Anybody else concerned about the flood of IMGs?

[ralk]

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.

 

If we significantly curtailed all IMG positions, the effect would largely be the same. It might leave a window open for CSAs, but if the number is in the single digits rather than the dozens, the incentives to become a CSA would still drop dramatically. Again, I think that should be happening regardless, but for different reasons than for CSAs.

 

Besides, there are ways to make it difficult for CSAs to return home that doesn't rely explicitly on country of origin - such as insisting that IMGs complete an undergrad or have attended high school outside of Canada, or explicitly disadvantaging students typical CSA training schools in the match. Neither of these are overly clean solutions (they're just what I could think of off the top of my head), but they would sidestep any constitutional issues.

 

Edit - Looking into this, I'm not sure even explicitly denying CSAs entry would qualify as a violation of the constitution. National origin isn't synonymous with citizenship or even country of residence. Furthermore, Section 15 (2) allows for exceptions to Section 15 (1) when a program serves to ameliorate other instances of discrimination, which a ban on CSAs returning through the IMG stream arguably would.

[BoyInTheBubble]

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.

 

 

The majority of the above is merely your opinion based off anecdotal evidence. What "data" demonstrates that IMGs (and/or CSAs) are ruining the health system? Do you know what impact foreign-trained doctors have in Canada? Do you know how many doctors were trained abroad? Have you ever been to a hospital in Newfoundland & Labrador or Sask?

 

Do you not think that medical schools are trying to increase the number of students they train? NOSM was opened to train doctors for underserviced areas. (Is it working?)

 

Please tell me how much money CSA's and their families spend, how much they pay in taxes, and how much it costs to fund medical students. Your vast knowledge appears to be a key point in your decision making.

 

CMGs are NOT more likely to work in underserviced areas, as evident by the fact they currently do not choose to work there more than urban areas.

 

How do you judge fairness by the way?

 

Who the F are you to say that someone who has training in another country is not welcome in Canada?

 

Who the F are you to say that Canadians are not welcome in Canada?

[aaronjw]

Maybe we should tighten up licensing exams and then allow anyone to apply who can pass the exams within a certain percentile. If CMGs think their so sh!t hot then they can compete in an open competition to prove that they are.

 

As someone who consumes and has paid into the system, I care that I'm being treated by the best person for the job. Not some whiny self-entitled CMG. That's more fair to Canadians as a whole than some aspiring wannabe med student.

[BoyInTheBubble]

 

Edit - Looking into this, I'm not sure even explicitly denying CSAs entry would qualify as a violation of the constitution. National origin isn't synonymous with citizenship or even country of residence. Furthermore, Section 15 (2) allows for exceptions to Section 15 (1) when a program serves to ameliorate other instances of discrimination, which a ban on CSAs returning through the IMG stream arguably would.

 

You looked into it?

 

I know, it's an open forum and all, but PLEASE tell us your qualifications to give opinions on Charter interpretations.

[A-Stark]

Maybe we should tighten up licensing exams and then allow anyone to apply who can pass the exams within a certain percentile. If CMGs think their so sh!t hot then they can compete in an open competition to prove that they are.

 

We don't write the LMCC Part 1 until well after the match. What "open competition" are you looking for?

 

As someone who consumes and has paid into the system, I care that I'm being treated by the best person for the job. Not some whiny self-entitled CMG. That's more fair to Canadians as a whole than some aspiring wannabe med student.

 

As if no one else here "consumes" or "pays into" the system...

[ralk]

The majority of the above is merely your opinion based off anecdotal evidence. What "data" demonstrates that IMGs (and/or CSAs) are ruining the health system? Do you know what impact foreign-trained doctors have in Canada? Do you know how many doctors were trained abroad? Have you ever been to a hospital in Newfoundland & Labrador or Sask?

 

Do you not think that medical schools are trying to increase the number of students they train? NOSM was opened to train doctors for underserviced areas. (Is it working?)

 

Please tell me how much money CSA's and their families spend, how much they pay in taxes, and how much it costs to fund medical students. Your vast knowledge appears to be a key point in your decision making.

 

CMGs are NOT more likely to work in underserviced areas, as evident by the fact they currently do not choose to work there more than urban areas.

 

How do you judge fairness by the way?

 

Who the F are you to say that someone who has training in another country is not welcome in Canada?

 

Who the F are you to say that Canadians are not welcome in Canada?

 

Actually, most of the data underlying my opinions is based off of surveys and studies, what little there are.

 

This one covers most of the information on CSAs

https://www.carms.ca/pdfs/2010_CSA_Report/CaRMS_2010_CSA_Report.pdf

 

This was the best I could find on IMG vs CMG performance, though I found a couple other minor studies which painted roughly the same picture

http://www.afmc.ca/pdf/fmec/05_Walsh_IMG%20Current%20Issues.pdf

 

Med school spots are constrained just like residency spots, and since the funding and support of both these come from a combination of provincial health authorities, regional hospitals, and universities, having only the universities wanting to expand their program isn't enough to actually make it happen (universities always want to expand their programs). Provincial government buy-in is necessary.

 

I work with several foreign-trained physicians, and many of them are excellent. In no way have I said that IMGs or CSAs are ruining our health system. I think most do a good job.

