Anybody else concerned about the flood of IMGs?

[Slipstream]

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

 

Yes and no. It shouldn't be a closed shop, they have to EXCEED far more than we do to get those residency spots. So what if they couldn't get into Canadian meds? If they're clearly better applicants when med school is over, it's our own fault for slacking and the public will benefit from more driven physicians in residency.

[penguin92]

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

 

IMG's aren't necessarily competing with us canadian med students. They're disadvantaged from the start, really only having a shot at primary care residencies. Plus, once we get into med school here, a lot of pressure is taken off of us. The system takes care of us and we're essentially guaranteed to graduate and match somewhere. IMG's go to schools where its still very cut throat and they need to maintain good grades else they fail out (especially if you go to Caribbeans). The curriculum at these schools are just as hard as those at Canadian schools and since many of their applicants are of the lower quality, I'd assume that's where failure rates come from.

 

So all in all, an IMG has significantly more debt than we do upon graduation, likely has to also write the USMLE as chances of matching in Canada are fairly low (only a fraction of IMG applicants actually match) and likely having no choice but to aim for something in primary care even though other fields may greatly interest them. You WILL graduate with an MD and have a shot at any field of medicine you want. Doesn't really sound like a competition to me

 

Going to an international med school isn't an attempt to "beat the system", for most, it's a last ditch effort to try and live your dream of being a physician. I don't know why you seem to think that your chances of success as a canadian med student are being hindered by an IMG. Feel fortunate that you still don't have that feeling of uncertainty of where you're life is going because for someone starting at an international med school, there's still a long road before they finally achieve some reassurance for their choice

[medisforme]

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

 

CMG's and IMG's don't compete for the same spots in CaRM's until the second round, when there are few spots anyways. Most IMG residency spots in Canada have their own quota. There is no competition.

There technically is a competition in the states where all residency spots are technically open to everyone - however, domestic grads are still at a major advantage due to the stigma associated with being an IMG/FMG.

[BoyInTheBubble]

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

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

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

 

Prove that it's luck.

 

What difference does it make how many times someone applied?

 

You last sentence is fantastically dumb. Your criteria for a "high caliber" applicant is that they have unsuccessfully applied to Canadian medical schools at least three times!!

[BoyInTheBubble]

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

 

1st checkpt: Admissions into Canadian medical school

2nd checkpt: Getting a residency in Canada

3rd checkpt: Getting hired by a hospital after residency

 

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

 

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

 

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

 

You should look at CSA's as more admirable than that. He or she fails to get into a Canadian medical school (which is defined by many on here as being "unlucky"), they then decide, they would still really like a career in medicine to help patients. So much so, that they risk huge amounts of money (bank loans, mortgage the parents house) and accumulate debt and leave friends and family for four years with no guarantee of a residency at the end.

 

AND THEN THEY MAKE IT BACK TO CANADA! HOW ABOUT HIGH FIVES ALL AROUND!

 

People often give this lame excuse about how CSA's are all rich kids who's parents are doctors, and blah blah. It's irrelevant. Plenty of people in Canadian medical schools grew up wealthy with doctors as parents.

[BoyInTheBubble]

I have no real opinion on imgs "killing" patients, but there is definitive evidence that they are less likely to pass the relatively mundane ccfp examination, more likely to be brought to the provincial college for discipline, and there have been claims that a big reason for the huge number of disasters in pathology is the fact that many of the practitioners within the field are imgs with insufficient training.

 

The residency and medical school admissions systems exist to ensure public safety. I, for one, am weary of individuals who bypass these safeguards to enter the system through less rigorous means. This includes both csa and img students. This lowers standards as a whole, lowers public trust, and may result in patient harm and the resulting erosion of the profession's self-regulation in lieu of government coregulation. Evidence is not needed; the standards should exist to prevent poor outcomes. To test this would be to risk such.

 

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

 

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

 

In most threads, you're just a prick, so this one is obviously no different. Are you so jaded in real life? "Evidence is not needed" for most of the crap you write.

 

IMGs fail exams at a higher rate than CMGs, but neither works without a license. The standards for receiving a license are the same.

 

Medical school and residency admissions exist to ensure public safety? Umm what? Maybe on some line at the bottom beside "we have the right to change our interview style at any time in Manitoba". Med school admissions exist to pick 150 out of 2500 applicants.

 

Lowering standards of care for rural areas is unethical. However, the "disgrace to the profession" is not the IMG in the small town, it's lack of CMGs in small towns.

