 1st checkpoint by choosing to study medicine at a foreign school. I'm not sure what extenuating circumstances you have at that time, which eventually made u decide to go abroad, but it is clear that you failed to get into a Canadian MD program.

 

Don't get me wrong. I'm not saying you are not qualified to be a Canadian doctor, but it's a fact that you you lost your faith in the Canadian MD programs. Consider yourself fortunate to have make it back against all odds!

 

UBC was training foreign doctors some time ago, before the introduction of the distributed sites program. At that time, there was a severe shortage of doctors in rural BC and there is a need to increase doc supply there. Today, they have greatly reduced the number of foreign doc they trained.

 

Thanks for bolding that he didn't get into a Canadian MD program. I'm sure he knew already, but it makes it easy to recognize you as an arrogant prick.

 

I agree with the general sentiment that IMGs are of questionable quality, but the ones that tend to come back - especially to fields like internal, or surgery, or whatever, are usually excellent, easily on par with any Canadian grad. The ones that get into family, path, and psychiatry not so much, but then again this is a generalization - I'm sure there's some excellent ones there too.

 

As far as the flood of IMG goes, Canada has had more IMG docs trained as % of its workforce in the past. I don't get where this "crisis" in the quality of Canadian physicians is coming from. Most of the complaining seems to be coming from the same posters that are bitter about the job market and would rather squeeze out any competition under the guise of "patient safety".

[hamham]

Thanks for bolding that he didn't get into a Canadian MD program. I'm sure he knew already, but it makes it easy to recognize you as an arrogant prick.

 

I agree with the general sentiment that IMGs are of questionable quality, but the ones that tend to come back - especially to fields like internal, or surgery, or whatever, are usually excellent, easily on par with any Canadian grad. The ones that get into family, path, and psychiatry not so much, but then again this is a generalization - I'm sure there's some excellent ones there too.

 

As far as the flood of IMG goes, Canada has had more IMG docs trained as % of its workforce in the past. I don't get where this "crisis" in the quality of Canadian physicians is coming from. Most of the complaining seems to be coming from the same posters that are bitter about the job market and would rather squeeze out any competition under the guise of "patient safety".

 

Sorry if I sounded arrogant. It's just that I don't feel good when I see pple trying to beat the system. We all know how hard it is to get into med sch in Canada (many of us tried many times before getting in), so the general consensus is that some of us don't feel good when IMGs simply return to compete for residency/jobs. I am sure some will agree with me.