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.”
CALGARY – Ryan Lomberg and Brayden Pachal each had a goal and assist on Saturday night to lead the Calgary Flames to a 4-2 victory over the Vancouver Canucks in NHL pre-season action.
Blake Coleman and Adam Klapka also scored for Calgary, which is 4-0-1 through five games.
Jonathan Lekkerimaki and Aatu Ratyu were the marksmen for Vancouver, which is 2-2 in exhibition play.
Dan Vladar, who stopped 17 of 19 shots in 40 minutes of action, got the win. Devin Cooley made nine stops in relief.
Artus Silovs, beaten four times on 24 shots, gave way to Nikita Tolopilo to start the third. Tolopilo had eight saves.
Calgary opened the scoring at 4:23 when Pachal’s rising wrist shot from the blue line through a maze of bodies eluded Silovs, who never saw it.
The Flames surged in front 2-0 three minutes later when Lomberg corralled a MacKenzie Weegar rebound in the slot and fired a shot just inside the goalpost.
Lomberg, 29, who broke into the NHL as a Flame in 2017-18, re-signed in the off-season in Calgary as a free agent after four years with the Florida Panthers, which was capped off by winning the Stanley Cup.
Vancouver got on the scoreboard at 8:35 of the second on a fortuitous bounce.
Lekkerimaki’s shot from the slot deflected off Flames defenceman Artem Grushnikov, went high into the air, and with seemingly nobody aware of where the puck went, it toppled over Vladar and landed in the Calgary net.
Since being drafted by Vancouver in the first round, in 2022, Lekkerimaki has spent the past two seasons in his native Sweden.
This will be the 20-year-old’s first season in North America and with three points (1 goal, 2 assists) in three games in the pre-season, he’s making a push for a job with the Canucks.
One of the players he is competing against is Raty, who after Calgary had taken a 3-1 lead, again got the Canucks back within one on a perfect shot after being set up on a 2-on-1 by Conor Garland.
Raty, a second-round pick in 2021, was acquired from the New York Islanders in the Bo Horvat trade. He’s spent most of the past two seasons in the AHL.
The Flames restored their two-goal cushion later in the second with Klapka firing a shot past Silovs for his third goal in as many pre-season games.
Klapka, who stands 6-foot-8, is looking to make the team’s fourth line. The 24-year-old has shown some offensive pop with three goals in as many pre-season games.
His physicality was also on display Saturday, throwing an open-ice hit in the first period on Nils Aman that sent the Canucks forward flying. In the third, a heavy hit on Akito Hirose send the defenceman careening into the sideboards. Hirose had to be helped off the ice.
UNEXPECTED OFFENCE
Known more for his physicality, Pachal has never had a multi-point game in his 62 career NHL regular-season games. The 24-year-old was in his fifth season with the Vegas Golden Knights organization when he was claimed off waivers by Calgary last February.
HUBERDEAU-MANTHA COMBO
Left-winger Jonathan Huberdeau played in his second pre-season game for Calgary and has been the case throughout camp, the right-winger was veteran Anthony Mantha, who the Flames signed to a one-year deal as a free agent. On this night, Yegor Sharangovich was at centre. In the first game, the two were centred by Martin Pospisil.
UP NEXT
Canucks: Visit the Edmonton Oilers on Monday.
Flames: Host the Seattle Kraken on Monday.
This report by The Canadian Press was first published Sept. 28, 2024.
TORONTO – Lirim Hajrullahu gave the Montreal Alouettes the boot Saturday night.
Hajrullahu kicked a CFL record-tying eight field goals to lift the Toronto Argonauts to a 37-31 win over the Montreal Alouettes.
“I did not know eight was the record,” Hajrullahu said. “We knew this was a tough opponent and we wanted to come out and get that (win).
“The East is heating up and so are we.”
Hajrullahu’s 27-yard field goal — his club record-tying seventh — at 12:43 of the fourth put Toronto ahead 34-31. Montreal took over at its 34-yard line with 2:10 remaining but turned the ball over on downs at its 39-yard line with 1:24 to play before an announced BMO Field gathering of 14,856.
That set up Hajrullahu’s 37-yard kick at 14:11 that put Toronto up 37-31. It tied the CFL record set in 1984 by Dave Ridgway and later tied by Mark McLoughlin and Paul Osbaldiston (both in 1996).
Montreal began its final possession at midfield but Tyshon Blackburn’s interception with 22 seconds remaining ended the threat and cementing the win for Toronto.
Toronto (8-7) earned its second win in three contests this season against Montreal (11-3-1). The Alouettes clinched first in the East — and home field for the division final — with the Ottawa Redblacks’ 29-16 road loss to the Saskatchewan Roughriders earlier Saturday.
But Montreal linebacker Darnell Sankey said that was the furthest thing from the Alouettes’ mind on Saturday.
