Do You Think The Licensure Process For Img's In Canada Is Fair ?

[SEAL]

I think IMG's are not that misinformed. When someone is moving to another continent, surely they will ask a few people with more experience about the system. And they will know it's tough yet they still will make the move. The problem comes when they actually apply to CaRMS and are shocked that although they studied as hard as they can and scored well on the exams they were still rejected (likely because there are CSA's with better English, connections, electives, younger age). The problem is that they need to score more than 95 percentile in the exams to be even considered competitive.

 

And the problem is there is no in between. They are either going to be a fully liscenced doctor or will work casual jobs just like any highschool grad, especially with their suboptimal English. Maybe there should be more clinical assistant and surgical assistant positions where these people could still handle low risk patients under supervision by an attending.

[SEAL]

Another problem I often hear from IMG's who have actually managed to secure residency positions is the return of service agreement. They say they are Canadian citizens and if Canada has a healthcare problem in underserves areas, then all canadians should contribute to solving this problem regardless of where they graduated. The government forces them to work in underserved areas for the same number of years as their residency. They say that's unfair because they have worked at least as hard as CMG's to earn their residency spots, it is not a free gift from the government.

[indefatigable]

That research study is great and all, but for every angry FMG who was unable to practice - there are many who are satisfied they were able to immigrate at all and gain Canadian citizenship for themselves and their families based on their medical training. Yes they can't practice medicine, but they can give a better life for their kids and future generations. There are millions of others who would kill to do the same, but don't have any education or qualifications to ride their backs on to a 1st world country citizenship. Yet many people with simple MBBS(which in many foreign countries, is much different and less restrictive in terms of academics - and sometimes even corrupt, i.e. you are from a well off family in India and you can pay your way into a seat), can get a huge leg up on immigration into Canada.  

 

So my point is, not all IMGs/FMGs are of the same opinion. In fact, im sure many who follow the path outlined above - would hate to lose this option, should the immigration system decide to smarten up and tie immigration to medical licensure availability, and tighten up/decrease the number of foreign doctors they allow in. In fact, why would you even allow in so many, if you know they can't practice? The rationale maybe is that because they are educated, perhaps they will then go towards other related professions and "settle" for something less, and thus be overqualified but easy to adapt and gain proficiency.  The next time you see your dental hygenist who's foreign for example, check to see if they were a dentist in their home country. This is VERY common - dentist back home, can't pass exams and/or get licensed here, so retrain in a shorter dental hygeine program. Still end up making very good money in a short amount of time, and have a far better quality of life compared to back home perhaps -if not for the long term prospect of their offspring being Canadian and the enormous potential opportunities.

 

I'll stand by the assertion that its on the individual to make sure they do their research. It's what expected of us here, and its no different for us should we want to go abroad, and in fact far worse.  There is ZERO reason during this digital age, with by far more information then ever before on the topic, for ANYONE to be entering Canada without understanding the situation and climate. But 100s-1000's still do, because they cling onto that "well only 5-10% make it, may as well be me. And that is their right and I'll defend that choice, based on the framework of immigration allowing them in.  

 

Anyways, just wanted to throw the counterpoint, as people seem to want to constantly berate Canada and its immigration.

 

 

 

I think IMG's are not that misinformed. When someone is moving to another continent, surely they will ask a few people with more experience about the system. And they will know it's tough yet they still will make the move. The problem comes when they actually apply to CaRMS and are shocked that although they studied as hard as they can and scored well on the exams they were still rejected (likely because there are CSA's with better English, connections, electives, younger age). The problem is that they need to score more than 95 percentile in the exams to be even considered competitive.

 

And the problem is there is no in between. They are either going to be a fully liscenced doctor or will work casual jobs just like any highschool grad, especially with their suboptimal English. Maybe there should be more clinical assistant and surgical assistant positions where these people could still handle low risk patients under supervision by an attending.

Regardless of whether it may seem possible for the IMGs to hold uninformed views, out of the 462 IMGs surveyed from Ontario, "Respondents overwhelmingly held the view that there are not enough residency positions available in Ontario and that this information is not clearly communicated to incoming IMGs."

 

At the very least, an up-to-date, official and accurate "Facts and Figures" or similar could be provided by the Ontario government (website or even brochure in the embassy), preferably before the IMGs decide to move continents.