[ralk]

Going to an international med school isn't an attempt to "beat the system", for most, it's a last ditch effort to try and live your dream of being a physician. I don't know why you seem to think that your chances of success as a canadian med student are being hindered by an IMG. Feel fortunate that you still don't have that feeling of uncertainty of where you're life is going because for someone starting at an international med school, there's still a long road before they finally achieve some reassurance for their choice

 

The intent may not be to "beat the system", but that's the effect regardless. The typical CSA has applied to a Canadian med school at least once (and presumably been rejected), wants to return to Canada, is relying significantly on family money, and has a stronger preference to work in a major centre than an underserved rural area when compared to Canadian medical grads. They're more likely to have a physician as a parent. They're also growing in number. Basically, the average CSA is richer, more connected, and less qualified than the average Canadian medical grad, and is more likely to exacerbate problems of physician distribution rather than ameliorate them.

 

The entire medical training system is trying to fight these traits in future physicians, by preferentially taking applicants from underserved areas/populations (Aboriginal streams, rural preferences, etc.), removing financial barriers to entering med school (subsidized tuition, bursaries, the LOC system, treating work as a valuable EC), and using anonymized application processes to prevent nepotism at the major point of entry to practice - med school.

 

CSAs avoid all of that. Poorer individuals can't realistically becomes CSAs - rich individuals can. They don't need to worry about regional requirements. They might have to do a ROS for a while to come back to Canada, but like most individuals who take on an ROS, they're not likely to stay in the area much longer than they have to (that's why rural pay incentives rarely worked long-term). And, because their major chokepoint for entry is CARMS, where connections matter significantly, the potential for nepotism grows considerably among CSAs.

 

Unless Canada severely restricts the opportunities for CSAs to return, these trends will continue. I'm not particularly concerned about having to fight CSAs for residency positions or jobs. What I am concerned about is CSAs returning to Canada who don't address the needs of the Canadian medical system, who had unfair advantages over other rejected Canadian med school applicants (poor individuals, those without connections), and who are now taking the spots of actual IMGs.

[Slipstream]

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

 

So for Quebec, the network is called RUIS McGill, here is their link: http://www.mcgill.ca/ruis/ . I'm actually not entirely sure where information on these programs exists, but I know Dr. Helene Rousseau at McGill was where I first heard about it. She's a family physician specializing in Obstetrics, and routinely goes into Northern Quebec and is a big part of the community there. She told a story of even delivering the baby of a mother who she had actually delivered when she was born, too. So this is a really cool way to become a community physician who lives in a city, is affiliated with an academic centre, but also serves rural populations

[leviathan]

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

 

1st checkpt: Admissions into Canadian medical school

2nd checkpt: Getting a residency in Canada

3rd checkpt: Getting hired by a hospital after residency

 

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

 

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

You're incorrect about the first 2 checkpoints of practicing medicine in Canada, since there's an established system in place to train graduates of both Canadian and international medical schools. There are also many international residency programs which are recognized in Canada, so you don't have to train locally.

 

Also I'm not sure what 'losing faith' means exactly, or what you were trying to get at by saying that. If you meant losing faith in the admissions process, then that is definitely true. I have tremendous respect for all those who have the perseverance to keep applying year after year. The unfortunate reality is there are far too many qualified applicants applying every year, so getting in does require a bit of either luck if it's on your first try, or determination to keep 'rolling the dice' until you get a spot.

 

I also think you should in turn have respect for IMGs who train abroad at great financial risk for a very small chance at returning home to practice medicine. I suppose there's less risk for people who come from wealthy families that foot the bill for their kids, but if you want to look at my line of credit statements, you'll see what camp I fall into for that issue. Either way, if you're a resident in Canada you have worked hard to get to that spot at some point along the line.

[shady]

I'm concerned about its effect on the availability of jobs for us CMG's in the future. I'm not concerned about the quality of IMG's if they manage to get a license in Canada*.

 

* within reason of course; I expect a certain rate of errors by doctors, but I don't expect it to be different between IMG's and CMG's.

[medisforme]

Prove that it's luck.

 

What difference does it make how many times someone applied?

 

You last sentence is fantastically dumb. Your criteria for a "high caliber" applicant is that they have unsuccessfully applied to Canadian medical schools at least three times!!

