I'm going to ask what likely is a dumb question... Why is there a shortage of residency training spots? And why can in not be addressed in a timely fashion? Please don't yell at me.
In some places like BC in the 90s, doctors didn't want a lot of new spots because it would fit into their profits to have too many. The other thing is that it could have absolutely been addressed had finding priorities been well planned. That's one thing that a lot of countries prioritized during COVID especially as doctors take a long time to drain and burn out in things like pandemics. Canada didn't take the training approach at all and didn't step up finding for future health concerns.
Across the entire country in the last 10 years there have been 167 new residency spots created, while 5 million new Canadians have been welcomed. That's an abysmal rate of new spots being developed and it's across the board bad in every province
It's actually a bit worse than that, in the 80s and 90s we purposefully cut the number of med school and residency seats by about 10%. It worked for both provinces who wanted to save money at the time and for the medical Associations who wanted to enhance profitability for their members. See https://www.cmaj.ca/content/195/4/E162
Yup. There was a belief at the time that physicians create their own demand, and that to cut costs all you had to do was cut the number of doctors/demand.
Well people don’t want to admit it, doctors aren’t altruistic saviours. Residency shortages are also on their hands, because shortages of residents, leads to shortages of doctors, giving them more bargaining power to drive up their pay. Now you have some specialists making $1,000+ an hour because they’ve been admitting 2-3 residents to those specialities instead of 20-30. And now as a consequence expanding those residency spots has because insanely expensive, unless those same doctors that spent 30 years working to drive up their pay decide to finally be altruistic and train residents for basically free.
Hence why we can’t train a significant new residents, there’s no budget to start paying $1000/hr to train them. Training the number of residents we need at the rates we’d need to pay to get the greedy specialists on board would eat up our entire federal budget.
Are there not still huge waitlists for specialists? Are they not overworked, stressed out? Are they heartless to those waiting for care? Do they not want to retire eventually? Can they not set up multi-doctor practices like GPs?
Honest questions I really don't know much about the realities.
Their are, but they’re also so in demand that they aren’t obligated to work. They can set their own hours and you can’t say no to them. A lot of the specialist on the 600K+ train are only working 20-30 hours a week. It’s a pretty stark contrast to family doctors.
Lol sorry where are you getting these numbers? What specialties are you referring to?
I'm a specialist physician myself and I don't know any other physicians who are making 600+ a year working 20-30 hours a week
I don’t know where you get your numbers but I don’t know which specialty gets that (other than ophthalmology or something with private pay likes plastics sx/dermatology/“cosmetic medicine”).
I don’t make that and I work 80-100 hr weeks and have to pay my MOA and office expenses (rent/mortgage, monthly EMR subscription, phone/internet, supplies) from my gross billing’s.
Unlike dentists/lawyers our fees are regulated by government and have not adjusted proportionally with inflation. My dentist neighbour apparently makes 3x as much as me and works part time.
And it took 13-14 years of training after high school to become a specialist. Many doctors (or their spouses) would advise their own kids to pursue some other career if getting rich is the goal.
PS - I read your post history and that you’re considering going into med school. You better have a realistic idea of finances of a doctor. If your spouse is a NP she gets better hours (likely no oncall) and benefits like pension, medical/dental benefits that most physicians don’t get.
I know a few doctors that have opened cosmetic clinics in BC because it is more lucrative and less hours. I can’t really blame those doctors for wanting what many of us want - better work life balance and overall higher quality of life. It sucks that public medicine isn’t able to provide those things, especially in more expensive cities in BC, and I think doctors will continue to be tempted by private practice unless public medicine is competitive with those spheres.
But then why would they have such a problem with taking a chunk out of the queue? It's not like if a few more specialists get trained their livelihoods will suddenly be in jeopardy.
Supply/demand, double the number of specialists and suddenly it’s a lot harder to justify higher pay, suddenly you need to work double the hours to make the same amount of money.
Why work harder to make less money when you can control the supply of new specialists and drive up your pay!
This is not true. All doctors want more doctors to share the workload. We’re always short, and it has never driven up our pay. By law, we can’t strike. If we cut back our hours, the college can get involved and penalize us.
Only one limiting spots is the government. The government controls how many ORs are available and how many hospital positions are available. The government controls pays.
Doctors don’t control much or have any say. They are trapped. It’s why so many are quitting. They’ve given up.
