Thousands of Canadian-born doctors are working abroad at a time when the country is facing an acute shortage of physicians — and there’s little prospect of them practising here because of barriers that block foreign-trained professionals from launching a career at home.
While it’s difficult to establish just how many Canadian doctors are working overseas, a CBC News analysis of publicly available data suggests they number in the tens of thousands.
Since the early 1990s, the number of Canadian international graduates who aren’t matched with residencies has grown significantly. Medical schools, which run the system, privilege their own Canadian-educated students over home-grown doctors trained abroad for the limited number spots that are available each year.
In 2022, for example, only 439 foreign-trained Canadian doctors out of a pool of 1,661 applicants were actually matched with residencies — post-graduate training that is required in order to be licensed. That’s a 26.6 per cent match rate.
That means 1,222 would-be doctors were cut loose and forced to find work elsewhere, according to data from the Canadian Resident Matching Service (CaRMS).
And these are not foreigners — you must be a Canadian citizen or permanent resident to even apply for a residency in Canada.
The number of CaRMS applicants doesn’t tell the whole story.
An untold number of Canadians go to school in countries like Australia, Ireland, the United Kingdom and the U.S. They tend not to apply for residencies at home because they know how unlikely it is they’ll be matched.
Dr. Steve Brennan was one of those students.
Rejected by Canada, he’s now a pediatric pulmonologist and the associate director of the rare lung disease centre at Washington University in St. Louis, Missouri.
Dr. Steve Brennan, born in St. Albert, Alta., works as a pediatric pulmonologist in St. Louis, Missouri. There’s a critical shortage of pulmonologists that work with children. (Submitted to CBC News)
He’s the kind of specialist Canada needs. The American Thoracic Society has said there’s a “critical shortage” of these doctors; fewer than 1,000 of them are actually practising in the U.S. They’re even more scarce north of the border.
Born in St. Albert, Alta., Brennan did his undergraduate degree in social work in Canada. Growing up in a family of nurses, Brennan ultimately decided medicine was his true calling. He applied to a number of Canadian medical schools but wasn’t accepted.
He’s not alone. Few medical school spots are available in Canada — the acceptance rate was just 5.5 per cent last year, according to university data.
Twenty years ago, there were 2,044 first-year medical school positions available at 16 universities nationwide. In 2020-21, there were about 2,800 positions available at 17 schools. Canada has added some eight million people to its population over the same time period.
Brennan went to the University of Queensland in Australia and graduated in 2013 with 100 other Canadian students. He said six of his closest Canadian friends in that graduating class also skipped out on a Canadian residency altogether.
‘Why bother?’
“I didn’t even try to come home. I just knew how hard it would be,” Brennan told CBC News.
“We had someone from the B.C. residency program come to Australia and they basically said, ‘Don’t come back.’ The statistically low match rate means even some of the top students don’t get through. So I said, ‘Why bother?’
“It’s really sad because I went to medical school thinking I’d just come back to Canada. I think that’s what all of us thought. Going to school in Australia — it’s a way to be a doctor, but it’s not actually a way to be a doctor in Canada.”
While he was reluctant to leave Canada, his mum and sister in Vancouver and his dad in Calgary, Brennan turned to the U.S., where international medical graduates are more than twice as likely to land a residency.
“They have enough spots to accommodate every single American student and a ton of internationals,” he said. “They’ve got it figured out.”
Brennan has made a career in St. Louis studying and treating children with asthma, cystic fibrosis and genetic disorders like primary ciliary dyskinesia. He’s married with kids and lives near his in-laws.
Canada is short nearly 17,000 physicians
But he can’t help but think the Canadian system is “a bit cruel” because it keeps Canadian doctors like him away from their own country — and the family and friends they left behind.
Brennan said there’s a reason why the number of internationally trained applicants for Canadian 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.
“In Canada, the system is just not really set up to take international graduates,” he said. “Word gets out.
“And that’s a problem because the health-care system cannot rely solely on Canadian doctors. That’s clearly not working. You have to alter the system somehow if you really want to train people in Canada.”
After years of restrained spending by federal and provincial governments and a generation of protectionist policies that restrict access to residency, Canada’s health-care system is short nearly 17,000 physicians, according to recent data compiled by the Royal Bank of Canada.
A nurse works with a patient in the intensive care unit at the Halifax Infirmary in Halifax on Feb. 25, 2022. Canada is facing a shortage of health-care professionals while thousands of Canadian-born, foreign-trained doctors are working abroad. (Andrew Vaughan/The Canadian Press)
The problem is expected to get worse.
In less than a decade, as the baby boomer cohort retires en masse and the population grows by some 500,000 people a year, Canada will be short an estimated 43,900 physicians — including more than 30,000 family doctors and general practitioners, the bank reported.