 

But I don't think they're necessary to supply adequate physicians, if we invest properly in physician training. I think we have enough smart, capable, motivated people here in Canada to fill those roles and that they can do so at a level that is at least as good, if not better than currently-arriving IMGs. And I want to give those smart, capable, motivated Canadians a better opportunity to be a physician here in Canada, while training here, in Canada.

 

I don't think it's fair that a rich Canadian who fails to get into a Canadian med school can have a second shot to practice medicine in Canada by going overseas, but a poorer Canadian can't. I don't think it's fair to CSAs that they're given just enough of a chance to return home to make them reach out to foreign schools for that desperate chance to become a Canadian doctor, yet deny so many of them the actual opportunity to do so. I don't think it's fair to the countries these IMGs are coming from that we take their best and brightest physicians because we aren't willing to train enough of our own people, even though those IMGs aren't more capable in the Canadian system than the CMGs we train here.

 

Who the F am I? I'm a guy who sees a bunch of problems with the current system, is looking at the available data behind those problems, and is trying to come up with a solution. That's all. If you've got better data, or better solutions, I'm all ears.

[ralk]

You looked into it?

 

I know, it's an open forum and all, but PLEASE tell us your qualifications to give opinions on Charter interpretations.

 

Tell me your qualifications and I'll tell you mine

 

Or better yet, actually provide an argument against my assertion, rather than suggestive insults.

[rmorelan]

If we significantly curtailed all IMG positions, the effect would largely be the same. It might leave a window open for CSAs, but if the number is in the single digits rather than the dozens, the incentives to become a CSA would still drop dramatically. Again, I think that should be happening regardless, but for different reasons than for CSAs.

 

Besides, there are ways to make it difficult for CSAs to return home that doesn't rely explicitly on country of origin - such as insisting that IMGs complete an undergrad or have attended high school outside of Canada, or explicitly disadvantaging students typical CSA training schools in the match. Neither of these are overly clean solutions (they're just what I could think of off the top of my head), but they would sidestep any constitutional issues.

 

Edit - Looking into this, I'm not sure even explicitly denying CSAs entry would qualify as a violation of the constitution. National origin isn't synonymous with citizenship or even country of residence. Furthermore, Section 15 (2) allows for exceptions to Section 15 (1) when a program serves to ameliorate other instances of discrimination, which a ban on CSAs returning through the IMG stream arguably would.

 

I actually got the constitutional argument from prior argument presented from the CMA. It was their point as they had to look into it. Not saying someone couldn't argue it legally but rather some people vastly more experienced than us in matters of law already have looked at it

[ralk]

I actually got the constitutional argument from prior argument presented from the CMA. It was their point as they had to look into it. Not saying someone couldn't argue it legally but rather some people vastly more experienced than us in matters of law already have looked at it

 

Alright, fair enough, though I'd love to find a more complete explanation on that one at some point - I mean, med schools legally discriminate on the basis of ethnic origin, so there are certainly ways in which a seeming violation of Section 15 (1) would be permissible.

[BoyInTheBubble]

Actually, most of the data underlying my opinions is based off of surveys and studies, what little there are.

 

This one covers most of the information on CSAs

https://www.carms.ca/pdfs/2010_CSA_Report/CaRMS_2010_CSA_Report.pdf

 

This was the best I could find on IMG vs CMG performance, though I found a couple other minor studies which painted roughly the same picture

http://www.afmc.ca/pdf/fmec/05_Walsh_IMG%20Current%20Issues.pdf

 

Med school spots are constrained just like residency spots, and since the funding and support of both these come from a combination of provincial health authorities, regional hospitals, and universities, having only the universities wanting to expand their program isn't enough to actually make it happen (universities always want to expand their programs). Provincial government buy-in is necessary.

 

I work with several foreign-trained physicians, and many of them are excellent. In no way have I said that IMGs or CSAs are ruining our health system. I think most do a good job.

 

But I don't think they're necessary to supply adequate physicians, if we invest properly in physician training. I think we have enough smart, capable, motivated people here in Canada to fill those roles and that they can do so at a level that is at least as good, if not better than currently-arriving IMGs. And I want to give those smart, capable, motivated Canadians a better opportunity to be a physician here in Canada, while training here, in Canada.

 

I don't think it's fair that a rich Canadian who fails to get into a Canadian med school can have a second shot to practice medicine in Canada by going overseas, but a poorer Canadian can't. I don't think it's fair to CSAs that they're given just enough of a chance to return home to make them reach out to foreign schools for that desperate chance to become a Canadian doctor, yet deny so many of them the actual opportunity to do so. I don't think it's fair to the countries these IMGs are coming from that we take their best and brightest physicians because we aren't willing to train enough of our own people, even though those IMGs aren't more capable in the Canadian system than the CMGs we train here.

 

Who the F am I? I'm a guy who sees a bunch of problems with the current system, is looking at the available data behind those problems, and is trying to come up with a solution. That's all. If you've got better data, or better solutions, I'm all ears.

 

 

Making the Canadian system more self contained is a good idea, but your solution is isolating 20-30% of the workforce? Why does your plan revolve around not having foreign trained doctors if you don't think they are causing a problem?

 

You think foreign trained doctors are worsening the health system. That they avoid rural areas, and just want to earn money in urban centres, and so on. They "beat the system". CMGs are much worse. Our health system is unsustainable without foreign trained doctors.

 

Who says CSA's are desperate? Who says they are rich? If so, are they more desperate or more wealthy than CMGs? Does it really matter? Do poor kids have the same chance at med school in Canada?