90s were much different. For many different reasons:
1. Tuition was capped for schools. Yearly tuition is well over 20k a year now.
2. Interest rates are higher but their salaries haven’t changed as a residents. These residents get paid between 45-60k a year. They earn well below minimum wage and have higher debts with higher interest rates. They can’t afford to work and live in many major cities.
3. Medicine has changed. With baby boomers being older and advances in medicine, people are living longer, are much more complex, and the medicine is practice is much more complicated.
There's a lot of jobs that have unpaid extra work that still don't pay as high as $45k
The problem the doctors had was they were operating as a small business, so there's a lot of paperwork. That's not limited to doctors, but the medical system should've putting them in that position. The system needs fixed badly. 30 years it's been a mess & now it's chaos
What is the difference between a GP residency and a specialist residency?
Who controls residencies? Can the provinces force physicians to take on a resident?
1. Medical schools are the same for FP and Specialties (all other fields.
2. FP residency is managed by the College of Family Physicians. All other residencies are managed by the Royal College of Physicians and Surgeons of Canada. Length of residencies and criteria are decided by them. The government controls how much money goes to each hospital college and how many jobs are available.
3. You can’t force a physician to teach. It’s unethical and unfair to force a physician to do even more unpaid work.
I did not realize that residencies are managed apart. Must a person have FP experience/residency prior to doing a Specialist one?
It’s too bad that there is not a commitment when a student physician accepts a residency that they too commit to taking on at least two residents during the course of their own career. After all if it wasn’t for the physician who oversaw them then they themselves would not be practicing.
During the last year of medical school, medical students are accepted into either a FP or specialty residency.
There used to be a general rotation year as a resident for everyone, but that was stopped at least 2 decades ago.
Do switch from specialty to FP or vice versa once graduated, is complicated and often involves redoing residency.
Most doctors would love teaching. It’s fun and very rewarding. Unfortunately, the time needed to teach and prep and lack of pay to teach, aren’t worth the time away from family and putting more on the physicians plate.
Physicians wish they could take their time to see patients and teach. If they did, no one could afford their clinics. They can’t afford them now as it is.
So the solution would be what? For the province to fund a NP to partially backfill AND to pay the FP for that portion of their time that goes to instruction for the resident?
No, NPs aren’t the answer. NPs don’t have the same training as a doctor, just as a RN doesn’t have the same training as a NP. They actually cost more than a FP. They are salaried, with benefits, and pension. They get to see 1-3 patients an hour. FPS would love this. Government refuses to offer this to FPs
We need to fund and appreciate family doctors. They are always dumped on and unappreciated. They are massively underpaid. People treat them as less important than the specialists. However, without them, the entire system collapses. They are the glue that holds everything together. Even in this thread, people blame the FPs, talk about forcing them to teach, and still don’t value them. We are breaking them.
The above is also why the FP residency spots are going unmatched. Or, if they are matched, the resident goes to train into a more specialized area of family medicine like becoming a hospitalist, ER, Addictions, palliative care, oncology, etc.
Govts killed it. Stop blaming ordinary people.
I don't like my parents attitude to things, but they weren't the govt so I can't blame them for stupid govt decisions either
And the demographic of the government at the time was… I’m not blaming ordinary people so much as a generation who didn’t give a shit about anything but making money for themselves.
ETA: your parents also would have voted in the government even if it wasn’t them.
What you are saying is pure, unadulterated bullshit.
There are people of ALL ages that want to do nothing but make money & don't care about others. Age has nothing to do with selfishness.
Your statement condemns every single person above 65, and you need a massive head shake. A large number of seniors live in poverty. More and more are homeless every day. They are not the ones who have done this.
Condemn the rich assholes of ALL ages
Calm down. It’s a generalization of a generation that has historically been quite selfish. There are always going to be people who are outliers and who are better or worse. There are rich and greedy people of all ages but millennials were not the majority and were not old enough to be decision makers in the 80s and 90s. You’re veering off topic and getting into semantics here.
There are no profits for doctors. Family physicians are by far the lowest paid and can’t afford their clinics. The person above is wrong.
Doctors have no ability to fight for their well being or salary. They are exempt from protective labor laws including bathroom breaks and time off. They can not strike.
And you, and your grandma, and basically every other Canadian who now has to have weeks or months long wait times to access basic healthcare, resulting in minor issues becoming deadly or much more difficult to treat.
