There's no place at home: Why thousands of Canadian graduates from overseas med schools can't work here

With just 17 medical schools offering 2,800 first-year seats each year, Canada lacks the academic capacity needed to train and produce enough physicians to meet the country’s healthcare needs. Consequently roughly nine of 10 medical school applicants are rejected, sending thousands of Canadians abroad to pursue their medical degrees in countries such as Ireland, Australia, Britain, Israel and the United States. But thanks to a system set up with numerous barriers to entry, Canadian medical graduates who studied overseas and want to practise at home are increasingly working in other countries, according to a Globe and Mail feature. “The Americans now have first dibs on Canadians training overseas,” said Dr. Desmond Leddin, a Halifax-based professor of internal medicine who has taught and practised in Canada and Ireland. “They’re only too happy to take these people.” A case in point: 92% of Canadians who graduate from St. George’s University in Grenada do their residency in the United States, where spots are offered weeks before Canada’s residency matching system opens for submissions and where 60% of internationally trained applicants are accepted into medical residency. By comparison, in Canada less than 25% of international graduates land a residency. Read: Plans for more med schools in Canada: Where will the residency spots come from? Britain has also become a popular—and welcoming—destination for international grads, who now make up more than one-third of all doctors, compared to just one-quarter six years ago. In Australia, the number of internationally trained physicians has grown to almost 60% of the physician workforce, an increase from less than half in 2001. Dr. Leddin said the country’s provinces need to create new residencies specifically for Canadians educated in medical schools abroad, in particular for graduates with ties to the recruiting region. “They’re an untapped resource,” he told the Globe and Mail. “There’s a deal to be made here, but the problem is it’s still so incredibly difficult to find postgraduate work in Canada. It’s a real chokepoint.” The number of seats designated for international graduates has been decreasing steadily over the years, from 346 in 2014 to 331 this year. In 2022, only 439—or about 13%—of the 3,296 medical grads matched to residency spots in Canada were educated in medical schools outside the country. Compare that to the late 1980s, when that number was close to 700. Read: Alberta to pilot fast-track program for international medical graduates At the same time, there are more graduates coming out of Canadian medical schools, which collectively produced 2,876 graduates in 2020 versus 1,704 in 1991, according to the Association of Faculties of Medicine of Canada. Another big obstacle for Canada's international graduates—in addition to the low number of residency spots earmarked for them—is the two years of post-grad supervised training required before they can get licensed as a physician. The same set of obstacles stand in the way of all international medical graduates, even those who are Canadian. There is no other pathway to residency and licensure for Canadians who study at medical schools overseas. “The messaging for so long has been that it’s nearly impossible to get a bloody residency in Canada if you’re an international graduate,” Peter Nealon, the California-based CEO of the Atlantic Bridge Program, the admissions organization for North Americans who want to attend medical school in Ireland, told the Globe and Mail. “These people are the cream of the crop, and they’re simply going elsewhere, because they’re in demand. You tell people to go away long enough, and eventually, they go away.” It should come as no surprise, then, that the number of international medical graduates applying for Canadian has fallen by 40% over the last decade, from 2,219 in 2013 to 1,1322 in 2022. Read: CaRMS by the numbers: More family medicine residency positions left unfilled this year than last 5 years That’s a disturbing statistic, given that foreign-trained doctors have historically accounted for nearly a third of family physicians and about a quarter of all doctors in Canada. The numbers are even higher in rural areas such Saskatchewan’s southernmost region, where 88% of family physicians are international graduates, or in Newfoundland and Labrador’s central health region where 62% of family doctors were trained outside Canada. Dr. Herb Emery, a health economist who heads the Atlantic Institute for Policy Research at the University of New Brunswick, said the restrictive rules governing international graduates can be traced back to the early 1990s, when governments tried to get healthcare costs under control by reducing the supply of doctors. To do this, provinces cut the number of seats in Canadian medical schools by about 10% and also made significant reductions in residency spots and other postgraduate training opportunities—such as internships—for international graduates. “The disconnect is we have politicians and the public screaming for a better level of service, but what we’ve built is a very bureaucratic machine, with 30 years of inertia, that’s designed at restricting physician supply,” said Dr. Emery. “Even if governments want to fix this and expand supply, they’re dealing with a system that’s designed to do the opposite. And it’s not going to be easy to change that.” Read: Canadian med schools add seats tailored to attract future FPs while family medicine residency spots go unfilled

There's no place at home: Why thousands of Canadian graduates from overseas med schools can't work here

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