Canada is short of doctors — and it’s turning away hundreds of home-grown physicians each year
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.”
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.
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.
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.
Grocery rebate coming in federal budget 2023
The 2023 federal budget will include a one-time “grocery rebate” for Canadians with lower incomes who may be struggling with the rising cost of food, CTV News has confirmed.
According to sources, the new measure will be unveiled in Tuesday’s federal budget and will help nearly 11 million lower-income Canadians.
The new measure would see eligible couples with two children receive a payment of up to $467, a senior would receive $225, while a single person would receive $234 dollars.
The benefit will be rolled out through the GST rebate system, once a bill implementing it passes in the House of Commons, according to sources. This move is essentially re-upping and re-branding the recent GST rebate boost.
The amounts expected to be offered are exactly what the Liberals offered through last fall’s doubling of the GST credit, a boost that was estimated to cost $2.5 billion and got all-party backing. It’s not expected that there will be a requirement to spend the rebate on groceries.
According to Statistics Canada’s latest inflation report, food prices rose 11.4 per cent year-over-year in January, nearly double the rate of inflation of 5.9 per cent and up from 11 per cent the previous month.
The increased cost of food has been the focus of a parliamentary study that’s seen grocery CEOs, including Loblaw chairman and president Galen Weston, grilled over grocery profits.
“I’ve been talking with Canadians from coast, to coast, to coast over the past many months hearing directly concerns around affordability, around the high cost of food, of rent, of so many different things. That’s why a big part of the budget will be focused on measures to help Canadians in targeted ways,” Prime Minister Justin Trudeau told reporters on Parliament Hill on Monday.
“Groceries will certainly be part of it but, there’s other things as well that we’re going to continue to do to be there for Canadians…I look forward to a great budget tomorrow.”
The NDP had been calling for the Liberals to double the GST tax credit. Reacting to the news, NDP Leader Jagmeet Singh said this measure “looks very much like… what we’ve been asking for, for a long time.”
Both Trudeau and Deputy Prime Minister and Finance Minister Chrystia Freeland have been hinting for weeks that the 2023 budget would include targeted affordability measures to directly help those feeling the pinch of inflation the most.
“This support will be narrowly focused and fiscally responsible. The truth is, we can’t fully compensate every single Canadian for all of the effects of inflation or for elevated interest rates,” Freeland said last week in a pre-budget speech signalling her priorities. “To do so would only make inflation worse and force rates higher, for longer.”
On Monday afternoon, the finance minister took part in a long-standing tradition of picking out a new pair of shoes to wear on budget day.
This year, Freeland opted for a pair of black heels that were on sale at Canadian retailer Simons, from the store’s in-house brand. She placed them in a reusable tote bag after purchase.
WHAT ELSE TO EXPECT IN BUDGET 2023?
With the economy expected to continue slowing in the months ahead, potentially leading to a recession, Freeland is facing calls for the massive fiscal document to include a plan to promote economic growth.
Amid Bank of Canada’s interest rate hikes, inflation cooled to 5.2 per cent in February. That’s down from 5.9 per cent in January, after 40-year record highs over the summer, reaching 8.1 per cent in June.
“What Canadians want right now is for inflation to come down and for interest rates to fall. And that is one of our primary goals in this year’s budget: not to pour fuel on the fire of inflation,” Freeland said in her pre-budget positioning speech.
At the same time, she signalled the 2023 federal budget will still be prioritizing “two significant and necessary investments”: the $46.2 billion in new funding included in the $196 billion federal-provincial health-care funding deals, and new measures to boost Canada’s clean industrial economy.
It’s the latter that government officials have signalled will get some attention in tomorrow’s budget, with several news outlets reporting there will be sizable—30 per cent, according to Reuters— new clean technology-focused tax credits to generate growth in the electrical vehicle supply chain and in critical mineral extraction and processing.
The November 2022 fall economic update had telegraphed that these kinds of credits and investments were ahead.
“Tomorrow…we’re bringing forward a budget that is focused on affordability and supporting Canadians… and creating great jobs for the middle class in a clean and growing economy. Those are the focuses that we’ve been laser focused on over the past many years,” Trudeau said in the House of Commons on Monday, fresh off of U.S. President Joe Biden’s visit, where the green economy was a central piece of discussion.
Canada’s clear focus on the clean transition comes in part out of a need for these sectors to remain competitive in the face of the U.S. Inflation Reduction Act, which offers billions of dollars in energy incentives south of the border.