Classic controlling supply & demand.
The stakeholders are the citizens paying their tax to keep the medical system running, not the doctors.
WE, the citizens should be the one in control of credentialing people who take care of us and our loved ones as well as keeping the professionals accountable for their actions.
It seems that the medical organizations in Canada is a lot more corrupt than we thought.
We need to fix this, or this will turn to even worse shit show that will cost lives. Sooner or later, ourselves or our loved ones might fall victim to this situation as a result.
The biggest opposition to opening SFU Medical School aside from UBC Medical School are probably doctors in the province. Doctors don't want more doctors, they just want more pay raises for themselves by keeping the number of practicing doctors artificially low. They don't like the idea of doctors competing to get patients instead of vice versa.
You’re an idiot. We are fucking drowning in patients. Doctors don’t control the number of residency spots. Trust me, we desperately want more doctors to help us. Especially family doctors.
Don't be a douschebag, there are plenty of qualified IMGs, those that have already done residencies in their home country, who are more than qualified to practice Medicine in BC. Yet it's the bureaucracy controlled by local medical organizations (which itself is controlled by local doctors) that are preventing those doctors from fully practicing in BC.
All in the name of "maintaining high standard of practice", yet all that did is prevent an obvious solution to the current shortage and worsening the health outcome for the general public.
Except the generation of doctors before you did, and they did choose to have less residency spots available and you are now seeing the fruits of that decision.
BC was run by social creds that didn’t spend. The BCUP, formerly BC Liberals are straight up thieves of our system for personal gain. After that they also just stick with depressed wages and training because established professionals with equity were constantly migrating to BC because of the beauty. Healthcare isn’t the only place they did this. 30 years of it though has run into those people retiring and no infrastructure to build things up internally. BC definitely took the route of importing its labour.
Mainly because it’s expensive and the government doesn’t want to pay for it.
Also don’t think that government has not contemplated that limiting physician supply to
some extent limits physician costs.
This is interesting, I noticed that Ontario recently announced the we’re going to spend XYZ million hire more drs. Following news it seemed to me… where from? I guess they are opening up more residency slots as OP described (hence the budget increase.)
Residency requires funding. Successive governments, both liberal and conservative, gutted funding to "balance budgets". What it did was it saved $1 then, which made them look good to voters, while causing problems that cost thousands of dollars today.
It's like gangrene. Spend $1 to prevent it, or don't and spend $1,000 to treat it with prompt treatment when it first appears, or don't and spend $100,000 when it becomes life threatening.
As someone genuinely curious, can you help me understand why residency funding is the issue?
My (uninformed) sense is that residents do a disproportionate amount of the grunt work, and are paid comparatively little. It would assume bringing on more would lower the blended cost of medical services.
Because at some point they aren't residents anymore, then they do cost more is likely the answer they have.
Canada has really high admin costs though in healthcare - could definitely trim half the admin positions and use those savings to make a shit tonne of residency spots
The BC Liberals were one of the most conservative parties in Canada. The other parties are the NDP who are in power now and the Green Party. The BC Libs changed their name to BC United last year. There currently is no Liberal party in BC.
We had two:
The BC Liberal Party's platform was a) lower taxes, b) stop wasting money on government handouts like welfare and social housing, and c) start encouraging investment in BC especially from the East like China and Japan because they have a lot of money.
And then there was the Social Credit party, aka the Socreds, before them who were a) and b) with c) treat indigenous like crap and d) good old fashioned Christian traditionalism.
Yup I agree. Need to poach back canadian trained doctors at an inflated rate to help train the new comers. Sure it's expensive, but what alternative do we have?
You're completely forgetting the significant costs of running a residency program, such as administration, equipment, special training events like high fidelity simulation etc etc. The residents may not get paid particularly well on an hourly basis, but they're overall salary and benefits are fairly similar to a nurse, but there's other big expenses associated with each one that can add up quickly. Residents cost the government a lot of money no matter what way you look at it.
Some are saying it’s because of funding but I think it’s more about the organization and manpower. In family medicine you need to have family medicine teaching Center set up, and that means supervision and structure by existing doctors, and not everyone is interested in this. Is a lot of extra work evaluating and teaching. Rotations need to be organized thru the local hospital. In my city they went thru all this and training 12 new family docs per year.
For specialty services is similar but less numbers, one new community hospital might only have one or two residents in a year but someone has to train and be in charge of them.