 

Clarity of information more than anything else is I think a first step.  There doesn't have to be a coupling of immigration to licensure - rather simply ensuring the IMGs are making an informed choice.  The IMGs may still choose to immigrate anyways, for various reasons, but they're now taking an informed decision.  

 

Seemingly though, many IMGs would appreciate a range of opportunities:  

 

"In addition to being provided with a realistic sense about their chances of getting a residency position, IMGs consistently shared that they would appreciate the opportunity to work in the health care field in any capacity. For example, many suggested an increase in observership or externship opportunities and expressed a willingness to do this without pay. Others suggested more information be provided around alternative health care opportunities, such as nurse practitioner or physician assistant roles."

 

Yes - some may hold out hope, despite being informed of the numbers.  But then that's clearly their reasoning, as trained medical professionals, rather than due to lack of good information.

[amichel]

Fully certified from Canada ?

No of course not. In his home country. He was starting a clinical assist job though which was a bit scary, since they operate sort of like residents.

[ralk]

Another problem I often hear from IMG's who have actually managed to secure residency positions is the return of service agreement. They say they are Canadian citizens and if Canada has a healthcare problem in underserves areas, then all canadians should contribute to solving this problem regardless of where they graduated. The government forces them to work in underserved areas for the same number of years as their residency. They say that's unfair because they have worked at least as hard as CMG's to earn their residency spots, it is not a free gift from the government.

 

CMGs also contribute to the healthcare problem in underserved areas. Most medical schools in Canada have geographic preferences on who gets admitted, since people from underserved areas are more likely to live and work in those underserved areas long-term. With these preferences in place, when it comes to addressing access issues in underserved areas, it does matter where someone graduated.

 

By contrast, IMGs have a strong preference towards living in overserved major city centres. CSAs are far more likely than CMGs to be from those cities, while non-CSA IMGs tend to cluster in the more ethnically-diverse metropolitan centres. Right now, the ROS requirement turns IMGs into an asset in addressing the distribution problem of physicians, though it's a flawed solution given how frequently IMGs leave those underserved communities once the ROS expires. If the requirement to go to an underserved community were evened out between CMGs and IMGs, say by eliminating the ROS requirement for IMGs, then IMGs go from being an asset in addressing distribution problems to being a significant liability. I understand the frustration IMGs must feel having to sign the ROS agreements, but it's a major reason - arguably THE major reason - that they have residency spots in the first place. Lose the ROS, and the rationale for dedicated IMG spots all but disappears.

[InstantRamen]

What would you suggest is a fair process for IMG's to practice in Canada?

 

Would making the process more lenient cause for more brain drain?

 

Would making the process more lenient encourage more students to study abroad and then come back to Canada?

 

Is it fair that making the process more lenient may cause for job security of Canadian graduates (who were trained in Canada) to decline? The market is already pretty competitive.

 

Would making liscensing more lenient change anything in the amount of IMG doctors practicing?

 

Not implying anything. Just have a bunch of questions that I'm curious about.

[kekappo]

Ah yes complaining and more complaining. Cannot get into med school in Canada -> goes to the caribbean or somewhere like that -> complain about how hard it is to return -> complain more about CMG....it never ends fam. Thats something you need to consider before packing your bags and leaving Canada to practice medicine elsewhere.

[JohnGrisham]

Ah yes complaining and more complaining. Cannot get into med school in Canada -> goes to the caribbean or somewhere like that -> complain about how hard it is to return -> complain more about CMG....it never ends fam. Thats something you need to consider before packing your bags and leaving Canada to practice medicine elsewhere.

I think the OP is focusing on FMGs = foreign doctors from other countries who immigrate to Canada and cant end up practicing.

 

 

[JohnGrisham]

http://www.canadavisa.com/canada-immigration-discussion-board/threads/doctors-how-do-you-succeed-in-canada.37491/ 

A link that took all of 10 seconds to acquire, and paints a somewhat accurate picture of hardships.

 

A post from 2010, with many references from early 2000s.
 

Again, most of it isn't very different than from the 1990s.

 

I think anyone planning a big move will be able to easily figure this out - and if you don't think so, because "the information isn't very clear", then you're pretty much implying FMGs aren't intelligent enough to use google. And if that is the case, then they probably wouldn't know how to use up-to-date and other tools that are a necessity these days in north american medical practice. 

