Becoming a doctor is an arduous process.

Most Canadian medical schools require an undergraduate degree and that’s just the start.

Once you’ve earned that degree, you enter a competitive pool of students applying for a spot in one of Canada’s small number of medical schools.

Then, once you’ve graduated from medical school, the Canadian Resident Matching Service (CaRMS) will hopefully match you to a residency program in Canada.

While the process seems simple enough, there are a number of logistical issues that are forcing a large number of prospective Canadian medical students to take their studies abroad.



BECOMING AN INTERNATIONAL MEDICAL GRADUATE

Studying abroad seems like a fantastic option for young Canadians looking to get into the field.

Not only is living and studying in a foreign country an incredible experience, but there are way more medical school options outside of Canada.

Canada only has 17 medical schools, compared to 172 in the U.S.A. and 32 in the U.K.

In Canada, like in the U.S., students have a slim chance of being accepted to medical school without a bachelor’s degree already under their belt.

In the U.K., medical school is a five or six year program and it’s something that you can apply to right out of high school.

“I knew getting into medical school in Canada is super competitive and it required not only really good marks in university, but lots of extracurriculars,” said Jessica Page*, a Vancouver native who went to medical school in the United Kingdom. “I knew that lots of times people would spend three or four years applying, while doing Masters and PhDs, and lots of people wouldn’t get in anyways.”

Page says she learned about the U.K. option in the later stages of high school and knowing how difficult the Canadian system is, that’s the route she chose to take.

When she made the decision, however, she didn’t realize how difficult it would be to get into a residency program back in Canada.

That’s because graduating from medical school overseas labelled Page as an international medical graduate (IMG).

IMGs, whether they’re born in Canada or not, are in tough when it comes to getting a residency spot and eventually working within Canada.

In 2016, there were 345 total residency positions available in B.C. and only 56 of those were available to IMGs.

For Page, upon graduating from medical school in the U.K., she was one of just two students accepted from nearly 1,000 applicants to a residency program in eastern Canada.



THE FORMATION OF SOCASMA

Stories like Page’s lead to the formation of an advocacy group in 2010 called the Society of Canadians Studying Medicine Abroad (SOCASMA).

“It was formed because Canadians who chose to study medicine outside of Canada or the U.S. were basically denied re-entry into B.C. to do their residency training, which meant that they couldn’t become licensed physicians,” explained SOCASMA president, Rosemary Pawliuk.

If you chose to study medicine in the U.S., you’re labelled as a U.S. medical graduate (USG) once you complete your studies.

That makes it easier to get back into Canada for your residency, but Pawliuk says it’s still by no means a cakewalk.

“In order to train in the states, you need the approval of Canada saying once you’re trained, there will be work for you here,” said Pawliuk. “In 2016, the provinces got together and said they’re going to limit, quite substantially, the number of people they’d approve to get training in the U.S.”

According to Pawliuk, B.C. approved 285 positions for people studying family medicine in the U.S. last year, but the nation’s biggest province, Ontario, didn’t approve a single position.

That leads to a number of USGs from outside of B.C. flocking towards those 285 available spots, leaving a lot of B.C. born medical graduates out in the cold.



CANADA’S REGULATORY REQUIREMENTS AMONGST THE HIGHEST IN THE WORLD

“We have some of the highest regulatory requirements of anywhere in the world for licensing for both family medicine and for the specialties,” says Dr. Alan Ruddiman, president of Doctors of BC. “There’s no special privilege given to you in returning to Canada as a Canadian citizen, you’re treated on the credentials that you’ve earned overseas.”

However, it doesn’t seem like there’s any reason for the credentials of Canadian medical schools to be held above the credentials of medical schools overseas.

The Times International world university rankings has three U.K. universities in the top five when it comes to medical schools.

The highest rated Canadian medical school is the University of Toronto, which ranks 14th on the list.

Seven American universities, as well as two schools from Sweden and Australia, all rank ahead of the U of T.

Despite these facts, IMGs need to pass a national exam before they’re allowed to even apply to residency programs in Canada.

Canadian medical school graduates (CMG) don’t need to complete any such exam to prove their abilities ahead of residency applications.

In fact, CMGs are almost guaranteed residency positions and a job, even if they barely passed medical school.



STRICT REGULATIONS STILL IN PLACE DESPITE DOCTOR SHORTAGE

These strict regulations remain in place for IMGs and even USG’s, despite the fact that Canada is dealing with a doctor shortage and has been for years.

“They’ve always been beating down my door,” says Richmond based family doctor, Barb Kelly*, referring to patients looking for a family doctor. “Every week there’s six or seven people phoning to ask if I’m taking new patients.”

Kelly says she’s been practicing in Richmond for 25 years and hasn’t taken on a new patient in two decades, with the exception of the odd favour for friends or other doctors.

Those claims check out, as Ruddiman says that the province needs to bring in 450 new family doctors a year to replace doctors who are retiring, relocating or dying.

The province, however, only trains 296 new doctors a year, less than a third of the necessary amount.

So if B.C. and Canada as a whole are seeing such large struggles with replacing the aging doctor population, why do these strict guidelines still exist against IMGs who are arguably more qualified than CMGs?

Creating more spots in Canadian medical schools seems like the logical solution, but it’s simply not that easy.

“Where are you going to find the teachers,” asks Kelly. “I have first-year medical students coming to my office today and they’re always looking for physicians to take medical students in to teach.”

Kelly, however, says that’s not an easy thing when there’s already a limited amount of physicians who are already working 10 to 12 hour days to try and fill the patient demand.

If there aren’t enough teachers at home, removing the restrictions on IMGs to come back home and practice seems like another logical solution.

Pawliuk, however, sees one big reason why a move like that hasn’t already happened.

“The government does everything it can to control the amount of doctors so they can control the amount of healthcare spending,” she said. “If you have more doctors, there will be more healthcare spending.”

“The provinces talk the talk, but there is no doubt that they are trying to control the number of doctors.”



IS THERE A SOLUTION TO THIS STALEMATE?

The government, however, has tried one major thing to try and amend the doctor shortage issue we see here in B.C.

That would be the GP for Me program, a jointly funded effort from the provincial government and Doctors of BC to enable everyone who wants a family doctor to find one.

Ruddiman says the government set some generous benchmarks for the program, including having a family doctor for everyone in the province by 2016, but he thinks it was relatively successful despite that.

According to Ruddiman, the province needs to be self-sustaining and not rely on immigration to solve the doctor shortage, which means training more doctors at home.

That dives right back into the issue of not having enough teachers, which lends credibility to Pawliuk and the rest of SOCASMA’s solution to the issue.

That would include changing the regulations behind Canadians studying abroad (CSA) to come home and practice.

A combination of the two solutions would put the largest dent in the doctor shortage that has plagued this province and country for years.

The province needs to find the funds to train more medical students in B.C. and find a better system for letting Canadian IMGs practice at home.

*Some names in the story have been changed.