 

Why are you denying the opportunity for other countries' "best and brightest" to immigrate their family to Canada? What if they don't want to raise their kids in Congo, Zimbabwe or Afghanistan? (Or anywhere else?) We didn't kidnap the foreign doctors, they chose Canada.

 

Foreign trained doctors aren't beating the system. They are part of the system.

[BoyInTheBubble]

Tell me your qualifications and I'll tell you mine

 

Or better yet, actually provide an argument against my assertion, rather than suggestive insults.

 

I'm sorry, I shouldn't have assumed anyone would have been confused enough to think your multiple interpretations of the Charter of Rights and Freedoms mattered.

 

You come up with an outrageous plan, discuss two different ways it could be applied and all of a sudden debate rages!

 

Your assertion that having an IMG stream that requires applicants to attend high school or undergrad outside of Canada needs no rebuttal or debate of ways to "sidestep constitutional issues".

[rmorelan]

Alright, fair enough, though I'd love to find a more complete explanation on that one at some point - I mean, med schools legally discriminate on the basis of ethnic origin, so there are certainly ways in which a seeming violation of Section 15 (1) would be permissible.

 

and when they do, which is of course rare, they do it under 15 (2) I believe as you pointed out before.

 

ha - again not that we are all experts on this or not Although - clearly people are wiling to advance legal action for their cause to gain access to various points in the Canadian medical system (we have another thread going wild on that at the moment). No one has successful argued legally that a CSA should have equal access.

 

My old med student advisor was quite right in pointing out that the CSA group politically is very well funded and supported - I mean these are people overall have enough wealth to spend 400K on the chance they can return to Canada. As a group they are not weak. Yet still they haven't been able to crack this.

[penguin92]

Alright, fair enough, though I'd love to find a more complete explanation on that one at some point - I mean, med schools legally discriminate on the basis of ethnic origin, so there are certainly ways in which a seeming violation of Section 15 (1) would be permissible.

 

They do make certain considerations for aboriginal applicants. Thats the only group (i think) that really gets any specific special considerations otherwise, its mainly geographic discrimination. And the exceptions made for aboriginal applicants are done because of the great need to serve those populations (although this issue is a whole other debate and you could argue whether the special considerations really do fall under "discrimination"). However i don't think the problem of rich CSA's getting opportunity over poor canadian pre meds that cant get into canadian med school is on the same level as the issue above. That being said, i dont think theres much data on the subject so i could be wrong. However, i firmly believe in not shutting the door to IMGS/CSA's. As cheesy as it sounds, this country is supposed to give citizens fair opportunity. I doubt theres enough money to open more seats in canada because we just saw 15 seats cut from UofA and a similar number cut from calgary the previous year. Ontario had that whole fight with oma last year about cutting healthcare costs as docs weren't really willing to budge on the money they make. Bottomline, we dont have the money to open more seats so we rely on CSA's/IMG's to supplement our system

 

Edit- ya forgot abt the whole diversity policy but i dont think the med school can legally say, "we have enough caucasians, john doe here therefore wont be offered admission this year"

[ralk]

Your solution is isolating 20-30% of the workforce? Why does your plan revolve around not having foreign trained doctors if you don't think they are causing a problem?

 

You think foreign trained doctors are worsening the health system. That they avoid rural areas, and just want to earn money in urban centres, and so on. They "beat the system". CMGs are much worse. Our health system is unsustainable without foreign trained doctors.

 

Who says CSA's are desperate? Who says they are rich? If so, are they more desperate or more wealthy than CMGs? Does it really matter? Do poor kids have the same chance at med school in Canada?

 

Why are you denying the opportunity for other countries' "best and brightest" to immigrate their family to Canada? What if they don't want to raise their kids in Congo, Zimbabwe or Afghanistan? (Or anywhere else?) We didn't kidnap the foreign doctors, they chose Canada.

 

Foreign trained doctors aren't beating the system. They are part of the system.

 

You're putting a lot of words in my mouth that didn't start there.

 

I never said IMGs on the whole were trying to "beat the system" - those comments I reserve for CSAs, since most applied to a Canadian Medical School, were rejected, and then applied abroad. Failing at the intended route, then pursuing an alternative avenue because you happen to have resources that other's don't is, I would argue, the definition of trying to beat the system.

 

Likewise, I haven't found good stats on IMGs' preferences for practice location, so I'm not going to make the claim that they don't want to work in underserviced areas. Since ROS plans in underserviced regions have consistently failed to produce lasting physician supplies in those areas, and since immigrants to Canada usually prefer major centres, my guess is that they're preferences are to work in major centres, but that's pure speculation and not backed by evidence. CSAs, on the other hand, clearly show a preference for major centres, especially Toronto, and my first link provides that evidence.

 

Desperation on the part of CSAs is evidenced by the data which shows that most CSAs unsuccessfully tried to get admissions to a Canadian medical school, that most want to return home after training, and that despite these goals, most fail to return home after training. They're also willing to spend hundreds of thousands of dollars on what is likely to be a failed attempt to practice medicine in Canada. You see someone betting their life savings at the blackjack table, they're probably desperate for some money that they don't have. The situation with CSAs isn't much different - if the goal is to become a Canadian doctor, as most have expressed, they're taking a fairly big gamble with their lives to do so. The upside is that they'll still be a doctor, and if they're fine with practicing outside of Canada, then that desperation isn't there. Certainly, not all CSAs are desperate. Yet, from what CSAs have indicated, most want to return home, and the desperation shows through their actions.