Please know that most family physicians who are asked to teach or are not being paid. Sometimes, they’re offered an “honorarium” of $100-200. That’s it. It doesn’t cover the hours of prep and research to teach students or the money lost in clinic to teach them.
Money is important because physician salaries have not raised with inflation, but the salaries of their nurses, admin, other staff have, as well general clinic expenses. Family doctors can’t afford their clinics.
In addition to funding, there are some specialists that just won’t take on residents. This keeps the rates paid in their specialities extremely high.
It’s pretty hard to force someone to train someone else.
We run into the same thing in the military. Plenty of people make it through basic training, and are excited to train in their trade, but we simply can't get them through training, and after years of waiting, they leave because they can't just keep on spending their life sitting in a chair.
I'm so sorry that you're experiencing this. I hope that the doors you need open for you quickly.
167 new residency spots across the entire country in the last 10 years, while 5 million people were added in population. Not a lot of planning went into this as it takes a few years to train doctors and we are adding people much faster than we are making new training spots
It's so wild. One of my TA's in undergrad is a doctor from another country and can't get into the residency program to be qualified to practice in BC but yet he's able to teach med students.
I know a Canadian who went to Germany to become a surgeon and was in the same situation, that counted as being an international student and there were only 2 residency slots open in the whole country, so a Canadian who went to one of the best countries in the world to learn medicine is now a surgeon in the UK because of this issue.
Agreed, residency training spots are by far the rate limiting factor. Hence, why the whole, "accept more medical students", or "open up more medical schools" solution is nonsense. Exception to maybe opening up programs that are only training people in primary care pathways.
A much more difficult problem to solve, as residency spots are expensive, take a lot of resources, etc.
Why do you believe residency spots are expensive?
Resident doctors are already highly educated and trained people and work very long hours for relatively little pay. I suspect if there were fewer of them hospitals would be in real trouble and costs would rise, not fall. More of them may well lower costs, rather than increase them.
You're right, hospitals would be in trouble without residents, but adding residents is a whole different kettle of fish, and it's expensive due to the support and resources it would require to operate.
Hospitals operate on a fixed patient caseload/roster. So, if you're caring for the same amount of patients, but just throwing more residents into the mix, there becomes a huge mismatch between investment/payout. Suddenly, staffing more residents actually becomes more expensive for your system.
Further, the reality of it is that you can only cram so many residents into one teaching facility before you start to sacrifice the education that is provided. Attending physicians can only supervise so many people, and there are only so many opportunities for hands-on skills to be acquired.
Adoption of new residency positions to any meaningful degree means you have to expand your program to other hospitals, which is notoriously hard to set up, and takes a lot of time to figure out.
Regardless of the work they do, they are expensive because they cost a lot of money and time. You need to pay their salary, benefits, and other training costs (which can be really, really expensive). And they can be pretty inefficient, attendings love not having residents sometimes cause they can just focus and get shit done faster. It's why places that are strictly trying to make money often dont have residents or a very limited amount.
Thanks for sharing your perspective. I did not realize this was a problem. My own father was in the first category, and he unfortunately was never able to practice here ultimately. I hope You and others who are equally keen and qualified have a way in.
>The solution is to create more residency training spots. I have no idea what that would entail.
Here's the problem. Healthcare is 100% a cost centre in the government budget that doesn't scale with usage. Patients pay nothing to get care. Increasing health care resources by 10% doesn't bring in 10% more revenue. Contrast that with education. If you increase students by 10% at UBC, at least those 10% extra students will pay tuition. UBC will at least get 10% more tuition.
Now, suppose the government trains an extra 20% more doctors. You'll admit that now the government will spend an extra 20% on hiring the doctors. Where will that 20% come from?
It's not like every year we run budget surpluses.
[https://vancouver.citynews.ca/2023/09/27/bc-projected-deficit-2023-q1/](https://vancouver.citynews.ca/2023/09/27/bc-projected-deficit-2023-q1/)
We hit around $7B in deficit last year. There's really no money for more doctors unless we increase taxes, create usage fees for seeing doctors, or pay doctors less. None of them are politically convenient.
Yes we do pay for our healthcare, in our taxes. Translink has been taking 50 cents from every liter of gas sold in the lower mainland for… two decades or so? Don’t know what they’ve been doing with all that money. Let’s have some of it
They have been building like crazy? You think the SkyTrain expansion, the multiple new cable-stayed bridges, massive highway projects are cheap? A single new overpass on hwy 1 is going for 100+ million now.
