International Medical Graudates Trying to Return

[moo]

Moo I don't think that anyone in Canada is questioning that there are great doctors trained elsewhere. I think the issue is how to discriminate between the good and the bad. Canadian schools

Have gone to a lot of effort to reform

Their admissions processes in order to select those who they think have the beat overall attributes that will lead them to

Be successful docs. That doesn't mean that nobody else will

Be great but this is where the selection process occurs. After this a lot o time money and energy is put into these students to prepare them for residency. It doesn't make sense to jeopardize their chances at successfully matching 4 years after deciding that this is the group that we want to be the future doctors of Canada. I think that most Canadian students are in favor of allowing some IMGs into Canada regardless of where they are originally from. We just want to make sure there is a process in place that makes sure we only get the very best And we don't want that process to affect the group that has already been chosen to be the future of the profession in this country.

 

The admissions process is but one way of weeding people out. Med school itself doesn't do a good job. You are all assuming that once you pass the hurdle of attaining a good GPA and getting a good MCAT score and doing well on the MMIs that you're going to be competent. That is false. Like I said, I've taught a lot of medical students, in clinic, in epidemiology, in other aspects. I've taught residents, I've taught students in all years. And to be quite honest, there are Canadian students who are lazy. There are Canadian students who get by by sucking up. There are Canadian students who really have a poor knowledge base. You guys are still close to the admissions game, that's why you think this is the be-all end all of physician training and evaluation. But getting into med school is only part of it. What molds someone into being a good doc comes from many aspects. And I think it's ridiculous to dismiss one's intellect by saying that just because they couldn't cut it here, that they are worthless.

[brolias]

The admissions process is but one way of weeding people out. Med school itself doesn't do a good job. You are all assuming that once you pass the hurdle of attaining a good GPA and getting a good MCAT score and doing well on the MMIs that you're going to be competent. That is false. Like I said, I've taught a lot of medical students, in clinic, in epidemiology, in other aspects. I've taught residents, I've taught students in all years. And to be quite honest, there are Canadian students who are lazy. There are Canadian students who get by by sucking up. There are Canadian students who really have a poor knowledge base. You guys are still close to the admissions game, that's why you think this is the be-all end all of physician training and evaluation. But getting into med school is only part of it. What molds someone into being a good doc comes from many aspects. And I think it's ridiculous to dismiss one's intellect by saying that just because they couldn't cut it here, that they are worthless.

 

This. is why he's a mod.

[lostintime]

There's already a bunch of IMG spots added for specialties even where CMG's can't even compete for those spots first round because they are reserved specifically and especially for IMG's, so I don't see what else the government needs to do? For specialties where there are no jobs right now...right.

[lostintime]

I haven't done cost-effective analyses or anything, but I find it very interesting how the government keeps funding more and more over the years, for IMG's, NP's, PA's, visa students from Saudi Arabia (well not fund but provide opportunities for), etc and obviously this takes away from training opportunities for CMG's. Is this cost effective?

 

If they think that training CMG's and having the population treated by Canadian med graduates is really not cost effective or beneficial in the long run and we should all be replaced by the above (although arguably we can't even be replaced by visa trainees from Saudi Arabia because they have to go back), then they should make statements that this is where health care for the future is going at the next federal/provincial elections.

[Robin Hood]

I haven't done cost-effective analyses or anything, but I find it very interesting how the government keeps funding more and more over the years, for IMG's, NP's, PA's, visa students from Saudi Arabia (well not fund but provide opportunities for), etc and obviously this takes away from training opportunities for CMG's. Is this cost effective?

 

If they think that training CMG's and having the population treated by Canadian med graduates is really not cost effective or beneficial in the long run and we should all be replaced by the above (although arguably we can't even be replaced by visa trainees from Saudi Arabia because they have to go back), then they should make statements that this is where health care for the future is going at the next federal/provincial elections.

