International Medical Graudates Trying to Return

[concernedmedstudent]

The following is my response to many recent newspaper articles that have been printed, claiming that Canadian born international medical school graduates (IMGs) face unfair obstacles when trying to return to Canada and gain acceptance into highly coveted publicly funded post graduate residency positions. These articles have statements from Canadian medical students studying abroad such as "The roadblocks put in our path by Canadian medical schools are almost impossible to break through" and "I didn't even apply in Canada because I feared I wouldn't get in...". The parents of these students, many of whom are physicians have also gone to the media claiming “All they’re asking for is to compete on a level playing field for residency positions".

 

First off, not applying because you are concerned you are not going to get into UBC should tell these candidates something about themselves. Either they are not qualified at this time to compete with successful candidates, or, they are not cut out for a competitive and demanding career in medicine.

 

Some international schools are fantastic but those that accept large numbers of international students have VERY low standards for these internationals, when compared to Canadian medical schools. Why do they have low standards? Because international students pay good money to attend and this money helps to fund their programs. The fact that the same countries that accepts many of these students, such as Australia, isn't willing to provide all of these international students with postgraduate training, despite also having a doctor shortage, should tell you something about how they feel about the quality of students they produce.

 

Lets face it, IMGs were either unable to get into Canadian Schools or they couldn't be bothered to apply, either way, it doesn't inspire confidence in their ability or perseverance.

 

"Just wanting a chance to compete" isn't a valid argument. These students all had the chance to compete and unfortunately they lost that competition when they didn't get into Canadian schools. Nothing is preventing them from applying over and over again and if they are truly qualified, they will get in. Just ask Canadian medical students whom on average applied more than 3 times before getting in.

 

That being said, I am in favor of accepting the best IMGs back into Canada if they can make it through the competitive processes that are currently in place for to assure that we are only getting back highly competent international medical graduates. All Canadian med students have already gone through an incredibly competitive and rigorous application process, IMGs have not, this is their chance to prove themselves. If they truly are exceptional students with high quality training I have no doubt that they will find a spot back in Canada, but to once again give them an easy option isn't the solution.

 

Not only is the quality of IMGs highly variable, but the quality of schools is too. As noted in other articles, some of the schools that IMGs are attending are world class, but others are not. In Canada we have some of the most stringent accreditation standards. We spend a lot of money and time making sure that every Canadian medical schools maintains these standards. It seems counter-intuitive to put this much effort into this process if we are willing to put blind faith in the quality of schools in other countries, each of which have different resources, standards and culture of care.

 

It is important to remember that we shouldn't be taking shortcuts when it comes to the quality of our healthcare, nor would I like to think that my doctor is someone who seeks such shortcuts.

 

It should also be noted that IMGs have hired a professional PR firm to tug on public heart strings and spin a very one sided argument.

[Lunasly]

Well said.

[Mashmetoo]

The following is my response to many recent newspaper articles that have been printed, claiming that Canadian born international medical school graduates (IMGs) face unfair obstacles when trying to return to Canada and gain acceptance into highly coveted publicly funded post graduate residency positions. These articles have statements from Canadian medical students studying abroad such as "The roadblocks put in our path by Canadian medical schools are almost impossible to break through" and "I didn't even apply in Canada because I feared I wouldn't get in...". The parents of these students, many of whom are physicians have also gone to the media claiming “All they’re asking for is to compete on a level playing field for residency positions".

 

First off, not applying because you are concerned you are not going to get into UBC should tell these candidates something about themselves. Either they are not qualified at this time to compete with successful candidates, or, they are not cut out for a competitive and demanding career in medicine.

 

Some international schools are fantastic but those that accept large numbers of international students have VERY low standards for these internationals, when compared to Canadian medical schools. Why do they have low standards? Because international students pay good money to attend and this money helps to fund their programs. The fact that the same countries that accepts many of these students, such as Australia, isn't willing to provide all of these international students with postgraduate training, despite also having a doctor shortage, should tell you something about how they feel about the quality of students they produce.

 

Lets face it, IMGs were either unable to get into Canadian Schools or they couldn't be bothered to apply, either way, it doesn't inspire confidence in their ability or perseverance.

 

"Just wanting a chance to compete" isn't a valid argument. These students all had the chance to compete and unfortunately they lost that competition when they didn't get into Canadian schools. Nothing is preventing them from applying over and over again and if they are truly qualified, they will get in. Just ask Canadian medical students whom on average applied more than 3 times before getting in.

