Foreign physicians (IMG) in Canada - myths and facts

I suppose you are planning to move to Canada and be a physician there. Some friend of mine has sent this to me, probably previously posted in some blogs. These are the facts about IMGs in Canada. So, think before you move. I am putting the thing as I got below:



It is a fact that of all the IMG's that come to Canada, 90-95% will not obtain a residency. The few that do, do so, after either years and years of trying, or, because they know people in high places who 'pull strings' for them

"For Canada to permit regulations to stand, which have as their sole foundation, appeals to discrimination toward Canadian citizens who are graduates of foreign medical schools, is to commit, a violation of the Bill of Rights, as heinous as the original set of injustices and inequalities, for which this Bill of Rights Act was created"

Thank you for taking the time to read this.

A) "I am going to do all my clinical rotations in Canada"

An IMG (International Medical Graduate/Student) (which is what we are) CANNOT do core rotations in Canada. Regardless of wether you are a Canadian citizen or not. You can only do electives.

In addition, the Association of Faculties of Medicine of Canada has ruled that the maximum length of time out-of-country medical students may be accepted for training in Canada is 12 weeks (www.afmc.ca, David Hawkins: dhawkins@afmc.ca).

Now, some Canadian's here at Saba have the idea that they will do their electives, and have Saba University count them as cores. For example, you go to Ontario (or somewhere else in Canada) and do, let's say, an elective in surgery, then Saba University accepts it for the Core surgery requirement. See what I mean? Well, this is a big mistake. Let me tell you why:

When you finish medical school, and residency and apply for a license in Canada, the Canadian medical governing bodies will evaluate (in great detail) every clinical you have done. And if all your clinicals were essentially just "electives", and you broke the rules by doing more than 12 weeks of electives in Canada as a foreign student, do you think one of the strictest countries in the world is going to grant you a license to practice medicine? . . .I'll let you ponder this.

B) "I going to transfer to a Canadian Medical School"

None of the sixteen Canadian medical schools accepts transfer students from outside Canada. In fact most, wont even look at an application from WITHIN Canada.

C) "I am going to get a residency in Canada"

It is a fact that of all the IMG's that come to Canada, 90-95% will not obtain a residency. The few that do, do so, after either years and years of trying, or, because they know people in high places who 'pull strings' for them.

Just visit www.carms.ca and see how few IMG's get a residency in Canadian match every year. There are currently 12,000 (twelve thousand) IMG's in Canada, actively seeking a residency position. In Ontario alone, there are currently over 4000 (four thousand) foreign doctors with no job and no residency.

Then you have all this talk about being able to get a residency in Canada 'outside the match'. Where? How? Don't just hear that and think that your set, you must have facts! The only ones that will be able to take advantage of this are those with some serious 'inside' connections. Their rumors, and hearsay are bogus, and we all know it. I definitely won't plan out my medical career based on the 'doors will open up' theory. Because quite frankly in Canada they never will, definitely not for graduates of foreign medical schools.

Across Canada there are thousands and thousands of desperate foreign trained doctors. Some of them are outright Canadian Citizens! Of those select few that actually complete all the requirements needed just to apply, only 10% will obtain a residency position (it has varied between 4% and 16% over the past 11 years). Also, those residency positions are the worst, left over ones, that NO Canadian medical graduate wanted.

Verification: www.carms.ca/jsp/main.jsp?path=../content/statistics/report/re_2005#table26

Keep in mind that CaRMS only lists the number of IMG's in the 'match'. You can only enter a rank order list and be in the match if you receive at least one interview. There are hundreds of IMG's that apply but never get any interviews and thus are not in the match, but these IMG's are not included in the statistics! So the actual 'match rate' is even lower than 10% if you were to include ALL the applicants. Please read the CMA interpretation here: www.CaribbeanMedicine.com/article18.pdf

In the Canadian Residency Match, 93% of all residency positions in Canada are filled by graduates of Canadian medical schools. The only residencies available to IMG's are those left over 2 year rural Family Practice spots, that NO Canadian medical graduate wanted. In Canada, Family Practice is only a 2 year program, in the United States it is a 3 year program. So in Canada you are getting basically 2/3 of the educational time you would compared to the U.S. Also, many of those left over FP spots in the second iteration are rural spots, so if you did get one, your opportunity to learn is very limited, because of the small patient population.