The Canadian Press has also reported that Tuesday’s budget will include an increase to the withdrawal limit for a registered education savings plan (RESP) from $5,000 to $8,000; and a plan to go after hidden or unexpected consumer fees known as “junk fees” that inflate the overall cost of a product or service.
Finance Canada officials, who for some time have been parsing the stacks of pre-budget submissions from various industries and sectors, will also have to factor in the Liberals’ commitments to the New Democrats, with key planks of the two-party confidence deal due to come to fruition this year.
“We still want to see confirmation of the dental care expansion to include seniors, people living with disabilities and kids 18 and under. We really want this budget to save money for people, and that’s something really important for us,” Singh said.
With this budget, Conservative Leader Pierre Poilievre has called on the federal government to lower taxes, end “inflationary” spending, match new spending with savings, and improve housing affordability.
“He wants to take away everybody’s money, centralize it in his own hands, and promise that it will trickle down through his mighty bureaucracy… And there will maybe be a few little drops that get down to the people who actually earned it in the first place,” Poilievre levelled at the prime minister during Monday’s question period. “Will he cap government spending and put an end to the inflationary deficits, tomorrow?”
The fall economic statement issued in November 2022 projected the federal deficit at $36.4 billion in 2022-23, down from the $52.8 billion forecast in the April 2022 federal budget. Freeland also forecasted that federal coffers could be back to balance by 2027-28.
The 2023 federal budget is coming just ahead of a two-week break in the House of Commons, allowing Liberal MPs to then descend on their ridings to promote it to their constituents before coming back to the capital to work on getting the budget implementation legislation passed through the minority Parliament.
With files from CTV News’ Chief Political Correspondent Vassy Kapelos, and CTVNews.ca’s Michael Lee and Spencer Van Dyk
Canada and the U.S. ready to ‘take on China’ on defence, trade: ambassador
Ottawa and Washington are prepared to “take on China” when it comes protecting defence and trade interests, but there remains work to do to catch up to Beijing’s lead on critical minerals development, the U.S. ambassador to Canada says.
In an interview Sunday with The West Block‘s host Mercedes Stephenson, David Cohen said if the two allies continued to work together and build on their successes, they will end up “being stronger and really moving the needle in 2023 and the years ahead.”
“There is no light between the two countries as to the importance of taking on China, competing against them more effectively, calling them out when they adopt non-rules based trade practices,” Cohen said.
“You sort of can’t leave the overall impression of the visit without realizing that Canada and the United States together are prepared to take on China when China needs to be taken on, to protect ourselves from a defence and a commercial capacity.”
His comments echoed those from Joe Biden, who wrapped up his first visit to Canada as the U.S. president this week.
During his two-day official visit, Biden held bilateral talks with Prime Minister Justin Trudeau and on Friday addressed the Canadian Parliament in Ottawa, saying the North American neighbours will “write the future together.”
China was among a range of issues that were on the table for the two leaders, as both U.S. and Canada are looking to become less reliant on Beijing for trade.
Cohen said China has a “big head start” in some areas, particularly the critical minerals sector, but there is a sense of urgency to take “one bite at a time” and catch up.
As part of that push, the two countries have launched a one-year task to accelerate cooperation on critical clean energy opportunities and supply chains.
A joint statement from Trudeau and Biden also stressed their commitment to competing “effectively with China on a level playing field.”
“Canada and the United States acknowledge the serious long-term challenge to the international order posed by the People’s Republic of China, including disruptive actions such as economic coercion, non-market policies and practices, and human rights abuses,” the statement released Friday said.
Tensions between Canada and China have escalated in recent weeks over allegations of foreign interference in recent federal elections.
“There are a lot of things that has been going on below the water level for many, many years by China in terms of influencing, interfering and meddling in Canadian affairs,” said Cheuk Kwan, co-chair of the Toronto Association for Democracy in China.
The meddling has not been limited to federal politics, but also threatened school board trustees, municipal mayors and councilors to the provincial government, Kwan said on The West Block.
“So this is something that I think we should be aware that, we’re not … barking up the wrong tree,” he said.
“We should be looking at what’s underneath that iceberg and really get a feel and understanding of perhaps the danger of such China’s meddling in our affairs.”
