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Canada is short of doctors — and it’s turning away hundreds of home-grown physicians each year

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2 years ago

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The country’s health-care system is suffering from an acute shortage of doctors — even as hundreds of qualified Canadian physicians trained abroad are turned away each year because of a tangle of red-tape and bias, experts say.

Canada is passing up a chance to add hundreds of these Canadian doctors to a strained system because, critics say, tight-fisted provincial governments have restricted the number of residency spots — and because the system explicitly privileges students who went to Canadian medical schools.

According to census data, there’s no shortage of doctors in Canada. What we have is a shortage of licensed doctors.

While estimates vary, there may be as many as 13,000 medical doctors in Canada who are not practising because they haven’t completed a two-year residency position — a requirement for licensing.

Critics of the system say discrimination is pervasive.

“There is a ‘don’t come home attitude’ in Canada,” said Rosemary Pawliuk, president of the Society for Canadians Studying Medicine Abroad.

“They have cute slogans like, ‘You’re wanted and welcome in Canada,’ but when you look at the barriers, it’s very clear that you should not come home. Their message is essentially, ‘Go away.’ And so they do.”

Rosemary Pawliuk is seen sitting for an interview.
Rosemary Pawliuk is the president of the Society for Canadians Studying Medicine Abroad. She says the current residency selection system puts internationally trained Canadian doctors at a serious disadvantage. (Dillon Hodgin/CBC)

Under Canadian regulations, medical schools themselves decide who gets a residency. Critics say those schools have a vested interest in seeing Canadian-educated students get as many of those positions as possible — leaving those Canadians trained at reputable schools abroad at a serious disadvantage.

Critics say the system is designed to ensure that every graduate of a Canadian medical school — no matter how competent they are — is licensed to practice medicine. Only a relatively small number of underperformers are weeded out each year.

The same cannot be said for Canadians who attend medical school overseas.

A bias built into the system

“The physicians running these departments want the best — but that’s not allowed. They’re not allowed to pick from the full pool of qualified applicants,” said Pawliuk.

About 90 per cent of all residencies are set aside each year for Canadian medical graduates. Internationally trained doctors get the rest.

In some provinces, domestic medical school graduates and those educated abroad can’t compete against one another — there are two separate pools, and the one reserved for international medical graduates is much smaller.

According to data from the Canadian Resident Matching Service (CaRMS), 1,661 international medical graduates (IMGs) applied for residency positions in Canada last year. Just 439 were matched with the necessary post-graduate training. That’s a “match rate” of just 26 per cent.

And these are not foreigners — you must be a Canadian citizen or permanent resident to even apply for a residency in Canada.

“The Canadian public should be entitled to the best qualified Canadian applicant. Whether they’ve graduated from a Canadian school or an international school, whether they’re a Canadian by birth or if they’re an immigrant, they should be competing on individual merit,” Pawliuk said.

The way the residency system works has consequences. For example, 115 residencies nationwide — mostly in family medicine — went unfilled last year because Canadian medical school graduates weren’t interested in them, according to CaRMS data.

These Canadians trained abroad also face a series of other hurdles.

Unlike Canadian medical graduates, for example, international medical graduates have to sit for the “MCCQE Part 1” exam administered by the Medical Council of Canada before they can apply for a residency.

Canadian medical graduates can do it after they’ve already secured a spot and, each year, about 5 per cent of them fail the exam but continue with their residency anyway, according to data from Pawliuk.

A shortage of space in med schools

Canada’s residency placement rate compares poorly to what’s been reported in other countries.

In the U.S., for example, 61.6 per cent of American-born or naturalized citizens who go to school abroad are matched with a residency position, according to data from the U.S. National Resident Matching Program.

Many medical students go abroad to train because there are very few medical school spots available in Canada.

Tens of thousands of pre-med students are competing for just 2,800 first-year openings at the country’s 17 medical schools. Their acceptance rate is only about 5.5 per cent, according to university data.

Every year, about 1,000 would-be Canadian doctors go to school in countries like Australia and Ireland, where first-year spots are more plentiful.

Toronto-born Jake Portnoff is one of those students.

