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Another IMG lawsuit against R-1 streaming in the pipeline


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Jeez Harris Falconer went the Caribbean route and wasn't even at one of the big four... These cases make me really question if they were ever good candidates for medical school in the first place. The big four will accept essentially anyone, and if you can't even get into one of them then how bad of a medical school candidate do you have to be...

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32 minutes ago, xiphoid said:

Jeez Harris Falconer went the Caribbean route and wasn't even at one of the big four... These cases make me really question if they were ever good candidates for medical school in the first place. The big four will accept essentially anyone, and if you can't even get into one of them then how bad of a medical school candidate do you have to be...

Sure way to never get accepted into any Canadian residency programs (possibly even US residencies).

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I think unless 100% CMG students match, it should be considered unconstitutional to have IMG reserved seats for any specialty except rural family medicine or specialties of impeding access, particularly because of tax dollars spent on unmatched Canadian students can be wasted at the expense of foreign students. In the case of specialties that do not have any CMG applicants and impede access like rural medicine, IMG spots can be ethical. 

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1 hour ago, Bluecolorisnice said:

I think unless 100% CMG students match, it should be considered unconstitutional to have IMG reserved seats for any specialty except rural family medicine or specialties of impeding access, particularly because of tax dollars spent on unmatched Canadian students can be wasted at the expense of foreign students. In the case of specialties that do not have any CMG applicants and impede access like rural medicine, IMG spots can be ethical. 

This could end up being an interesting discussion, but if history is any indication it just ends up becoming IMG bashing. You mention the constitution and tax payers - remember that IMGs are Canadian citizens or permanent residents and do also pay taxes. To that effect they're really no different than CMGs beyond where they did their training.

What Europe does is essentially create rankings and allocate spots to students that trained in their own country, then the EU, and then everyone else, if there are spots left over. There are problems with this as well, but it allows their own trainees to be guaranteed spots (e.g. the Irish in Ireland). There are relatively few people that do their training outside of the EU so its not a big issue. If we did that in Canada where Canadians were all competing with each other, the reality is it would amp up competition tremendously....which is probably why we're so protectionistic and why we have a separate IMG pool...

It is interesting to read a little about the history of the changes in CaRMS and how/why the IMG pool was created in the first place and to do some of my own reading about our Charter of Human Rights. Some of the barriers put forth in medicine in Canada aren't seen any where near the same degree in other professions like pharmacy, dentistry, veterinary, etc.

There any way to see where (if anywhere) this thing has gone? Be interesting to see at least from a legal perspective and an ethical perspective as well.
 

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11 hours ago, Intrepid86 said:

This case was discussed on the forum last year. Past comments can be found here:

http://forums.premed101.com/topic/101551-canadian-doctors-trained-overseas-petition-court-to-end-system-of-exclusion/

 

4 minutes ago, StarStrike said:

This could end up being an interesting discussion, but if history is any indication it just ends up becoming IMG bashing. You mention the constitution and tax payers - remember that IMGs are Canadian citizens or permanent residents and do also pay taxes. To that effect they're really no different than CMGs beyond where they did their training. 

It is interesting to read a little about the history of the changes in CaRMS and how/why the IMG pool was created in the first place and to do some of my own reading about our Charter of Human Rights. Some of the barriers put forth in medicine in Canada aren't seen any where near the same degree in other professions like pharmacy, dentistry, veterinary, etc.

There any way to see where (if anywhere) this thing has gone? Be interesting to see at least from a legal perspective and an ethical perspective as well.
 

The previous thread had more discussion along legal, ethical lines...  I  also skimmed this link a long time ago for IMG history - 

https://mspace.lib.umanitoba.ca/bitstream/handle/1993/30375/Cavett_Teresa.pdf?sequence=3&isAllowed=y

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16 minutes ago, tere said:

 

The previous thread had more discussion along legal, ethical lines...  I  also skimmed this link a long time ago for IMG history - 

https://mspace.lib.umanitoba.ca/bitstream/handle/1993/30375/Cavett_Teresa.pdf?sequence=3&isAllowed=y

Thanks for that. That bottom link is a wealth of information. Quite interesting!

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1 hour ago, StarStrike said:

This could end up being an interesting discussion, but if history is any indication it just ends up becoming IMG bashing. You mention the constitution and tax payers - remember that IMGs are Canadian citizens or permanent residents and do also pay taxes. To that effect they're really no different than CMGs beyond where they did their training.

What Europe does is essentially create rankings and allocate spots to students that trained in their own country, then the EU, and then everyone else, if there are spots left over. There are problems with this as well, but it allows their own trainees to be guaranteed spots (e.g. the Irish in Ireland). There are relatively few people that do their training outside of the EU so its not a big issue. If we did that in Canada where Canadians were all competing with each other, the reality is it would amp up competition tremendously....which is probably why we're so protectionistic and why we have a separate IMG pool...

