Foreign-Trained Physicians Frustrated At Lack Of Residency Positions
    By News Staff | June 26th 2014 12:47 PM | 8 comments | Print | E-mail | Track Comments

    The United States has the world's best medical care. Wealthy people from all over the planet abandon their country's government health plans and journey to the US for elite treatment. 

    Given that reputation, it's no surprise that doctors from countries with lower standards have a hard time getting residency positions.  Residency is a mandatory stage of graduate medical training in which someone who has received a medical degree works in a teaching hospital for two to five years learning from senior doctors. With America moving toward government health care, more elite doctors will stop taking poor patients, so it might be time to reconsider foreign doctors to offset that shortage, if it can be determined that their skills are under-utilized or not utilized in their new country. 

    Dr. Aisha Lofters, a family physician and researcher in the hospital's Centre for Research on Inner City Health, said only about 55 per cent of international medical graduates, or IMGs, living in Canada are currently working as physicians. In 2011, 1,800 applicants competed for 191 residency spots designated for foreign trained physicians in Ontario, Canada's largest province. The success rate that year was about 20 per cent for Canadians who had gone abroad for their medical training compared to six per cent for immigrant IMGs.

    The numbers are similar in the United States where almost half of international medical graduates are unsuccessful in their first attempt at securing a residency position. In 2013, 47.6 per cent of non-American citizen applicants secured a residency position compared to 53.1 per cent of U.S. citizens trained in international schools. IMGs who are originally from the United States ultimately have a 91 per cent success rate, while only 73 per cent of IMGs born outside of the United States are ultimately successful.

    Foreign-trained physicians feel there are not enough residency positions for them in countries such as Canada and the United States, according to a new study by Dr. Aisha Lofters. Photo courtesy of St. Michael's Hospital

    In a paper published in the Journal of Risk Management and Healthcare Policy, Dr. Lofters said those statistics for IMGs in Canada and the United States are not specific to immigrants from low- and middle-income countries, so it's possible their numbers might be even lower.

    Of the 462 people whose survey results were studied, Dr. Lofters said the top five reasons for choosing to emigrate were: socioeconomic or political situations in their home countries, better education for their children, concerns about where to raise children, quality of facilities and equipment and lack of opportunities for professional advancement. Those same responses were the top five reasons given for choosing to immigrate to Canada.

    "When asked if they had any other comments they would like to share regarding their migration experience, a substantial number of respondents reported feeling that they were misinformed as to their actual chances of obtaining a residency position in Canada," Dr. Lofters said. "Because they were skilled workers and allowed to migrate to Canada, many reported assuming that they would be easily able to find employment in medicine and expressed anger that their assumption was incorrect."

    She said many spoke of the shame they felt in taking what they viewed as "survival jobs," delivering pizzas or driving a cab instead of practicing medicine. Many said they regretted their decision to move to Canada.

    "Our findings suggest that brain waste is pervasive for physicians who migrate to Ontario and that both brain drain and brain waste have no easy of quick solutions," Dr. Lofters said. "Restricting emigration and immigration for health care workers would be very difficult from an ethical and moral standpoint."

    She said that where feasible, low- and middle-income countries should implement incentives to encourage their physicians and other health care workers to stay in their home countries, such as improved working conditions, financial incentives for working in rural or underserved regions. At the same time, she said, countries like Canada need to ensure that the immigration process clearly outlines the relatively low likelihood of obtaining a career in medicine after immigration, the low number of post-graduate training positions available for non-Canadian IMGs and the average time and financial commitment required.


    US health report card: 'A' for spending, F' for performance. Dan Mangan
    "The claim that the United States has 'the best health care system in the world' is clearly not true," stated the Commonwealth Fund report.
    "There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable—however, the Netherlands, U.K. and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services."

    "Basically, there's no wait times in countries like Germany, so it's not true that there's a tradeoff," Davis said. "Canada has long waits for specialists, but Canada and the U.S. have long waits just to get in to see your primary doctor."

    The Commonwealth Fund is an advocacy group that has always lobbied for nationalizing the health system in the US. Getting quoted by CNBC isn't exactly an endorsement for anyone either. Everyone in every country says their health care stinks, then they claim it is better than everyone else. 

    But no one flies to Germany or UK to get an operation, the way they do the US. That's data that can't be manipulated because it isn't based on surveys.
    Commonwealth Fund Study: National Healthcare ROI 'Falling Woefully Short'- Dan Munro
    " In tracking 42 measures of health care access, quality, costs, and outcomes between 2007 and 2012 for the 50 states and the District of Columbia, The Commonwealth Fund’s Scorecard on State Health System Performance, 2014, finds that, on a significant majority of measures, the story is mostly one of stagnation or decline. In most parts of the country, performance worsened on nearly as many measures as it improved. Commonwealth Fund Report ‒ Aiming Higher"
    U.S. Healthcare Ranked Dead Last Compared To 10 Other Countries-Dan Munro

    Are you Dan Munro? You linked to 3 articles all by the same person rewriting a press release by the exact same health care nationalization lobbyists. 
    Canada ranked last among OECD countries in health care wait times. Staff
    Published Monday, January 20, 2014 10:26AM EST

    Read more:

    Read more:

    Arrogance and prejudice are qualities of illiterate people. They are also recipes for disaster which we are now observing in all sectors of many so-called developed countries.