 

Seems the provincial governments were so concerned about how to fix the physician shortage as soon as possible that they started creating parallel structures to physicians, that will come and hurt when the shortage ends. Now that we got NP and PA, what will happen to them when the market stabilizes? That will just be more duplicate structures, which can also bring confusion to the patient about whom he should see, and PAs and NPs may come to a surplus. There's also allowing pharmacists to do some prescriptions, which also brings a conflict of interest.

[rswim]

The admissions process is but one way of weeding people out. Med school itself doesn't do a good job. You are all assuming that once you pass the hurdle of attaining a good GPA and getting a good MCAT score and doing well on the MMIs that you're going to be competent. That is false. Like I said, I've taught a lot of medical students, in clinic, in epidemiology, in other aspects. I've taught residents, I've taught students in all years. And to be quite honest, there are Canadian students who are lazy. There are Canadian students who get by by sucking up. There are Canadian students who really have a poor knowledge base. You guys are still close to the admissions game, that's why you think this is the be-all end all of physician training and evaluation. But getting into med school is only part of it. What molds someone into being a good doc comes from many aspects. And I think it's ridiculous to dismiss one's intellect by saying that just because they couldn't cut it here, that they are worthless.

 

I agree with a lot of what you have said but I think it is important to recognize that the admissions process that we currently have is the best we have thought of so far to try and select those that can be groomed to be great doctors in the future

. The process isnt perfect and it will continue to evolve as people come up with better ways. A lot of very intelligent people have put a lot of time and energy developing the current model. -sent from mobile

[Zukoota1]

A few points of view from an IMG.

 

Have just read this thread, and it has been fascinating. However, everyone seems to have missed the primary problem ---> Canada Does NOT Need That Many Doctors!! Yes, there may be some long waiting lists for specific procedures or some specialised clinic, but the majority of the population is well served by the medical students that Canada is producing. Its a simple case of supply and demand. Canada can afford to be picky about the international graduates it admits to its programmes because it doesn't need them to deliver healthcare. The US as an example NEEDS international graduates and hence makes it relatively easy to get matched into areas of need, i.e. Internal medicine or family medicine.

 

As an IMG who had to immigrate to Canada for personal reasons I found this out the painful way - several rejections from many programmes. I am not a canadian citizen and therefore did not have the advantage of getting canadian clerkships and electives as a medical student (Most CSA try and get electives in canadian hospitals in order to bolster their application) and my application suffered for that reason.

 

IMG and CSA need to realise that Canada does not need or want you. It's a simple message which I wish that the Canadian colleges and programmes give out. If students want to keep applying despite this clear message then we as IMG's do not have reason to complain as we have been forewarned. Canada puts forward a very small number of IMG specific seats every year and to be honest we should thank them for doing that because they really don't have to.

 

As for the debate about the importance of the medical school - yes, it matters to a certain extent but is also heavily dependent upon the student. IMG's who do match are very well vetted, many of them pass the MCCQE part 1 and tend to score very highly. Even after an IMG is accepted onto a programme they have to pass a 3 month probation period before they are accepted - if they are not up to scratch they are expelled and CAN NOT apply to the same speciality EVER AGAIN in Canada.

 

My advice to any CSA - make sure you complete your USMLE steps and apply to both countries. Canada does not guarantee a return to practice and nor does it have to.

[rswim]

A few points of view from an IMG.

 

Have just read this thread, and it has been fascinating. However, everyone seems to have missed the primary problem ---> Canada Does NOT Need That Many Doctors!! Yes, there may be some long waiting lists for specific procedures or some specialised clinic, but the majority of the population is well served by the medical students that Canada is producing. Its a simple case of supply and demand. Canada can afford to be picky about the international graduates it admits to its programmes because it doesn't need them to deliver healthcare. The US as an example NEEDS international graduates and hence makes it relatively easy to get matched into areas of need, i.e. Internal medicine or family medicine.

 

As an IMG who had to immigrate to Canada for personal reasons I found this out the painful way - several rejections from many programmes. I am not a canadian citizen and therefore did not have the advantage of getting canadian clerkships and electives as a medical student (Most CSA try and get electives in canadian hospitals in order to bolster their application) and my application suffered for that reason.