 

Search the UBC forum - you'll see dozens of posts of applicants who's NAQ score went either up or down from year to year without any change in what they put in the application or wording. In some years people post NAQ's that have went down when they have included numerous new EC's compared to their application the previous year. If you don't want to call it luck - call it subjectivity- either way, a major part of getting accepted is out of an applicants hands.

 

My comment about higher caliber applicants wasn't my argument it was something I have heard discussed before. Many people apply overseas who would not even be qualified to apply to a canadian medical school (usually due to GPA, MCAT etc.), or they come from affluent families with connections and use that as a door back to Canada without going through the rigorous application process that their peers do (many do so 3,4,5 times before acceptance). Consequently, according to this argument perhaps they shouldn't qualify to apply to CaRMs.

 

I really shouldn't have to tell you this but calling my argument fantastically dumb really does nothing to contribute to this discussion.

[AtomSmasher19]

I'm concerned about its effect on the availability of jobs for us CMG's in the future. I'm not concerned about the quality of IMG's if they manage to get a license in Canada*.

 

* within reason of course; I expect a certain rate of errors by doctors, but I don't expect it to be different between IMG's and CMG's.

 

Well you're totally wrong on both points. FMGs won't make a difference on your ability to get a job, but they are a major disgrace to the profession and their rate of errors is much higher.

 

It's incredibly sad that we as physicians set up certain standards to give peace of mind to the public and to ensure public health, then create a back-door loophole for the rich kids who weren't capable of meeting those standards (the FMGs). It's tricking the public into thinking they're getting higher standards than they actually are. What an sleazy thing to do. FMGs truly embody the underworld of medicine.

 

The FMGs need to be locked out of the system, both for patient safety and because it is simply dishonest not to do so.

[medisforme]

I am by now means an expert on this subject but if an FMG manages to get through the loopholes and obtain a canadian residency and then is able to competently navigate and graduate from a canadian residency, why would their practice skill be lower? I am assuming that 90+% of a physicians' real medical education takes place during residency as opposed to medical school. Ergo, the most important part of their medical training is taking place in Canada by quality programs. I don't see how their standard of care would be (substantially) lower as some people are writing on here.

[penguin92]

^agreed

 

10char

[MarshMellow]

I dunno about you guys...but I've asked a few of the doc's I've shadowed if they've noticed any difference between Canadian PGY's/Students vs IMG's/FMG's and all of them said that they've noticed that the students who come from Ireland are at a slightly better level than Canadians. But I guess they'd have to be, they're all fighting for a place in Canada or in the US

[rmorelan]

I dunno about you guys...but I've asked a few of the doc's I've shadowed if they've noticed any difference between Canadian PGY's/Students vs IMG's/FMG's and all of them said that they've noticed that the students who come from Ireland are at a slightly better level than Canadians. But I guess they'd have to be, they're all fighting for a place in Canada or in the US

 

and they are the ones that actually did get accepted

[MarshMellow]

and they are the ones that actually did get accepted

 

True, true!

[penguin92]

and they are the ones that actually did get accepted

 

Exactly! It's the exceptional graduates that are able to make it back to Canada. So people need to stop talking about IMG's like they're incompetent and are lowering the quality of our physicians as a whole

[rmorelan]

Exactly! It's the exceptional graduates that are able to make it back to Canada. So people need to stop talking about IMG's like they're incompetent and are lowering the quality of our physicians as a whole

 

It is interesting when I look around the hospital I work in - see a very significant chunk of the senior staff - you know 20+ years as staff - with degrees from all over the place. Particularly the UK actually. Granted that is just one hospital of course but I think people make it out that IMGs are somehow new to the system. We have had steady back and forth transfer of people between a variety of countries for decades and decades.

[A-Stark]

CSAs are something of a new phenomenon, though. I agree with whoever said above that IMGs who make it into speciality residencies tend to be strong (at least as good as their CMG colleagues), but I don't know how true that is of those in peripheral FM programs or psych programs that usually fill in the second iteration.

[ralk]

Exactly! It's the exceptional graduates that are able to make it back to Canada. So people need to stop talking about IMG's like they're incompetent and are lowering the quality of our physicians as a whole

 

Anecdotal information about quality isn't overly helpful - from my experience, while there are certainly better and worse physicians as both CMGs and IMGs, the IMG residents I've worked with I've found to be somewhat less capable than CMG residents.

 

But my anecdotal evidence isn't any more useful than those from MarshMellow's physicians. What little aggregate data we have, however, shows that IMGs fail qualifying exams in much greater numbers than CMGs. Even though large numbers of IMGs get rejected from Canadian residency, those "exceptional graduates" who get through aren't keeping up with CMGs when put through rigorous evaluations.