It amazes me that highly qualified foreign medical graduates, allow the Canadian medical system to degrade and humiliate them like this. IMG’s, have some pride! Do not let CaRMS, MCC, OIMGP and other Canadian medical organizations rip you off of your hard earned dollars. Because in the end, in Canada, you will have lost a lot of years and money and will have nothing to show for it, except your used airplane ticket.

D) "I am not going to write the USMLE, because I am going to Canada, so I won't need it"

If you don't write the USMLE, your life and career will turn into such a big joke, that even the best comedians in Hollywood will have difficulty portraying it . . . that's all I'm going to say about this.

E) "I am going to come back to Canada, after doing a residency in the United States"

This won't happen. After you finish residency in the U.S. and return to Canada, you cannot practice medicine. Why? Because Canada does not accept the USMLE, Canada does not accept the ECFMG certificate. To work in Canada as a doctor you would have to do the entire Canadian certification process all over again. That's right, you would have to write MCCEE, MCCQE Part 1, MCCQE Part 2, and the Canadian board exams for the residency that you did in the United States.

Also you may have to do extra year(s) of residency training in Canada, for example if you did an Internal Medicine residency in U.S. you would have to do one more year of residency in Canada.

Ontario residents: Keep in mind that you cannot return to your home province initially. You have to go to another province first and then work your way back to Ontario via reciprocity. And when you do return to your home province you must go to a rural/underserviced area for five years. For more info contact: College of Physicians and Surgeons of Ontario (CPSO) www.cpso.on.ca , (416) 967-2617

Also to go through that whole process to come back to Canada to make a lot less money makes no sense either. After you finish your residency in the U.S. you will be offered a job for $150,000 (that's U.S. dollars).
You are trying to tell me, you will pass this up to go back to Penetanguishene, Ontario to work in some rural area for $90,000 Canadian dollars (which converts to only $64,000 U.S. dollars by the way).

Verification: http://jobfutures.ca/fos/M521.shtml

F) "I absolutely will go back to Canada to live, after doing a residency in the United States"

O.k. since you persist with this, let's entertain this delusional comment.

To obtain a residency in the U.S. you have to pass USMLE Step 1, USMLE Step 2 and USMLE Step 2 CS. Then during your U.S. residency you have to pass USMLE Step 3. Then to graduate from that program you have to pass the residency board exam. For example, if you are doing a residency in the U.S. in Family Practice, you have to pass the U.S. Family Practice board exam. Let's see, so far there are five board exams you need to pass.

Now after you complete all this and go back to Canada, you must write all the Canadian board exams in order to obtain a license to practice medicine in Canada. Those tests are the: MCCEE, MCCQE Part 1, MCCQE Part 2, and the Canadian Residency board exam. That's an additional four board exams.

I know people who could not even pass USMLE Step 1. It is impossible for me to believe that they will pass nine board exams. Whatever. . .

Even if you did achieve this phenomenal and miraculous feat of academia, it would result in you ending up in some rural area like Northern Manitoba or the Yukon, earning half the salary that you could earn in the United States.

For further info contact:

Royal College of Physicians and Surgeons of Canada - http://rcpsc.medical.org
College of Family Physicians of Canada - www.cfpc.ca

The truth is that as soon as you get on that airplane and head toward a foreign medical school, you have pretty much cut Canada off forever. Therefore you'd better fully accept this certainty before going abroad for the M.D. degree.

G) "I am going to write a letter, to have Canada eliminate the Evaluating Exam, because there is no need for it"

Canadian medical licencing authorities have the right and obligation to ensure Canadians get the best medical care in the world and it is my view this can be accomplished through generally accepted standardized tests such as the MCCEE that the RCPSC requires. Visit:

RCPSC - Royal College of Physicians and Surgeons of Canada
http://rcpsc.medical.org

Contact the CPSO for more info:
College of Physicians and Surgeons of Ontario (www.cpso.on.ca)
80 College Street
Toronto, ON M5G 2E2 (416) 961-1711

Even the most massive letter campaign is NOT going to get them to change this requirement. I mean c'mon, that's like me saying "oh, I am going to write a letter to ECFMG, and ask them to eliminate the CSA, because I know my English well and because the CSA is too expensive."

Be realistic.