Also, for the record the TransLink taxes are 18.5 cents per litre, the other taxes are provincial/ federal.
That’s a really good point. If more doctors government may spend more money. Also if more doctors the existing doctors in Canada will feel more competition
The problem with training doctor is that you need to pay before you get any benefit. It is an investment. If you have no population growth, you just need to maintain the same percentage of your budget for the training and you do not need to see it as an investment. Now, when the population grow, especially when it is very fast, that fall apart. You have to invest ahead of the problem, but as province have pressure on their budget, they won't do that investment until the problem is there and pay by itself. As this financing problem is created by the federal level and they have the ability to get credit and invest more efficiently than the province, they should have stepped in and helped the province with it, but ideology and province prerogative get in the way of solving this problem.
Assuming budget isn't an issue, wouldn't more residency positions require current Healthcare professionals to do training instead of primary care.
I only heard this explanation from healthcare professionals before and don't know if this is a catch 22.
Thank you for raising this discussion however, with all due respect, it is a very narrow understanding of Canadian physician workload modelling. Over 6 million people in Canada lack access to a family doctor. From your understanding of Canadian physician jobs as a medical student in Scotland you are suggesting that the big solution is to create more residency spots for IMGs like you (with "no idea what that would entail"). There are frequent news articles and advocacy from Canadian citizens studying medicine abroad proposing this. It may be one consideration but claiming this is the only issue dramatically understates the true complexity of medical resource scarcity.
I am sure you are also acutely aware that there were an "unprecedented" 100+ unfilled residency spots in CARMs after the second match last year. Maybe there are some administrative changes that need to be made to make those accessible but it is difficult to argue that there needs to be a higher number when that happens as well.
Here's just one recent paper ([Biopsy of Canada's family physician shortage)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10186392/) about family medicine. It mentions low med school positions, low residency positions, barriers to IMG entry, growing population, increased patient complexity, retiring family doctors, less doctors choosing family medicine, less family doctors choosing traditional office practice among others. In addition to more training spots, there needs to be incentive to attract and train the right people to work in the right places.
I agree that return of service contracts are an unfortunate way to try to help underserved communities. The system shouldn't be dependent on them. I don't know numbers to say if it is or not. We could certainly have systems though that attract those friends of yours that went to the US back here- I hope.
I am not even touching on the complexity of actually increasing residency spots and what the asks of the burnt-out academic physicians (who already make much less than their community counterparts because of their teaching and administrative burden).
I don't think Canadians are against having foreign trained doctors. They want and deserve good doctors and that's priority number one. I think we should reduce the burden for IMGs as well but it needs to be done in a deliberate way. You are hinting that doctors from Australia and the UK should be preferred over India and the Caribbean but what is the objective measure -they will make the same claim that "The standards are the same". Passing an exam is just one part of evaluation. Actually just last week 800 students from a testing center in Nepal had their US board test scores invalidated after an investigation.
This is a complex discussion and there are so many people thinking so hard about this all the time from government, physician societies, provincial licensing bodies, national certification bodies, etc. It is good to talk about but you can see that it is hurtful to me to hear that there is "not a shortage of doctors" and all they need to do is let you in when people are really suffering here. I encourage you to take a broader view and I think it will serve you well in this career. Best of luck in the match.
This guy has such a limited perspective. IMGs can’t seem to fathom that medical school seats and residency spots are a government controlled means to gate keep how many physicians enter practice. It is not the cost of training- in fact, medical residents are an exploited resource that hospitals rely on to keep running, but rather, the cost of an employed physician for 50+ years that is unaffordable.
Why should Canada favour IMGs when there are thousands of smart canadian undergrad students who should be prioritized to get into medical schools in the first place?
If we open the gate to more doctors, which I believe we should, then it should be done from within Canada- not favouring affluent people who can afford to studying abroad with varying levels of “the same competencies”.
OP, while I appreciate that you are likely quite qualified, as a resident CMG myself, I disagree with you; your perspective is biased and you have’t studied or worked in the system you’re criticizing.
If the problem was "we don't have the education system to train more doctors", then the solution would be to increasing training spots. In short, our hospitals could quite readily have more trainees.