 

That being said, I am in favor of accepting the best IMGs back into Canada if they can make it through the competitive processes that are currently in place for to assure that we are only getting back highly competent international medical graduates. All Canadian med students have already gone through an incredibly competitive and rigorous application process, IMGs have not, this is their chance to prove themselves. If they truly are exceptional students with high quality training I have no doubt that they will find a spot back in Canada, but to once again give them an easy option isn't the solution.

 

Not only is the quality of IMGs highly variable, but the quality of schools is too. As noted in other articles, some of the schools that IMGs are attending are world class, but others are not. In Canada we have some of the most stringent accreditation standards. We spend a lot of money and time making sure that every Canadian medical schools maintains these standards. It seems counter-intuitive to put this much effort into this process if we are willing to put blind faith in the quality of schools in other countries, each of which have different resources, standards and culture of care.

 

It is important to remember that we shouldn't be taking shortcuts when it comes to the quality of our healthcare, nor would I like to think that my doctor is someone who seeks such shortcuts.

 

It should also be noted that IMGs have hired a professional PR firm to tug on public heart strings and spin a very one sided argument.

 

Here we have a few examples of the logical fallacy - the false dilemma

Definition:

 

A limited number of options (usually two) is given, while in reality there are more options. A false dilemma is an illegitimate use of the "or" operator.

 

Putting issues or opinions into "black or white" terms is a common instance of this fallacy.

 

Examples:

 

Either you're for me or against me.

America: love it or leave it.

Either support Meech Lake or Quebec will separate.

Every person is either wholly good or wholly evil.

Either they are not qualified at this time to compete with successful candidates, or, they are not cut out for a competitive and demanding career in medicine.

IMGs were either unable to get into Canadian Schools or they couldn't be bothered to apply

 

Proof:

 

Identify the options given and show (with an example) that there is an additional option.

 

 

The last one is a Non sequitur logical fallacy:

 

Non sequitur is a Latin phrase that means “that which does not follow”. It means that the conclusion reached does not follow from the premise(s). Often examples of non sequitur arguments are hilariously disconnected, but often they can be subtle, so need to be looked out for. The reason that such arguments are fallacious in logic should be fairly obvious.

 

2 examples can be given as follows:

 

Men are human.

Mary is human.

Therefore, Mary is a man.

 

If they truly are exceptional students with high quality training, then they will no doubt find a spot back in Canada

[leviathan]

You missed the boat with that publication. The roadblock BC students studying abroad are facing is that they can't even apply for IMG positions in BC. The OSCE they hold for IMGs is administered in April, after CaRMS is finished. So all the qualified IMGs who could have addressed the shortage in BC end up matching elsewhere.

 

Congrats on your med school acceptance. Your sense of entitlement, however, is nauseating. There are far more qualified applicants than seats, and so if a student decides to seek education abroad, it's probably best not to hold such a condescending attitude like they are less worthy or capable than you. While some IMGs are weaker students, the rigorous training of medical school weeds the vast majority of these people out. There are many more IMGs who are likely much more capable than you because of how many strong applicants get rejected yearly and go abroad, and then are forced to work much harder than their Canadian counterparts. For various reasons, not everyone has the capacity to keep applying for years without a guarantee that they'll eventually get an acceptance.

 

I would argue it takes far more courage and hard work to attend an international medical school than to sit around idly in Canada until you get an acceptance. Especially if you are the type who comes from a wealthy family that pays all your student loans, and allows you to lie around their house for free and reapply yearly until you get in. I think we can all agree that once you're in med school in Canada, it's smooth sailing from there. The same is clearly not the case for international students.

[leviathan]

I like how you just knocked him down with logic. 10/10

[Robin Hood]

If I was a residency PD, I would automatically send a rejection letter for all IMGs. How can you verify the credimentals of each schools? Also, even if they come from a prestigious school, diseases are not the same everywhere.

[Kasiunut]

If I was a residency PD, I would automatically send a rejection letter for all IMGs. How can you verify the credimentals of each schools? Also, even if they come from a prestigious school, diseases are not the same everywhere.

 

Seriously? Cause its THAT different learning about how to deliver babies in an Irish OB-GYN rotation from a Canadian? Does the brain really differ so much in Australia and Canada that an Australian trained med student wouldn't be able to be an adequate neurologist? You think that a Cambridge med school student would be worse at dealing with a heart attack patient than a Canadian med student?