It is interesting to read a little about the history of the changes in CaRMS and how/why the IMG pool was created in the first place and to do some of my own reading about our Charter of Human Rights. Some of the barriers put forth in medicine in Canada aren't seen any where near the same degree in other professions like pharmacy, dentistry, veterinary, etc.

There any way to see where (if anywhere) this thing has gone? Be interesting to see at least from a legal perspective and an ethical perspective as well.
 

In terms of taxes, I meant the tax dollars it costs to train a CMG. I find it unethical to spend millions of government $ to train CMGs and then saying "sorry this spot is img reserved". It is ridiculous.

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1 hour ago, Bluecolorisnice said:

In terms of taxes, I meant the tax dollars it costs to train a CMG. I find it unethical to spend millions of government $ to train CMGs and then saying "sorry this spot is img reserved". It is ridiculous.

So is your argument that because tax payer dollars are necessary to train CMGs, residency spots should automatically be reserved for them? Why do you think so? Why is it unethical for residency spots to be available for IMGs or Canadians that studied abroad? Is it unreasonable to think that this practice could potentially be seen as discriminatory?

Help me understand your perspective.

Remember, many of the IMGs (which to reiterate are Canadian citizens or permanent residents and tax payers) that train abroad either self-fund their education abroad (which funny enough saves the government money - they don't need to fund 3-4 years of medical school) or take out loans which also burden the government and our bank system. If you look at it from this perspective it is a financial burden both ways on the Canadian economy.

Once you're at the point of competing for residency, the cost of training a CMG or an IMG is already sunk. So the question is, what is our goal/intention? Is our goal is to prioritize CMGs to ensure they're guaranteed residency spots? Or to train the best future doctors?

If the goal is the former, then it is really important to sit down and really think about what is happening with CMGs not matching. Most IMG spots are in primary care - what if it turns out a large proportion of the CMGs that don't match only wanted surgery, ophtho, radiology, etc.? Cutting out the IMGs will not change anything significantly in that circumstance. It is tempting to scapegoat IMGs as being villains (or crooks, cheats, idiots, etc.), but I think it is important we actually try and address the larger systemic issue rather than creating enemies out of each other. If a potential solution is to cut out (which is what many people on this forum seem to be advocating) or restrict (the current case) the IMGs then I think it is our obligation to think about this rationally and from both a legal and ethical perspective.

If the goal is to train the best future doctors, a good argument can be made that increasing competition in a level playing field, not decreasing it, is better suited to achieving this (e.g. like the US). Understandably, I think this is in part where a lot of the fear comes from. It is akin to the situation elsewhere in the world where people exclaim "the immigrants are taking our jobs!" except here they aren't immigrants, but Canadians.... 

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15 minutes ago, StarStrike said:

So is your argument that because tax payer dollars are necessary to train CMGs, residency spots should automatically be reserved for them? Why do you think so? Why is it unethical for residency spots to be available for IMGs or Canadians that studied abroad? Is it unreasonable to think that this practice could potentially be seen as discriminatory?

Help me understand your perspective.

Remember, many of the IMGs (which to reiterate are Canadian citizens or permanent residents and tax payers) that train abroad either self-fund their education abroad (which funny enough saves the government money - they don't need to fund 3-4 years of medical school) or take out loans which also burden the government and our bank system. If you look at it from this perspective it is a financial burden both ways on the Canadian economy.

Once you're at the point of competing for residency, the cost of training a CMG or an IMG is already sunk. So the question is, what is our goal/intention? Is our goal is to prioritize CMGs to ensure they're guaranteed residency spots? Or to train the best future doctors?

If the goal is the former, then it is really important to sit down and really think about what is happening with CMGs not matching. Most IMG spots are in primary care - what if it turns out a large proportion of the CMGs that don't match only wanted surgery, ophtho, radiology, etc.? Cutting out the IMGs will not change significantly in that circumstance. It is tempting to scapegoat IMGs as being villains (or crooks, cheats, idiots, etc.), but I think it is important we actually try and address the larger systemic issue rather than creating enemies out of each other. If a potential solution is to cut out (which is what many people on this forum seem to be advocating) or restrict (the current case) the IMGs then I think it is our obligation to think about this rationally and from both a legal and ethical perspective.

If the goal is to train the best future doctors, a good argument can be made that increasing competition in a level playing field, not decreasing it, is better suited to achieving this (e.g. like the US). Understandably, I think this is in part where a lot of the fear comes from. It is akin to the situation elsewhere in the world where people exclaim "the immigrants are taking our jobs!" except here they aren't immigrants, but are Canadians.... 

I find the whole situation a tragedy just because of these predatory schools and the significant debt these students take on. However, I will address some of your points with my thoughts on the issue

1) The IMGs who take out loans are not burdening the bank system as those loans are calculated based on things like the default rate and collateral. The bank is not going to be making bad bets in the grand scheme of things. They're making a profit on average.

