Untrained And Unemployed: Medical Schools Churning Out Doctors Who Can't Find Residencies And Full Time Positions

[ralk]

Yes, I can point the numbers, and let’s give them some context because over- or under-supply can be argued as relative.

 

After European Commission published 2014 Report on Health, UK widely lamented their poor ranking with regards to the number of physicians - 24th of 27 European countries - with 2.71 doctors per 1000 population (less than some poorest EU countries including Bulgaria, Estonia and Latvia). Health advocacy groups branded the situation “extremely worrying”.

 

Now Canada. OECD Health Statistics 2014 indicated that Canada has experienced a “substantial expansion” of its medical workforce since 2000, when it had a dismal 2.1 doctors per 1000 population. The report has only 2012 data from Canada showing 2.5 doctors per 1000 population, Canada thus remaining well below the OECD average of 3.2.

 

Lack of newer data is interesting considering all the publicity here, claiming that the number of doctors in Canada is rising faster than population. That may be true, but Canada remains shamefully behind, not only comparing to Europe but also to the most other developed countries including Australia, US, New Zealand, South Africa, and even Asian countries such as Mongolia and several others.

 

Still thinking that there are too many doctors in Canada ?

 

Well, that first point was meant to be somewhat sarcastic, because there is no defined "appropriate" number of physicians. I'm completely aware of the international comparison, system-level utilization of physicians can greatly affect the need for physicians, and more physicians doesn't necessarily translate to better care. I mean, Mongolia may have more physicians, but does that mean they have a better healthcare system?

 

In addition, a 19 increase in 12 years is a substantial increase, especially since we're only now starting to see the effects of the massive expansion in Canadian med school spots on physician numbers. In 2012, newly-certified specialists would be coming from medical school classes that trained 270 fewer students per year in Ontario alone than medical schools will be training in the incoming cohort of new students. We could easily hit 3.0 physicians per 1000 within a decade (and our physicians work longer hours than most of the OECD). The trend is meaningful, particularly when considering changes - including what I've proposed - that will primarily have an impact the make-up of our newly-certified physicians 6-10 years from now.

 

Besides, you're arguing a strawman - I never said Canada was oversupplied with physicians. I agree that we have too few (though that may change, quickly). I said there was a limit on how many physicians we were willing to pay for, and more specifically, how many residency positions we're willing to fund. Based on the declining applicant-to-residency ratio, the number of unemployed or underemployed physicians, and the actions taken by provincial governments to reign in physician costs (Ontario being the most obvious example), we are hitting that point.

[older]

Yes, there is a limit on how many physicians we were willing to pay for, and  how many residency positions we're willing to fund - and this limit is lower than in other developed countries. That's why residency spots for IMGs and CSAs stir so many emotions, not always rational (I am still not buing negative impact on economy and quality of care). .

 

Never mind Mongolia, but numbers don't look good for Canada yet, despite significant progress.

[A-Stark]

Yes, there is a limit on how many physicians we were willing to pay for, and  how many residency positions we're willing to fund - and this limit is lower than in other developed countries. That's why residency spots for IMGs and CSAs stir so many emotions, not always rational (I am still not buing negative impact on economy and quality of care). .

 

Never mind Mongolia, but numbers don't look good for Canada yet, despite significant progress.

 

Sorry, was there a certain number we should be aiming for? Is there evidence that the number of physicians per capita is associated with population health outcomes? There are more physicians being trained in Canada than ever before. 

 

As for the CSA/IMG issue, the simple fact is that the proportion of total IMG spots has risen faster than the overall number, and the numbers actually look a lot worse when you parse out the francophone training positions in Quebec. Since 2012 there has also been a significant rise in the absolute number of unmatched CMGs, and not just the small handful of them who had significant personality and/or academic issues. 

 

There are absolutely some good CSA/IMG students around; some are really good. But medical training in Canada is a continuum from undergrad to postgrad and it is crucial to ensure availability of spots for CMGs first. For the most part, this works out. 

[ralk]

Yes, there is a limit on how many physicians we were willing to pay for, and how many residency positions we're willing to fund - and this limit is lower than in other developed countries. That's why residency spots for IMGs and CSAs stir so many emotions, not always rational (I am still not buing negative impact on economy and quality of care). .