“We were going out there to win a football game,” said Sankey, who had six tackles and a sack. “We’re not going to use that as an excuse, we didn’t come out and play our best game, for whatever reason.
“Props to Toronto … they came out and executed their game plan better than we did. They were the better team tonight.”
Toronto moved to within a point of second-place Ottawa (8-6-1) in the East Division and four points ahead of fourth-place Hamilton (6-9). The Argos host the Redblacks on Oct. 19.
“Lirim was huge, you’ve got to make those kicks,” said Toronto head coach Ryan Dinwiddie. “(But) we’ve got to finish in the red zone.
“We can’t have eight field goals. I know it tied a record but I’d settle for one to score some touchdowns.”
Toronto’s offence rolled up 517 net yards, including 234 yards rushing. Ka’Deem Carey led the way with 90 yards and a touchdown on 13 carries while adding three catches for 49 yards.
“This (win) is huge,” Carey said. “This could turn our season around and I’m going to make sure it turns our season around.”
Makai Polk had five receptions for a game-high 103 yards for Toronto. Starter Chad Kelly was 19-of-30 passing for 287 yards and an interception.
“Disappointing we didn’t run the ball well enough on second down,” Dinwiddie said. “We knew Montreal would let us run on first down, they wanted to get us in that second-and-five, do you pass it or do you run it?
“We didn’t move the chains as much as I wanted on second down but I have to go look at it. We didn’t play a great football game, we played good enough to win but we’ve got to continue to get better.”
Montreal came in allowing a CFL-low 19.6 offensive points per game but was ranked eighth against the run (112.1 yards per game). Toronto had the CFL’s second-ranked ground attack (118.4 yards per game).
Alouettes’ quarterback Cody Fajardo completed 20-of-29 passes for 225 yards with two touchdowns and an interception. Cole Spieker recorded three catches for 99 yards and a TD.
Montreal made it 31-31 on Dominque Davis’s one-yard TD run at 8:45 of the fourth, then Fajardo’s pass to Tyler Snead for the two-point convert. Hajrullahu’s 35-yard field goal at 3:15 had put Toronto ahead 31-23.
Deonta McMahon scored Toronto’s other touchdown. Hajrullahu also had a convert.
James Letcher Jr. and Walter Fletcher had Montreal’s other touchdowns. Jose Maltos added three converts and two singles.
Hajrullahu’s 49-yard field goal to end the half made it 22-22 and capped a wild finish to the second. Letcher’s 100-yard punt-return TD at 14:42 put Montreal ahead 22-19 after Fajardo’s 35-yard TD pass to Spieker at 13:27, and Maltos’ ensuing 84-yard kickoff single cut Toronto’s lead to 19-15.
Toronto dominated the opening half, rushing for 155 yards and holding the ball for more than 20 minutes. However, it managed just one touchdown and five times had to settle for field goals.
Carey had Toronto’s lone TD of the half on a five-yard run at 10:00 that put the Argos ahead 19-7. It capped a solid seven-play, 90-yard march.
Fajardo put Montreal ahead 7-3 with a 10-yard TD strike to Fletcher at 6:30. It was set up by Dionte Ruffin’s 27-yard interception return to Toronto’s 10-yard line in a light drizzle.
UP NEXT
Alouettes: Bye week.
Argonauts: Bye week.
This report by The Canadian Press was first published Sept. 28, 2024.
MEXICO CITY (AP) — Riding in a black SUV with tinted windows, lawyer Mariel Colón rolls up to the gates of a remote mansion, strolling past a security guard side-by-side with Emma Coronel, the wife of notorious drug lord Joaquín “El Chapo” Guzmán.
Sporting suits and sunglasses, the pair stride into a dimly lit room full of slickly dressed men smoking cigars.
All to the roar of trumpets.
The scene is from “La Señora,” the latest music video from Colón, who spent several years working as a defense lawyer for Guzmán while he faced trial in a U.S. court. Now, at a time when regional Mexican music is becoming a global phenomenon, the 31-year-old is leveraging her association with the former leader of the Sinaloa Cartel to launch her music career under the stage name of “Mariel La Abogada” (Mariel, the Lawyer).
“La Señora” features — and pays tribute to — Guzmán’s wife, who was released from prison last year and has struggled to find work. It paved the way for the two to model together last weekend during Milan Fashion Week, raising eyebrows in Italy and beyond.
“(My work) opens doors for me because of the morbid, because of people’s curiosity … They want to understand this,” Colón told The Associated Press. “I’ve always told people that Mariel is a singer who became a lawyer.”
The Puerto Rican daughter of a music director grew up listening to Mexican ballads, loving the brokenhearted passion infused in the music. She always wanted to be a singer, but her family pushed her to pursue a law degree.
She began working for Guzmán’s defense team in 2018 after graduating from law school in the U.S. and stumbling upon a Craigslist ad seeking a part-time paralegal to help prepare a Spanish-speaking client for trial.