 

Richness is pretty evident from the fact that CSAs are paying hundreds of thousands of dollars in tuition/living expenses/travel and their primary source of funding is family money. That's all available in the CARMS study.

 

You're right in that the current system isn't sustainable without IMGs, but my point is that it doesn't have to be that way. We could make our system sustainable using CMGs alone. I think there are some exceptional IMGs that we certainly still want to come to Canada, but the available evidence indicates that we have a lot of IMGs that are not exceptional.

 

As for physicians wanting to come to Canada to escape other countries, our medical training system is not a refugee system. It's not just physicians who want to leave some of those countries with their families in tow. Restricting IMG spots doesn't stop a physician from immigrating to Canada any more than the current system stops farmers, factory workers, lawyers, or plumbers from immigrating to Canada. Our medical training system is there to provide the best physicians for Canada - full stop.

 

Edit - Much of what I'm arguing is presented more succinctly in this paper by the Canadian Federation of Medical Students (http://www.cfms.org/attachments/article/163/CFMS%20IMG%20and%20IMGC%20paper_final.pdf) I take it a bit further in that they argue for maintaining IMG slots while I advocate reducing them, but the underlying rationale is much the same. They also make the point that it's legally difficult to distinguish CSAs from IMGs, so I'll concede that point for now

[ralk]

They do make certain considerations for aboriginal applicants. Thats the only group (i think) that really gets any specific special considerations otherwise, its mainly geographic discrimination. And the exceptions made for aboriginal applicants are done because of the great need to serve those populations (although this issue is a whole other debate and you could argue whether the special considerations really do fall under "discrimination"). However i don't think the problem of rich CSA's getting opportunity over poor canadian pre meds that cant get into canadian med school is on the same level as the issue above. That being said, i dont think theres much data on the subject so i could be wrong. However, i firmly believe in not shutting the door to IMGS/CSA's. As cheesy as it sounds, this country is supposed to give citizens fair opportunity. I doubt theres enough money to open more seats in canada because we just saw 15 seats cut from UofA and a similar number cut from calgary the previous year. Ontario had that whole fight with oma last year about cutting healthcare costs as docs weren't really willing to budge on the money they make. Bottomline, we dont have the money to open more seats so we rely on CSA's/IMG's to supplement our system

 

Edit- ya forgot abt the whole diversity policy but i dont think the med school can legally say, "we have enough caucasians, john doe here therefore wont be offered admission this year"

 

Absolutely, the case with aboriginal applicants has quite a bit more justification than any discrimination-based argument for distinguishing CSAs from IMGs. I think there are still ways to make the case for it, but it's on much shakier ground, so I'll just concede that point and let it drop.

 

As cheesy as it sounds, this country is supposed to give citizens fair opportunity.

 

This I agree with completely, and it underlies my entire argument. This country is supposed to give citizens fair opportunity. CSAs are getting more than a fair opportunity because they're bypassing the major chokepoint for citizens to become physicians in Canada: gaining entrance to a Canadian Medical School. By doing so, they have an unfair advantage over other citizens for whom the CSA route is not a viable option. As for cost, because so much money is sent out of the country to support CSAs compared to the number of CSAs that return to practice in Canada, I don't agree that accepting CSAs saves Canada money. It's a penny-wise, pound-foolish arrangement that saves provincial governments the cost of subsidizing med school but costs them millions of dollars in economic activity (and subsequent tax revenue) that gets spent overseas rather than at home in Canada.

 

True IMGs, on the other hand, are not Canadian citizens. We do our own citizens a disservice by preferring IMGs over additional CMGs when there's no evidence that the IMGs we accept are more qualified than Canadian grads. They are, however, cheaper, that I definitely agree on, and it does make the situation with true IMGs much more complicated, as I alluded to earlier.

[penguin92]

This I agree with completely, and it underlies my entire argument. This country is supposed to give citizens fair opportunity. CSAs are getting more than a fair opportunity because they're bypassing the major chokepoint for citizens to become physicians in Canada: gaining entrance to a Canadian Medical School. By doing so, they have an unfair advantage over other citizens for whom the CSA route is not a viable option. As for cost, because so much money is sent out of the country to support CSAs compared to the number of CSAs that return to practice in Canada, I don't agree that accepting CSAs saves Canada money. It's a penny-wise, pound-foolish arrangement that saves provincial governments the cost of subsidizing med school but costs them millions of dollars in economic activity (and subsequent tax revenue) that gets spent overseas rather than at home in Canada.

 

True IMGs, on the other hand, are not Canadian citizens. We do our own citizens a disservice by preferring IMGs over additional CMGs when there's no evidence that the IMGs we accept are more qualified than Canadian grads. They are, however, cheaper, that I definitely agree on, and it does make the situation with true IMGs much more complicated, as I alluded to earlier.

 

It will always be difficult for true IMG's to practice here (and they make up a very small percentage of our physician population) and although the little data out there (which probably isn't enough to make any major claims) may show they aren't on par with CMG's, I personally just can't agree to completely making healthcare exclusive to Canadian grads (just a personal belief that immigrants should still have some sort of opportunity here. This is just anecdotal evidence but my family doc is a true IMG and I think she's amazing).