 

Never mind Mongolia, but numbers don't look good for Canada yet, despite significant progress.

Again, all of this is a side argument, since even a rise in the limit set still leaves us with a limit. We can hit that limit entirely with CMGs or with a proportion of IMGs - I'd prefer to move towards the first option, for the many reasons I've detailed in this thread.

 

I've tried to present a dispassionate defense of my position, so I'm not sure what you're getting at by saying these positions "stir so many emotions". I'm not making an emotional argument here - are you?

 

Lastly, care to advance an argument in support of your belief that there is no negative impact on economics or quality of care? Simply stating you don't buy my position isn't a valid argument and doesn't further this discussion.

[GrumpyMoriarty]

Can you point out to data showing  that Canada has too many doctors?

 

Can you point out the data showing that Canada doesn't have too many doctors?

 

So don't want to be too mean (jk i totally do), but that's basically Ad Ignoratiam

[ralk]

So don't want to be too mean (jk i totally do), but that's basically Ad Ignoratiam

Bit hard for there to be an argument from authority in there when neither question is an argument

[GrumpyMoriarty]

Bit hard for there to be an argument from authority in there when neither question is an argument

 

Except its not really an argument from authority at all (that's ad verecundiam...) so much as a basic logical fallacy

 

you pointed out there's too many docs in canada (lets call that claim D)

older asked you to prove that D is true.

You asked him to prove that D is not true. ---> therein lies the fallacy. The onus is on you (the one who claimed D), to back it up, not for the other person to prove that your claim is untrue.

[ralk]

Except its not really an argument from authority at all (that's ad verecundiam...) so much as a basic logical fallacy

 

you pointed out there's too many docs in canada (lets call that claim D)

older asked you to prove that D is true.

You asked him to prove that D is not true. ---> therein lies the fallacy. The onus is on you (the one who claimed D), to back it up, not for the other person to prove that your claim is untrue.

 

Argh, mistypes - I meant argument from ignorance. I should never post from a phone while distracted

 

As I pointed out earlier, I never claimed there were too many docs in Canada. My question was a rhetorical device meant to illicit that distinction, as well as a segue to the point that there is no "correct" level of physicians, making it difficult to say with any certainty that we have too many or too few regardless of metrics available. I wasn't making an argument and I certainly wasn't making the argument you claim I was. Can't be an argument from ignorance when there is no argument presented.

[older]

Again, all of this is a side argument, since even a rise in the limit set still leaves us with a limit. We can hit that limit entirely with CMGs or with a proportion of IMGs - I'd prefer to move towards the first option, for the many reasons I've detailed in this thread.

 

I've tried to present a dispassionate defense of my position, so I'm not sure what you're getting at by saying these positions "stir so many emotions". I'm not making an emotional argument here - are you?

 

Lastly, care to advance an argument in support of your belief that there is no negative impact on economics or quality of care? Simply stating you don't buy my position isn't a valid argument and doesn't further this discussion.

 

I don't buy your position (the negative impact on economics or quality of care) because you did not present convincing argument, yet alone a proof.  Grumpy Moriarty has a good point - the onus is on you (the one who made the statement ) to back it up, not for the other person to prove that your claim is untrue.

 

The subject of IMGs does not come first time, discussions in the press and all kind of fora, or event court challenges date many years back. Many angry words were exchanged at both sides. While I appreciate (and admire)  that your arguments are logical and cool, it's not the case with everyone. I did not mean you.

 

[ralk]

I don't buy your position (the negative impact on economics or quality of care) because you did not present convincing argument, yet alone a proof.  Grumpy Moriarty has a good point - the onus is on you (the one who made the statement ) to back it up, not for the other person to prove that your claim is untrue.

 

The subject of IMGs does not come first time, discussions in the press and all kind of fora, or event court challenges date many years back. Many angry words were exchanged at both sides. While I appreciate (and admire)  that your arguments are logical and cool, it's not the case with everyone. I did not mean you.

 

 

Following Grumpy Moriarty's lead of bringing up logical fallacies, here's one for you - argument from incredulity. You don't find my arguments convincing but you don't state why. Your inability to accept my position says nothing about its merits.