2) We train medical students in Canada because it gives the government more control over the Human Resources pipeline rather than be at the whims of foreign medical schools that can have admission logistics change in an instant. Since they are spending that money regardless they have a vested interest in making sure that the subsidized education they provide is not for nothing. 

We are not a free market regulated profession like law where students are able to compete in the job market for clients  that results in some lawyers doing well and some failing. I don't believe the goal is to train the best possible doctors but to train enough "skilled" physicians to fulfill population needs while staying in a single-payer budget. 

I am okay with IMGs in the residency system as the ones I have met are fine residents. However, I think that should be based on the amount of slack in the system of which there is more in the US. In Canada I think the match has become so competitive then we should do our best to ensure that medical students in good standing are matched first. 

If there is less certainty in the educational pathway then we are setting up a system where students could incur 200k+ debt with no job at the end of it and possibly no way to discharge their student loans. This will discourage the socioeconomically disadvantaged from pursuing medicine as a career in Canada and reduce the diversity we see in medicine. Instead only students who have the financial stability (upper class) can pursue medicine wisely. 

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2 minutes ago, COMMANDO said:

CSA is only available as an option to the upper class anyways. Cost of living + travel between Europe/Caribbean to Canada + FOR-PROFIT TUITION with odds stacked against for matching in canada = poor people need not apply. Maybe that’s why these people feel so entitled to CMG residency spots? Chad couldn’t get into medical school so mommy and daddy paid for him to study abroad. Chad can’t match back into Canada so mommy and daddy hired a lawyer to sue the provincial government. 

 

Also if you’ve in province advantage at UBC and still don’t make it... thank your lucky stars you’re not from Ontario outside of Southwestern and Northern Ontario

I agree that the people who go overseas are either well off or make poor financial choices.

There is value to diversity of background in medicine to treat the diversity of patients we see. If we continue to increase tuition while reducing the chance of making it to the end of training then only the wealthy will be able to take the risk of studying medicine which I would lobby against.

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4 hours ago, StarStrike said:

So is your argument that because tax payer dollars are necessary to train CMGs, residency spots should automatically be reserved for them? Why do you think so? Why is it unethical for residency spots to be available for IMGs or Canadians that studied abroad? Is it unreasonable to think that this practice could potentially be seen as discriminatory?

Help me understand your perspective.

Remember, many of the IMGs (which to reiterate are Canadian citizens or permanent residents and tax payers) that train abroad either self-fund their education abroad (which funny enough saves the government money - they don't need to fund 3-4 years of medical school) or take out loans which also burden the government and our bank system. If you look at it from this perspective it is a financial burden both ways on the Canadian economy.

Once you're at the point of competing for residency, the cost of training a CMG or an IMG is already sunk. So the question is, what is our goal/intention? Is our goal is to prioritize CMGs to ensure they're guaranteed residency spots? Or to train the best future doctors?

If the goal is the former, then it is really important to sit down and really think about what is happening with CMGs not matching. Most IMG spots are in primary care - what if it turns out a large proportion of the CMGs that don't match only wanted surgery, ophtho, radiology, etc.? Cutting out the IMGs will not change anything significantly in that circumstance. It is tempting to scapegoat IMGs as being villains (or crooks, cheats, idiots, etc.), but I think it is important we actually try and address the larger systemic issue rather than creating enemies out of each other. If a potential solution is to cut out (which is what many people on this forum seem to be advocating) or restrict (the current case) the IMGs then I think it is our obligation to think about this rationally and from both a legal and ethical perspective.

If the goal is to train the best future doctors, a good argument can be made that increasing competition in a level playing field, not decreasing it, is better suited to achieving this (e.g. like the US). Understandably, I think this is in part where a lot of the fear comes from. It is akin to the situation elsewhere in the world where people exclaim "the immigrants are taking our jobs!" except here they aren't immigrants, but Canadians.... 

The inherent issue here is the ethics of having dedicated IMG spots at the expense of CMGs. A country that spends millions of $ trying to subsidize medical school for Canadian students also allows the same students to go unmatched at the expense of wealthy IMG students that pursue medical school overseas. Even if 10% of CMGs go unmatched - that costs the system thousands of $$.

For the IMGs (CSA in particular) complaining, the CSA students are given equal opportunity to apply to Canadian medical schools and pursue residency through the regular route (i.e apply to MD programs in Canada and then residency). Many students go abroad after rejections from Canadian schools with hopes of returning back via IMG stream. This is unethical in the first place since 1) it allows financially well off Canadians to study in countries like ireland/aus/carribean - issue of inequality 2) It denies CMGs opportunity to pursue residency and wastes tax dollars

A better option is to open more medical schools in Canada and charge the students higher tuitions (similar to ireland/carribean etc) - this might bring down the GPA/MCAT cutoffs. It would also ensure 100% match rate. 

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9 hours ago, blah1234 said:

I find the whole situation a tragedy just because of these predatory schools and the significant debt these students take on. However, I will address some of your points with my thoughts on the issue

1) The IMGs who take out loans are not burdening the bank system as those loans are calculated based on things like the default rate and collateral. The bank is not going to be making bad bets in the grand scheme of things. They're making a profit on average.