A pre-med graduate of Queen’s University, Portnoff wasn’t accepted at his Canadian medical school of choice — in part because there was a flood of applications after years of COVID-related deferrals.

He’s now at the University of Queensland with about 100 other Canadian students who were also shut out of what he calls a “very competitive and daunting” Canadian medical school selection process.

Jake Portnoff is seen sitting for an interview.
Toronto-born Jake Portnoff is going to medical school at the University of Queensland in Australia. He says there should be many more residency positions open to Canadian doctors trained abroad. (Rick Sproxton/CBC)

Portnoff said most of the Canadian students there want to return home — they’re just worried about a residency process that looks like an uphill battle.

“There are so many qualified and educated medical students who I believe really should be given a chance. The amount of residency seats available right now is just such a barrier. It’s certainly hard to hear that many qualified Canadians are being turned aside in the face of what we’re experiencing,” he told CBC News.

“Increasing the amount of residency spots would be a huge benefit to Canadians, especially when the system there is in a crisis.”

With some emergency departments closing due to staff shortages and a dearth of family doctors nationwide, Portnoff said it’s obvious Canada needs to increase the number of residency spots on offer.

“We do all we can to promote the best health-care outcomes for our patients. That doesn’t change, whether I’m in Australia or Canada. I’d take all my skills and clinical acumen home and all apply them in the Canadian system,” he said.

Number of international residency applicants dwindling

Beyond adding more residency positions, Portnoff called for other creative solutions — such as an international exchange program so that students in Australia can go home to Canada to gain experience before diving into the cutthroat residency matching process.

Portnoff co-founded the Canadian-American-Australian Medical Student Association, an advocacy group designed to help students make the transition at time when word has gotten out that it’s difficult to come back to Canada.

The number of international applicants to residency positions has fallen steadily from 2,219 in 2013 to 1,661 in 2022 — a drop of 25 per cent in just a decade.

Some foreign-trained doctors are giving up on Canada because the process is so difficult, Pawliuk said.

“If you tell people to stay away long enough, they will,” she said.

That’s an issue because Canada depends in part on foreign-trained doctors to fill the ranks of departing doctors.

Foreign-trained physicians historically account for about 25 per cent of all doctors, according to data from the Canadian Institute for Health Information.

Nurse-led clinics, like this one in Emery-Keelesdale, have been positioned as one potential solution for the family doctor shortage.
A nurse-led clinic in Toronto. More than 100 residencies nationwide — mostly in family medicine — went unfilled last year because Canadian medical graduates weren’t interested in them. (Laura Pedersen/CBC)

In family medicine, nearly a third of all doctors have international medical degrees.

This week, the federal Liberal government announced an offer to the provinces of about $46 billion in new health-care spending.

In exchange for that cash, critics say Ottawa should demand that the provinces do more to streamline foreign-credential recognition.

As part of his health-care plan, Conservative Leader Pierre Poilievre has pitched working the provinces to fast-track the process.

“It’s outrageous that my little girl has to sit in the emergency room with a migraine for six hours because there’s not enough doctors and nurses,” he told reporters Wednesday after Trudeau unveiled his health-care plan.

“I think we should team up with the provinces to come up with a simple system that gives a ‘yes’ or a ‘no.’ It should happen within sixty days, not six or seven years.”

The Royal College of Physicians and Surgeons of Canada oversees the accreditation of medical resident training in Canada for specialists.

In a statement, the Royal College said it considers residents who completed medical school outside of Canada to be “important contributors to a robust education environment and future health workforce,” and it is currently considering some “alternate pathways” to streamline the system.

“I think five years from now, internationally trained physicians would be getting into the system within one or two years, regardless of their medical specialty, as opposed to five to seven years,” said Glen Bandiera, executive director of standards and assessment at the Royal College.

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Former receiver Green part of Canadian Football Hall of Fame’s 2024 class

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September 13, 2024

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For over a decade, S.J. Green was the enemy of Hamilton Tiger-Cats fans.

He should receive a warmer reception Saturday when recognized as a member of the Canadian Football Hall of Fame. Then again . . .