 

There is an onus on me to back up my statements, but I've done that. I may not have backed them up to your standards, but without knowing what you find lacking, I have no way of knowing what additional information would be necessary to convince you. Please provide more details on why you feel my position is wrong or insufficiently supported.

[older]

Following Grumpy Moriarty's lead of bringing up logical fallacies, here's one for you - argument from incredulity. You don't find my arguments convincing but you don't state why. Your inability to accept my position says nothing about its merits.

 

There is an onus on me to back up my statements, but I've done that. I may not have backed them up to your standards, but without knowing what you find lacking, I have no way of knowing what additional information would be necessary to convince you. Please provide more details on why you feel my position is wrong or insufficiently supported.

 

As I said, I don't buy your position  because of lack of convincing arguments.

 

1. Your statement  "there's good reason to believe the average CSA is less competent than the average CMG" is based on assumption that whilst CSAs have lower GPA and MCAT (not necessarily true),  "GPA/MCAT  have been correlated with performance in medical school and beyond".  I don't know what you mean by "beyond", but I am not aware about any studies showing that CSA doctors practicing in our health system are any less competent that CMG doctors.

 

2. In another post, you state   "on average a CMG is likely to outperform an IMG", again without information what this statement is based on (and what “outperforming” means).

 

Firstly, CSAs and IMGs are not doctors yet, they are  med graduates.  The premise of the qualification system is to make sure that  graduates, whether CMGs or IMGs, meet the standards of the profession.  Once they met the criteria and passed the hoops, whatever they are for their respective categories, there is no reason to believe that they are any less than qualified doctors, and that they will not provide quality care to patients. Unless you can show that IMG qualification system is so ineffective that it does not meet its main objective, allowing unqualified people to practice, there is no grounds to say that quality of care is compromised. While not all doctors are equally good (and this is true forany grad category), all of them have to be qualified.

 

With regards to economics, you made a really week case with regards to CMGs  (as quoted below), but I did not see anything showing  IMG's  adverse impact on Canadian economy.

 

The weakness of the argument below is that CSAs (with the exceptions to those who choose to study medicine abroad even though they would qualify in Canada)  would not have the opportunity to spend their tuition and expense money in Canada, since they could not get a place here. What they spend abroad is not the money that would otherwise flow to Canadian med schools and Canadian economy. With regards to "opportunity costs” (the time spent overseas studying medicine when many do not get to practice), it is exactly what imparting CSA back to the system is trying to rectify.  The cost would be in NOT allowing these doctors to practice here.

  

"as the CSA population grows, we send more Canadian money overseas to train largely intelligent, hardworking Canadians in a field some are ill-suited for and that others will never get the chance to practice. There are direct monetary costs (tuition/living expenses spent out of the country), human capital costs (skilled Canadians being productive outside the country either temporarily or permanently), and opportunity costs (the time spent overseas studying medicine when many do not get to practice). We focus on the marginal savings of not covering these students' med school subsidies, but we lose a lot when they go overseas. Economically, having the CSA route available likely costs Canada more than it saves. It's a penny-wise, pound-foolish approach to supplying Canada with physicians".  

 

[GrouchoMarx]

CSA's circumvent the stringent competitive system in place for medical school admissions, which is unjust in that the determining factor for practicing medicine in Canada becomes not excellence but wealth. 

 

An argument could be made that CMGs were on average academically superior to their peers and thus more likely to have the ability to tackle the complexities of medicine. Medical admissions were once based on the principle of exceptionalism and current efforts attempt to maintain that. Students who consider being a CSA an option are under less pressure to maintain academic excellence.

 

CSA's are made of a rag-tag bunch of impatient yet highly-competent Canadians who just had bad luck one cycle and truly average students whose academic fortitude for medicine is questionable. Yet the barrier to entry is low as long as one can pay, and to my knowledge few statistics exist that separate out the undergraduate credentials of the unlucky CSAs to the unworthy ones.

 

CSA's are not a panacea for the physician distribution issues. Most settle in metro areas. The fact that IMG-only positions in competitive specialties like urology and dermatology exist in large centers like Ottawa suggests an element of corruption. CSA's on average hail from wealthy families and have enough political pull to game the system to their favor.

 

An American study (just one to my knowledge) followed patient outcomes with the educational origin of the intern. They found that IMGs and USMGs had better outcomes than US students studying abroad. I can remember nothing more of that study. Contrary to the post above, IMGs and CSAs are doctors if they are practicing medicine in a residency program.