2) We train medical students in Canada because it gives the government more control over the Human Resources pipeline rather than be at the whims of foreign medical schools that can have admission logistics change in an instant. Since they are spending that money regardless they have a vested interest in making sure that the subsidized education they provide is not for nothing. 

We are not a free market regulated profession like law where students are able to compete in the job market for clients  that results in some lawyers doing well and some failing. I don't believe the goal is to train the best possible doctors but to train enough "skilled" physicians to fulfill population needs while staying in a single-payer budget. 

I am okay with IMGs in the residency system as the ones I have met are fine residents. However, I think that should be based on the amount of slack in the system of which there is more in the US. In Canada I think the match has become so competitive then we should do our best to ensure that medical students in good standing are matched first. 

If there is less certainty in the educational pathway then we are setting up a system where students could incur 200k+ debt with no job at the end of it and possibly no way to discharge their student loans. This will discourage the socioeconomically disadvantaged from pursuing medicine as a career in Canada and reduce the diversity we see in medicine. Instead only students who have the financial stability (upper class) can pursue medicine wisely. 

4

1) For the most part you are correct about the bank situation. Bad bets do happen and those do burden the banks (and usually the family that has co-signed the student's debts). I've seen it happen with many of my colleagues and some are doubly screwed if they don't match. What about the government loans?

2)  I might not understanding your point well, but I'm not sure that is much of an argument. Admission logistics can change "on a whim" anywhere, including Canada. For residency, think about the abolishment of the rotating internship, creation of the IMG stream, creation of CAP, etc. Same thing with medical school admission, many schools no longer require prerequisites, favour non-academics equally, etc.

As for the free market question, I guess that is part of the point and what these guys are petitioning. Why is it that it isn't a free market like other professionals (like you mention with law). I'm not necessarily saying a free market is better, but why is medicine so different? Plenty of Canadians train abroad in professions like law, pharmacy, dentistry, etc and many immigrants also successfully make it in to the Canadian system with their education and credentials.

I was just looking at the mission statement of CaRMS which is:
"Our mission is to serve as an independent, arms-length provider of a client-centred, fair, transparent, and equitable matching service for medical education in Canada"

An argument can be made that the current process isn't equitable - by definition IMGs have to jump through the NAC OSCE, MCCEE (next year the QE1), and the CAP for UBC to even compete at the same level as CMGs. You could also argue that it isn't fair, given that it discriminates between Canadians based on their place of training. You could argue that the purpose of the board exams (which CMGs don't have to do until they've matched or are in residency) is to create a level playing field, but then why are Canadian IMGs separated into a different pile? 

The last point you make about setting up a system where students incur 200k+ debt is an interesting one. Nobody wants that. The reality is,  this situation already happens with CSAs and CMGs that don't match. To a degree, you are probably right that the average CSA is better off than the average Canadian, but I'm not so sure you could say that about the average CMG - do we have any statistics on that anywhere? It would be interesting to see what the data is in Canadian medical schools RE their socioeconomic status compared to the average CSA. Although the money usually needed to go abroad is usually a deterrent, I think you might be surprised how many people mortgage their lives to make it happen. Some of my own colleagues in Ireland are in a dire situation financially (though as you may argue and correctly so, at a risk of their own, but also borne by their families and the gov't). Many of these people aren't the stinking rich people that you think they are. It is tempting to believe that because it justifies the resentment and hate the IMGs regularly and constantly receive. Over my last few years in Ireland, I've talked to so many people that are desperate  to become doctors, many of whom are working class, strong academically, etc. Their misfortune is they couldn't play the game as well as the CMGs did - and the reality is to a large degree it boils down to luck and "playing the game". And depressingly, it is actually our own medical system in Canada that is unintentionally or intentionally discouraging the socioeconomically disadvantaged from pursuing medicine in Canada - which is precisely why many go abroad. 

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9 hours ago, COMMANDO said:

CSA is only available as an option to the upper class anyways. Cost of living + travel between Europe/Caribbean to Canada + FOR-PROFIT TUITION with odds stacked against for matching in canada = poor people need not apply. Maybe that’s why these people feel so entitled to CMG residency spots? Chad couldn’t get into medical school so mommy and daddy paid for him to study abroad. Chad can’t match back into Canada so mommy and daddy hired a lawyer to sue the provincial government. 

 

Also if you’ve in province advantage at UBC and still don’t make it... thank your lucky stars you’re not from Ontario outside of Southwestern and Northern Ontario

That is a totally nonsensical statement. What makes you believe that CSAs are all upper class? Many of these people come from working class families that work themselves to the ground for years trying to make a living and get into Canada and then bravely make the decision to make the jump abroad to pursue their dream. Even still, very few people have a "full ride", we've all mortgaged our future to an extent and many of the ones that didn't match are in dire straits. 