 

IMG and CSA need to realise that Canada does not need or want you. It's a simple message which I wish that the Canadian colleges and programmes give out. If students want to keep applying despite this clear message then we as IMG's do not have reason to complain as we have been forewarned. Canada puts forward a very small number of IMG specific seats every year and to be honest we should thank them for doing that because they really don't have to.

 

As for the debate about the importance of the medical school - yes, it matters to a certain extent but is also heavily dependent upon the student. IMG's who do match are very well vetted, many of them pass the MCCQE part 1 and tend to score very highly. Even after an IMG is accepted onto a programme they have to pass a 3 month probation period before they are accepted - if they are not up to scratch they are expelled and CAN NOT apply to the same speciality EVER AGAIN in Canada.

 

My advice to any CSA - make sure you complete your USMLE steps and apply to both countries. Canada does not guarantee a return to practice and nor does it have to.

 

Very well said. You should consider submitting this pov to a newspaper. Your opinion is very valuable as someone who is not biased by your personal situation.

[leviathan]

Except the entire message of his post was incorrect, because Canada does need more doctors. That's why the IMG spots were implemented in the first place with ROS attachments. Also, you can't apply to CaRMS if you're not a Canadian citizen or permanent resident, so his back story is a bit fishy.

[Robin Hood]

Except the entire message of his post was incorrect, because Canada does need more doctors. That's why the IMG spots were implemented in the first place with ROS attachments. Also, you can't apply to CaRMS if you're not a Canadian citizen or permanent resident, so his back story is a bit fishy.

 

Quebec and NL do allow non Canadians. But yes, Canada does need doctors, else, there wouldn't be all the IMG spots and all these big med school cohorts.

[lostintime]

Except the entire message of his post was incorrect, because Canada does need more doctors. That's why the IMG spots were implemented in the first place with ROS attachments. Also, you can't apply to CaRMS if you're not a Canadian citizen or permanent resident, so his back story is a bit fishy.

 

Actually Canada does NOT more of all specialists and family doctors. It needs more family doctors, particularly in rural areas. It certainly does NOT need a lot of specialists right now especially in big urban centres. So training IMG residents in those specialties is super fishy to me. My opinion is that there should NOT be IMG reserved spots for specialties in 1st round. That makes no sense. I think IMG should be able to compete equally for those spots (i.e. residency directors can take them if they want over a CMG) but why put them into specialty spots when there is a greater need for GP's?

[leviathan]

Actually Canada does NOT more of all specialists and family doctors. It needs more family doctors, particularly in rural areas. It certainly does NOT need a lot of specialists right now especially in big urban centres. So training IMG residents in those specialties is super fishy to me. My opinion is that there should NOT be IMG reserved spots for specialties in 1st round. That makes no sense. I think IMG should be able to compete equally for those spots (i.e. residency directors can take them if they want over a CMG) but why put them into specialty spots when there is a greater need for GP's?

That's a good point. My guess is there may still be a need for specialists in smaller towns that isn't being met by CMGs? I know specialists who are having trouble finding work, but only because want to do general surgery in Vancouver, not Fort Nelson, BC. Even the specialist IMG positions have an ROS attached to them.

[lostintime]

Seems the provincial governments were so concerned about how to fix the physician shortage as soon as possible that they started creating parallel structures to physicians, that will come and hurt when the shortage ends. Now that we got NP and PA, what will happen to them when the market stabilizes? That will just be more duplicate structures, which can also bring confusion to the patient about whom he should see, and PAs and NPs may come to a surplus. There's also allowing pharmacists to do some prescriptions, which also brings a conflict of interest.

 

I think it's super confusing to patients when most people in the medical profession are confused themselves about the specific roles of med students, residents, PA's, NP's, PA students, nursing students, NP students etc Imagine someone super sick and tired, in hospital, family members not there, and you have all these random people come up to them and ask them questions over and over. Talk about creating confusion.