 

We need to stop conflating complaints on the ground with prior immigration motives/understanding of the process. Of course someone who immigrates and is having a terrible time of getting their license is going to complain - it serves a function of perhaps hitting the write tones with those in power to make it easier for them to reach their goal, even if very unlikely to see change. Silence would just assume there is not a problem. But as i mentioned already, silence(no complaints) also serves a function: to keep the immigration door open for those who don't necessarily care if they practice as doctors, because they are using their medical degree(or other professional degrees with poor job prospects/licensure abilities due to canadian professional organization memberships) to immigrate easier and do a different line of work. 

This is no different than CSAs who complain about the unfair process they have to go through - anyone who enters the fray of being a IMG these days has ZERO excuse for not knowing the hardships. It is well documented and known for the last decade, and in the last 5 years as things have gotten even harder. But of course people are going to complain and try to get things changed for their benefit - why wouldnt they? It is functional and serves a purpose.  If they don't then there is zero chance in things improving for their benefit.  Look at how many more IMG residency there are these days compared to the past.  The last few years have been some big hits against them though, with Health Canada statement of needs changing drastically and being more restrictive than ever. Is that fair? Definitely not. But those who choose to matriculate after the changes were made, should know the risks. Those who had the rug pulled under them however, after having already matriculated but then having the outlook change drastically, have very valid concerns. They raised their concerns via lobbying, and many were grandfathered under old rules, not all of those in current training(i.e. at the medical school level) received this benefit though. 

The study you mentioned above about the 400 Ontario docs is just a part of the picture. There are thousands more over decades. Primarily non-commonwealth, and 3rd world/developing countries. Many chose to just leave medicine and do other things, so that their kids could have a better life (and then live vicariously through them when they get into Canadian medical schools and become doctors...very common in most metropolitan areas where they immigrate). 

 

[GrouchoMarx]

In some ways IMGs are given preference. There are Carms spots in round 1 that are exclusive to them. Cmgs can't apply.

 

Let's stop using the term CSA. It's inherently Racist.

 

In some specialties the standard for imgs is very low, as my experience in pathology has revealed. Some communities will hire foreign pathologists with questionable foreign credentials and no eligibility for canadian certification just to keep the biopsy gears turning. In my opinion that's sickening.

[ralk]

Let's stop using the term CSA. It's inherently Racist.

 

Sorry, how is the term CSA racist? It's not a racial group. It's also the technical term used by most official organizations in the Canadian medical education system, including CaRMS.

[indefatigable]

What would you suggest is a fair process for IMG's to practice in Canada?

 

Would making the process more lenient cause for more brain drain?

 

Would making the process more lenient encourage more students to study abroad and then come back to Canada?

 

Is it fair that making the process more lenient may cause for job security of Canadian graduates (who were trained in Canada) to decline? The market is already pretty competitive.

 

Would making liscensing more lenient change anything in the amount of IMG doctors practicing?

 

Not implying anything. Just have a bunch of questions that I'm curious about.

 

To me at this point it's not really a question of leniency, but more a question of transparency with regards to the potentially immigrating IMGs.

 

But yes - in my view it's reasonable to assume that simply taking IMG training as is, without requiring any further credentialing or review, could have deleterious consequences not only for domestic and foreign health care systems & practitioners, as you suggest, but also for Canadian patients.  There's little reason to generally lower standards at this point though, given the strong supply both domestically and especially internationally of medical graduates.  

 

The broader question of IMG selection isn't easy.  A specific process that fits all situations could be tricky.  Possibly, in some specialties with 5+ year training periods, the 4 year+ fellowship training seems like a reasonable suggestion.  Of course, this always depends on domestic supply & needs, not to mention the perceived quality and competence of IMG with training, which is clearly difficult to evaluate (as discussed). 

 

For general practitioners, if the medical residency programs are not interested in taking experienced immigrating IMG physicians, this should be made clear during the immigration process, so those IMGs don't immigrate with the expectation of becoming practicing physicians.  This seemed to be the greatest cause of concern.  

[SEAL]

What would you suggest is a fair process for IMG's to practice in Canada?

 

Would making the process more lenient cause for more brain drain?

 

Would making the process more lenient encourage more students to study abroad and then come back to Canada?

 

Is it fair that making the process more lenient may cause for job security of Canadian graduates (who were trained in Canada) to decline? The market is already pretty competitive.

 

Would making liscensing more lenient change anything in the amount of IMG doctors practicing?

 

Not implying anything. Just have a bunch of questions that I'm curious about.