 

The Royal College does not publish IMG pass rates unfortunately. The IMG pass rate for my specialty, anatomic pathology, is rumored to be around 60 to 70% while the CMG pass rate is above 95%. General pathology has a pass rate of 30%, mostly IMGs write it. I would like to see the numbers for all specialties, since this would help settle the question of whether CSA/IMGs are more or less competent than their CMG peers.

[ralk]

 

As I said, I don't buy your position  because of lack of convincing arguments.

 

1. Your statement  "there's good reason to believe the average CSA is less competent than the average CMG" is based on assumption that whilst CSAs have lower GPA and MCAT (not necessarily true),  "GPA/MCAT  have been correlated with performance in medical school and beyond".  I don't know what you mean by "beyond", but I am not aware about any studies showing that CSA doctors practicing in our health system are any less competent that CMG doctors.

 

2. In another post, you state   "on average a CMG is likely to outperform an IMG", again without information what this statement is based on (and what “outperforming” means).

 

Firstly, CSAs and IMGs are not doctors yet, they are  med graduates.  The premise of the qualification system is to make sure that  graduates, whether CMGs or IMGs, meet the standards of the profession.  Once they met the criteria and passed the hoops, whatever they are for their respective categories, there is no reason to believe that they are any less than qualified doctors, and that they will not provide quality care to patients. Unless you can show that IMG qualification system is so ineffective that it does not meet its main objective, allowing unqualified people to practice, there is no grounds to say that quality of care is compromised. While not all doctors are equally good (and this is true forany grad category), all of them have to be qualified.

 

With regards to economics, you made a really week case with regards to CMGs  (as quoted below), but I did not see anything showing  IMG's  adverse impact on Canadian economy.

 

The weakness of the argument below is that CSAs (with the exceptions to those who choose to study medicine abroad even though they would qualify in Canada)  would not have the opportunity to spend their tuition and expense money in Canada, since they could not get a place here. What they spend abroad is not the money that would otherwise flow to Canadian med schools and Canadian economy. With regards to "opportunity costs” (the time spent overseas studying medicine when many do not get to practice), it is exactly what imparting CSA back to the system is trying to rectify.  The cost would be in NOT allowing these doctors to practice here.

  

"as the CSA population grows, we send more Canadian money overseas to train largely intelligent, hardworking Canadians in a field some are ill-suited for and that others will never get the chance to practice. There are direct monetary costs (tuition/living expenses spent out of the country), human capital costs (skilled Canadians being productive outside the country either temporarily or permanently), and opportunity costs (the time spent overseas studying medicine when many do not get to practice). We focus on the marginal savings of not covering these students' med school subsidies, but we lose a lot when they go overseas. Economically, having the CSA route available likely costs Canada more than it saves. It's a penny-wise, pound-foolish approach to supplying Canada with physicians".  

 

 

Ok, now we're at least moving things forward.

 

Let's start with the cost issue. It's true that the arguments given don't apply to foreign-born, foreign-trained IMGs. Those are a net win for Canada from an economics standpoint, which is part of the reason other countries got so upset with us when we recruited their physicians - it's a net loss for them.

 

For CSAs the costs are as I outlined, but I can go into more depth. For direct costs, CSAs spend money from Canada in other jurisdictions that might otherwise be spent in Canada. I say might deliberately, because money not spent on CSAs would not all be spent in Canada otherwise. Some of it would be spent on other products/services supplied by non-Canadian businesses or invested abroad, but some of it would be spent or invested in Canada. That's a loss to our economic productivity. How big of a loss is hard to say, but a typical CSA is spending $200k+ overseas over those 4 years. Canadian imports top out at around 35% of our GDP, so let's give ourselves some wiggle room, round down and say that 60% of that 200k stays in Canada. $120k per CSA is nothing to scoff at when you consider the number of new CSAs each year - about 800 per year and rising. That would put direct costs to the economy at $96 million in total.