 

I agree that CSA's may be bypassing the choke point of getting into med school here however i do want to point out that they don't exactly have as safe an environment as you and I in terms of staying in school (quite a bit pressure is taken off us once we get in and we're basically guaranteed an MD, in their case, the pressure only mounts). However, I like you also want to prevent CSA's from coming back based on connections.

 

Could you explain to me your point about millions of dollars in lost economic activity? I just want to make sure so that we are on the same page. My interpretation of what you said was that instead of these individuals studying overseas, have them remain here, perhaps pursue different careers and work here and thereby use the income tax, that wouldnt have existed had they left, to fund more medical seating. I'm not sure if it truly is "millions of dollars" but if yes, than I admit your argument has legitimacy however I feel funding medical seats is more complicated than that. Afterall, there's a lot of other things the govt would like to solve with extra money available to them and governments don't always do the right thing with that money hahaha. Allowing CSA's\IMG's to practice here might just give them enough of an excuse to have one less thing to budget for (increasing medical seats)

 

Overall its a pretty complex issue. You and I are obviously on different sides and I don't think there's really a "flood" that the OP seemed to indicate way back in the first post but its been a fun debate ralk

[BoyInTheBubble]

When you start an argument with an ad hominem attack, it brightens my day because I know you know you're on shaky ground.

 

IMGs failing at a higher rate means that on average, IMGs are less qualified to practice. Those that do pass exams still go on to have more college discipline hearings than their CMG counterparts. Furthermore, perhaps the exams are not hard enough and the fail rates should be higher for both!

 

Medical school admissions do serve to ensure public safety, or at least they should. Stupid people should not get in, or they will make it through and harm people. I do agree with whomever said that medical school education itself does a poor job in ensuring public safety - nobody fails - and this should change. My opinion is that medical school should adopt a more pyramidal training system, but this will not happen given the obscene amount of government money invested in each student.

 

The lack of CMGs in small town is due to a lack of CMG spots in medical school (and thus a market that is so open that CMGs can choose not to practice in small towns) and the lack of sufficient enticement to attract qualified students to these communities given the current market dynamics. I outlined this in a previous post. It is not the fault of the CMG to not want to move to Moose Factory because the sacrifice/reward ratio just isn't worth it. It is not, however, an ethical solution to lower standards for physicians to work there, or to ensnare IMGs, who are more likely to be insufficient, into return-of-service agreements to patch the hole for a few years (if you see the Ontario ROS contract, its a joke). Governments should work together with the medical societies to find the level at which reward matches sacrifice and entices doctors to work there, if we want safe, effective care for those in remote areas. Maybe we have to cut from the ophthalmology or dermatology pie to fund these remote doctors.

 

In closing, please do not resort to name calling when making an argument. It makes one sound unintelligent.

 

You probably feel really good when you get to say ad hominem.

 

What I meant was, you're a prick for stating that all foreign trained doctors should not be allowed to work in Canada. Shaky ground, I know.

 

You then changed your wording from "exist" to "should serve public safety". Now my knees are quivering.

 

IMGs are not less qualified. They either qualify or they don't. It's no different than CMGs. You get a license to practice as decided by the governing body, or you do not. A CMG that fails the exam on the first attempt, then passes on the second attempt is not given the title of "less qualified doctor".

 

We already pay rural doctors lots of money. The reasons people don't choose to work there as often go well beyond that.

 

Your plan is to remove approx 1/3 of the workforce, and adopt a pyramidal medical school scheme to eliminate more CMGs, and abracadabra the rural shortage goes away? You still didn't address how an underqualified, bad IMG is better than leaving rural areas without a doctor?

 

I'm glad I could brighten your day!

[BoyInTheBubble]

You're putting a lot of words in my mouth that didn't start there.

 

I never said IMGs on the whole were trying to "beat the system" - those comments I reserve for CSAs, since most applied to a Canadian Medical School, were rejected, and then applied abroad. Failing at the intended route, then pursuing an alternative avenue because you happen to have resources that other's don't is, I would argue, the definition of trying to beat the system.

 

Likewise, I haven't found good stats on IMGs' preferences for practice location, so I'm not going to make the claim that they don't want to work in underserviced areas. Since ROS plans in underserviced regions have consistently failed to produce lasting physician supplies in those areas, and since immigrants to Canada usually prefer major centres, my guess is that they're preferences are to work in major centres, but that's pure speculation and not backed by evidence. CSAs, on the other hand, clearly show a preference for major centres, especially Toronto, and my first link provides that evidence.

 

Desperation on the part of CSAs is evidenced by the data which shows that most CSAs unsuccessfully tried to get admissions to a Canadian medical school, that most want to return home after training, and that despite these goals, most fail to return home after training. They're also willing to spend hundreds of thousands of dollars on what is likely to be a failed attempt to practice medicine in Canada. You see someone betting their life savings at the blackjack table, they're probably desperate for some money that they don't have. The situation with CSAs isn't much different - if the goal is to become a Canadian doctor, as most have expressed, they're taking a fairly big gamble with their lives to do so. The upside is that they'll still be a doctor, and if they're fine with practicing outside of Canada, then that desperation isn't there. Certainly, not all CSAs are desperate. Yet, from what CSAs have indicated, most want to return home, and the desperation shows through their actions.