O.K. now let's look at some of the points, we as Canadians need to be aware of, and consider when we are planning out our medical career and future:

1) The licensing exams you need to pass, to practice in Canada are:

1. successful completion of the MCCEE (evaluating exam)
2. successful completion of the Qualifying Examination Part I (MCCQE part 1)
3. successful completion of the Qualifying Examination Part II (MCCQE part 2)

Information about the Evaluating and Qualifying Examinations of the Medical Council of Canada may be obtained from

Medical Council of Canada, Box 8234, Ottawa, Ontario, Canada, KlG 3H7, telephone: (613) 521-6012, fax: (613) 521-9417 www.mcc.ca

2) One year of unpaid clerkship requirement for IMG's in Ontario.

One the requirements for obtaining a residency in Ontario, is to first obtain and complete one year of unpaid post-graduate training.

MYTH: In the Ontario IMG Program, there are 50 spots for residency in Ontario for IMG's.
FACT: Those 50 spots are not for residency. They are for this one year of unpaid post-graduate training that is a prerequisite for applying for a residency position in Ontario through the Ontario International Medical Graduate Program.

The OIMGP provides this pre-residency training to evaluate and to upgrade the qualifications of IMG's. Contact the OIMGP for details:

Tel: (416) 946-0550, Fax: (416) 946-0572
Ontario IMG Program: www.oimgc.utoronto.ca

Let's talk a little about this:

Basically, after getting your M.D. from a foreign medical school you would have to:

1) Pass the MCCEE
2) Pass the required English tests (TOEFL, TSE)
3) Apply to the Ontario IMG program Clerkship (which is NOT residency by the way, it is just one year of pre-residency training. It is an UNPAID position. Actually you have to pay $2000 to be in this program)
4) There are hundreds and hundreds of applicants for the 50 spots that the Ontario IMG program offers, so they narrow it down with two tests
5) First test: IMG exam, from which the top 200 are selected
6) Second test: OSCE exam, from which the final 50 are selected, for this PRE-residency UNPAID program.
(the above application process is about a year long, so one year lost)
7) If selected, you must complete this one year, pre-residency, unpaid program
(a second year lost, as this is essentially another year with no job)
8) After all this is completed successfully, then you are eligible to APPLY for a residency in Ontario.
(so in total, you lose two years of your life, trying to become eligible to apply for a residency in Ontario)

ABSOLUTELY RIDICULOUS PROCESS.

9) In Ontario you cannot enter the first or second round of the Canadian CARMS residency match, you have to wait until after the second round. And after the second round there is nothing left. Keep in mind that there are 4000 (four thousand) IMG's in Ontario and 12,000 (twelve thousand) IMG's across Canada, who are actively seeking a residency position or employment as a physician in Canada. There are several thousands more IMG's who are in Canada but have long given up on this process.

Reality my dear friends. Reality.

The Practice Ready and PGY-2 positions are only for those IMG's who have completed a residency or at least some post graduate training in their home country. So this is not an option for Canadians who have gone abroad for their MD degrees.
As for the PGY-1 Family Practice positions -> Family Practice in Canada is a only a 2 year program. As a result, you don't really learn anything. These positions are basically the scraps that the Canadian government throws (like left over meat to stray dogs) to desperate IMG's in the country. Worthless.

The only thing available to IMG's outside of Ontario (other Canadian provinces) is some other worthless, left over, two year rural family practice spot that NO Canadian medical graduate wanted, not to mention that it will be in some boony town where it is -30 (minus thirty) degrees celcius everyday with a non-diverse population, up north (eg goose bay, labrador, or north battleford, saskatchewan).

Will you honestly be happy with this?

3) Not much left in the second iteration, and nothing left after the second iteration.

Let's talk briefly about the CaRMS match.

Canadian Resident Matching Service
151 Slater Street, Suite 802
Ottawa, ON Canada K1P 5H3
www.carms.ca
www.carms.ca/stats/stats_index.htm

The match is done in two rounds (iterations). The first round is open ONLY to graduates of LCME (Canadian and American) medical schools. Not foreign medical schools!

The second round is open to graduates of foreign medical schools in some provinces. But if you go and visit the CaRMS web site, you will see that there is didly squat left in the second round . . . nickel and dime.

4) B-1 Visa for clinicals.