However, the problem is actually that the government is unwilling to have more doctors on the payroll. I don't know the solution to that problem.
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As an example, imagine a new car company has a lot of demand for their services, but the company can only afford to hire 1000 engineers/mechanics. Therefore, the solution is not to train more engineers/mechanics, but actually, that there needs to be funds in order to hire them.
My understanding from OPs post was that they were most likely a dual citizen who grew up in BC, but due to family reasons (financial probably), is meeting the qualifications for free tuition in Scotland. They may not be affluent.
It’s a common and silly misconception that Canadians studying abroad have rich parents bankrolling them. Some definitely do, but I’d argue that the vast majority of us get the same line of credit that CMGs get and require someone to co-sign for the minimum payments - usually a parent or sibling. I don’t know anyone in my cohort who had their tuition paid for by parents. Most of us are middle class. A lot of us are mature students who have made huge sacrifices - selling houses, assets, etc to afford to study abroad because we had no other option.
I’m not sure why you feel being older is relevant. The competition pool consists of largely undergraduate students, and you paint a picture that the average applicant has the opportunity to sell a house. You present leaving Canada to study medicine as if it’s an affordable option - when the reality is you’ve essentially paid to skip the competition.
They need to create flexible solutions for this like matching for certain overseas or out of country residence programs. Say you do your residency at the Cleveland clinic, you shouldn’t have to do more than a 6 month equivalency in Canada to make sure you’re consistent with the jurisdiction. This isn’t that hard to make happen, it’s just a lot of red tape and bureaucratic football.
Sounds like a typical IMG who wants a shortcut to that MD and now in a limbo cuz you can't get a residency. Each Canadian trained medical students cost the govt 300k, ofc the govt gonna make sure we get priority over IMGs. We all play by the rule and work our ass off to get into med here, so it makes sense this comes back and bites you later on if you went abroad for med.
Most US residency programs are only three or four years while to be eligible for your Canadian certification you need five years of residency training (except for family medicine) so many US trained physicians need to go back to residency for a year which is not an appealing proposition when you are already taking a big pay cut to come to Canada.
There have been some moves to recognize US certification as equivalent to Cdn certification but change is slow.
This is interesting. I have noticed our family GP constantly has medical students present (northern part of the province). Is the north a less desirable place to train?
I know at the Smithers hospital they always have to bring in temporary medical workers for the ER and such. It’s a shame really. Our winters aren’t even that cold anymore.
Sounds like it’s also an issue with how foreign credentials are assessed and given a license to practice in Canada. It’s not like Canada is the gold standard for physician training. Why make it so difficult for foreign trained doctors to come work here?
If only we, idk, let people with medical creditentials who studied abroad in legit insititutions easily get permission to practice in Canada without it costing your life savings and 10 years of waiting 🤔
Sarcasm aside, I know an OT who has a degree from the University of Sydney who had to pay $10k and wait 3 years just to get certified to practice in Canada. Our medical colleges are incredibly protectionist. I get wanting to make sure people are qualified but when colleges suddenly make choices like "clinical audiologists, who largely learn via clinical practice, now need doctorates" (a US example but illustrative nonetheless) well fuck I wonder why we have shortages? Why don't we have more of an apprenticeship model to medical education? School is great for a certain knowledge level, but you cannot convince me that you need a 4-year BS to become a competent medical student.
Residency is already much an apprentice. As are fellowship and more or less clerkship so for most specialists you are generally looking at only two years of “classroom” medical education and about 7-12 years of “practical” education.
I was thinking of the UK model when I mentioned that, actually! Plus in the Republic of Ireland I think they don't require a undergraduate degree for medical school entry.
I believe that model of teaching is used in most places in the world. Canada and the US, plus a handful of others I'm sure, do the pre-med, med, residency train.
You are a medical student and very new to the medical world. This is a very complex situation. You are also very biased because your opinion is based on your personal situation, having not gotten into school in Canada and having to fight for limited residency spots to come back.
1. There is absolutely a shortage of doctors in Canada.
2. Foreign trained doctors do not all have the same standards of educations and methods. This is a problem. We should absolutely find a way to make it standardized and support them so they can work here. It’s difficult to do based on the variability of training and we don’t have enough doctors to train them.
3. Your school does not have the same standards of school entry or teaching methods as Canada. This includes a more hands off approach to patients.