Dr. Kate Stewart wanted to help Canada fill the gap. Born and raised in St. Catharines, Ont., Stewart did an undergraduate degree and got her master’s at the University of Guelph.
She’s now a practising obstetrician-gynecologist in the Melbourne area.
Dr. Kate Stewart (right) is a Canadian-born doctor living near Melbourne, Australia, with her husband Dr. Chamath De Silva (left). Stewart wanted to come home after her medical training but there are significant roadblocks that make it difficult for Canadian doctors trained abroad to return. (Submitted to CBC News)
Stewart was another Canadian who didn’t bother with the CaARMS residency match process after she graduated in 2012.
She knew the chances of getting a position were slim — there were only three ob-gyn residency positions in all of Ontario open to international graduates that year.
She also didn’t want to be separated from her Australian husband, who is an anesthesiologist.
Stewart thought that after she completed her residency and specialist training in Australia, she could come home and live near her parents in Ontario’s Niagara region.
But after doing a deep dive on the process, she realized it was difficult to get the Royal College of Physicians and Surgeons, which oversees the accreditation of specialists in Canada, to recognize her Australian credentials.
While the Royal College has a streamlined process for trained specialists coming from select Commonwealth and other western countries, Stewart would still be forced to sit for an exam — a test that requires at least 20 to 30 hours of study per week for a year.
Stewart said she can’t juggle that with her obligations as a doctor and as a parent to two young girls.
“It’s really not something I’m interested in doing again. I’ve been there and I’ve done that,” she told CBC News.
She’d also be out $8,000 — there’s a fee to assess her “exam eligibility” and a separate fee for the exam itself. The test can’t be done remotely — she’d have to come to Canada.
“I could pick up the phone tomorrow and ring the U.K. or New Zealand and I’d be able to apply for a job there without restrictions. It doesn’t make sense to me why I couldn’t do the same with Canada,” she said.
“I’ve practised and worked and learned in a Western, English-speaking country with similar cultures and values. People coming from countries like New Zealand, Australia, the U.K., they have the capacity to integrate into the Canadian system as good workers, easily.”
Her Australian husband, Dr. Chamath De Silva, was willing to move to Canada — but he also found the process daunting, time-consuming and expensive.
It’s a shame, Stewart said, because the Niagara region desperately needs anesthesiologists like De Silva. Last month, a hospital in Welland, Ont. had to cancel surgeries because there wasn’t one available.
With Canada experiencing such an acute shortage of doctors, Stewart said the roadblocks thrown up by provinces and regulatory bodies are puzzling.
“The country should be grateful that these Canadians are willing to come back and be completely overworked and underpaid,” she said. “And you didn’t even have to pay to educate them.”
Nova Scotia RCMP say their investigation into two suspicious deaths earlier this month has concluded that one man died by homicide and the other by suicide.
The bodies of two men, aged 40 and 73, were found in a home in Windsor, N.S., on Sept. 3.
Police say the province’s medical examiner determined the 40-year-old man was killed and the 73-year-old man killed himself.
They say the two men were members of the same family.
No arrests or charges are anticipated, and the names of the deceased will not be released.
RCMP say they will not be releasing any further details out of respect for the family.
This report by The Canadian Press was first published Sept. 16, 2024.
For the first time in their history, members of the Cree community of Nemaska received a visit from a sitting Quebec premier on Sunday and were able to share first-hand the story of how they were displaced by a hydroelectric project in the 1970s.
François Legault was greeted in Nemaska by men and women who arrived by canoe to re-enact the founding of their new village in the Eeyou Istchee James Bay region, in northern Quebec, 47 years ago. The community was forced in the early 1970s to move from its original location because members were told it would be flooded as part of the Nottaway-Broadback-Rupert hydro project.
The reservoir was ultimately constructed elsewhere, but by then the members of the village had already left for other places, abandoning their homes and many of their belongings in the process.
George Wapachee, co-author of the book “Going Home,” said community members were “relocated for nothing.”
“We didn’t know what the rights were, or who to turn to,” he said in an interview. “That turned us into refugees and we were forced to abandon the life we knew.”
Nemaska’s story illustrates the challenges Legault’s government faces as it looks to build new dams to meet the province’s power needs, which are anticipated to double by 2050. Legault has promised that any new projects will be developed in partnership with Indigenous people and have “social acceptability,” but experts say that’s easier said than done.
François Bouffard, an associate professor of electrical engineering at McGill University, said the earlier era of hydro projects were developed without any consideration for the Indigenous inhabitants living nearby.
“We live in a much different world now,” he said. “Any kind of hydro development, no matter where in Quebec, will require true consent and partnership from Indigenous communities.” Those groups likely want to be treated as stakeholders, he added.