“I’ll be honest, if I get a boo or two I won’t be surprised,” Green said with a chuckle. “It’s fun, I’m looking forward to everything that comes with this weekend.”

Joining Green in the Class of 2024 are former players Chad Owens, Weston Dressler, Vince Goldsmith and Marvin Coleman. Former CFL coach Ray Jauch and amateur football icon Ed Laverty (posthumously) were named as builders.

The seven were scheduled to be formally inducted Friday night, and then honoured Saturday at halftime of the Hamilton-Ottawa game at Tim Hortons Field. Green now fully appreciates the magnitude of the honour.

“Being here and getting to see some of the other inductees has been the ground-breaking moment for me where it’s actually starting to set in, that it’s a real thing,” Green said. “To put it into the shortest phrase I can, it’s football eternity.

“Not everyone gets to play the game at a professional level … to be a part of this brotherhood and statistically elite group is amazing and very humbling.”

The six-foot-three, 216-pound Green was a fluid receiver with Montreal (2007-16) and Toronto (2017-19). Green, 39, registered 716 catches for 10,222 yards with 60 TDs.

He suffered a serious knee injury early in 2016 but registered career highs in catches (104) and yards (1,462) the next season with Toronto. The Argos would win the Grey Cup, Green’s third (2009-10 with Montreal).

Green’s pro career ended in the XFL in 2020 as the CFL didn’t play that season due to the global pandemic. However, Green’s contract was abruptly terminated when the league suspended operations.

He retired in 2022 after signing a one-day contract with Montreal. Green, who owns and operates a landscape business in Tampa, said his transition to life after football wasn’t seamless.

“I went through a period … I don’t want to call it depression but I don’t know what else to call it, where it was just hard to watch the CFL game,” Green said. “I felt like I didn’t get to end it how I truly wanted.

“I miss the game still to this day and it was hard to get over but eventually you grow up, right? This (induction) makes all the time worth it, it feels right.”

Green also appreciates being inducted with Owens. Both began their CFL careers as practice-roster players with Montreal.

“That makes it more special,” Green said. “We both came in from the perspective of being practice-squad guys, having to prove ourselves to get on the field.

“Unfortunately, Chad had to leave Montreal to show the league who he was as a player and person while I was able to stay in Montreal and reap the same benefits. To watch him go to Toronto and become the player he was made it all come full circle. It’s very rewarding to go in with Chad.”

The five-foot-eight, 180-pound Owens, dubbed The Flyin’ Hawaiian, spent 10 seasons with Montreal (2009), Toronto (2010-15), Hamilton (2016, 2018) and Saskatchewan (2017). He was a four-time all-star, the league’s top special-teams player (2010) and its outstanding performer (2012).

Owens, 42, claimed his first Grey Cup ring with Montreal. He earned a second with Toronto in 2012.

Owens recorded 521 career catches for 6,217 yards and 26 touchdowns. He also had 4,027 punt-returns yards (11-yard average, five TDs) and 5,479 kickoff-returns yards, amassing 16,698 combined yards.

Dressler, 39, played with Saskatchewan (2008-15) and Winnipeg (2016-18), registering 715 catches for 10,026 yards and 61 TDs. The five-foot-seven, 168-pound Bismarck, N.D., native was the CFL’s top rookie in ’08 and a two-time all-star who made two Grey Cup appearances, winning in ’13 in Regina with the Riders.

Goldsmith, 65, was a dominant defensive lineman with Saskatchewan (1981-83, 1988-90), Toronto (1984) and Calgary (1985-87). He was the CFL’s top rookie in 1981 with 17 sacks then posted a career-best 20 two years later.

Goldsmith had 10 or more sacks eight times and finished with 130.5 (eighth all-time). He won a Grey Cup in ’89 with Saskatchewan.

Coleman, 52, was another dual threat. The five-foot-nine, 170-pound cornerback played with Calgary (1994-2000) and Winnipeg (2001-03) and was a three-time league all-star with 28 interceptions (six return TDs) and 538 tackles.

Coleman stands fourth all-time in punt-return yards (5,211), seventh in kickoff-returns yards (11,545) and scored seven return TDs. He played in four Grey Cups, winning twice with Calgary.