 

And patients do have a right to know exactly how much clinical training and education someone has had if they're the ones recommending disease management decisions to them.

[lostintime]

That's a good point. My guess is there may still be a need for specialists in smaller towns that isn't being met by CMGs? I know specialists who are having trouble finding work, but only because want to do general surgery in Vancouver, not Fort Nelson, BC. Even the specialist IMG positions have an ROS attached to them.

 

Realistically speaking though, the IMG's who want to train at huge urban centres as a resident, will unlikely want to go to small rural areas. I believe the ROS covers some areas that are like less than 1 hour away from large urban centres in many cases. And there are not enough resources in very small places for a specialist especially surgical ones. You would need an OR.

[moo]

That's a good point. My guess is there may still be a need for specialists in smaller towns that isn't being met by CMGs? I know specialists who are having trouble finding work, but only because want to do general surgery in Vancouver, not Fort Nelson, BC. Even the specialist IMG positions have an ROS attached to them.

 

There are a lot of South African grads who go up to rural areas.

 

But that is a good point. I have argued in the past that we are producing too many doctors. Restricting IMGs is an argument one makes in restricting supply. But the problem is that that is too discriminatory. You cannot justify this on the basis that if you can't get into med school in Canada, too bad, you can't be a doctor in Canada.

 

I don't think that CSA IMGs or IMGs in general should be guaranteed a residency spot, as we are already producing too many doctors, as I've stated many times before. For those who can legitimately compete and get a position, I believe that they can just be as competent as most CMGs.

 

Canada suffers from a maldistribution of doctors, but as I've said before, we are becoming more and more oversupplied in more and more specialties. In some specialties now, there are no jobs even in rural areas of the country.

[Robin Hood]

I think it's super confusing to patients when most people in the medical profession are confused themselves about the specific roles of med students, residents, PA's, NP's, PA students, nursing students, NP students etc Imagine someone super sick and tired, in hospital, family members not there, and you have all these random people come up to them and ask them questions over and over. Talk about creating confusion.

 

And patients do have a right to know exactly how much clinical training and education someone has had if they're the ones recommending disease management decisions to them.

 

Yes, imagine you're at the hospital and you want to see the doctor, and then comes to you a...nurse (in your head, a nurse can't do medical stuff). The nurse examines you, and then get something she has no experience in, and calls the doctor...

Or you get a PA/resident/clerk, while examining you, s/he says: "I don't have the right to do this/I don't have much knowledge in this), and then he calls the doctor.

[Robin Hood]

There are a lot of South African grads who go up to rural areas.

 

But that is a good point. I have argued in the past that we are producing too many doctors. Restricting IMGs is an argument one makes in restricting supply. But the problem is that that is too discriminatory. You cannot justify this on the basis that if you can't get into med school in Canada, too bad, you can't be a doctor in Canada.

 

I don't think that CSA IMGs or IMGs in general should be guaranteed a residency spot, as we are already producing too many doctors, as I've stated many times before. For those who can legitimately compete and get a position, I believe that they can just be as competent as most CMGs.

 

Canada suffers from a maldistribution of doctors, but as I've said before, we are becoming more and more oversupplied in more and more specialties. In some specialties now, there are no jobs even in rural areas of the country.

 

Seems we will be soon getting the same problem with pharmacists here in Quebec.

[Robin Hood]

There are a lot of South African grads who go up to rural areas.

 

But that is a good point. I have argued in the past that we are producing too many doctors. Restricting IMGs is an argument one makes in restricting supply. But the problem is that that is too discriminatory. You cannot justify this on the basis that if you can't get into med school in Canada, too bad, you can't be a doctor in Canada.

 

I don't think that CSA IMGs or IMGs in general should be guaranteed a residency spot, as we are already producing too many doctors, as I've stated many times before. For those who can legitimately compete and get a position, I believe that they can just be as competent as most CMGs.