It really is disheartening to see the bias that is on this forum. Even though we learn things like compassion and empathy, I guess the reality is it all goes out the window when it may (or may not) affect you.

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6 hours ago, Bluecolorisnice said:

The inherent issue here is the ethics of having dedicated IMG spots at the expense of CMGs. A country that spends millions of $ trying to subsidize medical school for Canadian students also allows the same students to go unmatched at the expense of wealthy IMG students that pursue medical school overseas. Even if 10% of CMGs go unmatched - that costs the system thousands of $$.

For the IMGs (CSA in particular) complaining, the CSA students are given equal opportunity to apply to Canadian medical schools and pursue residency through the regular route (i.e apply to MD programs in Canada and then residency). Many students go abroad after rejections from Canadian schools with hopes of returning back via IMG stream. This is unethical in the first place since 1) it allows financially well off Canadians to study in countries like ireland/aus/carribean - issue of inequality 2) It denies CMGs opportunity to pursue residency and wastes tax dollars

A better option is to open more medical schools in Canada and charge the students higher tuitions (similar to ireland/carribean etc) - this might bring down the GPA/MCAT cutoffs. It would also ensure 100% match rate. 

Think about that first statement here for a moment. The issue here is the ethics of having dedicated spots for one group of Canadians and another group of Canadians. The exact reverse argument is being made in the petition that we're discriminating against other Canadians. Even if we can play mental gymnastics to justify discriminating against groups of Canadians (replace IMG/CMG with anything else and you see the problem - black/white, religious/non-religious, etc) are we even sure that these IMG spots are created at the expense of the CMGs? When the separation was first created in 1993, do we know if IMG spots created through funding from elsewhere or if spots were reallocated from CMGs? My understanding of this was that this was borne in part out of a need to service our underserved areas (hence the RoS on IMG positions) and to fill the gap not met by the CMGs (primary care - which is why most spots are allocated in IM/FM/etc). 

About your second statement, I'm not so sure the opportunity to apply and get into Canadian medical schools is equal or equitable. Our adcoms are definitely moving in that direction to make it so, but it would be silly to think that certain groups of people are not at an advantage. Many of these same people are those that you dislike so much - the rich, the connected, etc.

For my own curiosity, how many CSAs or IMGs do you know well personally? They're not all the "scumbags" you make them out to be. You have a broad range of people going abroad, from those busting their ass from day 1 but unable to get into Canada, those wanting a change in career, those wanting to travel and learn about a new medical system, etc. They're Canadians just like you or me. I don't see what is so unethical about them traveling abroad for their medical education.

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4 hours ago, StarStrike said:

Think about that first statement here for a moment. The issue here is the ethics of having dedicated spots for one group of Canadians and another group of Canadians. The exact reverse argument is being made in the petition that we're discriminating against other Canadians. Even if we can play mental gymnastics to justify discriminating against groups of Canadians (replace IMG/CMG with anything else and you see the problem - black/white, religious/non-religious, etc) are we even sure that these IMG spots are created at the expense of the CMGs? 

(from last Thread)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-

Fine you might say, but Aus/Irl are very similar to Canadian training (setting aside the cost question for a moment) and so this shouldn't apply to them (i.e. college shouldn't have any safety concerns).  

 Here's where it gets a little tricky: at one point (before CSAs existed), Canada did treat IMGs differently (in a formal sense) depending on where they trained (e.g. UK vs Asia...).  Some immigrant-IMGs appealed this, even went on hunger strikes, and the IMG quota was born in Manitoba.  

My take-home from this is that all IMGs must be treated equally from a procedural point of view: in fact even separating CSAs from immigrant IMGs seems to me unconstitutional.  

Moving ahead - legally speaking, CSAs then piggybacked off the quota created for immigrant IMGs and their numbers went up dramatically (200 in 2008 vs 1000 in 2014 vs ? in 2019).  And they even now dominate the IMG match vs immigrant IMGs for probably basic reasons like language, culture, etc.

And yes - effectively speaking CSAs from certain regions Aus/Irl are preferred over other CSA/IMGs despite the formal non-discrimination.

So back to cost..  Canadian schools are set-up for the benefit of the Canadian public incl non-discrimination and pay lip-service at least to accessibility.  No IMG school has the same mandate, and the cost of attending some of these schools is staggering - an earlier forum post states that Aus is ~300K+ and Irl is ~260K+  in tuition alone (link).  Which means 4 years is going to be 400-500K+, a colossal sum for almost all Canadians which bank (if cosigner available)+government loans don't come to close to covering  and thus require major personal/family income/savings.  

Ironically, these schools are using this `revenue source' of Canadian students to subsidize training of their own students.

And then what's the payoff for would-be CSA?  The best odds are 1:1 from Aus.  That's a staggering  half-million dollar gamble, that not many can or would take.  

So unless one is able/prepared to write-off the money completely (i.e. very expensive international adventure),  able/allowed/prepared to work in the location of training (or nearby area), or prepared to match to the US, then it doesn't make a lot of sense.

