The Myth of Canada: The Exclusion of Internationally Trained Physicians

This guest blog is co-authored by Simran Purewal, Research Associate, SFU Faculty of Health Sciences, Paola Ardiles Gamboa, Senior Lecturer, SFU Faculty of Health Sciences, and Evelyn Encalada Grez, Assistant Professor, Department of Labour Studies. The authors worked on a research project with funding in part through CERi’s Community-Engaged Research Funding Program.

Amid chronic physician shortages and a healthcare crisis exacerbated by the COVID-19 pandemic, internationally trained physicians (ITPs) are excluded from the Canadian medical profession. Internationally trained doctors refer to a diverse group of practitioners who completed their medical training outside of Canada or the United States. Though the Canadian immigrant department favours their medical education and training across various specialties, systemic barriers impede their access to licensure.

In April 2020, internationally trained physicians and advocates in British Columbia supported by RADIUS SFU Refugee Livelihood Lab and academic and community partners convened to initiate the Trained to Saves Lives social media campaign. This campaign urged action to enable ITPs to support the province’s response to COVID-19 and support overwhelmed healthcare systems.

Following the campaign, a partnership emerged between RADIUS SFU and SFU researchers Dr. Evelyn Encalada Grez, Dr. Paola Ardiles Gamboa, and Simran Purewal, and members of the Canadian on Paper Society for Physician Equality, Alliance for Doctors Denied by Degree, and Umbrella Multicultural Health Co-op. Collectively, we conducted community-driven research to explore the experiences of ITPs throughout the Canadian medical licensing process.

Primary Research Questions

The research questions we explored came from discussions with our community partners and were informed by literature reviews. The primary research questions of interest were:

1. What are the systemic barriers for qualified ITPs to practice medicine in British Columbia?

2. How do these barriers impact the lives of ITPs?

Through this research, we were keen to highlight the lived experiences of ITPs, including the negative impacts of barriers on their integration, well-being, and families. Commencing in February 2022, we interviewed 11 ITPs and three experts in the field.

Key findings

The interviews we conducted with ITPs highlighted distinct barriers in the licensing process. The steps toward licensure are complex and lengthy, especially because each province has its own system.

Before immigrating to Canada, most had a positive view of the country, underscoring Canada’s identity as a welcoming nation. However, their experiences upon arrival and throughout the medical licensing process shifted their perception of the country. This was, in part, attributed to the lack of clear and transparent information about licensure, impacting their expectations of the process.

Another key barrier involves limited access to residency, which is post-graduate training required for licensure in Canada. When applying for residency, ITPs and graduates of Canadian medical schools are separated into different streams. However, ITPs are prohibited from applying to 90% of the positions available. Furthermore, they are restricted to a limited number of medical specialties, primarily underserved and lower-paying fields, such as family medicine. The ITPs who are successful in securing a residency must sign a return of service contract, requiring them to work in an underserved community, as directed by the provincial government, for 2-5 years. This requirement is not imposed on graduates of Canadian medical schools, signalling the devaluation of ITPs' experiences, education, and knowledge.

Moving Forward

Based on the findings of this report, we strongly urge the timely implementation of the seven recommendations outlined in MOSAIC’s and the Alliance for Doctors Denied by Degrees (ADDD) report (see Appendix F of our report). These seven recommendations directly address the discriminatory and exclusionary policies impacting ITPs. 

Presently, there are minimal opportunities for policymakers to engage with internationally trained physicians and understand their experiences. At the outset, meaningful engagement with doctors who have endured the licensing process is critical to understand systemic barriers and the impacts on their mental health, professional identities, and the family members they migrate with. Additionally, we propose the following:

1. Increase the number of residency positions available to ITPs, as well as the medical specialties they can apply to

2. Enhance the transparency of information about licensure, including feedback on medical licensing examinations and information before migration

3. Increase the availability of mental health support for internationally trained doctors throughout the licensing process

Knowledge mobilization

To mobilize the findings of this study, we have taken a multi-pronged approach. We engaged our community partners to gain their insight into knowledge translation strategies, enabling us to share the report widely through RADIUS SFU and SFU Community-Engaged Research Initiative. Additionally, we published a brief piece with The Conversation, which amassed more than 29,000 reads in three days. Alongside social media dissemination, Paola Ardiles did an interview with CBC Español, which will be airing the week of March 6th. Together, these strategies have increased the reach of this report across Canada.