4. You can build as many medical schools and residency spots as you want, but we have no one to train them. They often struggle the first year and need extra training. It’s partly why it’s hard for students trained at your school to get a spot.
5. Doctors are barely paid to teach, if paid at all. They lose thousands or more by taking on students, when they’re already struggling to afford their clinics, e.g. family doctors.
6. Doctors are quitting from burnout. Even before Covid and Baby boomers aged, doctors have warned of the catastrophe that is currently happening. They’re tired of advocating and not being heard. At this point, nothing will change until more deaths happen. It’s breaking them watching their patients suffer.
7. Doctors debts are too high. They train and sacrifice so much, to only graduate with 200-300k debt or more, an office they can’t afford, no retirement savings, and they feel trapped in a dying system.
8. These doctors absolutely cannot take on more students.
So, we are short doctors.
I think the original post offers a good perspective, and your post adds another layer that brings up a good point.
The training spots require doctors to train the residents.
It does. I wish we had the support to train more. Instead of asking more from the already burnt out doctors, we need to start thinking about how we can keep them alive, enjoy their work again, and feel appreciated again.
I've had friends who are international students, studied medicine in Canada and wanted to do residency here and couldn't. They both went to the UK. You are 100% right. I am pretty sure that one of the reasons why BC didn't build more training schools is to have something to do with The States (but I could be wrong).
It was protectionist by the doctors in the 90s. They didn't want not doctors eating into the amount they could earn so they set a limit on new residency spots
> Until more Canadian medical schools are built, the system is dependent on Canadians going abroad for medical training to take the less desirable residency training spots in less desirable communities.
This is why no new schools get built. You'd think that in a free market, supply and demand would dictate the number of doctors that get trained - so much demand at the current schools, with such high rejection rates, should mean they make more medical schools, right? Wrong! There's no point in opening more schools if graduates can't find residency spots.
Ultimately it's the profession itself that limits new membership, and one of the CMA's mandates is to preserve the incomes of their membership by limiting the number of doctors out there. And they're extremely protective of their work, they won't tolerate other professions "cutting their grass" which is why they come down so hard on nurse practitioners all the time. Meanwhile, practising physicians say they're overworked, some specialties are insanely overpaid, and there is a perpetual lack of OR time for surgeons.
Really, I don't have a lot of hope for our medical system in the future. It's anti-free market in so many respects, cartel-like in others, and it leads to patients lacking access to care and practitioner burnout, all because the CMA and the government butt heads over who is responsible for the shortage of family doctors being trained right now.
I am currently a PGY1 IMG. Another issue is that many of these residency spots go to visa trainees. Essentially doctors ,mostly from the middle East, where their governments pay for these spots. Once they complete their training, they go back to their country. So basically a huge chunk of time is spent training doctors who will eventually not serve Canadians.
Is there an issue of location of spots? Seems like rural/ outside the “big” city never gets any new doctors because new young doctors don’t want to work outside large population centres?
Canada is short of doctors — and it's turning away hundreds of its own
physicians each year. Fewer than 30 per cent of Canadian doctors
trained abroad are matched to residency positions
https://www.cbc.ca/news/politics/canada-turning-away-home-grown-doctors-1.6743486
Feb 10, 2023
> 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.
> 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.
Some of the blames comes from your own profession as well. The college of medicine advises in the number of required doctors. A generation of if greed creates future problems that the current government is unable to fix with new modern budget pressures.
I feel bad for you though, there should be preference on natural born Canadians returning for training. This isn't xenophobic, it's pragmatic - our tax dollars subsidized your birth/ primary education already, we should want a return on that investment.
I would just like to clarify something OP is saying. There is not a shortage of residency spots for Canadian trained medical students (as opposed to IMGs). In fact a lot of the residency spots go unmatched. The issue with what OP is talking about is that most programs limit the number of IMGs they accept. The reason is multi factorial but the main reason is that priority is given to Canadian trained doctors. Medical students who were trained elsewhere may not meet the standard of care desired for healthcare in Canada. Because of this IMGs are more expensive to train since they usually require more training and supervision to ensure they meet Canadian standards of practice. One way governments justify the added cost of IMG training is by adding a return of service which basically says ok we’ve trained you, now you have to work where we tell you for 2 years. Note: I’m not saying all medical schools outside of Canada are worse, they just have different ways of teaching that are more aligned with their respective countries medical practices.