 

For human capital and opportunity costs, it is true that if we cut off CSAs from being able to practice in Canada it would increase those human capital and opportunity costs if the number of CSAs remained constant. My point is that in cutting off the CSA route, we would substantially reduce the number of CSAs out there. CSAs used to exist in very small numbers back when the opportunities for IMGs in Canada were limited. When we introduced the IMG-stream, CSA numbers grew quickly, and have risen steadily since. By-and-large, CSAs want to practice in Canada and the CSA route does provide them a chance at that. Remove that chance and the incentives to go abroad all but disappear. Currently the match rate for CSAs through CaRMS is about one in three. That leaves the other two thirds either not working in Canada as physicians or not working in Canada at all. These are generally well-educated, intelligent people who we have lost for a minimum of 4 productive years, some for much longer. If these individuals did not study medicine abroad, they would pursue their next-best career pathway which would likely be here in Canada. Now, there will always be people desperate enough to become a physician who would become CSAs even if they couldn't practice in Canada, but that number would likely be more similar to the historical rates before we opened up residency spots for IMGs than the current levels. The human capital and opportunity costs of 100% of that previous number of CSAs would still be a fraction of those costs for the two thirds of current CSA numbers unable to practice medicine in Canada.

 

 

Ok, onto physician quality. To start, I have no idea as to why you're bringing up qualifications. Of course IMGs are qualified, they're not practicing here illegally. But despite passing the qualificaiton schemes, there could be differences in quality - as you said yourself, not all physicians are equally good. The question is - are IMGs as a whole of higher, equal, or lower quality relative to CMGs?

 

That's a tough question to answer because there is no perfect measure of physician quality. There are some indications, however. Pass rates from certification exams gives us a view of quality at the resident level. Reports on disciplinary proceeds by regulatory colleges indicate somewhat higher rates of discipline for IMGs than for CMGs. Various studies on physician performance along some more specific criteria of practice give different results, but the ones I've found indicate either lower performance or equivalence of performance. I will fully admit that the available data does not provide conclusive evidence of lower quality among IMG physicians, though it is suggestive that this may be the case and it is completely inconsistent with the notion that IMGs are of higher quality than CMGs.

 

I want to reiterate, while my case for reducing the proportion of IMGs in the set of incoming physicians might be strengthened if IMGs were of lower quality than CMGs, my case doesn't rest on it. Rather, my argument is that we should be moving towards CMGs to provide fairer access to the medical profession for those of all backgrounds and to increase the number of physicians serving underserved populations and that because IMGs are, at best, no better than CMGs, there is no countervailing reason why we should want IMGs ahead of more CMGs. Increasing CMG spots in place of IMG spots gets the Canadian healthcare system something (physicians who want to practice with underserved populations) for, at worst, nothing (no change in physician quality).

[uwopremed]

 

As I said, I don't buy your position  because of lack of convincing arguments.

 

1. Your statement  "there's good reason to believe the average CSA is less competent than the average CMG" is based on assumption that whilst CSAs have lower GPA and MCAT (not necessarily true),  "GPA/MCAT  have been correlated with performance in medical school and beyond".  I don't know what you mean by "beyond", but I am not aware about any studies showing that CSA doctors practicing in our health system are any less competent that CMG doctors.

 

2. In another post, you state   "on average a CMG is likely to outperform an IMG", again without information what this statement is based on (and what “outperforming” means).

 

Firstly, CSAs and IMGs are not doctors yet, they are  med graduates.  The premise of the qualification system is to make sure that  graduates, whether CMGs or IMGs, meet the standards of the profession.  Once they met the criteria and passed the hoops, whatever they are for their respective categories, there is no reason to believe that they are any less than qualified doctors, and that they will not provide quality care to patients. Unless you can show that IMG qualification system is so ineffective that it does not meet its main objective, allowing unqualified people to practice, there is no grounds to say that quality of care is compromised. While not all doctors are equally good (and this is true forany grad category), all of them have to be qualified.

 

With regards to economics, you made a really week case with regards to CMGs  (as quoted below), but I did not see anything showing  IMG's  adverse impact on Canadian economy.

 

The weakness of the argument below is that CSAs (with the exceptions to those who choose to study medicine abroad even though they would qualify in Canada)  would not have the opportunity to spend their tuition and expense money in Canada, since they could not get a place here. What they spend abroad is not the money that would otherwise flow to Canadian med schools and Canadian economy. With regards to "opportunity costs” (the time spent overseas studying medicine when many do not get to practice), it is exactly what imparting CSA back to the system is trying to rectify.  The cost would be in NOT allowing these doctors to practice here.