It is not about making the process more lenient. It is about making it reasonable. If you take a pediatrics test right after your Peds rotation, you will ace it. If you take at the end of medical school you will need to brush up for a week or two and you will still do well. Take the same test when you are 40 and have been an ENT attending for the past 10 years, and you will fail big time or at least it will take a significant amount of time to study just to get an average score. You are the same person it is just that your performance naturally declines when you are older and not in touch with the basics. We all want a rigourous process before giving anyone a liscence, but it is just unreasonable to force everyone to start from scratch.

 

Most posters commented on the importance of clearly communicating the high risk of not practical to people considering immigration. Yet this won't stop them from coming, and they admit that. The biggest problem for them is starting from scratch.

 

IMGs are willing to go through any amount of exams or assessments or supervised training before they become fully liscenced but within their specialty they used to practice, they can't switch back to being generalists again.

 

It is true that current IMG's are substandard and require extended training before they can be released into the community. But that's because the way the system works attracts lower quality doctors.

 

Suppose you have a high quality Indian doctor. He is 40, has a wife and 2 teenagers. He would love to immigrate to Canada but the prospect of having to spend 10 years in Canada just to get to where he is now in India just isn't possible for him. So he stays in India.

 

On the other hand, a low quality Indian doctor who is already struggling in India will immigrate to Canada regardless of whether he gets to practice because in both cases he would be better off than I. India.

[indefatigable]

http://www.canadavisa.com/canada-immigration-discussion-board/threads/doctors-how-do-you-succeed-in-canada.37491/ 

 

A link that took all of 10 seconds to acquire, and paints a somewhat accurate picture of hardships.

 

A post from 2010, with many references from early 2000s.

 

Again, most of it isn't very different than from the 1990s.

 

I think anyone planning a big move will be able to easily figure this out - and if you don't think so, because "the information isn't very clear", then you're pretty much implying FMGs aren't intelligent enough to use google. And if that is the case, then they probably wouldn't know how to use up-to-date and other tools that are a necessity these days in north american medical practice. 

 

We need to stop conflating complaints on the ground with prior immigration motives/understanding of the process. Of course someone who immigrates and is having a terrible time of getting their license is going to complain - it serves a function of perhaps hitting the write tones with those in power to make it easier for them to reach their goal, even if very unlikely to see change. Silence would just assume there is not a problem. But as i mentioned already, silence(no complaints) also serves a function: to keep the immigration door open for those who don't necessarily care if they practice as doctors, because they are using their medical degree(or other professional degrees with poor job prospects/licensure abilities due to canadian professional organization memberships) to immigrate easier and do a different line of work. 

 

This is no different than CSAs who complain about the unfair process they have to go through - anyone who enters the fray of being a IMG these days has ZERO excuse for not knowing the hardships. It is well documented and known for the last decade, and in the last 5 years as things have gotten even harder. But of course people are going to complain and try to get things changed for their benefit - why wouldnt they? It is functional and serves a purpose.  If they don't then there is zero chance in things improving for their benefit.  Look at how many more IMG residency there are these days compared to the past.  The last few years have been some big hits against them though, with Health Canada statement of needs changing drastically and being more restrictive than ever. Is that fair? Definitely not. But those who choose to matriculate after the changes were made, should know the risks. Those who had the rug pulled under them however, after having already matriculated but then having the outlook change drastically, have very valid concerns. They raised their concerns via lobbying, and many were grandfathered under old rules, not all of those in current training(i.e. at the medical school level) received this benefit though. 

 

The study you mentioned above about the 400 Ontario docs is just a part of the picture. There are thousands more over decades. Primarily non-commonwealth, and 3rd world/developing countries. Many chose to just leave medicine and do other things, so that their kids could have a better life (and then live vicariously through them when they get into Canadian medical schools and become doctors...very common in most metropolitan areas where they immigrate). 

 

 

What's clear to you or me isn't necessarily relevant to the IMG experience - quoting:

 

"Receiving “points” for their education during the immigration process was incorrectly assumed to be indicative of recognition and approval of their qualifications".  

 

The immigrating IMGs thus appeared to be  under the impression they would be able to practice in Canada.  A simple change could be mandatory information describing that "points" doesn't mean they will be licensed in Canada included in a bulletin or pointer for immigrating professionals (what are the chances? what careers? available..). 