 

Richness is pretty evident from the fact that CSAs are paying hundreds of thousands of dollars in tuition/living expenses/travel and their primary source of funding is family money. That's all available in the CARMS study.

 

You're right in that the current system isn't sustainable without IMGs, but my point is that it doesn't have to be that way. We could make our system sustainable using CMGs alone. I think there are some exceptional IMGs that we certainly still want to come to Canada, but the available evidence indicates that we have a lot of IMGs that are not exceptional.

 

As for physicians wanting to come to Canada to escape other countries, our medical training system is not a refugee system. It's not just physicians who want to leave some of those countries with their families in tow. Restricting IMG spots doesn't stop a physician from immigrating to Canada any more than the current system stops farmers, factory workers, lawyers, or plumbers from immigrating to Canada. Our medical training system is there to provide the best physicians for Canada - full stop.

 

Edit - Much of what I'm arguing is presented more succinctly in this paper by the Canadian Federation of Medical Students (http://www.cfms.org/attachments/article/163/CFMS%20IMG%20and%20IMGC%20paper_final.pdf) I take it a bit further in that they argue for maintaining IMG slots while I advocate reducing them, but the underlying rationale is much the same. They also make the point that it's legally difficult to distinguish CSAs from IMGs, so I'll concede that point for now

 

I misquoted you about all foreign docs playing the system. However, I think you should look at it in a more positive light. Not beating the system. We don't need to stop CSAs from entering in 4 years. They aren't desperate. They are free to spend as they please - family funding doesn't mean wealth. I've heard of people getting tuition money from parents re-mortgaging their house. (Bad idea? Likely, but that doesn't make them wealthy elites.)

 

Currently, CMGs do not cover rural areas enough. This isn't unique to foreign trained docs. It's not CMGs vs IMGs, it's just that people want to live in cities. So you can't really blame one group for it. Certain areas, like Man, Sask and NFLD have no choice. They need to hire huge amounts of IMGs or settle for no one.

 

CSAs are not in despair. They are taking advantage of an opportunity, not playing blackjack with life savings.

 

The government should really be working to maximize the opportunity it has: a large chunk of young people willing enough to leave their friends and family for four years to learn medicine. The majority of them go to the UK, Australia and Caribbean schools (that are essentially US-based curriculums). Which of those countries do you feel uncomfortable seeing a doctor from if you were on vacation? Oh no, not the Australians with whom we have reciprocal licensing agreements! Look out for those dumb doctors! The Royal in RCPSC comes from ....So the mothership of Royal Colleges isn't good enough either?

 

Why is this so bothering to you? Why would you settle for "well I didn't get in" so the dream is over finding a different way to the final goal?

 

They aren't going anywhere, so the Health System should do more to make them a better fit then the opposite.

[spontaneouscombustion]

I think the lack of rural doctors is a problem that receives too much focus. Most people who live in these communities understand that living in a remote region means worse access to services, including medicine. It is inherent to living in a remote region. This is a sacrifice they have chosen to accept by living in these regions. There's no point wasting huge amounts of resources and thinking of grand schemes to fix a problem that cannot be solved.

[ralk]

It will always be difficult for true IMG's to practice here (and they make up a very small percentage of our physician population) and although the little data out there (which probably isn't enough to make any major claims) may show they aren't on par with CMG's, I personally just can't agree to completely making healthcare exclusive to Canadian grads (just a personal belief that immigrants should still have some sort of opportunity here. This is just anecdotal evidence but my family doc is a true IMG and I think she's amazing).

 

I agree that CSA's may be bypassing the choke point of getting into med school here however i do want to point out that they don't exactly have as safe an environment as you and I in terms of staying in school (quite a bit pressure is taken off us once we get in and we're basically guaranteed an MD, in their case, the pressure only mounts). However, I like you also want to prevent CSA's from coming back based on connections.

 

Could you explain to me your point about millions of dollars in lost economic activity? I just want to make sure so that we are on the same page. My interpretation of what you said was that instead of these individuals studying overseas, have them remain here, perhaps pursue different careers and work here and thereby use the income tax, that wouldnt have existed had they left, to fund more medical seating. I'm not sure if it truly is "millions of dollars" but if yes, than I admit your argument has legitimacy however I feel funding medical seats is more complicated than that. Afterall, there's a lot of other things the govt would like to solve with extra money available to them and governments don't always do the right thing with that money hahaha. Allowing CSA's\IMG's to practice here might just give them enough of an excuse to have one less thing to budget for (increasing medical seats)

 

Overall its a pretty complex issue. You and I are obviously on different sides and I don't think there's really a "flood" that the OP seemed to indicate way back in the first post but its been a fun debate ralk

 

I agree that fully shutting the doors to true IMGs is too restrictive - I work with a few IMGs who I consider to be fantastic physicians, and I think we need to keep the opportunity to practice in Canada open for exceptional foreign grads. My concern is that we've gone beyond accepting exceptional IMGs to accepting simply average, or even mediocre IMGs.

 

For the economic effects, while income of CSAs is a factor, I'm more referring to direct costs. A CSA who spends $50k a year on an overseas medical degree is essentially taking 50k a year away from the Canadian economy, because that money largely comes from Canadian sources (50k is lowballing it as well; some schools have higher tuition alone). And since only a fraction of CSAs are able to return to Canada, the cost per eventual Canadian physician is quite high. If one in four return, we're talking a cost per CSA who becomes a Canadian resident of $200k per year while that CSA is training at a foreign school. For that money, we could easily finance another spot at a Canadian Med School.