Jauch, 86, played in the ’59 Rose Bowl as a running back with Iowa and was an AFL first-round pick by Buffalo, but opted for Winnipeg.

He suffered a career-ending torn Achilles in Winnipeg’s ’61 Grey Cup win over Hamilton. Jauch became Edmonton’s running back coach in 1966 before being promoted to head coach in 1970.

He served as head coach with Edmonton (1970-76), Winnipeg (1978-82) and Saskatchewan (1994-95). He recorded 127 regular-season wins (sixth all-time) and in ’75 led Edmonton to its first Grey Cup win since 1956.

Jauch was the 1980 CFL coach of the year.

Laverty served as president of the Ottawa Nepean touch football league from 1964 to 2015. He held a similar post with the Ontario Touch Football League for over 10 years and helped launch Touch Football Canada.

Laverty was inducted into the Ottawa Sports Hall of Fame in 2014.

This report by The Canadian Press was first published Sept. 13, 2024.



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Ticats host Redblacks in important East Division contest for both teams

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September 13, 2024

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HAMILTON – For Scott Milanovich and the Hamilton Tiger-Cats, what’s understood need not be discussed.

Hamilton (3-9) hosts Ottawa (8-3-1) on Saturday afternoon in an important East Division matchup for both teams. The Ticats enter weekend action six points behind third-place Toronto (6-6) while the Redblacks can clinch their first post-season berth since 2018 with a victory.

And with Toronto visiting the B.C. Lions (7-6) on Friday night, Hamilton will have a clearer indication of its situation Saturday.

But Milanovich, in his first season as Hamilton’s head coach, has steadfastly maintained his club’s most pressing duty is to win the next game on its schedule.

“There’s too many games left, we’re too far away to start thinking about these things,” he said. “I certainly don’t think I have to impress upon (Ticats players) the importance of this game.

“They’re well aware of it.”

Ottawa won the first meeting of the season 24-22 at TD Place on June 30. Before that, though, Hamilton had won 10 straight over the Redblacks.

Hamilton comes off a bye week following its 31-28 Labour Day win over Toronto on Sept. 2. That gave the Ticats the season series with the two teams slated to meet once more (Sept. 20 at BMO Field).

The reality is Hamilton will need help to overtake Toronto for third and reach the CFL postseason. Ottawa, on the other hand, controls its playoff fate entering Saturday’s contest.

The Redblacks are 2-1 within the East Division but 2-3 away from TD Place. Hamilton is 2-3 versus its conference rivals and just 2-4 at Tim Hortons Field.

Veteran Bo Levi Mitchell threw for 347 yards and two TDs in the Labour Day win. He’ll start against Ottawa even though youngster Taylor Powell came off the injured list after suffering a head injury in the Ticats’ 47-22 home win over Edmonton on Aug. 17.

Mitchell has a career record of 10-3-2 against Ottawa. And over the Ticats’ last two games, receiver Tim White has 13 catches for 314 yards (24.2-yard average) and two TDs.

With the bye week, Hamilton will play 12 days after its rivalry win over Toronto. Ideally, the Ticats would’ve been able to ride the momentum of that victory into the following week but Mitchell said during a long CFL regular season players take their downtime whenever it comes.

“Yeah, I definitely think guys wanted to build off this momentum,” he said. “We still will but we also know momentum is very subject to the moment.

“You might have momentum going into a game but they feel the same way and that all changes basically after the first kickoff.”

Rookie running back Greg Bell will make a fifth start and fourth straight ahead of veteran James Butler. The six-foot, 200-pound American has rushed for 204 yards and three TDs on 33 carries (6.2-yard average) in his last three contests while adding 11 catches for 132 yards and a touchdown.

The five-foot-nine, 210-pound Butler ran for 1,116 yards last season, his first with Hamilton. And over eight contests in 2024, Butler rushed for 440 yards and a TD on 92 carries (4.8-yard average) while also recording 37 receptions for 312 yards and a touchdown.

“I know what it looks like, this is not an indictment on James Butler whatsoever,” Milanovich said. “He’s a good back.