 

Unlike a forum, the information would be an official source and mandatorily mentioned during the process  There would be clarity for the IMG.  And not every individual turns to google or forums as a first step - doesn't make them any less intelligent.

 

Many IMGs may still choose to immigrate, knowing their chances to become practitioners are slim.  But this would be an informed choice.  The "brain drain" + "brain waste" phenomenon should then happen less.  

 

It wouldn't drastically change the immigration system - chances of immigrating, since I doubt that any of the numbers are a surprise to politicians and policy-makers.  

[SEAL]

It is not about making the process more lenient. It is about making it reasonable. If you take a pediatrics test right after your Peds rotation, you will ace it. If you take at the end of medical school you will need to brush up for a week or two and you will still do well. Take the same test when you are 40 and have been an ENT attending for the past 10 years, and you will fail big time or at least it will take a significant amount of time to study just to get an average score. You are the same person it is just that your performance naturally declines when you are older and not in touch with the basics. We all want a rigourous process before giving anyone a liscence, but it is just unreasonable to force everyone to start from scratch.

 

Most posters commented on the importance of clearly communicating the high risk of not practical to people considering immigration. Yet this won't stop them from coming, and they admit that. The biggest problem for them is starting from scratch.

 

IMGs are willing to go through any amount of exams or assessments or supervised training before they become fully liscenced but within their specialty they used to practice, they can't switch back to being generalists again.

 

It is true that current IMG's are substandard and require extended training before they can be released into the community. But that's because the way the system works attracts lower quality doctors.

 

Suppose you have a high quality Indian doctor. He is 40, has a wife and 2 teenagers. He would love to immigrate to Canada but the prospect of having to spend 10 years in Canada just to get to where he is now in India just isn't possible for him. So he stays in India where he is already successful.

 

On the other hand, a low quality Indian doctor who is already struggling in India will immigrate to Canada regardless of whether he gets to practice because in both cases he would be better off than I. India.

[bloh]

I think it's actually too easy to get licenced in Canada and there are far too many loopholes. The ROS agreements are far too short. One of the places I locumed in just lost one of their GPs after 3 or so years. She got pregnant, 3 years were up and so she moved to the city to work. But then again what are we expecting? A nigerian MD to live in a desolate, cold, small town?

[A-Stark]

I just think if someone is good enough to pass the Royal College exams in his/her specialty then they should be able to practice directly. It is reasonable to say that they should be also required to pass a language test and perhaps have a course on how the Canadian medical system works. But to start all over, it is just impossible.

 

Well, presumably if an IMG is eligible for and can pass their respective RC exam, that would certainly be sufficient. Only physicians trained in the US, Australia, New Zealand, Singapore, Hong Kong, the UK, South Africa, and - interestingly - Switzerland qualify as equivalent to RC training, by virtue of being "approved jurisdictions". Even this is not automatic and may not apply for all specialties. 

 

Again, I will fully disagree that passing the Royal College or CFPC exam is sufficient to certify a physician to work in Canada, unless they are from a very similar country to Canada. That's an insufficient safeguard for the patients those physicians would treat, and is an unnecessary risk to take given the current state of physician supply relative to demand for their work.

 

Well they would also need to pass the MCC exams to qualify for licensure and, indeed, certification. Those are silly exams, though. 

 

I'm not sure why RC or CFPC certification is not "sufficient", but of course not everyone is eligible to write those exams. 

[lulu95]

Sorry to bring up an old(ish) thread, but I was reading through this and found that the viewpoints about the conditions of IMGs in Canada are quite at odds with my personal experience. While I have met taxi drivers who were former doctors, the reality isn't a black and white between fully licensed doctor and minimum wage job, as some seem to think. I've also met those who - as JohnGrisham mentioned - went into related professions and became overqualified nurses and physician's assistants, and though they may no longer be a doctor, the salary and job security of their current positions are still good. But of course, you won't hear the stories of these experiences shared by news outlets or by word of mouth because "foreign doctor becomes nurse" isn't as shocking or jarring as "taxi driver", and people who have found a satisfactory job - whether by succeeding in getting licensed or by joining a related profession - won't be the loudest voices.

Moreover, the preoccupation with the possibility that someone may not have immigrated to Canada if the job prospects (or lack thereof) were made more clear, was interesting to read. If the person came to Canada, stayed for a while, and didn't like the way it works here, the option to return to their home country is usually open, if they preferred it back there (unless they severed ties there so terribly that they aren't welcome back, but if they were a skilled and valued doctor, I'm not sure how often that would occur). If they chose to stay, they chose to stay for a reason, despite knowing that it'll be difficult to pick up their old profession again; the situation wouldn't change if you placed the job prospects in all caps on the immigration info page.