 

I've very much enjoyed this discussion as well - I always learn a lot from debates like this

[ralk]

I misquoted you about all foreign docs playing the system. However, I think you should look at it in a more positive light. Not beating the system. We don't need to stop CSAs from entering in 4 years. They aren't desperate. They are free to spend as they please - family funding doesn't mean wealth. I've heard of people getting tuition money from parents re-mortgaging their house. (Bad idea? Likely, but that doesn't make them wealthy elites.)

 

Currently, CMGs do not cover rural areas enough. This isn't unique to foreign trained docs. It's not CMGs vs IMGs, it's just that people want to live in cities. So you can't really blame one group for it. Certain areas, like Man, Sask and NFLD have no choice. They need to hire huge amounts of IMGs or settle for no one.

 

CSAs are not in despair. They are taking advantage of an opportunity, not playing blackjack with life savings.

 

The government should really be working to maximize the opportunity it has: a large chunk of young people willing enough to leave their friends and family for four years to learn medicine. The majority of them go to the UK, Australia and Caribbean schools (that are essentially US-based curriculums). Which of those countries do you feel uncomfortable seeing a doctor from if you were on vacation? Oh no, not the Australians with whom we have reciprocal licensing agreements! Look out for those dumb doctors! The Royal in RCPSC comes from ....So the mothership of Royal Colleges isn't good enough either?

 

Why is this so bothering to you? Why would you settle for "well I didn't get in" so the dream is over finding a different way to the final goal?

 

They aren't going anywhere, so the Health System should do more to make them a better fit then the opposite.

 

Again, you're attacking arguments I haven't made. I'm not saying that Australia produces bad doctors. What I am saying is that overall, IMGs do not provide superior service in Canada than CMGs do (and based on evidence, may provide worse service), and because of that, there's little reason to use them over additional CMGs.

 

CMGs don't currently service certain areas enough, but neither do IMGs - that's why there are still shortages. Furthermore, CSAs at least have a strong preference for major centres, especially Toronto. So, moving from CSAs to CMGs would help, not hurt, the problem of regional physician distribution. IMGs do provide valuable service to certain communities, but they don't do so by choice. Often, their presence in those locations is due to return-of-service agreements that are conditional parts of their acceptance to Canada. That is, it's practice in Newfoundland/Manitoba/Saskatchewan, or don't practice in Canada at all. That's fairly exploitative of IMGs who otherwise have no options. More importantly, it's not working. Once the ROS term is over, practitioners often leave, which is why these underserviced areas continue to be underserviced, despite these agreements. It's a bandaid solution that eschews the real problem - doctors don't want to work in Newfoundland, Manitoba, or Saskatchewan. The one strategy we've found that has made some progress is regional recruitment - and only CMGs can be subject to that constraint.

 

Lastly, people with a house they can afford to mortgage their house to send their child off to medical school in another country aren't exactly poor either. Yes, it's great that we have a lot of people so eager to become Canadian doctors, and that is an opportunity we should be taking advantage of. But it's not just CSAs who are willing to chance becoming an IMG, and have the resources to do it, who are eager to become Canadian physicians. There are over 10,000 people applying to Canadian Med Schools each year, who all want to become physicians. They're eager too. And it is aptitude, not finances, that should decide which ones have the opportunity to become physicians - with the CSA route, aptitude still plays a factor, but it's money that determines whether that path is open in the first place.

 

You say "they aren't going anywhere", but in the case of CSAs, that's not necessarily true. CSAs, by and large, exist because there's a chance they could return to Canada as physicians. Remove that chance, remove that incentive to study medicine abroad, and the number of CSAs will drop, because that path will cease to be a viable option for them.

[BoyInTheBubble]

I agree that fully shutting the doors to true IMGs is too restrictive - I work with a few IMGs who I consider to be fantastic physicians, and I think we need to keep the opportunity to practice in Canada open for exceptional foreign grads. My concern is that we've gone beyond accepting exceptional IMGs to accepting simply average, or even mediocre IMGs.

 

For the economic effects, while income of CSAs is a factor, I'm more referring to direct costs. A CSA who spends $50k a year on an overseas medical degree is essentially taking 50k a year away from the Canadian economy, because that money largely comes from Canadian sources (50k is lowballing it as well; some schools have higher tuition alone). And since only a fraction of CSAs are able to return to Canada, the cost per eventual Canadian physician is quite high. If one in four return, we're talking a cost per CSA who becomes a Canadian resident of $200k per year while that CSA is training at a foreign school. For that money, we could easily finance another spot at a Canadian Med School.

 

I've very much enjoyed this discussion as well - I always learn a lot from debates like this

 

You make arguments that lack substance. You are implying that we are letting subpar IMGs in, while all CMGs are perfect. As if a mediocre CMG doesn't exist...

 

And your economics argument is weak. Having money available to spend on a degree in Medicine outside of Canada, does not mean that if they didn't do that, they will spend that money in Canada. Maybe they go travelling, maybe they do what rich people do, and let their money sit there and make more money. Essentially that money doesn't exist for use from government, it's in private hands.

 

You also ignored the fact that while one in your story ends up in Canada, the other 3 still end up physicians...