 

That doesn't necessarily mean that IMGs in Canada are a major risk to patients, but the data doesn't support the idea that they're better - or even on par with - CMGs. In the case of CSAs, Canada loses a lot of good people, and money, when Canadians go abroad for medical school for that tiny chance to return home to practice medicine. Most don't get to come back. And maybe it would be worth effectively exiling numerous intelligent, hardworking young Canadians if the few we accepted back were truly of exceptional quality, but there's no reliable evidence that they are. It's just not a good deal for Canada.

[rmorelan]

CSAs are something of a new phenomenon, though. I agree with whoever said above that IMGs who make it into speciality residencies tend to be strong (at least as good as their CMG colleagues), but I don't know how true that is of those in peripheral FM programs or psych programs that usually fill in the second iteration.

 

There is logic there - there could be a relatively newly introduced different between strictly Canadians studying within Canada and those aboard.

[penguin92]

Anecdotal information about quality isn't overly helpful - from my experience, while there are certainly better and worse physicians as both CMGs and IMGs, the IMG residents I've worked with I've found to be somewhat less capable than CMG residents.

 

But my anecdotal evidence isn't any more useful than those from MarshMellow's physicians. What little aggregate data we have, however, shows that IMGs fail qualifying exams in much greater numbers than CMGs. Even though large numbers of IMGs get rejected from Canadian residency, those "exceptional graduates" who get through aren't keeping up with CMGs when put through rigorous evaluations.

 

That doesn't necessarily mean that IMGs in Canada are a major risk to patients, but the data doesn't support the idea that they're better - or even on par with - CMGs. In the case of CSAs, Canada loses a lot of good people, and money, when Canadians go abroad for medical school for that tiny chance to return home to practice medicine. Most don't get to come back. And maybe it would be worth effectively exiling numerous intelligent, hardworking young Canadians if the few we accepted back were truly of exceptional quality, but there's no reliable evidence that they are. It's just not a good deal for Canada.

 

The fact that most don't get to come back means there isn't necessarily a "flood". However your last post about some CSA's having connections and what not probably does have some claim to it (which obviously needs to be stopped) which affects the data collected on those who have international medical degrees as selection of these individuals may not have purely involved merit.

 

There may not be enough data (meaning there definitely needs to be more) about the abilities of CMG's compared to their IMG counterparts but I wouldn't go so far as to completely restrict all IMG/CSA's from ever coming back (which may or may not be your position). Like you said, there are some very hard working and intelligent people that go overseas. Medical school here is notoriously hard to get into and many many qualified candidates are turned away every year. And trying again and again isn't easy, its mentally taxing and very discouraging. So they take that risk for the small opportunity to come home. We have enough problems with physician shortages/distribution that closing the door on those who studied abroad probably wouldn't be the best. It has the potential to create more problems than it would solve

[ralk]

The fact that most don't get to come back means there isn't necessarily a "flood". However your last post about some CSA's having connections and what not probably does have some claim to it (which obviously needs to be stopped) which affects the data collected on those who have international medical degrees as selection of these individuals may not have purely involved merit.

 

There may not be enough data (meaning there definitely needs to be more) about the abilities of CMG's compared to their IMG counterparts but I wouldn't go so far as to completely restrict all IMG/CSA's from ever coming back (which may or may not be your position). Like you said, there are some very hard working and intelligent people that go overseas. Medical school here is notoriously hard to get into and many many qualified candidates are turned away every year. And trying again and again isn't easy, its mentally taxing and very discouraging. So they take that risk for the small opportunity to come home. We have enough problems with physician shortages/distribution that closing the door on those who studied abroad probably wouldn't be the best. It has the potential to create more problems than it would solve

 

I'm not too worried about a flood of IMGs, but I do worry about the efficiency of our policies (whether we're getting good return for the money we spend on training), about fairness to Canadians with medical aspirations, about fairness to the countries from which we're getting these IMGs, and about the control we have over our own supply of physicians.

 

Based on the admittedly limited data available, I think we should be restricting IMG positions significantly, and in the case of CSAs, shutting the door almost entirely. To maintain physician levels by these restrictions, we should be increasing enrollment for CMGs, particularly at schools in underserviced areas.