I'm not saying that the licensure system isn't frustrating for immigrant doctors, because it is, but there is no perfect system. Perhaps there could be accelerated training programs in related fields for foreign doctors who are unable to return to the profession so there are less taxi-driving former doctors, as that truly would be a "brain waste" if they weren't able to apply any of their acquired knowledge, but I'm skeptical about facilitating the IMG licensing process across the board when there isn't enough funding for all the positions those licensed doctors will need.

[indefatigable]

Ralk said it best - it's a "bait and switch" on the immigration front.  The article gives the stats for a sample from Ontario - about 20% did go back to their home country and a number of others couldn't.  It's not easy to uproot a family to move to a new continent, and many of the former physicians believed that they had a solid future chance at licensure which made them kept trying.   Sure there are success stories which are the exceptions, but no reason to lead people down the garden path.    

Here's a quote:

Many reported regretting their decision to migrate to Canada:

… issuing a visa to an IMG like me to work as a security guard is simply a mockery of the immigration dream. I immigrated to ensure a secure future for my two daughters who lost their mother in 2009. By immigrating to be a security guard at the age of 52, I have betrayed my poor nation, which made me a doctor with tax payers’ money. Also, by throwing into the garbage my long 25 years of experience and knowledge of medicine I have committed a crime to myself. [Male, aged 50+ years]

 

[JohnGrisham]

On 5/23/2017 at 8:05 PM, bloh said:

I think it's actually too easy to get licenced in Canada and there are far too many loopholes. The ROS agreements are far too short. One of the places I locumed in just lost one of their GPs after 3 or so years. She got pregnant, 3 years were up and so she moved to the city to work. But then again what are we expecting? A nigerian MD to live in a desolate, cold, small town?

Yes there are some loopholes, but getting licensed in Canada is NOT easy at all for the vast majority.  Look at the Annual reports most provinces issue on their physician demographics, and see how many active practicing doctors from various countries exist. Then compare that to how many are actually provided immigration passage based on their NOC class of medical professional(medical doctor).  Only a small percentage actually become licensed to practice.

23 hours ago, calcan said:

Ralk said it best - it's a "bait and switch" on the immigration front.  The article gives the stats for a sample from Ontario - about 20% did go back to their home country and a number of others couldn't.  It's not easy to uproot a family to move to a new continent, and many of the former physicians believed that they had a solid future chance at licensure which made them kept trying.   Sure there are success stories which are the exceptions, but no reason to lead people down the garden path.    

Here's a quote:

Many reported regretting their decision to migrate to Canada:

… issuing a visa to an IMG like me to work as a security guard is simply a mockery of the immigration dream. I immigrated to ensure a secure future for my two daughters who lost their mother in 2009. By immigrating to be a security guard at the age of 52, I have betrayed my poor nation, which made me a doctor with tax payers’ money. Also, by throwing into the garbage my long 25 years of experience and knowledge of medicine I have committed a crime to myself. [Male, aged 50+ years]

 

Actually, it was that doctor at age 52 that betrayed his own nation by choosing to leave this country that trained him, for greener pastures. Greener pastures that werent so green, and that could easily have figured out in 10 minutes of google searching. He makes it sound like Canada forced him to become a security gaurd. He could have left and returned back once he realized the issues. 

Sorry, again, I have less sympathy for people who don't do their research before uprooting their family. That is on your personal due diligence, regardless of the immigration system. Once again, the alternative is cutting off the immigration system access to these people - and alot of people would be pissed off by that, because many people KNOW they won't be a doctor, but are being allowed into the country based on that qualification, and then they CHOOSE to go into allied health fields..Fields that still pay better and offer more future security for their families in the long term.

No one forced him at the age of 50+ to leave his country.  