 

Look, don't get me wrong, I know there are standards and the quality of med school is incredibly important. But are you really saying that in the 4 years of med school you learn ALL that is important? And somehow knowledge of "local" diseases trumps all that? I feel like that is a dumb reason for "automatically rejecting" IMGs. Especially since you learn the most while in residency, not in med school where you get at best a couple months to learn about a specialty. By that logic technically we should be giving more Ontario residency spots to people trained in NY state than anyone from the West of Canada, since NY is SOOO much closer than BC or Alberta and those trained there wouldn't be as familiar with "local" diseases.

 

But seriously I'd like you to name one "local" disease that ONLY a Canadian educated med student would be able to deal with effectively. I think this is an incredibly xenophobic approach, especially since the world is becoming so connected - people travel all over the world and will bring back diseases with them --> ex. SARS.

 

Many people who go overseas aren't only going there because they didn't get in to Canada but because they didn't want to WAIT. The average acceptance time in Canada is 2.7 attempts - what if they got rejected after one attempt and decided to try else where? What if living abroad appeals to them? What if they have family in other countries? For me personally, I'd love to go to Australia because my husband's family lives there - it would be better for me to go there than to BC, where I have no support at all.

[apache]

They pass numerous OSCE's, the EE, the QE1, TOEFL, and a barrage of other exams, isn't that similar to how we assess Canadian grads when med school is all over? I'm not even talking about Canadian born IMG's either, I'm talking about the foreign born ones.

 

If I was a residency PD, I would automatically send a rejection letter for all IMGs. How can you verify the credimentals of each schools? Also, even if they come from a prestigious school, diseases are not the same everywhere.

[dokrbb]

If I was a residency PD, I would automatically send a rejection letter for all IMGs. How can you verify the credimentals of each schools? Also, even if they come from a prestigious school, diseases are not the same everywhere.

 

Really, RobinHood I am astonished by this reaction from you...

 

or, wait , this might be the famous canadian hypocrisy, because I don't understand the reason Why you help all IMGs, so kindly, on this forum...

 

and BTW, by "credimentals" you meant credentials - these are verified directly by ECFMG, and inderectly by Canadian College..., an IMG is not allowed to pass exams until diplomas are not verified,

 

and the thing about diseases is just hilarious,

 

seriously, I didn't expect such a comment from you...

[charmer08]

If I was a residency PD, I would automatically send a rejection letter for all IMGs. How can you verify the credimentals of each schools? Also, even if they come from a prestigious school, diseases are not the same everywhere.

 

Exactly, many other countries have far more diseases than Canada does... so they must be more experienced?

[seeking1]

I like how you just knocked him down with logic. 10/10

 

I presume this is sarcasm, but I am not sure.

[seeking1]

Notice how all of these arguments ignore the obvious element: residency spots, whether for CMG's or IMG's, cost a lot of money. We're not like the USA, where we can just throw money at the problem and accept whoever we feel like.

[dokrbb]

Notice how all of these arguments ignore the obvious element: residency spots, whether for CMG's or IMG's, cost a lot of money. We're not like the USA, where we can just throw money at the problem and accept whoever we feel like.

 

yes, and keep in mind that as for official declarations the CMGs and IMGs are in the same pool, but unofficially, an IMG have no chances in competing with an CMG,

[Robin Hood]

Really, RobinHood I am astonished by this reaction from you...

 

or, wait , this might be the famous canadian hypocrisy, because I don't understand the reason Why you help all IMGs, so kindly, on this forum...

 

and BTW, by "credimentals" you meant credentials - these are verified directly by ECFMG, and inderectly by Canadian College..., an IMG is not allowed to pass exams until diplomas are not verified,

 

and the thing about diseases is just hilarious,

 

seriously, I didn't expect such a comment from you...

 

Maybe I was wrong for the disease part, but that was an argument I already heard, about why it's hard for countries to recognized medical education done elsewere. As for credentials, currently, the CMC uses the WHO's list, and the WHO's list is about med schools recognizd by their governments, but in most of the non developped countries, the standards used are inferior to those used in Canada.

[Robin Hood]

Notice how all of these arguments ignore the obvious element: residency spots, whether for CMG's or IMG's, cost a lot of money. We're not like the USA, where we can just throw money at the problem and accept whoever we feel like.

 

For this, maybe we should have Ottawa fund the residency spots for those whom the CIC brings based on their MD/MBBS and gives them false hopes about being able to practice here.

[dokrbb]

Maybe I was wrong for the disease part, but that was an argument I already heard, about why it's hard for countries to recognized medical education done elsewere. As for credentials, currently, the CMC uses the WHO's list, and the WHO's list is about med schools recognizd by their governments, but in most of the non developped countries, the standards used are inferior to those used in Canada.