 

Canada suffers from a maldistribution of doctors, but as I've said before, we are becoming more and more oversupplied in more and more specialties. In some specialties now, there are no jobs even in rural areas of the country.

 

When the shortage will end, IMG spots will come close to 0. No one will care if it's discriminatory and no one will care about the hardships and unfortunate situations that pushed CSAs to study abroad. I don't think the layperson will trust a new doctor that graduated from the Caribbeans.

[Zukoota1]

Except the entire message of his post was incorrect, because Canada does need more doctors. That's why the IMG spots were implemented in the first place with ROS attachments. Also, you can't apply to CaRMS if you're not a Canadian citizen or permanent resident, so his back story is a bit fishy.

 

Not that fishy really, I have permanent residency status in Canada after I immigrated here for personal reasons.

 

I am just presenting the reality of the situation, which can be difficult to accept but is something that we should face. This would allow us to present a true picture to future IMG's and CSA and allow them to make a much more informed decision and hence feel less hard done by when it becomes difficult to obtain a residency position.

 

I myself had a backup plan, which was to return to my home country if i hadn't matched or try and match in the US. I was not about to sit in Canada for 5 years and drive a taxi whilst I wait for a residency position. This is because I accepted the reality of the situation.

 

As for IMG specific spots - I imagine they were implemented for political reasons. To give hope to foreign doctors and get them to spend thousands of dollars on exams and courses in order to try and match into a spot. Think about it, the cost of the EE, the QE1, PCRC verification, NAC OSCE fees and the CaRMS fees. Canadian medical associations make a ton of money from foreign graduates.

 

I find it a bit rich when CSA complain about the system not being fair, compare yourself to a true IMG - they have it much, much worse. Without the connections back into the system, they can't get electives, they can't get letters of references and struggle to try and compete for the very limited seats present in CaRMS. I don't begrudge that, i would use any means possible in order to secure a spot myself so I can't possibly complain about someone else doing the same. I am just trying to say that CSA should not be calling for a "fair" system when the system is already designed to be massively in their favour compared to true IMG's in the first place.

[RickRick]

When the shortage stops the IMG spots should close, but I don't see that happening in family practice, GIM, Emerg anytime soon, especially if they continue to have a ROS to service rural communities.

 

Canadian medical schools were created to produce Canadian doctors. We haven't been able to produce enough docs to fill our shortages and thus we open up a parallel track for IMGs to compete for those spots. That is the way it is and the way it should be. It is only recently that a self righteous group of CSAs and their well connected parents have tried to make the public feel sorry for them and make it an issue of what is or isn't fair.

 

Why else spend BILLIONS of dollars on Canadian medical schools?

 

We do this because we want to have say on who gets in, what they are taught and what standards they must meet.

 

IMGs are a great supplement, but they are a supplement to be used as needed. There should be no competition. The competition ended for CSAs when they got in. We need CMGs to work together to become the best physicians possible, they shouldn't be wasting time worrying about looking over their shoulders. That's the whole reason the pass/fail system exists, it promotes working together, eliminates cut throat BS and makes it all about learning to be the best doc you can rather than beating the person next to you on exams.

[lostintime]

Yes, imagine you're at the hospital and you want to see the doctor, and then comes to you a...nurse (in your head, a nurse can't do medical stuff). The nurse examines you, and then get something she has no experience in, and calls the doctor...

Or you get a PA/resident/clerk, while examining you, s/he says: "I don't have the right to do this/I don't have much knowledge in this), and then he calls the doctor.

 

That's actually a pretty good scenario. It's a bit scarier when people think they do know what they're doing (when they actually don't) and don't call the doctor. Which I can see happening if all the Canadian medical grads are replaced in the future.

 

And yeah I agree, if IMG's (regardless of where, how they trained) meet the standards in equal competition for CMG's, then they for sure should train for residency spots. BUT if they are accepted with these "guaranteed" or "reserved" spots, then it's really kind of fishy. But that's still safer than having mid-levels practice independently. And if they don't practice independently, then how cost effective is it? Meh.