 

I believe preventing CSAs from returning to Canada is important in order to stop them from leaving in the first place. Most CSAs want to return to Canada - if that wasn't a possibility, the incentives for them to leave would be much, much lower. If they stayed here, they and their families would spend money in Canada, rather than overseas, the taxes from which could fund spots at Canadian Med Schools (and CMG residencies) to offset loss of CSA residency spots. Those spots would go the most qualified individuals, not just to those who could afford the current CSA route, increasing fairness to aspiring Canadian premeds. Since CMGs are more likely to want to work in underserviced areas than CSAs, the problems of regional physician supply should get better under this scheme, not worse.

 

For individuals who would choose to become CSAs under the current system, my proposed scheme at least allows them to know their situation BEFORE they spend 4+ years of their lives and hundreds of thousands of dollars. If they choose to go abroad, they'd have to stay abroad - most current CSAs have to do this anyway. Otherwise they can evaluate their options and pursue something in Canada. Just because someone's not the best candidate to become a doctor, doesn't mean they can't be quite useful in other roles here, in health care or otherwise. We need smart and motivated nurses, pharmacists, therapists, and techs too. This system at least removes the uncertainty and lets potential CSAs fully understand the consequences of their choice. Right now, too many CSAs convince themselves their plan is viable when it really only is for a small handful.

 

Of course, to make this plan fair, it would have to be phased in over the course of several years, so that those already studying abroad wouldn't get screwed by the changeover. Basically, indicate that in four years from now, CSAs won't have access to Canadian residencies, and you'll see a lot fewer CSAs.

 

For true IMGs, the situation is a fair bit more complicated. The crux of my feelings on this is that there are enough smart people here to fill the need for physicians, and so we don't need to grab up physicians from other countries. We should be facing up to the problem of physician supply in our country without leeching off the rest of the world as a patchwork solution.

[rmorelan]

I'm not too worried about a flood of IMGs, but I do worry about the efficiency of our policies (whether we're getting good return for the money we spend on training), about fairness to Canadians with medical aspirations, about fairness to the countries from which we're getting these IMGs, and about the control we have over our own supply of physicians.

 

Based on the admittedly limited data available, I think we should be restricting IMG positions significantly, and in the case of CSAs, shutting the door almost entirely. To maintain physician levels by these restrictions, we should be increasing enrollment for CMGs, particularly at schools in underserviced areas.

 

I believe preventing CSAs from returning to Canada is important in order to stop them from leaving in the first place. Most CSAs want to return to Canada - if that wasn't a possibility, the incentives for them to leave would be much, much lower. If they stayed here, they and their families would spend money in Canada, rather than overseas, the taxes from which could fund spots at Canadian Med Schools (and CMG residencies) to offset loss of CSA residency spots. Those spots would go the most qualified individuals, not just to those who could afford the current CSA route, increasing fairness to aspiring Canadian premeds. Since CMGs are more likely to want to work in underserviced areas than CSAs, the problems of regional physician supply should get better under this scheme, not worse.

 

For individuals who would choose to become CSAs under the current system, my proposed scheme at least allows them to know their situation BEFORE they spend 4+ years of their lives and hundreds of thousands of dollars. If they choose to go abroad, they'd have to stay abroad - most current CSAs have to do this anyway. Otherwise they can evaluate their options and pursue something in Canada. Just because someone's not the best candidate to become a doctor, doesn't mean they can't be quite useful in other roles here, in health care or otherwise. We need smart and motivated nurses, pharmacists, therapists, and techs too. This system at least removes the uncertainty and lets potential CSAs fully understand the consequences of their choice. Right now, too many CSAs convince themselves their plan is viable when it really only is for a small handful.

 

Of course, to make this plan fair, it would have to be phased in over the course of several years, so that those already studying abroad wouldn't get screwed by the changeover. Basically, indicate that in four years from now, CSAs won't have access to Canadian residencies, and you'll see a lot fewer CSAs.

 

For true IMGs, the situation is a fair bit more complicated. The crux of my feelings on this is that there are enough smart people here to fill the need for physicians, and so we don't need to grab up physicians from other countries. We should be facing up to the problem of physician supply in our country without leeching off the rest of the world as a patchwork solution.

 

we can never limit the IMG pool based on country of origin. That is actually been looked at and it would violate Canada's constitution. Kind of weird to think of it that way but

 

15. (1) Every individual is equal before the and under the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age, or mental or physical disability.

 

So you cannot discriminate on the bases of national origin, even if that origin is actually Canada itself.