 

just to avoid polemics, this difference in standards is abolished by the EE, QE1 and QE2 exams, so I don't think this should be a problem when the IMGs are allowed after all three exams to go through the entire post-grad training, even if most of them are already licenced,

 

still, speaking about diseases, you might be right - you have just to say it properly: Not the diseases are different from country to country, but the approach to the Diagnostic process and their treatment - these differences are multifactorial, but again - COULD be abolished by doing the entire training after completing the above mentioned exams,

 

The problem is not in the exams, neither in repeating the residency program, but it's between these two phases...

[pheochromocytoma]

no offense meant, but aren't students who go to international medical school on average coming from much wealthier homes? A huge amount of them come from homes where their parents are doctors. And you don't get in to medical school by sitting idly by applying year after year. The grade trends and competition are increasing as sitting on your butt for a year is not how people here get in.

 

I do agree that there are many more qualified applicants than there are spots in Canadian medical schools, no one denies that. But I also agree with OPs point about Canada's standards of accreditation and the contradiction provided by then allowing IMGs to compete in the same pool. The April OSCE situation is unfortunate, but can they not take the OSCE, spend some time flying around to actually meet the people running the programs they wish to apply to (thus increasing likelihood of success by getting some pre-CaRMS face time) and do a one year MPH or something of the sort (also making them a more attractive candidate), of course this is time and money and no one wants to take a year off but if it helps you get the residency you want I think it would be worth it.

[Robin Hood]

just to avoid polemics, this difference in standards is abolished by the EE, QE1 and QE2 exams, so I don't think this should be a problem when the IMGs are allowed after all three exams to go through the entire post-grad training, even if most of them are already licenced,

 

still, speaking about diseases, you might be right - you have just to say it properly: Not the diseases are different from country to country, but the approach to the Diagnostic process and their treatment - these differences are multifactorial, but again - COULD be abolished by doing the entire training after completing the above mentioned exams,

 

The problem is not in the exams, neither in repeating the residency program, but it's between these two phases...

 

The problem is that CaRMS spots are limited, and thus, it's logical for CMGs to get preference, Canada doesn't have enough space for the IMGs, the US can absorb them, so it would be better for IMGs to apply there. Also, CMGs work there butts off, and expect to get a rez spot and a job, else, why would someone risk working like crazy for 4-10 years to finish as a hightly endebted. Also, the provincial governments pay a lot of $$$ to train med students, they expect them to find a job, and not pay all this money for nothing. Plus, immigrant IMGs have access to rez in their countries, and CaRMS is tight.

[dokrbb]

For this, maybe we should have Ottawa fund the residency spots for those whom the CIC brings based on their MD/MBBS and gives them false hopes about being able to practice here.

 

- I don't think some measures should be taken in this direction (speaking about IMGs , Not CMGs) because they behave in the same way as with you - canadian pre-meds,

yearly, you apply to canadian med schools, being aware that you compete with another (roughly) 700-800 canadian premeds, for only 80-100 spots;

 

the same IMGs - yearly there are like 1500-1600 applying through CaRMS for a total of 200 spots,

 

As an IMG, before recieving your VISA of Perm Resident you sign a letter of confirmation that you wouldn't ask a permission to practice as MD if you wouldn't complete all the required conditions for this,

 

And it's nothing wrong in this - the IMGs (like me, for ex.) didn't come here because they heard the doctors are well paid, they came here because in their undevelloped countries (as canadians often like to say) they were living with 80 - 120$/month (yes, it's not a typo),

 

The part of selection I dislike is about the attitude toward the IMGs as of some stupid, unprepared and unaware "healers", and when you find statements like "Yes, my Internal medicine PD last year had to interview some IMGs, so for 1 spot he invited 4 candidates, from which one was an IMG, But nobody forced him to accept this IMG, right? " you begin to look different to some things

[moo]

This is really funny.

 

Canadian med schools are not the be-all and end-all. Did you know that Dal, USask and UA all have been put on probation in the past decade by the LCME/CACMS? What does that speak to their "quality" or lack thereof? USask has been hit again with a "confidential" threat of probation. Are the students there incompetent?

 

Typical Canadian arrogance. And you thought Americans were bad.

[pheochromocytoma]

This is really funny.

 

Canadian med schools are not the be-all and end-all. Did you know that Dal, USask and UA all have been put on probation in the past decade by the LCME/CACMS? What does that speak to their "quality" or lack thereof? USask has been hit again with a "confidential" threat of probation. Are the students there incompetent?