  

"as the CSA population grows, we send more Canadian money overseas to train largely intelligent, hardworking Canadians in a field some are ill-suited for and that others will never get the chance to practice. There are direct monetary costs (tuition/living expenses spent out of the country), human capital costs (skilled Canadians being productive outside the country either temporarily or permanently), and opportunity costs (the time spent overseas studying medicine when many do not get to practice). We focus on the marginal savings of not covering these students' med school subsidies, but we lose a lot when they go overseas. Economically, having the CSA route available likely costs Canada more than it saves. It's a penny-wise, pound-foolish approach to supplying Canada with physicians".  

 

 

I've been reading 'Olders' comments...and again and again. it is pretty clear that he/she has a vested interest in IMGs or CSAs for having easy access to becoming highly paid canadian physicians.  Ralk has been very good about expressing that CSAs in particular circumvent the basics of fairness and that there are already enough doctors in Canada - but Older goes on.  I come from an extended family of A LOT of physicians.  I also know the London scene in particular pretty well (being born and raised here and having done most of my schooling here).  It's the reason why as a premed I am willing to comment.

 

1.  CMGs consistently do much better than both IMGs and CSAs at all levels of training.  The most obvious is at the Royal College level - where CMG Canadian Residency Trained residents have pass rates of 95%+ in virtually every specialty.  For those outside this group, pass rates are usually 70% or less.  The CMG pass rates are published every year.

 

2.  Medicine is one of the few pathways for entry into the upper-middle classes that is primarily merit based.  Of course there are some issues here and there - but for the most part if you have the marks, the MCAT, have some ECs, AND are very social - you will likely get into a medical school.  And even if you are poor - you will still have your education funded without any significant concern for the future.  CMGs also understand Canadian culture, and Canadian medical culture in particular better on average than IMGs (who train in a totally different system).    CSAs are Canadians who could not get into the Canadian system because they were unable to get a competitive spot.  In some ways, these are the worst - because they circumvent a system of fairness of entry into the upper-middle class, with using money as the conduit to that success.  Many of them are the children of other physicians or other wealthy families to begin with - and hence the reason why the authorities have had difficulty limiting these spots.  Particularly those that go to Ireland or Europe or Australia.

 

3.  While the per capita physicians ratio in Canada is lower than many other countries - the comparison is a bit silly as all medical systems run very differently.  Our outcomes are actually pretty fantastic for the most part.  The weaknesses are in areas of aboriginal health - but these exist in all wealthy countries with poor aboriginal populations (NZ, Australia, USA. etc).  But the key point is that the current physician body COULD see more patients if allowed to.  OR time is at a premium.  One urologist family friends says he could literally DOUBLE is surgeries if given OR time - and there is competition for OR time when one takes vacation.  This is true for Orthopedics as well.  Hiring more surgeons makes no sense, IF current surgeons themselves can rapidly increase their OR productivity.  This is true in an incredible number of specialties.  And with the new PA programs in Toronto and Hamilton pumping out grads, as well as nurse practitioners - the need for doctors will decrease in the near future.

 

Canada has ZERO obligation for CSAs and IMGS whatsoever.  Especially those with low standards for admission to the medical schools they went to.  Heck - even CMGs should not be guaranteed training if they are not stellar students. 

[ralk]

I've been reading 'Olders' comments...and again and again. it is pretty clear that he/she has a vested interest in IMGs or CSAs for having easy access to becoming highly paid canadian physicians.

 

I agree with much of your post, but I will take exception here. I don't know what older's motivation is for taking their position, whether they have a personal interest in the accessibility of residency positions for IMGs or if their position is based on an intellectual position. Frankly, it doesn't matter. This is a topic that has implications for a good number of people and they should all have a say. As long as everyone's sticking to reasoned arguments, I'm happy to keep this discussion going from my end.

[武田信玄]

I agree with much of Ralk's points. I would just like to add that perhaps we can show a bit more compassion toward our own fellow Canadians. Sure CSA gains their residency spots with extra money, but still the percentage is small. I think it's not entirely morally wrong to be a bit lenient toward our own kids. As Gohan pointed out earlier, our admission system excludes many talents (although the system still ensures that whoever gets is top-notch).

