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Canadian Medical Graduates Who Study Abroad Face Prejudice And Barriers When They Try To Return Home

Canadian Medical Graduates Who Study Abroad Face Prejudice And Barriers When They Try To Return Home

There are British Columbians with international degrees who have scored in the top 2% in the American licensing exams who will be going to work in the US, not because they want to, but because of the barriers and restricted opportunity to compete they face in BC.


The Society for Canadians Studying Medicine Abroad (SOCASMA) states that entry into jobs for medical resident physicians, called residencies, is founded in a culture of entitlement and prejudice. Equal opportunity does not apply in respect to entry into one of the most prestigious professions in Canada. SOCASMA says that this is because the government has allowed Canadian medical schools, rather than the College of Physicians and Surgeons, to decide who gets their first job practicing medicine. The universities have set up a system that virtually guarantees their graduates jobs by prohibiting international graduates from competing against their graduates.

In no profession other than medicine, are qualified Canadians denied the ability to compete on their merits for entry jobs into the profession just because they obtained their degree outside of North America.

Canadian immigrant physicians and Canadians who chose to study abroad (CSAs) can only compete for the few resident physician jobs leftover after Canadian and American medical school graduates have had their first pick. Or they can compete with hundreds of others for a total of 34 positions in the International Medical Graduate stream for jobs as family physicians or in 3 areas of specialization: psychiatry, internal medicine, or pediatrics. Immigrant physicians and CSAs cannot access residency positions in 61 out of 65 medical disciplines in BC. And although these Canadians have paid for their own education, to be allowed to compete for these 34 jobs, they must sign return of service contracts agreeing to work where they are told after they become fully licensed for 2 to 3 years.

Many people believe that Canadians who study outside of Canada, do so because they were not good enough to get into Canadian medical schools. The most recent study done by the Canadian Residency Matching Service in 2010 found that Canadians chose to study at international medical schools for various reasons, including an inability to get into Canadian medical schools. However, the study found that 26.7% never applied to a Canadian medical school. More than half, 63.7%, never applied or applied only one time. While on average a CSA applied to a Canadian medical school 1.76 times, a Canadian medical school student applied 2.95 times before getting in. A study by the Canadian Medical Students Association of Poland in 2013 found that only 2.6% of their students chose English language Polish schools because they could not get into a Canadian medical school. The most common reason cited for studying in Poland was that the medical program was high quality and time efficient. The second most common reason was a desire to explore the world. The third most common reason was the tuition fees were lower than in Canadian medical schools.

The CRMs study found that most CSAs were not aware that when they returned home with medical degrees, that there would be significant barriers to returning to work in Canada. CSAs thought they could return home to compete on their individual merits for entry jobs.

Another judgment commonly passed on CSAs is that they attend second rate schools and are second rate medical graduates. The Medical Council of Canada has established exams that weed out medical graduates who do not meet Canadian standards.  Before any international medical graduate) is allowed to apply for a medical resident physician position in BC, (with the exception of medical graduates from oil rich Middle East countries who gain entry to resident physicians in BC by paying UBC $75,000 per year), (s)he must pass the national medical knowledge and skills (MCCEE) and clinical skills (NAC OSCE) examinations. The Medical Council of Canada states on its website that a passing grade establishes medical knowledge and clinical skills “are at a level of a Canadian medical graduate entering postgraduate training.”

The Times international higher education rankings for 2013-14 establishes that 3 out of the top 5 medical schools are in the United Kingdom. The other two are in the U.S.A. Oxford in England ranked first. The University of Toronto is the highest ranked Canadian medical school at 15th. UBC ranks 30th. Ten out of the 17 Canadian medical schools did not rank in the top 100 medical schools in the world. Currently one Canadian medical school, the University of Saskatchewan, is under threat of losing its accreditation.

Even Canada’s most elite scholars, recognized for exceptional academic and social achievements with a Rhodes scholarship to Oxford, cannot compete against Canadian medical school graduates for medical residency jobs. A Rhodes scholar with a medical degree from Oxford is restricted in British Columbia to competition in the international medical stream where 61 out of 64 areas of specialization are not available to him or her.

The Canadian medical education system makes it difficult to objectively evaluate how Canadian medical graduates stack up against international medical graduates. A number of Canadian schools do not issue grades or class rankings. At UBC medical school grading is pass/fail.

Graduates of Canadian medical schools do not have to take national licensing exams to prove the extent of their knowledge and clinical skills before competing for residency jobs. The US, and most other countries, require all medical graduates, whether domestic or international, to write the same licensing exams to enable an evaluation on merit, not place of education.
There are British Columbians with international degrees who have scored in the top 2% in the American licensing exams who will be going to work in the US, not because they want to, but because of the barriers and restricted opportunity to compete they face in BC.

Nor is admission into medical school based on uniform admissions standards. For instance, UBC has admitted students into medical school with grade point averages as low as 70% and disregarded MCAT (medical aptitude test) scores. UBC Admissions states that these students were judged suitable to work in rural British Columbia. Two years ago CBC reported that less than 25% of the students who got into the UBC North medical program actually stayed to practice in northern and rural British Columbia as was intended. These students did not have to sign return of service contracts for the concessions made on their lower admission standards.

Students with GPAs in the 90s or MCATs in the 99th% have been denied admission to UBC medical school because of inadequate volunteer work. Students who had to work through university and students who went to school while contributing to the physical support of their handicapped or elderly family members were disadvantaged in this way in the UBC medical school admission process.

The president of SOCASMA, Rosemary Pawliuk, states that an objective examination of the facts establishes that CSAs and immigrant physicians are not excluded from competition because they are not qualified. She says that the exclusion of Canadians who are legally entitled to work in Canada from competing for jobs as resident physicians is a function of the train coming off the tracks. Regulatory colleges are supposed to determine the rules for entry into the profession, not the university who has an interest in promoting its graduates and advocating for the perception that their education is top notch. Public interest is served when professionals are chosen on the basis of the best Canadian getting the job.

SOCASMA states that a medical selection system that protects Canadian graduates, and discriminates against and places barriers or conditions on other qualified Canadians from competing for entry level jobs into the medical profession, is unconstitutional and an affront to the principles of a free and democratic society. Pawliuk states, “CSAs and immigrant physicians are judged as second rate as a function of the fact that they can only compete in a second class stream. That is the beauty of power. You can foster an atmosphere of entitlement for you and yours, and prejudice against others just by prohibiting them from competing. One must ask, if international medical graduates are not as good as Canadian medical school graduates, what is the harm in letting them compete on their merits? They will lose. But if it is the Canadian medical graduates who cannot compete, then we have to ask the universities why. ”

More information about how medical residency works and the barriers Canadian international medical graduates face can be found at socasma.com.

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