Securing wider social acceptability for projects that significantly change the landscape — as hydro dams often do — is also “a big ask,” he said. The government, Bouchard added, will likely focus on boosting capacity in its existing dams, or building installations that run off river flow and don’t require flooding large swaths of land to create reservoirs.
Louis Beaumier, executive director of the Trottier Energy Institute at Polytechnique Montreal, said Legault’s visit to Nemaska represents a desire for reconciliation with Indigenous people who were traumatized by the way earlier projects were carried about.
Any new projects will need the consent of local First Nations, Beaumier said, adding that its easier to get their blessing for wind power projects compared to dams, because they’re less destructive to the environment and easier around which to structure a partnership agreement.
Beaumier added that he believes it will be nearly impossible to get the public — Indigenous or not — to agree to “the destruction of a river” for a new dam, noting that in recent decades people have come to recognize rivers as the “unique, irreplaceable riches” that they are.
Legault’s visit to northern Quebec came on Sept. 15, when the community gathers every year to remember the founding of the “New Nemaska,” on the shores of Lake Champion in the heart of the boreal forest, some 1,500 kilometres from Montreal. Nemaska Chief Clarence Jolly said the community invited Legault to a traditional feast on Sunday, and planned to present him with Wapachee’s book and tell him their stories.
The book, published in 2022 along with Susan Marshall, is filled with stories of Nemaska community members. Leaving behind sewing machines and hunting dogs, they were initially sent to two different villages, Wapachee said.
In their new homes, several of them were forced to live in “deplorable conditions,” and some were physically and verbally abused, he said. The new village of Nemaska was only built a few years later, in 1977.
“At this time, families were losing their children to prison-schools,” he said, in reference to the residential school system. “Imagine the burden of losing your community as well.”
Thomas Jolly, a former chief, said he was 15 years old when he was forced to leave his village with all his belongings in a single bag.
Meeting Legault was important “because have to recognize what happened and we have to talk about the repercussions that the relocation had on people,” he said, adding that those effects are still felt today.
Earlier Sunday, Legault was in the Cree community of Eastmain, where he participated in the official renaming of a hydro complex in honour of former premier Bernard Landry. At the event, Legault said he would follow the example of his late predecessor, who oversaw the signing of the historic “Paix des Braves” agreement between the Quebec government and the Cree in 2002.
He said there is “significant potential” in Eeyou Istchee James Bay, both in increasing the capacity of its large dams and in developing wind power projects.
“Obviously, we will do that with the Cree,” he said.
This report by The Canadian Press was first published Sept. 16, 2024.
NEMASKA – For the first time in their history, members of the Cree community of Nemaska received a visit from a sitting Quebec premier on Sunday and were able to share first-hand the story of how they were displaced by a hydroelectric project in the 1970s.
François Legault was greeted in Nemaska by men and women who arrived by canoe to re-enact the founding of their new village in the Eeyou Istchee James Bay region, in northern Quebec, 47 years ago. The community was forced in the early 1970s to move from their original location because they were told it would be flooded as part of the Nottaway-Broadback-Rupert hydro project.
The reservoir was ultimately constructed elsewhere, but by then the members of the village had already left for other places, abandoning their homes and many of their belongings in the process.
George Wapachee, co-author of the book “Going Home,” said community members were “relocated for nothing.”
“We didn’t know what the rights were, or who to turn to,” he said in an interview. “That turned us into refugees and we were forced to abandon the life we knew.”
The book, published in 2022 by Wapachee and Susan Marshall, is filled with stories of Cree community members. Leaving behind sewing machines and hunting dogs, they were initially sent to two different villages, 100 and 300 kilometres away, Wapachee said.
In their new homes, several of them were forced to live in “deplorable conditions,” and some were physically and verbally abused, he said. The new village of Nemaska was only built a few years later, in 1977.
“At this time, families were losing their children to prison-schools,” he said, in reference to the residential school system. “Imagine the burden of losing your community as well.”
Legault’s visit came on Sept. 15, when the community gathers every year to remember the founding of the “New Nemaska,” on the shores of Lake Champion in the heart of the boreal forest, some 1,500 kilometres from Montreal. Nemaska Chief Clarence Jolly said the community invited Legault to a traditional feast on Sunday, and planned to present him with Wapachee’s book and tell him their stories.
Thomas Jolly, a former chief, said he was 15 years old when he was forced to leave his village with all his belongings in a single bag.
Meeting Legault was important “because have to recognize what happened and we have to talk about the repercussions that the relocation had on people,” he said, adding that those effects are still felt today.
Earlier Sunday, Legault had been in the Cree community of Eastmain, where he participated in the official renaming of a hydro dam in honour of former premier Bernard Landry.
This report by The Canadian Press was first published Sept. 16, 2024.