“I just felt like we wanted Greg’s juice out there a little bit.”

Milanovich said Butler and Bell are very different players.

“James is more of a power runner, the first guy is not going to bring him down,” Milanovich said. “James is an elite pass protector and also a good receiver.

“He (Bell) is explosive … he’s kind of a slasher. When he does see the hole he hits it and he’s a threat receiving. Certainly, there are things he needs to continue to work on but he’s a threat out there, he’s somebody guys have to worry about.”

At first glance, an easy solution would seem to be having both players in the lineup. But Milanovich said it’s not that simple.

“It’s just it’s hard right now with where we’re at with the roster,” he said. “It’s hard to get another American on who’s not going to play a major role offensively or defensively.”

Bell will make his second appearance versus Ottawa, running for 52 yards on 13 carries back in June. And Bell isn’t getting preoccupied with the importance of Saturday’s contest.

“No pressure,” he said. “We’ve all been doing this our whole lives so it’s just football.

“Just run hard, follow my blockers. If they open a hole I’m going to hit it hard.”

This report by The Canadian Press was first published Sept. 13, 2024.



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Longtime AD and 2-time national champion baseball coach Tanner to switch roles at South Carolina

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September 13, 2024

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COLUMBIA, S.C. (AP) — Ray Tanner is stepping down as South Carolina’s athletic director after more than 12 seasons, he said Friday.

Tanner, a two-time national champion baseball coach for the Gamecocks, took over as head of the department in 2012 following his team’s third straight trip to the College World Series. The 66-year-old announced his intentions at a meeting of the school’s board of trustees.

Tanner will remain athletic director until his successor arrives. Tanner will then transition to become athletics director emeritus and senior advisor to the president, focusing on fundraising and community engagement.

“There was going to be a time” to change, Tanner said. “When I coached baseball, I didn’t leave the baseball program because I didn’t think it was good anymore to become the athletic director, it was time. And I knew it was getting close to time in this role as well.”

A national search for a new athletic director will begin at the end of November, university president Michael Amiridis said.

Tanner’s tenure has had its highs and lows.

Women’s basketball has won three national titles under coach Dawn Staley in 2017, 2022 and, most recently, 2024. And while Tanner was still baseball coach when Staley came on board before the 2008-09 season, he helped keep her with the Gamecocks despite other outside opportunities.

Tanner has hired two full-time football coaches over his 12 years as the program has tried to make strides in the difficult Southeastern Conference.

Will Muschamp served from 2017 until his dismissal before the end of the 2020 season, going 28-30 overall and 17-22 in the SEC.

Current coach Shane Beamer was hired in December 2020 and has had two winning seasons in his first three years. The Gamecocks (2-0, 1-0 SEC) face No. 16 LSU (1-1) at home on Saturday.

Tanner said he was honored to be at South Carolina for nearly three decades and the chance to continue in a different role.

Amiridis was reluctant to let Tanner go as athletic director when the two began chatting about his successor. But Amiridis was pleased to have Tanner remain as athletic director emeritus and a presidential advisor with a focus on fundraising and community engagement.

“I am glad to see he’s continuing on in a role with the university and his willingness to do that,” said Board of Trustees chairman Thad Westbrook. “Ray, he doesn’t have a degree from South Carolina, but there’s no one who loves our university more.”

Tanner came to South Carolina in 1996 as baseball coach and went on to make six trips to the College World Series. The Gamecocks won it all in 2010 and 2011 and reached the final series in 2012 before missing a three-peat against Arizona.

A short time later, Tanner was named athletic director after Hyman left for Texas A&M.

Tanner said his successor would need to be “nimble” in navigating the new, rapidly changing world of college athletics.

Amiridis said he would look for an athletic director with experience who had a similar respect for athletics as Tanner.

Tanner said he will not be closely involved in picking the next athletic director.

“I’m gratefully for the time that I’ve been able to spend in South Carolina and the opportunity moving forward,” he said. “We have a great place, we have wonderful people and I’m excited to remain in a capacity that’s going to be new to me, but certainly will energize me in a way that I haven’t experienced in a number of years.”

___

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