So for some, this may still be worthwhile route even if they may treated with vitriol if they come back.  

But for others, esp who would be stretching family finances to the max on a risky proposition, then it's probably best to think twice.

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4 hours ago, StarStrike said:

1) For the most part you are correct about the bank situation. Bad bets do happen and those do burden the banks (and usually the family that has co-signed the student's debts). I've seen it happen with many of my colleagues and some are doubly screwed if they don't match. What about the government loans?

2)  I might not understanding your point well, but I'm not sure that is much of an argument. Admission logistics can change "on a whim" anywhere, including Canada. For residency, think about the abolishment of the rotating internship, creation of the IMG stream, creation of CAP, etc. Same thing with medical school admission, many schools no longer require prerequisites, favour non-academics equally, etc.

As for the free market question, I guess that is part of the point and what these guys are petitioning. Why is it that it isn't a free market like other professionals (like you mention with law). I'm not necessarily saying a free market is better, but why is medicine so different? Plenty of Canadians train abroad in professions like law, pharmacy, dentistry, etc and many immigrants also successfully make it in to the Canadian system with their education and credentials.

I was just looking at the mission statement of CaRMS which is:
"Our mission is to serve as an independent, arms-length provider of a client-centred, fair, transparent, and equitable matching service for medical education in Canada"

An argument can be made that the current process isn't equitable - by definition IMGs have to jump through the NAC OSCE, MCCEE (next year the QE1), and the CAP for UBC to even compete at the same level as CMGs. You could also argue that it isn't fair, given that it discriminates between Canadians based on their place of training. You could argue that the purpose of the board exams (which CMGs don't have to do until they've matched or are in residency) is to create a level playing field, but then why are Canadian IMGs separated into a different pile? 

The last point you make about setting up a system where students incur 200k+ debt is an interesting one. Nobody wants that. The reality is,  this situation already happens with CSAs and CMGs that don't match. To a degree, you are probably right that the average CSA is better off than the average Canadian, but I'm not so sure you could say that about the average CMG - do we have any statistics on that anywhere? It would be interesting to see what the data is in Canadian medical schools RE their socioeconomic status compared to the average CSA. Although the money usually needed to go abroad is usually a deterrent, I think you might be surprised how many people mortgage their lives to make it happen. Some of my own colleagues in Ireland are in a dire situation financially (though as you may argue and correctly so, at a risk of their own, but also borne by their families and the gov't). Many of these people aren't the stinking rich people that you think they are. It is tempting to believe that because it justifies the resentment and hate the IMGs regularly and constantly receive. Over my last few years in Ireland, I've talked to so many people that are desperate  to become doctors, many of whom are working class, strong academically, etc. Their misfortune is they couldn't play the game as well as the CMGs did - and the reality is to a large degree it boils down to luck and "playing the game". And depressingly, it is actually our own medical system in Canada that is unintentionally or intentionally discouraging the socioeconomically disadvantaged from pursuing medicine in Canada - which is precisely why many go abroad. 

1) On the whole, the bank will make money as they have accounted for their risk by adjusting the interest rate and asking for possible co-signers. I have no doubt it burdens families but there is no other way the bank would give them the loan without the collateral. Similarly, the government is giving loans because as a whole it will reap the benefit of an educated population. Some people will default on their loans and the government isn't going to be making money hand over fist but the overall population being more educated is beneficial to the country.

2) Imagine a country that completely outsources its undergraduate medical education to other countries. Medical training can result in a decade worth of lag time for a human resources point of view. What if Australia or Ireland or whatever were to suddenly say our capacity is full and we can't train any more Canadians. The amount of time it would take to set up medical training programs at home and an accreditation and standards process would take years and result in a huge gap of physicians entering the workforce a decade down the line. It is in the interest of the country to have domestic medical schools that train citizens.

I bring up this argument because often say that IMGs are great because the government didn't have to spend money educating them. Ideally, if we could keep up that talent stream then we wouldn't have any medical schools because it's just cheaper to shift the burden to people's personal savings and other country's training infrastructure. However, as I pointed out I think it is hugely irresponsible to not have domestic schools so we essentially always have CMGs. This means that we are going to be wasting hundreds of thousands of dollars subsidizing each CMGs education which we should absolutely see a return on.

3) The other fields have a free market in the sense that they are able to compete for work as independent professionals. Residency is still part of the training process that is publically funded and because of our public healthcare system, we won't be having private hospitals with residency spots anytime soon. If people want to do their residency in the US, Australia, etc and come back there is no issue as I know plenty of physicians who trained elsewhere. However, Canadian training spots are part of the training pipeline that is synced up with medical schools. If we are going to be training X CMGs we should be making sure that whatever capacity available should be provided to them first with the slack room given to other candidates.

4) With regards to the exams, I think the reasoning is that domestic students go to programs that are accredited by our local body who is probably in charge of the exam writing so they know what students are capable of. International students have curriculums that our leaders may not be 100% familiar with and thus these extra steps exist for quality assurance purposes.