[Robin Hood]

That's actually a pretty good scenario. It's a bit scarier when people think they do know what they're doing (when they actually don't) and don't call the doctor. Which I can see happening if all the Canadian medical grads are replaced in the future.

 

And yeah I agree, if IMG's (regardless of where, how they trained) meet the standards in equal competition for CMG's, then they for sure should train for residency spots. BUT if they are accepted with these "guaranteed" or "reserved" spots, then it's really kind of fishy. But that's still safer than having mid-levels practice independently. And if they don't practice independently, then how cost effective is it? Meh.

 

PAs can't practice indepndently, they are like residents, expect that they can't become full-fledged doctors. Yes, I know they should call the doctor when they don't know what to do, but it's kind of silly given some people watered down medical education. The only thing missing was assigning some physician tasks to dentists (who BTW, deserve it more than other professionals, because dentistry is a medical speciality, and I think it should be integrated into medicine).

As for IMGs, the only reason why they have reserved spots is because no CMG would like to have the spot. I think the best thing would be to have only one stream (like Quebec and Manitoba), PDs will prefer CMGs to IMGs anyways when getting equally-competent candidates (yes, CMGs shouldn't be entitled to get a spot without showing competence).

[leviathan]

The reserved spots for IMGs were created with additional funding from the government in order to train doctors for underserved areas. That's why that funding must be paid back if you do not honour the return of service. I don't believe Canadians are entitled to apply to these spots because there's simply no need, but theoretically a CMG could also apply for an IMG spot if they made some phone calls, and were willing to sign up for the ROS that is attached to the position.

[leviathan]

Canadian medical schools were created to produce Canadian doctors. We haven't been able to produce enough docs to fill our shortages and thus we open up a parallel track for IMGs to compete for those spots. That is the way it is and the way it should be. It is only recently that a self righteous group of CSAs and their well connected parents have tried to make the public feel sorry for them and make it an issue of what is or isn't fair.

As I've mentioned a few times already, the only issue raised in the media outlets was that they are not being given access to the IMG spots that exist in BC unless new grads take a year off and do the awkwardly scheduled OSCE that occurs after CaRMS. They undoubtedly have other agendas under the surface, but that news report only addressed getting equal access to IMG spots. To be fair, the publication simply said that CSAs are facing 'red tape' when trying to access these spots, and didn't specify what that tape was. I can understand how that red tape could be interpreted to be over access to CMG spots.

 

As much as I agree they sounded 'whiny', their message is far from self-serving and has big implications for BC. The citizens of BC are the biggest losers in this ordeal, because they are missing out on a lot of highly trained physicians who end up matching elsewhere in Canada and the US. UBC ends up having to pick from a small pool of IMGs who either been out of clinical practice for a long time, or were poor applicants that didn't match in CaRMS/NRMP and thus have the ability to reapply to CaRMS and take the OSCE. Obviously I'm biased, but I think it's important for UBC to fix this problem. These are doctors who will be expected to provide solo care in rural towns across BC, and I think we should have the smartest and most capable doctors especially in those kinds of practice environments.

 

So as much as this thread has escalated into 20+ pages, I feel it has been revolving around a media publication that didn't actually address the issues that we've all been discussing.

[lostintime]

The reserved spots for IMGs were created with additional funding from the government in order to train doctors for underserved areas. That's why that funding must be paid back if you do not honour the return of service. I don't believe Canadians are entitled to apply to these spots because there's simply no need, but theoretically a CMG could also apply for an IMG spot if they made some phone calls, and were willing to sign up for the ROS that is attached to the position.

 

Fair enough, although I guess looking at the ROS map, I'm just a bit skeptical because some of these "in need areas" imo are pretty saturated themselves particularly some that are in fact part of GTA. Perhaps there is still a small need in some of those places for GP's, but talking to some people from there, they are definitely saturated with specialists. Maybe they should update it then to make it more serving for the people who actually need doctors.