I sound like a broken record, but i have worked with many immigrants in this scenario. Educating people can only do so much, and at some point you have to hope they have a bit of resourcefulness themself to look things up. Again, I agree 100% that they should make it very clear that immigration is not tied to licensure, but the major issue then (as ive stated repeatedly) is that if Immigration services publically acknowledged that the NOC class of medical doctor was "not in need" or "not directly utilized", then they would not have any logical basis for even providing immigration pasture to that NOC class in the first place. This would close doors on a lot of people who are using their foreign physician status as a way to gain PR for a better future.  For every person pissed off that they can't be a doctor, or return to their country after trying in a odds-stacked-against them system, there are others that are happy to be Canadian, and move onto a different "surviving job" until they can get into another healthcare related field perhaps, or a different field all together. Whereby the net sum of their earnings, lifestyle and family potential are STILL better off than back home. And still some yet, will become taxi drivers and such, and "make the sacrifice" so that their children can have a better future. Yes an undesirable situation to be in personally, but net-sum for their family is still likely better.  In collective based cultures, that compromise many of the FMG doctors, this is still an acceptable outcome.  BUT that doesn't mean that many of them who continually try (and a small amount succeed after many years of attempts), won't still complain and try to get change.  Because why wouldn't you? There is no loss to complaining to try to get the system to change in your favour, but everything to gain(to be a canadian physician now and not have wait to see your children become Canadian professionals!)

[indefatigable]

5 hours ago, JohnGrisham said:

Actually, it was that doctor at age 52 that betrayed his own nation by choosing to leave this country that trained him, for greener pastures. Greener pastures that werent so green, and that could easily have figured out in 10 minutes of google searching.

Sorry, again, I have less sympathy for people who don't do their research before uprooting their family. That is on your personal due diligence, regardless of the immigration system. Once again, the alternative is cutting off the immigration system access to these people - and alot of people would be pissed off by that, because many people KNOW they won't be a doctor, but are being allowed into the country based on that qualification, and then they CHOOSE to go into allied health fields..Fields that still pay better and offer more future security for their families in the long term.

No one forced him at the age of 50+ to leave his country.  

I think we'll have to politely disagree.  Without rehashing old arguments, I view contextual factors as more important - i.e. coming from a developing country and maybe not too forums/internet savvy or even accessible and reliable.  I don't think the alternative is necessarily cutting off immigration system access - it's simply a misinterpretation on the part of the would-be immigrants of what "points" mean - not a ticket to licensure.  I mean [IMG misinformation] was the main conclusion of the research study based on a sample of 400+ IMGs.  As long as the federal government clarified that "points" are not a promise of licensing at all, I think the slate would be clean.  The points system seems to work overall, so there's no reason to change it.   And moreover, there'd be something concrete to oppose the notion of a "bait and switch" - since it was clearly disclosed that points does not equal license.  If people then still choose to immigrate then it's an informed and consenting choice.  

[indefatigable]

5 hours ago, JohnGrisham said:

I sound like a broken record, but i have worked with many immigrants in this scenario. Educating people can only do so much, and at some point you have to hope they have a bit of resourcefulness themself to look things up. Again, I agree 100% that they should make it very clear that immigration is not tied to licensure, but the major issue then (as ive stated repeatedly) is that if Immigration services publically acknowledged that the NOC class of medical doctor was "not in need" or "not directly utilized", then they would not have any logical basis for even providing immigration pasture to that NOC class in the first place. This would close doors on a lot of people who are using their foreign physician status as a way to gain PR for a better future.  For every person pissed off that they can't be a doctor, or return to their country after trying in a odds-stacked-against them system, there are others that are happy to be Canadian, and move onto a different "surviving job" until they can get into another healthcare related field perhaps, or a different field all together. Whereby the net sum of their earnings, lifestyle and family potential are STILL better off than back home. And still some yet, will become taxi drivers and such, and "make the sacrifice" so that their children can have a better future. Yes an undesirable situation to be in personally, but net-sum for their family is still likely better.  In collective based cultures, that compromise many of the FMG doctors, this is still an acceptable outcome.  BUT that doesn't mean that many of them who continually try (and a small amount succeed after many years of attempts), won't still complain and try to get change.  Because why wouldn't you? There is no loss to complaining to try to get the system to change in your favour, but everything to gain(to be a canadian physician now and not have wait to see your children become Canadian professionals!)

It looks like this was added later. It's a nuanced point unfortunately and would be a challenge to communicate- that despite a profession being possibly in need, that licensure is not automatic.  Word choice would be important.  But that doesn't undo the fact that the points system could still be used anyways as a means to favour immigration.  And I agree that individuals are free to exercise their choice as they see fit.  As I mentioned above, it's important that the process has very clear transparency to precisely avoid charges of unfairness.