Foreign doctors take up more medical residency spots as Canadians struggle to get in
The number of foreign ‘visa trainees’ in medical residency is up 70 per cent since 2019
Canada has an acute shortage of doctors — a staffing crisis that is expected to get much worse in the years ahead as the number of residency positions on offer fails to keep up with rapid population growth.
Despite those challenges, roughly 1,000 Canadian doctors who went to school abroad are turned away every year because they can't get residency spots in Canada, according to a CBC News review of medical school data. Physicians are required to go through a residency in order to be licensed to practice.
Canadian doctors who want to come home to work are routinely told it's not possible because resources are limited and there are only so many residency positions to go around.
But the medical schools that run residency programs still find room for foreign nationals from countries like Oman, Kuwait and Saudi Arabia — people who frequently have no intention of staying here to work over the long term.
All of this is done with Ottawa's blessing. The federal government has exempted medical schools from immigration laws that require Canadians get priority for a job.
Critics maintain that dismantling the foreign "visa trainee" program — which gives several hundred residency spots to non-Canadians — would free up positions so more homegrown doctors can work here in Canada and help chip away at the physician deficit.
In the current academic year, 1,810 Canadian international medical graduates (IMGs) applied for a residency, according to data from the Canadian Resident Matching Service (CaRMS). They include doctors who went to medical school in countries like Australia, Ireland and the United Kingdom.
Because Canadian medical schools privilege their own graduates and strictly enforce a quota on IMGs, only 370 of them were actually placed with residencies to complete the required post-graduate training.
The result is a massive brain drain, as many qualified Canadian physicians are forced to go to the U.S. — a country where residency positions are more readily available.
Dr. Joshua Ramjist is originally from Pickering, Ont.
He went to medical school at St. George's University in Grenada, a small island nation in the Caribbean.
Anxiety set in when he tried to come home and practise.
"There were definitely a few sleepless nights and a little bit of uncertainty," Ramjist told CBC News.
"There is a tremendous pool of international medical graduates who are talented, who are dedicated, who want to take care of their fellow Canadians."
Ramjist secured a coveted residency and now works as a pediatric surgeon at the Hospital for Sick Children in Toronto.
But the bruising experience has made him an advocate for other would-be residents who are trying to navigate the labyrinthian system.
"It diminishes the pipeline. We just won't see people becoming doctors. And that's dangerous — we need physicians. We need to reduce barriers to tap into that internationally trained talent," he said.
Federal data suggest Canada will be short some 44,000 doctors, including more than 30,000 family doctors and general practitioners, by 2028.
While Canada is cutting loose some native-born and naturalized doctors who went to medical school overseas, hundreds of foreign trainees are routinely admitted to residencies here, despite an apparent scarcity of resources. Saudi Arabians make up the largest single national group among foreign residents.
And the number of these foreign trainees is increasing.
In 2019, the year before COVID hit, 87 foreign trainees started the first year of a residency position in Canada, according to data from the Canadian Post-MD Education Registry (CAPER), the body that tracks IMG data.
In 2022, 148 did the same — a 70 per cent increase in just three years' time.
There were 727 foreign trainees in medical residencies in Canada last year, according to CAPER.
Meanwhile, the number of Canadian doctors trained abroad who were admitted to residencies here remained static over the same time period.
In 2019, 326 IMGs got a residency position in Canada, according to CaRMS.
In 2022, 331 IMGs were matched with one of these highly coveted entry-level jobs — a 1.5 per cent increase.
Typically, foreign trainees are contractually required to go home when their residency is over. The Saudi government and the state-owned oil company Saudi Aramco — two of the entities that pay the way for some visa trainees — demand they leave Canada once their residencies are complete.
That means precious Canadian residency spots are wasted, critics maintain.
These foreign residents are not being permanently deployed to physician-starved rural and remote areas or hanging their shingles in a province like Nova Scotia — where 142,000 people, roughly 14 per cent of the population, are on a waiting list for a family doctor.
IMGs, by comparison, are Canadian citizens or permanent residents who generally want to live and work in the country they call home.
The Society for Canadians Studying Medicine Abroad (SOCASMA), an advocacy group that fights for the rights of IMGs, wants to dismantle the regime.
"We're in a dire doctor shortage and there are literally thousands of Canadians who are not only prepared but also willing and qualified and desperate to do the job they were trained to do. But they are sidelined by their own government in favour of people who come from these oil-rich countries," Rosemary Pawliuk, the group's president, told CBC News.
"Thousands of Canadians are dying every year because of delayed access to health care," she added, citing a Deloitte study. "And we're training foreigners who take away spaces from Canadians who want to be doctors."
In 2010, Immigration, Refugees and Citizenship Canada (IRCC) implemented a policy, Bulletin 230, that exempted Canadian medical schools from conducting labour market impact assessments (LMIA).
Under federal law, jobs and training opportunities are supposed to go to Canadian citizens or permanent residents. An employer is only permitted to bring in a foreign national if it can't find a Canadian to do the work.
By dropping the LMIA requirement, the federal government freed medical schools from being compelled to prove no Canadian is available to fill a residency position — even though more than 1,000 Canadian doctors are locked out of the residency system ever year.
These foreign nationals have benefactors that pay much more for medical residencies than the sums offered by provincial governments for Canadian residents.
That explains why the current system continues, Pawliuk said: foreign trainees are a cash cow for the medical schools that administer the residency program.
Not only do Saudi interests pay more, they also cover the salaries of some of the teaching staff, she said.
"Canadians trained abroad get very poor and limited options and they are subject to a quota. These foreign nationals can just buy their way in," she said. "It's all about the money. Money talks.
"We need to revoke Bulletin 230 so foreigners can only come if there isn't a Canadian or permanent resident to fill those jobs. Until then, there are thousands of Canadian doctors who are sitting unlicensed."
The Association of Facilities of Medicine of Canada did not respond to CBC's request for comment.
Ivy Lynn Bourgeault is an expert on health care human resources and a professor at the University of Ottawa.
She's studied the visa trainee issue and has found that Canadian taxpayers actually foot part of the bill for foreign residents.
About 70 per cent of the funding comes from abroad while the rest comes from public funds, according to Bourgeault's data.
"We are definitely in a health workforce crisis. We need to look at the way visa trainees occupy spots here in Canada and it needs to be considered as part of a systemic review," she said.
The system should be designed to prioritize the health needs of our own population, she said — and that requires giving the existing trainee program a hard look.
But Bourgeault warned an abrupt change could be disruptive.
Foreign residents do serve some critical functions while they're here.
"We need to implement it in a phased approach so that it doesn't cause more instability than we already have," she said.
A spokesperson for IRCC said foreign medical residents "obtain specialized practical experience in Canadian hospitals and clinics" and they benefit Canada by "contributing their time and expertise to Canada's health care systems and the treatment of Canadians."
The federal department suggested there's no plan to dismantle the regime.
"IRCC regularly monitors its programs and will publicly share any information if changes to current policies are made," the spokesperson said.
Pawliuk said that response is misleading.
"How can IRCC possibly claim that foreigners displacing Canadians is a benefit? If Canadians filled these positions, they would stay to serve Canadians," she said. "In the meantime, Canadians are dying from a lack of access."
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