MONTREAL—The number of Canadian medical school graduates unable to find a residency training program could triple in the coming years, jeopardizing the career paths of hundreds of future doctors, a new report warns.

The Association of Faculties of Medicine of Canada is recommending that provincial health ministries boost funding to create additional residency spots. It says this is needed to prevent the growing backlog of graduates caught between the classroom and the operating room, unable to complete the last required step in their medical training.

From 114 Canadian medical graduates who were not successfully matched to a residency program in 2017, the figure could climb to more than 330 in 2021 if no corrective action is taken, the association said in a report Tuesday.

It is also urging an overhaul of the two-round system through which the annual residency spots are filled so that Canadian medical school graduates have less competition from spots from graduates coming from international medical schools.

“We see this as a very potentially effective way to reduce the number of unmatched Canadian medical graduates,” said Dr. Geneviève Moineau, president of the AFMC.

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Individual provinces create residency programs based their own needs. But in recent years, funding has grown so tight that there is an almost 1:1 ratio between residency spots and Canadian medical graduates.

Factors like francophone graduates picked for programs outside Quebec — which leaves French-language residencies vacant — or competition from international medical school graduates has resulted in heavily subsidized, intensively trained Canadian graduates being bumped out.

The problem is most pronounced in Ontario, where 35 individuals were left out of a residency program in 2017, compared to 20 in western Canada, eight in Quebec and two in the Maritime provinces.

Moineau said the recommendations have been approved by the deans of the country’s 17 medical schools.

“The fact that the deans approve of this report means that they are willing to take these recommendations to their provincial ministries of health to make these requests,” she said. “Depending on the province, it’s a significant ask.”

The problem of Canadian medical school graduates who are prevented from completing the final step in their training was highlighted last June when the Star detailed the tragic case of Dr. Robert Chu.

A brilliant young student, Chu graduated from McMaster University but was turned down two years in a row for a residency program. He wrote letters to federal and provincial lawmakers about his ordeal with the residency application process.

Written several months before he took his own life on Sept. 5, 2016, he noted that medical school enrolment has been steadily increasing while residency positions were decreasing.

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“This makes no sense. What good is a doctor who cannot (practise) as one?”

Clara Chu, his mother, said she read the report’s recommendations with “bittersweet” emotions. They echoed many of the problems her son identified and fought against in the final months of his life.

“While he was alive his search for answers fell on deaf ears,” she said. “His letters and tenacity were instrumental in bringing about change and paving the way for others. Even posthumously, Robert continues to try to help others.”

The Star has spoken to numerous other students who had been passed over for residency programs, often due to their application strategies rather than their medical abilities. Some had applied for competitive residency programs, but neglected to take courses in other disciplines where they might have been more likely to be picked.

Many unmatched students complained about the almost complete lack of feedback from the application process, denying them insights into what they should have done differently. Others spoke of the shame and stigma of not matching for a residency program, as well as the absence of support from the medical community while they wait another year to apply again.

The report urges medical schools to create policies and procedures to support unmatched graduates, such as allowing them to complete a fifth year of medical school during which they could hone their skills and experiences while waiting to reapply to residency programs.

Henry Annan, president of the Canadian Federation of Medical Students, said responsibility for the “crisis” lies now with the provincial governments, who must create more residency positions.

“We also think there’s potential for even the federal government to get involved if there are ways they can fund some (residency) seats,” he said, noting that Ottawa could play a role in underserved areas of the country or in the remote northern reaches.

“We need to think a little bit outside of the box as to where we can make some impact.”

Correction – Feb. 13, 2018: This article was edited from a previous version that misstated the number of recommended residency spots.