It was only later that she learned she would be working with Guzmán, taking him and Coronel as clients full time. She saw it as a “great opportunity professionally” and said she wasn’t easily intimidated.
Once among the most wanted men in the world, Guzmán led his Sinaloa Cartel in a bloody war for control of the international drug trade, gaining a cinematic level of notoriety for his dramatic prison escapes before his extradition to the U.S. in 2017. Now his sons, known as “Los Chapitos,” are locked in a deadly power struggle with another faction of the cartel, leaving mutilated bodies around the state capital.
“(People ask) how I can do this job, that I’m part of the mafia, how can I sleep at night?” Colón said. “I don’t care what they say about me. I sleep very well at night.”
Colón is one of few people who maintain regular contact with Guzmán. She visits him three times a month in the maximum security prison in Colorado where he’s serving a life sentence. She declined to discuss details of Guzmán’s cases, citing attorney-client privilege.
Colón serenades Guzmán with Mexican classics from bands including Los Alegres del Barranco and Tucanes de Tijuana. To this day, she said, he’s among the first to hear her new music.
“Whatever genre, anything that was coming out that I liked, I would sing it to him because he doesn’t have a radio,” she said.
Her musical career began little more than a year ago, when she released her first video, “La Abogada,” which features Colón dressed in a pink suit, crooning to law enforcement from a courtroom. Like much of the genre, her music is diverse, ranging from percussion-heavy banda to character-focused ballads known as corridos.
“La Señora” features a table sprinkled with diamonds, Guzmán’s wife astride a trotting horse and strolling beside a pool.
Colón said the song was based on Coronel’s life, sending a message of redemption and second chances. It was also a way to offer the 35-year-old work, a condition of her probation.
Coronel, a former beauty queen, was released from prison last year after completing her three-year sentence for drug trafficking and money laundering in relation to her husband’s drug empire. Coronel declined to be interviewed.
“A small waist and beautiful eyes. A brain for business and a strong voice for the bad boys. She only shows her affectionate side to El Chaparrito,” Colón belts out in her ballad. “El Chaparrito,” meaning “the little shorty,” plays with Guzmán’s nickname.
Colón’s musical rise coincides with a relative golden age of Mexican music, which grew 400% worldwide over the last five years on Spotify. In 2023, Mexican artist Peso Pluma bested Taylor Swift as the most streamed artist on YouTube.
While corridos have dominated for more than a century, young artists have filled stadiums by twisting the style on its head, mixing classic ballads with trap in corridos tumbados.
But it also cuts to the heart of a larger debate: Does the music capture the realities facing many Mexicans or does it glorify the narco-violence long plaguing the Latin American nation?
Narco culture has long been part of corridos, with many singers idealizing traffickers as “an aspirational figure going against the system,” said Rafael Saldívar, a researcher at the Autonomous University of Baja California.
“They’re cultural expressions speaking to the realities of the country,” Saldívar said. But “in a way they glorify these criminals, or do so in a way where some feel it’s pushing this kind of lifestyle.”
A classic example: king of corridos Chalino Sánchez used the violence around him in Sinaloa to spin lyrics while also calling out the “Sinaloa gang” for torturing and killing innocents. He was shot dead at a performance in the state’s capital in 1992.
Last year, Peso Pluma – who paid homage to Guzmán in songs – was forced to cancel a show in Tijuana after the 25-year-old received threats from a rival of the Sinaloa Cartel that if he came it “would be your last performance.”
Later, Tijuana banned the performance of narco ballads altogether to protect “the eyes and ears” of youths as it tries to contain violence. Local authorities in northern states previously banned musicians singing narcocorridos.
Colón, who hasn’t gone so far as to glorify arms or drugs, is quick to defend narcocorridos.
“There’s a reason why Netflix did the ‘Narcos’ show, it’s because there’s an audience for it. It intrigues people,” she said. “That doesn’t mean they’re applauding or celebrating what this person did, but they do have a sort of admiration for this person or this person’s life. Not everything is violence. These people have hearts, they have families.”
While Colón plans to put out her first record in December, Coronel has leveraged “La Señora” to launch her career as a model and social media influencer.
April Black Diamond, the designer who asked Coronel and Colón to model in a side event during Milan Fashion Week, said her choice was met with “shock.”
“People evolve. My platform isn’t about judgment but about showing different dimensions of women, their strength, and resilience,” she wrote in a statement. The next day, photos of Coronel in one of the designer’s dresses appeared plastered on a billboard in New York’s Times Square.
On Wednesday, Italy’s National Fashion Chamber issued an “urgent” press release saying the show wasn’t affiliated with official fashion week events and that brands need to follow its code of ethics.
Meanwhile, eyes on Colón and Coronel’s video continue to grow, clocking around 750,000 views on YouTube.
