<<Reposted from the Globe and Mail | December 12, 2022>>

Canada’s health care system needs physicians to fill important gaps, but it has also set up barriers for international graduates to practise here instead of the U.S., Britain and Australia

GREG MERCER Globe and Mail
Matthew Macciacchera of Vaughan, Ont., stands in Dublin outside the original building of the Royal College of Surgeons Ireland, where he is studying in hopes of becoming an orthopedic surgeon. Canadians make up more than 40 per cent of the medical students here.LORRAINE O’SULLIVAN/THE GLOBE AND MAIL

With nearly 300 Canadian students enrolled in its programs, the Royal College of Surgeons in Ireland feels a lot like a medical school in Canada, just separated by 3,340 kilometres of Atlantic Ocean.

While this historic university in the heart of Dublin has been producing doctors since 1784, in recent decades, it’s become an important training ground for many young Canadians who go overseas to pursue their dreams of becoming a physician.

More than 40 per cent of the students in RCSI’s four-year medical program are from Canada – more than any other nationality.

To help them feel at home, the students organize celebrations for Canadian Thanksgiving, annual Terry Fox runs and road trips to watch professional ice-hockey games in Belfast.

Even the curriculum is geared toward a career in medicine in North America – with an academic calendar built around the writing periods for Canadian and U.S. medical exams.

“There’s so many Canadians. It almost feels like you’re at a Canadian school,” said Matthew Macciacchera, an aspiring orthopedic surgeon from Vaughan, north of Toronto, in his final year at RCSI.

Mr. Macciacchera, like many of his classmates, wants to return to Canada to begin a career in medicine. He’s among the thousands of Canadians getting medical degrees in places such as Ireland, Australia, Britain, Israel, the U.S. and medical schools in the Caribbean affiliated with American education corporations.

They’re leaving Canada because it’s nearly impossible to get one of the 2,800 first-year seats in the country’s 17 medical schools – where roughly nine out of 10 applicants are rejected, often despite impeccable grades and qualifications, since demand far outstrips supply.

Many want to come home but can’t. These international medical graduates are increasingly working as doctors in other countries, where they’re highly coveted, because they’re often blocked from returning to Canada by a system that’s been slow to respond to crippling physician shortages here.

It’s a problem Canada can’t afford to keep ignoring, experts say. At a time when hospitals across the country are strained by backlogged surgeries, clogged emergency departments and burned-out staff, and millions of Canadians are struggling to find family doctors, the country needs to urgently tackle its medical brain drain and the many impediments for international medical graduates who want to work here. Provinces and medical faculties also need to create more training residencies for international graduates, which is one of the most cost-effective ways to solve Canada’s worsening health-access crisis.

A B.C. physician demonstrates at the We Need Doctors Now rally outside the provincial legislature in Victoria this past October.CHAD HIPOLITO/THE GLOBE AND MAIL

Between its domestic and international graduates, and thousands more immigrant physicians who live here but don’t work in their field, Canada has more than enough doctors to help the country fill shortages in family medicine, clinics and hospitals. But for many physicians who did their studies overseas, the road to a medical career in Canada remains closed because of a lack of provincially funded residency positions – the two-year-long, postgraduation supervised training period required to become a licensed physician.

International graduates must compete for a separate and much smaller pool of residencies than those available to graduates of Canadian medical schools. There is no other stream for Canadians who have gone overseas to study – they’re seen as every other international student in the eyes of our medical system.

A 2010 study by the Canadian Resident Matching Service (CaRMS), the national, not-for-profit organization that pairs medical school students with postgraduate training residencies, estimated there were 3,500 Canadians going abroad for medical training every year, and 90 per cent of them wanted to return to Canada to work.

Of the 3,295 medical graduates matched to residency training programs in Canada this year, only 439 of them – just about 13 per cent – were educated at medical schools outside the country. A decade ago, Canada gave 499 residency positions to people who were trained internationally. In the late 1980s, it was nearly 700. As well, the number of residencies within the same pool that are designated for international grads has been in steady decline, from 346 in 2014 to 331 this year.

Because it’s so hard to secure a residency position in Canada, these medical graduates are choosing to work in countries such as the U.S., Britain and Australia, where the barriers to entry are lower for Canadian and other international medical graduates. While dozens of RCSI graduates do return to Canada every year, most end up in the American health care system, where international grads are on equal footing with domestically trained medical students.

“The messaging for so long has been that it’s nearly impossible to get a bloody residency in Canada if you’re an international graduate,” said Peter Nealon, the California-based CEO of the Atlantic Bridge Program, the admissions organization for North Americans who want to attend medical school in Ireland. “These people are the cream of the crop, and they’re simply going elsewhere, because they’re in demand. You tell people to go away long enough, and eventually, they go away.”

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