 

IMGs may leave rural areas after the ROS, but CMGs don't go. Neither group does it regularly.

[ralk]

You are implying that we are letting subpar IMGs in, while all CMGs are perfect. As if a mediocre CMG doesn't exist...

 

I've not once implied that all CMGs are perfect - in fact, I've made at least one statement to the contrary. There are CMGs who are not all that great physicians; I've worked with them. There are IMGs who are amazing physicians; I've worked with them too. However, if we were to accept one less IMG to Canada and train one more CMG, current evidence suggests that the CMG would be more likely to pass their end-of-residency exam than the IMG. At a sheer minimum, this indicates that the IMG that was rejected would not be a better physician than the CMG.

 

And your economics argument is weak. Having money available to spend on a degree in Medicine outside of Canada, does not mean that if they didn't do that, they will spend that money in Canada. Maybe they go travelling, maybe they do what rich people do, and let their money sit there and make more money. Essentially that money doesn't exist for use from government, it's in private hands.

 

Even for the rich, a Canadian family isn't likely to consistently spend 50k+ a year on vacations overseas. The few families that do could probably afford their child's med school costs without cutting into their obscenely lavish vacation fund. You're right in that much of the funding for CSAs comes from increased debt and reducing savings, rather than changes in spending. However, debt and savings matter for the economy as well - every dollar borrowed to finance CSAs is a dollar not borrowed for another purpose, and every dollar save is one that can be invested in a productive activity. As much as banks get maligned, they do a pretty good job of making sure money doesn't sit idle. Keep in mind that the $200k a year estimate I gave is both a lowball figure, and well above the subsidy required for a single med student. Even if half of that money just sat there unproductively - which it is unlikely to do - my overall argument is still perfectly valid.

 

The money isn't the government's, but any plan that saves the government money by pushing additional costs onto the Canadian economy above and beyond what the government saves is still a pretty terrible plan.

 

You also ignored the fact that while one in your story ends up in Canada, the other 3 still end up physicians...

 

No, I haven't. I actually excluded CSAs who did not express an interest at returning to Canada - for every CSA who returns to Canada, there's another one who never wanted to come back at all. Changing residency eligibility for those CSAs has no impact on them, so I ignored them. Those other three CSAs don't just want to be physicians, they want to be physicians in Canada. They're operating on the hope of returning. If the chance to return were gone, many wouldn't become CSAs. Some would, but at least then they'd know where they stand before taking on the costs of studying overseas, rather than after.

 

IMGs may leave rural areas after the ROS, but CMGs don't go. Neither group does it regularly.

 

Right. The choice now is between coercing IMGs into ROS because they have no choice if they want to practice in Canada, bribing CMGs into rural practice at great expense to the taxpayer, or accepting more CMGs with rural roots. Of the three, I prefer the third option, because it appears to produce more lasting results, provides opportunity to Canadians rather than non-Canadians, and has minimal costs.

[BoyInTheBubble]

Passing exams isn't the measure of a good doctor. (In fact, it's very hard to measure.) Probably the most effective way at ruling out good doctors is ones who get brought before the college. This occurs slightly more regularly to IMGs than CMGs (like 1.3 -1.5 times, if I remember correctly). But that hardly means "good".

 

The CaRMS stats showed 146/306 recent grad (last year) IMGs matched with only 102 unmatched. The missing 60 maybe matched to the US between round 1 and round 2? It's odd that they would not get in to round 1 and disappear out of round 2 if they didn't get a job else where.

 

Not spending money on tuition does not mean the money does anything else. (My point wasn't that they might travel, it's that they might not spend it in the Canadian economy as you seem to be implying.) You just can't include it. And big companies DO sit on huge amounts of cash.

[ralk]

Passing exams isn't the measure of a good doctor. (In fact, it's very hard to measure.) Probably the most effective way at ruling out good doctors is ones who get brought before the college. This occurs slightly more regularly to IMGs than CMGs (like 1.3 -1.5 times, if I remember correctly). But that hardly means "good".

 

The CaRMS stats showed 146/306 recent grad (last year) IMGs matched with only 102 unmatched. The missing 60 maybe matched to the US between round 1 and round 2? It's odd that they would not get in to round 1 and disappear out of round 2 if they didn't get a job else where.

 

Not spending money on tuition does not mean the money does anything else. (My point wasn't that they might travel, it's that they might not spend it in the Canadian economy as you seem to be implying.) You just can't include it. And big companies DO sit on huge amounts of cash.

 

No doubt, ability to pass the qualifying exams is a flawed metric, but it's not a useless one either. It's not equivalent to quality, but it's suggestive of quality - I don't think it's a stretch to say that a good doctor is more likely than a mediocre one to pass an exam summarizing the expertise they're supposed to have gathered over 2-6 years of their lives. Likewise, other flawed-but-suggestive metrics also indicate that IMGs are, on average, performing at a slightly lower level than CMGs.

 

Money not spent on tuition doesn't disappear or become useless. Unless it's sitting underneath the mattress rather than in a bank account, it's being used by someone else as a loan, or it's being actively invested. This is especially true of personal savings, since individuals don't need that much liquidity (compared to say, a corporation) and so actively invest. A dollar invested/saved/loaned, as the economy currently stands, certainly doesn't contribute as much as a dollar spent, but it's value isn't zero either - not even close.