Ontario’s government is introducing new requirements that will see fewer residency spots for internationally trained doctors, even as it faces a doctors’ shortage.
International medical graduates, from places like the U.K., Australia or the Caribbean, will now be required to have completed at least two years of high school education in Ontario if they hope to apply for the province’s first round of residency matching.
Those looking to do their residency in Canada are required to apply through CaRMS — the national agency tasked with pairing doctors to residency programs — to be matched with a residency spot.
But doctors across the province say the government’s decision is having “unintended” consequences.
Toronto anesthesiologist Filipe Santos, who was internationally trained himself, said it’s important to have a physician workforce that reflects the general population.
“You need Canadian-trained doctors and I’ll never say no to that,” he said. “But I do also think that we need immigrants. We need those international trade positions with very diverse backgrounds to care for our population.”
Residency applications range wildly, depending on the specialization, province and educational background. Generally, international medical graduates will complete one or more tests as they prepare for the first round of matching.
Hundreds wait in the snow to get a family doctor in rural Ontario
That round has already started, which is frustrating for some applying for the residency spots, Ontario Medical Association president Zainab Abdurrahman told CBC Radio’s Metro Morning.
“Having the rules change right when you’re trying to submit your documents, starting to get things in place, is really throwing them off,” she said. The first round will close on Nov. 27, CaRMS told CBC in an email statement.
Before the new requirements, there were 1,200 available spots for international medical graduates at Ontario residency programs, Now, it’s just 170.
Santos said that’s simply not enough.
“We feel like we have to overperform to be able to be in the same places and spaces as other physicians that are Canadian trained,” he said. “When you’re trying to get a license, you just feel like you’re never good enough.”
In the email statement, CaRMS said Ontario is the only province with such eligibility criteria, but not the only one with dedicated application streams. Nova Scotia and New Brunswick, for example, have their own streams, through which internationally trained physicians can apply if they can prove they have a connection to the provinces.
Ontario’s second round of matching includes the positions left over after the first round of matching. That round won’t require international medical graduates to have two years of high school in Ontario. But those applying for the second round will be in competition with Canadian trained doctors who didn’t place in the first round.
“This is very discriminatory,” Santos said. “We basically are creating two types of citizens in our society: the citizens by birth and the Canadian citizens by immigration.”
A spokesperson for Ontario’s Ministry of Health said the change in requirements aims to support residents educated within the province who also have international medical degrees.
“Our government is not only ensuring local post-graduate training opportunities, we are also continuing to build our health care workforce to connect people in every corner of the province to convenient care,” Ema Popovic said in an email.
Abdurrahman said she understands the province is trying to bring Ontarians back to the workforce. But she highlighted doctors who sign up to do their training in the province also have to sign a legally binding contract that means they’re required to practice in Ontario for at least five years.
“Once you’ve settled down, you’re practicing, maybe built a family, you often stay in that same area,” she said.
Abdurrahman said the Ontario Medical Association has been in talks with the province about the changes because they could mean fewer applicants.
“Unfortunately, this type of approach is also having a lot of unintended consequences,” she said. “I think we might be going against what we’ve worked so hard to improve.”
CaRMS said it wouldn’t know the impact of the change until the end of the first round of matching.
However, the province is already in desperate need of doctors. Approximately 2.5 million Ontarians were without a family doctor last June, according to INSPIRE-PHC, a health research network.
“Reducing who is in that pool to apply for those spots could actually leave us with a lot of unmatched spots in our system, which we don’t want,” Abdurrahman said.
The OMA’s section of general and family practice chair, David Barber, said in an email statement that he thought he had read the new requirements wrong when he first saw them.
“We are in desperate need for more family doctors in Ontario. If a new doctor has completed medical school, I cannot imagine why we would prevent them from starting residency based on where they went to high school,” he said.
“We should be opening doors, not closing them.”