 

...which leads to my second point, why on earth do we reserve residency spots for IMGs but not for CSAs??? I just found out this yesterday and I still can't believe it. Has this country gone insane????

[武田信玄]

.

[amichel]

I agree with much of Ralk's points. I would just like to add that perhaps we can show a bit more compassion toward our own fellow Canadians. Sure CSA gains their residency spots with extra money, but still the percentage is small. I think it's not entirely morally wrong to be a bit lenient toward our own kids. As Gohan pointed out earlier, our admission system excludes many talents (although the system still ensures that whoever gets is top-notch).

 

...which leads to my second point, why on earth do we reserve residency spots for IMGs but not for CSAs??? I just found out this yesterday and I still can't believe it. Has this country gone insane????

 

They're not reserved specifically for IMGs.  They're reserved for both.  

[武田信玄]

They're not reserved specifically for IMGs.  They're reserved for both.  

I thought so too until I read this:

 

http://www.vancouversun.com/news/Opinion+Canada+shuts+door+Canadian+doctors+foreign+medical+schools/9714934/story.html

 

"A few residency training positions were created in an International Medical Graduate stream specifically for immigrant physicians after a 1999 human-rights case. Canadians who studied abroad are told they are entitled to compete for these few positions because they, as immigrant physicians, are international medical graduates. But barriers have been put in place to protect these jobs for immigrant physicians. So CSAs very rarely receive any of these IMG positions."

 

That's just absurd.

[amichel]

I thought so too until I read this:

 

http://www.vancouversun.com/news/Opinion+Canada+shuts+door+Canadian+doctors+foreign+medical+schools/9714934/story.html

 

"A few residency training positions were created in an International Medical Graduate stream specifically for immigrant physicians after a 1999 human-rights case. Canadians who studied abroad are told they are entitled to compete for these few positions because they, as immigrant physicians, are international medical graduates. But barriers have been put in place to protect these jobs for immigrant physicians. So CSAs very rarely receive any of these IMG positions."

 

That's just absurd.

That is written by a CSA, and is backed up by zero evidence.

 

People who are further along in medicine can back me up here, but I'm pretty sure that's not the case.

 

Even if it was true, don't forget that many IMG residents are full fledged attendings in their home countries.

[A-Stark]

I thought so too until I read this:

 

http://www.vancouversun.com/news/Opinion+Canada+shuts+door+Canadian+doctors+foreign+medical+schools/9714934/story.html

 

"A few residency training positions were created in an International Medical Graduate stream specifically for immigrant physicians after a 1999 human-rights case. Canadians who studied abroad are told they are entitled to compete for these few positions because they, as immigrant physicians, are international medical graduates. But barriers have been put in place to protect these jobs for immigrant physicians. So CSAs very rarely receive any of these IMG positions."

 

That's just absurd.

 

It's also just wrong. IMG positions are for graduates of non-North American medical schools. Like almost any applicants to CaRMS, IMGs must be Canadian citizens or permanent residents. No distinction is made between immigrants with prior overseas training and CSAs. 

 

Otherwise, the vast majority of IMGs at my centre are CSAs with Irish, Australian, or less commonly Caribbean degrees. Many of these people matched in the second round. But the notion that CSAs "very rarely" (or even "rarely") obtain IMG positions is 100% wrong. 

[ralk]

 

 

I thought so too until I read this:

 

http://www.vancouversun.com/news/Opinion+Canada+shuts+door+Canadian+doctors+foreign+medical+schools/9714934/story.html

 

"A few residency training positions were created in an International Medical Graduate stream specifically for immigrant physicians after a 1999 human-rights case. Canadians who studied abroad are told they are entitled to compete for these few positions because they, as immigrant physicians, are international medical graduates. But barriers have been put in place to protect these jobs for immigrant physicians. So CSAs very rarely receive any of these IMG positions."

 

That's just absurd.

 

CSAs receive the majority of IMG spots, despite being the minority of applicants.