    Dear Editor,
    Thank you very much for publishing this article. Immigration of physicians to different countries is nothing new. The UK and Australia both have a very systematic process by which physicians can immigrate to those countries and practice medicine. Many doctors from South Asia are practicing in those countries and are contributing to the development of health care systems of those countries. Recent studies showed that the UK and Australia are both ahead of Canada and the USA in health care service delivery.
    I have read the original article: “Brain drain” and “brain waste”: experiences of international medical graduates in Ontario. Aisha Lofters, Morgan Slater, Nishit Fumakia, Naomi Thulien5Risk Management and Healthcare Policy 2014:7 81–89.
    I appreciate Dr. Lofters and her colleagues for their wonderful work. Their work will help the authorities in Canada in making decision regarding immigration of health care professionals in Canada. However, I would like to point out some important issues which are missing in this article. These issues if included in this study would allow us to understand the root cause of this problem.
    First, skilled immigration in Canada is carried by the ministry of citizenship (CIC). According to the CIC website the ministry decides the category of skilled immigrants on the basis of skill shortage in Canada. In this process the ministry of citizenship and honourable minister himself arranges conversation with different stakeholders and professional groups to select which professionals will be allowed to migrate to Canada in the skilled category. They also decide the number of immigrants who will be allowed to migrate as skilled professionals depending upon the shortage in the particular skill category. So, immigration of skilled professionals in Canada is regulated by the ministry of Citizenship of Canada and a professional can only migrate to Canada in the skilled category if there is a definite shortage of professionals in that category which is decided by the ministry after completion of proper survey and a stringent process.
    Secondly, Dr. Lofters in her paper mentioned that the immigrant doctors had to spend more than fifteen thousand dollars in the process of preparing themselves for the residency position. I would be grateful if she could let us know a more in detail about how these fifteen thousand dollars were spent and if spending money was enough for the preparation. Every immigrant doctor needs to go through a very difficult and lengthy procedure to obtain a retraining position (known as residency) in Canada. They need to prove that the name of their medical school was in the list of FAIMER (an international body which publishes the list of medical schools deciding on the standard of medical education in different countries). They also need to verify their medical degree, training obtained in their jurisdiction and all other qualifications using credential service provided by the Medical Council of Canada (now also known as Physician Apply Canada). In this process they need to pay two hundred dollars as registration fee and hundred and forty five dollars for each document they need to verify. As a result some of the internationally trained doctors need to spend more than a thousand dollar for this process. After that an internationally trained doctor can sit for a set of examinations conducted by the Medical Council of Canada. These examinations included Medical Council of Canada Evaluation Examination (MCCEE), Medical Council of Canada Qualifying Examination 1 (MCCQE1), Medical Council of Canada Qualifying Examination 2 (MCCQE2) and NAC OSCE examination. Among these examinations MCCEE costs more than 1700 Dollars, MCCQE1 costs approximately 900 dollars, MCCQE1 costs 2200 dollars and NACOSCE costs 2200 dollars.
    An internationally trained doctor needs to qualify at least in two examinations (MCCEE and NACOSCE) to be able to compete for a residency position. They also need to qualify in MCCQE1 and MCCQE2 before or during their residency. On the other hand graduates from Canadian medical schools need to pass only MCCQE1 and MCCQE2 examination and these are not requirements for obtaining their residency. They don’t need to qualify in MCCEE and NACOSCE examination. You would be surprised that many internationally trained doctors obtain much higher scores in these examinations than the graduates of Canadian medical schools. So, the nationality of the immigrant doctor or if he or she has come from a poor of not so poor country becomes immaterial after the process he or she needs to go through to prove his or her ability to apply for these residency positions. I do not know if there is any sensible human being in this world who will question the eligibility of an immigrant doctor who could obtain more than 99 percentile score in his or her Canadian examinations and who also got score which is much more than the pass score and the mean score of the Canadian medical graduates. Is not it unfortunate for all of us that Canada cannot use these doctors when many Canadians do not have access to doctors and the wait time and other parameters of Canadian health system are much below than those of many other countries?
    Finally, I want to thank Dr. Lofters for her sympathy for the internationally trained doctors. These doctors are helpless. They need help. They believed in Canadian system and they spent everything to make their belief true. Their only mistake is their faith in Canadian system. They put too much at stake while doing so. They had no idea that the process of decision making and that of execution may be totally different in a country like Canada. The sufferings of internationally trained doctors multiplied because they left their much respected and prosperous life as doctors. Dr. Lofters missed an important point. The people of every country (either rich or poor) always show respect to their doctors. The immigrant doctors had to leave their friends, family, colleagues and patients behind them to move to this country. They expected too much from the Canadian system. They cannot forgive them for their mistake.
    Thank you.

    I hope Dan Munro or the Commonwealth Fund is paying all of these commenters handsomely.