5) My point was targetted towards domestic education. If we are running medical schools domestically we should ensure that we have a diversity of student backgrounds. We won't promote that if the training pathway becomes less certain as people won't take that financial risk. I don't have the literature right now so I can't give you exact statistics. I personally feel awful for the schools that have taken advantage of CSA students and their subsequent debt burden but that is the exact situation we want to avoid domestically.

No one has a right to a certain career. I'm sure many IMGs and many Canadians would be great physicians. I will be the first to say that the job doesn't require you to be a rocket scientist. Many people have the intelligence and grit needed to succeed. However, there is a capacity issue in every phase of training. Just because you finish residency doesn't mean there's easy employment at the end.

6) With regards to the fairness of the process. Schools are doing programs to reach out to underrepresented students like UofT with Black students. The overall process (at least when I did it) was pretty straightforward. Score well on the MCAT, get great grades, extracurriculars. Perhaps students cannot afford the MCAT test prep or have to work a job during school. However, such a large part of the admissions process is based on these academic markers that I would say is the fairest way to evaluate students. Perhaps extracurriculars have a huge subjective component to it but I never discriminated students on if they worked at McDonalds vs if they were in varsity fencing. I honestly think the fairest way to equalize the playing field would just be to make it about an academic score, however that makes us lose out on a lot of context that colors a person's profile. If doing well in school is playing the game then I'm not sure how we can change that for the better as we should be rewarding students who do well in school through putting in the time and hard work. 

 

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5 hours ago, tere said:

(from last Thread)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-

Fine you might say, but Aus/Irl are very similar to Canadian training (setting aside the cost question for a moment) and so this shouldn't apply to them (i.e. college shouldn't have any safety concerns).  

 Here's where it gets a little tricky: at one point (before CSAs existed), Canada did treat IMGs differently (in a formal sense) depending on where they trained (e.g. UK vs Asia...).  Some immigrant-IMGs appealed this, even went on hunger strikes, and the IMG quota was born in Manitoba.  

My take-home from this is that all IMGs must be treated equally from a procedural point of view: in fact even separating CSAs from immigrant IMGs seems to me unconstitutional.  

Moving ahead - legally speaking, CSAs then piggybacked off the quota created for immigrant IMGs and their numbers went up dramatically (200 in 2008 vs 1000 in 2014 vs ? in 2019).  And they even now dominate the IMG match vs immigrant IMGs for probably basic reasons like language, culture, etc.

And yes - effectively speaking CSAs from certain regions Aus/Irl are preferred over other CSA/IMGs despite the formal non-discrimination.

So back to cost..  Canadian schools are set-up for the benefit of the Canadian public incl non-discrimination and pay lip-service at least to accessibility.  No IMG school has the same mandate, and the cost of attending some of these schools is staggering - an earlier forum post states that Aus is ~300K+ and Irl is ~260K+  in tuition alone (link).  Which means 4 years is going to be 400-500K+, a colossal sum for almost all Canadians which bank (if cosigner available)+government loans don't come to close to covering  and thus require major personal/family income/savings.  

Ironically, these schools are using this `revenue source' of Canadian students to subsidize training of their own students.

And then what's the payoff for would-be CSA?  The best odds are 1:1 from Aus.  That's a staggering  half-million dollar gamble, that not many can or would take.  

So unless one is able/prepared to write-off the money completely (i.e. very expensive international adventure),  able/allowed/prepared to work in the location of training (or nearby area), or prepared to match to the US, then it doesn't make a lot of sense.

So for some, this may still be worthwhile route even if they may treated with vitriol if they come back.  

But for others, esp who would be stretching family finances to the max on a risky proposition, then it's probably best to think twice.

10

Yeah, I see your point. Obviously not a straight forward situation, be interesting to see what if anything comes out of the petition.

Agreed with the point that some schools are predatory and yes they do use the revenue source to subsidize and improve the training of their own students. Personally, I think these overseas schools also have an ethical responsibility to provide a pathway for their international cohort if they are to continue taking them on.

As for stretching family finances, I agree 100%, but that doesn't stop people from taking these risks. I suppose the question is to see what if any obligation we have to our own fellow Canadians.

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3 hours ago, blah1234 said:

1) On the whole, the bank will make money as they have accounted for their risk by adjusting the interest rate and asking for possible co-signers. I have no doubt it burdens families but there is no other way the bank would give them the loan without the collateral. Similarly, the government is giving loans because as a whole it will reap the benefit of an educated population. Some people will default on their loans and the government isn't going to be making money hand over fist but the overall population being more educated is beneficial to the country.

2) Imagine a country that completely outsources its undergraduate medical education to other countries. Medical training can result in a decade worth of lag time for a human resources point of view. What if Australia or Ireland or whatever were to suddenly say our capacity is full and we can't train any more Canadians. The amount of time it would take to set up medical training programs at home and an accreditation and standards process would take years and result in a huge gap of physicians entering the workforce a decade down the line. It is in the interest of the country to have domestic medical schools that train citizens.