Another hot button issue has been the detention of Canadians Michael Kovrig and Michael Spavor, who spent more 1,000 days in a Chinese prison over espionage charges.
Both were invited to a dinner in honour of the Biden’s visit Friday night and received a standing ovation in the House of Commons Friday, where they watched Biden’s address.
Biden lauded Canada for leading a coalition of nearly 70 countries endorsing the declaration against arbitrary detention in state-to-state relations in his speech.
“Our citizens are not bargaining chips, they’re not diplomatic leverage,” said Biden. “They’re human beings with lives and families that must be respected. And I’m very glad to see the two Michaels are safely back to their family.”
Tuesday’s budget to include grocery rebate for lower income Canadians: source
The federal budget, set for Tuesday, will include a grocery rebate measure aimed at lower income Canadians to help address the affordability crisis, particularly to mitigate the rising cost of food, CBC News has learned.
A senior government official familiar with the budget, but not authorized to speak publicly before the budget is rolled out, told CBC News that the overall cost of the measure is “north of $2 billion” and will benefit 11 million households. It will be facilitated through the GST credit, aimed at lower income families.
“It’s being called a grocery rebate,” said the source, but noted the rebate amount will not be based on a person’s grocery expenditures, nor will the government require that the one-time payment be spent on groceries.
“It’s a targeted measure that won’t add fuel to the inflation fire,” said the source.
The source explained that a single person with no children could get a one-time payment of up to $234, while a couple with two children could receive up to $467 and a senior citizen about $225. The timing of these payments will depend on how quickly the government can get the legislation to implement the budget passed.
Tuesday’s budget will have other affordability measures as well. CBC News can confirm that the government plans to crack down on so-called junk fees for consumers, first reported by Canadian Press. Junk fees are hidden or unexpected consumer charges that are tacked on to the initial price of a product or service, ultimately inflating the total cost.
Ottawa will have to work with various regulatory agencies and the provinces and territories to eliminate junk fees. Sectors that might be affected by the crackdown include phone and internet providers and large event ticket sellers.
The federal budget will also include an increase to the limit on what students can withdraw from their registered education savings plan (RESP) for post-secondary education. Right now, the limit on the education assistance payment (EAP), which is the investment earnings and government grant portions of the RESP, is $5,000. The federal government plans to increase that to $8,000, to reflect the rising cost of college and university.
There is no limit on the post secondary education (PSE) withdrawals, which are the contributions made by the subscriber.
Investments in clean industrial economy
Other affordability measures are also expected in the budget and money has been set aside for pay for recent health-care deals made with the provinces and territories.
A key plank of the budget will also be investments in the clean industrial economy, spurred in part by the U.S. Inflation Reduction Act (IRA), which will pump hundreds of billions of dollars into clean energy in that country.
CBC News can also confirm a Reuters report that the budget will include a tax credit for clean tech manufacturing worth 30 per cent of capital investment costs in manufacturing equipment.
The government source used the critical mineral sector as an example of where the government wants to accelerate production. The tax credit would provide an incentive to mine and process critical minerals, with the recognition that there is a growing demand for them in the U.S., particularly for the electric vehicle market.
The source said that the new tax credit is one of the bigger tax measures that will be part of a comprehensive package the Liberal government will bring in to match or complement what the U.S. is doing with its Inflation Reduction Act.
The budget will also provide greater detail about two tax credits first proposed in last November’s fall economic statement. The Clean Hydrogen Tax Credit and the Clean Tech Investment Tax Credit will take shape in this budget. Companies that invest in those areas and do so in a way that boosts pay for workers will benefit the most, said the source.
“There are similar positive incentives for unionized workers in the U.S.’s IRA. We mirror that in some ways,” said the source, adding that the government has been consulting organized labour over the last two months to ensure budget measures are not “designed in isolation.”
In fact, the new tax credits will be worth more to employers if their workers are paid more, said the source.
The source would not specify whether there’s a projection for a balanced budget.
The fall economic statement projected a balanced budget by 2028 — the first time the Liberal government had projected a balanced budget since it was first elected in 2015.
But economic growth is significantly weaker now.
“Expect to see the fiscal picture adjusted, not because of expenditures, but because nominal GDP growth is hugely different from a year ago,” said the source.
The slow growth might also impact the debt-to-GDP ratio, a key fiscal anchor for the government that has relied on a downward trajectory of the ratio to reassure Canadians that deficit spending is not out of control.
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