Yes, Canadians need a B-1 Visa to do clinicals in the United States. Apply as early as possible for this otherwise you won't be allowed into a hospital to do your rotations.

Saba administration has the forms, also visit

US Embassy: www.usembassycanada.gov
Citizenship and Immigration Canada: www.gic.gc.ca for related info.

5) The H-1B visa for residency training in the U.S.

To get the H-1B visa a residency program in the U.S. has to be willing to sponsor you. Unfortunately very few residency programs in the U.S. do this. To get this visa you will have to write USMLE Step 3 before starting your residency. Around twelve states allow candidates to register for this exam before residency (Step 3 is normally written DURING residency).

The great thing about this visa, is that once you get it, you can then apply for a Green Card, which will allow you to live and work in the U.S. permanently. This really is the best option.

To find out which states, visit:
FSMB (Federation of State Medical Boards): www.fsmb.org

To find out about the USMLE Step 3 visit:
www.usmle.org

For info about the J-1 and H-1B Visa's visit:
www.murthy.com
www.shusterman.com
www.visalaw.com/IMG/resources.html
www.myvisa.com/Visasage/Droption.htm

6) The J-1 visa for residency training in the U.S.

First of all look at the requirements you have to fulfill to get this Visa:

www.hc-sc.gc.ca/hppb/healthcare/pubs/requirements2005/

www.ecfmg.org/evsp/index.html

To get this visa from the ECFMG you will first need to get an offer from a residency program in the U.S. and you will need to get a "Statement of Need" from the Canadian Health Ministry.

You need to pass the MCCEE before you can get that "Statement of Need" from Canada. If you get the J-1 visa, then you are entitled to stay in the U.S. to do a residency. But after the residency is completed you have to return to Canada for a minimum of two years. By law, this is a MUST, because when you first get the J-1, Canada requires you to sign a consent form which will allow them to recruit you when you finish residency in the U.S.

When you return to Canada, you have to get your U.S. residency training assessed by the Royal College of Canada (for which they charge a hefty fee). Then you have pass ALL the Canadian board exams in order to obtain a license to practice medicine in Canada. Those tests are the: MCCEE, MCCQE Part 1, MCCQE Part 2, and the Canadian board exams for the residency you did in the U.S.

Now, when you go back to Canada, your U.S. training alone is not eligible for Ontario, so forget about Ontario. You will have to go to some other province, where they will place you in some small rural town, where it is minus thirty degrees everyday (Labrador, Northern Alberta etc). But to get a permanent license to practice medicine there (or anywhere else in Canada), you MUST pass ALL the Canadian board exams! All this nonsense and degradation just to make half the salary you could have earned if you were allowed to stay in the U.S.

If you are doing a residency in the U.S. on a J-1 visa, it is possible to stay in the U.S. after your residency, if you get a J-1 waiver. You can obtain this waiver by agreeing to work as a physician in a health manpower shortage area (rural/underserviced area in the U.S.) for 3-5 years. Each state in the U.S. has 30 J-1 Waiver spots per year. For more information about these J-1 waiver programs, visit:

www.caribbeanmedicine.com/j1waiver.htm

7) So as you can see, Canadians are in a different stream than all other IMG's, and that stream is appropriately called "Sh*ts Creek".

8) The Doctor shortage in Canada.

By now I am sure all of you have heard about this. But don't get too excited. Yes there is a doctor shortage in Canada. But the way Canada is solving that doctor shortage is by increasing the number of spots at Canadian medical schools. Every medical school across Canada has increased enrollment.

In addition Canada has decided to open up a new medical school in Northern Ontario which will produce a new batch of Canadian medical graduates (Canadian MD’s) that will be used to solve the doctor shortage.

New Northern Ontario Medical School: www.normed.ca

Think about it! There are 12,000 (twelve thousand) foreign trained doctors across Canada with no job and no residency, 4000 (four thousand) of them are in Ontario. They have passed the Canadian exams (MCCEE, MCCQE), they are ready to work now! . . . AND there is a doctor shortage. Why doesn't Canada provide opportunities for them? Why all this effort and money into this new Canadian medical school?

Because the bottom line is that despite a doctor shortage, Canada will never provide jobs to graduates of foreign medical schools, even if you are a Canadian citizen. Canada only wants graduates of Canadian medical schools.