I bring up this argument because often say that IMGs are great because the government didn't have to spend money educating them. Ideally, if we could keep up that talent stream then we wouldn't have any medical schools because it's just cheaper to shift the burden to people's personal savings and other country's training infrastructure. However, as I pointed out I think it is hugely irresponsible to not have domestic schools so we essentially always have CMGs. This means that we are going to be wasting hundreds of thousands of dollars subsidizing each CMGs education which we should absolutely see a return on.

3) The other fields have a free market in the sense that they are able to compete for work as independent professionals. Residency is still part of the training process that is publically funded and because of our public healthcare system, we won't be having private hospitals with residency spots anytime soon. If people want to do their residency in the US, Australia, etc and come back there is no issue as I know plenty of physicians who trained elsewhere. However, Canadian training spots are part of the training pipeline that is synced up with medical schools. If we are going to be training X CMGs we should be making sure that whatever capacity available should be provided to them first with the slack room given to other candidates.

4) With regards to the exams, I think the reasoning is that domestic students go to programs that are accredited by our local body who is probably in charge of the exam writing so they know what students are capable of. International students have curriculums that our leaders may not be 100% familiar with and thus these extra steps exist for quality assurance purposes.

5) My point was targetted towards domestic education. If we are running medical schools domestically we should ensure that we have a diversity of student backgrounds. We won't promote that if the training pathway becomes less certain as people won't take that financial risk. I don't have the literature right now so I can't give you exact statistics. I personally feel awful for the schools that have taken advantage of CSA students and their subsequent debt burden but that is the exact situation we want to avoid domestically.

No one has a right to a certain career. I'm sure many IMGs and many Canadians would be great physicians. I will be the first to say that the job doesn't require you to be a rocket scientist. Many people have the intelligence and grit needed to succeed. However, there is a capacity issue in every phase of training. Just because you finish residency doesn't mean there's easy employment at the end.

6) With regards to the fairness of the process. Schools are doing programs to reach out to underrepresented students like UofT with Black students. The overall process (at least when I did it) was pretty straightforward. Score well on the MCAT, get great grades, extracurriculars. Perhaps students cannot afford the MCAT test prep or have to work a job during school. However, such a large part of the admissions process is based on these academic markers that I would say is the fairest way to evaluate students. Perhaps extracurriculars have a huge subjective component to it but I never discriminated students on if they worked at McDonalds vs if they were in varsity fencing. I honestly think the fairest way to equalize the playing field would just be to make it about an academic score, however that makes us lose out on a lot of context that colors a person's profile. If doing well in school is playing the game then I'm not sure how we can change that for the better as we should be rewarding students who do well in school through putting in the time and hard work. 

 

1

1) I think we are in agreement here. These are calculated risks for sure, but that doesn't mean it doesn't come with costs. I suppose the situation with our loan system here is no where near as bad as the US.

2) I never said anything about completely outsourcing education outside Canada. This is a straw man argument. I agree with you that we should have CMGs and Canadian medical schools.

3) It is true that the residency is an added barrier compared to most other professions. The addition of residency potentially adds yet another choke point. I see the rationale for wanting to stamp out competition, but I'm not convinced the argument is cohesive. I suppose what makes it more difficult is both of us are coming at this from different angles and understandably with different biases.

Do we have any information about the unmatched CMGs from CaRMS RE their choice of discipline? If most of these applicants were aiming for primary care, you could make a case about the allotment of residency spots to IMGs. Though before we do that we would need to determine whether this separation is unconsitutional and/or ethical.

4) Absolutely, I get that. If the purpose of these exams is to see that applicants are at the same standard of CMGs, why have that separation between the CMG/IMG group. If passing/doing well on these exams shows you are on the same playing field, why are we separating these groups still?

5) I'm in agreement with you on that. Nobody has a right to a certain career. Not everyone gets to go to medical school, or pursue a residency, or even have a job waiting for you at the end. What I am disagreeing with is why this is selectively being applied to different groups of Canadians. I could make the same argument about CMGs and say that getting into medical school doesn't entitle you to pursue a residency of your choice. Not everybody becomes a surgeon. As competition is getting more and more intense...not everyone gets to practice clinical medicine (though the upside is that this is not the only thing we can do with our credentials...). 

6) I'm glad to hear about that. I know many of our medical schools also have pathways to support our Indigenous population which I think, if it is working well, is fantastic. 

I'm not so sure I agree with you that we should base our admission just purely on academics. You just end up selecting for people that do well on exams and who focus their energies on the things that provide the highest yield. I know its a fluffy/subjective process the way we have it now, but I think it allows for some degree of diversity in the field and encourages people to build their soft skills and involve themselves in the community. Academics is only one of the many aspects that are important to be a good doc' nowadays (or so what most PDs tell me...).

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