 

Typical Canadian arrogance. And you thought Americans were bad.

 

At least that means that schools are held accountable and to high standards, no? I find that reassuring if anything.

[seeking1]

yes, and keep in mind that as for official declarations the CMGs and IMGs are in the same pool, but unofficially, an IMG have no chances in competing with an CMG,

 

Yes, because residency supervisors do not trust IMGs as much as they trust CMGs.

 

I am sure people will have issue with this statement, so I will clarify. I do not mean "trust" as in "I trust this person's diagnostic skills and knowledge". Rather, I mean "I trust this person's skill in the English language and comprehension".

 

Basically, I am saying that CMGs are seen as better English-speakers than are IMGs by residency supervisors, regardless of if that stereotype is true or not.

 

What proof do I have of my claim? Well, admissions for MD programs reward high verbal reasoning score moreso than any other section on the MCAT. Further, most medical school programs in Canada operate their programs in the English language only. Those that do not usually have the program in French, and applicants to that program must be fluent in French.

 

It follows, then, that this bias is prevalent through to residency training as well.

 

I will never argue with anyone that IMGs are worse than CMGs at the science of medicine; some are far better, in fact. I truly believe, though, that the perception of greater in trust in CMGs, particularly in language faculties, is the reason why CMGs are preferred to IMGs for competitive residency positions.

[seeking1]

For this, maybe we should have Ottawa fund the residency spots for those whom the CIC brings based on their MD/MBBS and gives them false hopes about being able to practice here.

 

That will never happen, ever. Ottawa does not want to be seen as interjecting in the affairs of provinces, at least not as directly as that.

 

Moreover, the political and social fallout of being painted in the papers as "THEY'RE GIVING AWAY ARE JOBS! THEY WANT OUR CHILDREN TO BE POOR AND DOCTORLESS!" is not worth it to any political party. These things do not happen in a vacuum.

[moo]

At least that means that schools are held accountable and to high standards, no? I find that reassuring if anything.

 

Reassuring? To a point.

 

Fact remains that even some Canadian schools can lag behind in terms of accreditation standards. Stanford med has been put on probation before, I believe. My point is that the docs they graduate are still competent, for the most part. I've been in Canada and the US and have worked in multiple institutions and have worked with IMGs from all over the world. Canadian IMGs who've studied in Australia, Ireland, etc. are generally pretty similar to CMGs. I've met many bad CMGs as well, some who have no common sense, some who are so lazy, you wonder how they ever got in, and some who are amazing.

 

Just because you get into a Canadian school, it doesn't mean you're the best. It means you won the lottery. Undergrad medical training is pretty uniform in developed countries. Arguing over whether someone is a better doctor based on undergrad GPA/ECs and whether you won the admission lottery is really juvenille, IMHO.

[dokrbb]

Yes, because residency supervisors do not trust IMGs as much as they trust CMGs.

 

I am sure people will have issue with this statement, so I will clarify. I do not mean "trust" as in "I trust this person's diagnostic skills and knowledge". Rather, I mean "I trust this person's skill in the English language and comprehension".

 

Basically, I am saying that CMGs are seen as better English-speakers than are IMGs by residency supervisors, regardless of if that stereotype is true or not.

 

What proof do I have of my claim? Well, admissions for MD programs reward high verbal reasoning score moreso than any other section on the MCAT. Further, most medical school programs in Canada operate their programs in the English language only. Those that do not usually have the program in French, and applicants to that program must be fluent in French.

 

It follows, then, that this bias is prevalent through to residency training as well.

 

I will never argue with anyone that IMGs are worse than CMGs at the science of medicine; some are far better, in fact. I truly believe, though, that the perception of greater in trust in CMGs, particularly in language faculties, is the reason why CMGs are preferred to IMGs for competitive residency positions.

 

Are you sure the language issue is one of the most important reasons for bias,

 

but for this the "humanity" (like north-american humanity) invented the TOEFL as a prereq, , is it new for you

 

more then, french north-american humanity invented TFI as a prereq, and the hilarious thing in this is that they don't accept DELF-DALF above TFI, even if DELF/DALF is far more complex than TFI...

 

- and... just to continue my statements about abolishing the differences - the language issue is NOT an issue at all, any language is learned if it is practiced, give to an IMG a chance to be all around the english environment for few months and he/she will learn not only the language , but also the accents of the region

 

I expected more realistic reasons to be said here, not some romantic views about an utopic world