9) Applying for a residency in the United States:

To apply for a residency in the U.S. to have to apply through the ERAS
Electronic Residency Application Service: www.ecfmg.org/eras/index.html

The U.S. residency match is done by
NRMP (National resident matching program): www.nrmp.org

The list of all available residency positions in the U.S., is nicely summarized at this excellent site:
FREIDA (Fellowship and Residency Electronic Interactive Database):
www.ama-assn.org/go/freida

10) Canadians need to be very realistic about their goals.

The worst Saba student, who de-celled twice and failed USMLE on his/her first try (but is a U.S. citizen) will be able to get a residency in Internal Medicine in the U.S. without ANY problem. But you as a Canadian, even with a 90 on your USMLE and a #3 ranking in your class could still get screwed, blued and tattooed come match time. Hospitals look at applicants without a Visa, the way you and I would look at our feces, if we were suffering from inflammatory diarrhea.

11) It is important to do ALL your clinical rotations (cores and electives) in the U.S.

We have (I hope) already established that Canada is a closed door for IMG’s. So our goal is a residency in the United States. Doing all your clinicals in the U.S. allows you maximum opportunity to make contacts, which are invaluable come residency selection time. Also, the USMLE Step 2 exam is based entirely on U.S. clinical experience, doing clinicals outside of the U.S. does not prepare you well for the Step 2 exam.

Never do clinical rotations in Mexico or Canada or the Caribbean islands, this is a total waste of time. The whole point of going to a Caribbean medical school is to get clinical rotations in the U.S. at ACGME accredited hospitals. That is what maximizes your chance of getting a residency in the U.S.

12) Is the United States a nice place to raise a family?

For those Canadians afraid to go to the U.S., let me offer you this: there are plenty of places in the U.S. that are as safe, and crime free as Goose Bay, Labrador . . . so don't sweat it. You can live a happy life, with your family, keeping your culture alive, and your children will have a prosperous future. It is a fact that the best and brightest Canadians move to the U.S., and never come back.

13) Caribbean Medical Schools were never intended or designed to educate Canadians.

They were opened to cater to rejected U.S. applicants. That is the whole premise, and that is for whom this whole system is geared toward. But what happened over the years is that, it became so ridiculously difficult to gain admission into a Canadian medical school that many, many Canadian students flocked down to the Caribbean.

The Association of Canadian Medical Colleges states in their manual every year:

"Applicants should be aware that enrolling in dubious, proprietary, for-profit medical schools opened specifically to cater to rejected applicants to medical schools in Canada or the USA is highly unlikely to be a path to practising medicine in Canada."

Verification: www.cfms.org/pre_med/applying.cfm

The American Association of Medical Colleges (www.aamc.org) publishes a list annually of the most difficult places to gain admission into a medical school. Ontario tops the list every year, followed by California, New York, British Columbia and Texas.

14) Canada has ruined the lives of thousands of foreign doctors for the past twenty years.

When I was younger, I always wondered why foreign doctors immigrated to Canada, when it is a world wide known fact that Canada is career suicide for them. Well the reason is as follows: Canadian Embassies around the world lie to foreign doctors.

These embassies tell them “Oh yes, come to Canada, we need doctors!”. Canadian immigration organizations lie and paint this picture that Canada is Utopia, because they want foreigners to come to Canada. Why? Because foreigners bring money and they after they come they do the blue collar jobs. That is exactly what Canada wants! The Canadian government wants foreign money and cheap foreign labor.

So after being deceived, these foreign doctors, pack up, and immigrate with their families (spouse, children) to Canada. They have to bring with them at least $10,000 and pay an additional $1500 to land in Canada. Canada has an immigration quota of 250,000 per year. So please do the math, 250,000 multiplied by $10,000 each equals a whopping 2.5 Billion dollars that Canada gains from immigrants every year.

However, after they arrive, Canada shuts the door in their face and tells them that their foreign credentials are not ‘good enough’ and that they need to pass a series of expensive tests and do additional unpaid training. Shame on those Canadian embassies!

This forces the foreign doctors to get minimum wage jobs like factory work, driving taxi cabs or delivering pizzas, and to try whatever they can to support themselves and their families. They have passed the Canadian exams (MCCEE, MCCQE), applied for residency positions with CaRMS year after year, yet the end result is nothing. This is the tragedy associated with immigration to Canada.