 

In many ways, CSAs and IMGs are casualties of our system, both being fed false hope that only work well for a minority of those given that hope. CSAs are fed that hope by the schools accepting them, who promote the subset of successful CSAs while ignoring the larger subset who are unsuccessful. IMGs are fed that hope by our immigration system which promises of certification pathways in Canada, while failing to inform them of hurdles they'd need to jump and the (low) chances of them succeeding in jumping those hurdles.

 

Closing the pathway for CSAs and IMGs seems like it's closing a door on deserving individuals, but in reality the system already closes the door for the majority of those individuals, it just asks for 4+ years of their life (for CSAs) or a move to Canada (for IMGs) before officially telling them the door is shut. All other arguments aside, we need to do a much better job about being transparent and honest with prospective CSAs and IMGs who might want to practice in Canada.

[older]

uwopremed, on 21 Jul 2015 - 5:13 PM, said:

I've been reading 'Olders' comments...and again and again. it is pretty clear that he/she has a vested interest in IMGs or CSAs for having easy access to becoming highly paid canadian physicians.

 

I agree with much of your post, but I will take exception here. I don't know what older's motivation is for taking their position, whether they have a personal interest in the accessibility of residency positions for IMGs or if their position is based on an intellectual position. Frankly, it doesn't matter. This is a topic that has implications for a good number of people and they should all have a say. As long as everyone's sticking to reasoned arguments, I'm happy to keep this discussion going from my end.

 

Thank you. Some people cannot comprehend that one can argue an issue on merit, without having any vested interest in it. Not to mention situations when one argues against  their own vested interest, being guided by a principle (not totally unique).    

 

I

[older]

Ok, now we're at least moving things forward.

 

Let's start with the cost issue. It's true that the arguments given don't apply to foreign-born, foreign-trained IMGs. Those are a net win for Canada from an economics standpoint, which is part of the reason other countries got so upset with us when we recruited their physicians - it's a net loss for them.

 

For CSAs the costs are as I outlined, but I can go into more depth. For direct costs, CSAs spend money from Canada in other jurisdictions that might otherwise be spent in Canada. I say might deliberately, because money not spent on CSAs would not all be spent in Canada otherwise. Some of it would be spent on other products/services supplied by non-Canadian businesses or invested abroad, but some of it would be spent or invested in Canada. That's a loss to our economic productivity. How big of a loss is hard to say, but a typical CSA is spending $200k+ overseas over those 4 years. Canadian imports top out at around 35% of our GDP, so let's give ourselves some wiggle room, round down and say that 60% of that 200k stays in Canada. $120k per CSA is nothing to scoff at when you consider the number of new CSAs each year - about 800 per year and rising. That would put direct costs to the economy at $96 million in total.

 

 

Don't you see sophistry of your argument? You are saying it is bad for the economy that CSAs spend their money on their med education abroad. Good or bad, the real issue is that they don't have a choice - they CANNOT spend their money on their med education in Canada, no matter how much they want to. Exceptions aside, it is not that they've been offered a place in UoT and yet they decided to go to Ireland and spend their money there. In this line of reasoning, you should speak against Canadians studying in US.  I don't know the numbers but there might be more of those than CSAs.  

[older]

 

1.  CMGs consistently do much better than both IMGs and CSAs at all levels of training.  The most obvious is at the Royal College level - where CMG Canadian Residency Trained residents have pass rates of 95%+ in virtually every specialty.  For those outside this group, pass rates are usually 70% or less.  The CMG pass rates are published every year.

 

 

I would be surprised if the results were any different. Actually I find it stunning  that as many as 5% of the excellent, chosen, superior CMGs still cannot jump the hoop for which they are extremely well prepared in our education system.

 

IMGs come from all kind of educational systems, some excellent, others potentially very weak. Rigoruous program here may level the field in terms of familiarity with Canadian system,but then it might not if there are serious underlaying deficiencies. The point is that those  who are under-educated are being weed out. There is no reason to believe that those who remain are worse. Ralk makes a good point that indicators related to performance down the road (such as disciplinary proceedings or malpractice lawsuits), not exam results, would be much more indicative. And if proven, it should lead to tightening the screw. Nobody defends incompetence. .

 

If the system works as it should, than the "quality"  would differ no more that qualities of an individual doctor, regardless of which group he/she comes from.   No need to state the obvious  that "quality of care" depends on many factors (largely systemic), and Royal College results of an individual doctor is not the primary one.