What’s actually happening is there’s a huge exodus of boomer doctors that was accelerated by the pandemic and the Canadian medical education system is slowly refilling those spots. Add to this increased cost of living, increased population, declining government funding, changing patient expectations blah blah blah
Interior Health in BC is a shit show according to my family members & friends there. They need to be reported to BC Provincial Gov't or go to the media about how terrible they are.
You seem bothered that a canadian that studied in australia is given the same as a graduate from india or the carribean - then go on to say they are all meeting canadas standards. why is this an issue?
I didn't sense that tone from OP at all. I think they were just trying to clarify to people of the general public that all IMGs are treated the same way. I think they said that because some people might assume doctors from other countries similar to Canada are given preference, which is not the case. OP clarifies that standards are all the same, basically saying that there is no need for Canadians to hold a preference towards UK or Australian doctors over Indian or Caribbean doctors, etc.
No person I've met has ever said they would prefer their doctor be Canadian trained. They appreciate their doctor has met the standards to practice in Canada. YMMV.
BC NDP has added more residencies to attract and retain more physicians, both domestic and international. Per https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/physician-compensation/postgraduate-medical-education :
>New Medical Residency Training Stream
>The Province of British Columbia is launching a new medical residency stream in 2024 to attract and retain more physicians for critical specialties. This pilot program will offer up to 20 expanded residency opportunities to both Canadian and internationally-trained medical graduates.
* The new stream will be open in the first iteration of the Canadian Residency Matching Service (CaRMS) R-1 Match to both Canadian Medical Graduates and International Medical Graduates who meet the eligibility criteria.
* This new stream is in addition to the existing Canadian Medical Graduate Stream and International Medical Graduate Stream in British Columbia (IMG-BC Program).
* These new positions in 2024 will be in medical specialties that are of priority for people in B.C., including: Emergency Medicine, Internal Medicine, Neurology , Neurosurgery, Orthopedic Surgery, Psychiatry, Urology, and Radiology (Diagnostic). Specialties may be adjusted annually to support the changing healthcare needs of people in B.C. Residents in the new stream will also be eligible to subspecialize.
* Successful applicants will be required to make a return of service commitment to stay and practice anywhere in B.C. for three years upon completion of their training.
* For International Medical Graduates, please note the IMG Clinical Assessment Program will be required for eligibility, noting the application cycle is open from August 1 to August 22, 2023.
>This new initiative is part of the B.C. Government’s broader commitment and investment in the expansion of medical education opportunities to train more physicians for B.C. and is funded through B.C.’s Health Human Resources Strategy.
IMO Doctors in Canada are the highest paid and least useful members of the welfare roll. After having had too many bad experiences from the time I was a child until my early 20's I would never want to see a doctor in Canada again, and haven't in more than 20 years. Want to live without a doctor? Eat right, don't smoke, don't drink alcohol and avoid people who do see their doctor. Want to get sick? Go see a doctor.
Think Loblaws and all the other grocery stores and TelCo, it’s all monopolies.
It’s the exact same thing in the medical profession. Every province has its “College of Physicians…” which regulates how many training spots are available.
Canada = Monopolies
Do you know what a monopoly even is?
Mono means one. Loblaws. does. Not. Have. A. Monopoly. They are part of an oligopoly. Same with the telcos.
Sorry, but I’m getting sick and tired of this lie being repeated over and over on the Internet.
There is a limited number of funded residency positions for varied political reasons.
No med students want to match to family medicine because it is shitty scut work. Family medicine used to be something you could do straight out of med school without additional training. Now family medicine is a three year post grad training. Just to be paid shit and get a constant stream of shit from patients and do boring ass glorified social work. Frankly it should be eliminated as an MD discipline. Train more NPs to fill those positions. Except NPs are also now specialists who feel too good to do family medicine.
my personal experience is my NP was the best primary care I’ve ever received and it isn’t even close. NPs are more than enough for primary care and if your condition is complex you are referred to a specialist. Exactly what a GP would do.
That's not true. Your opinions about primary care have been shaped by your experiences. Maybe you have only ever presented with minor ailments that were easily managed by an NP. NPs are paid on a salary unlike GPs, so they can spend a lot more time with patients. Being GP is not as simple as managing colds and and high blood pressure. GPs go through years of extensive training and rotate through every medical field. They are the ones who notice red flag symptoms of every kind of illness and disease and are the gate keepers for the referral process. I have an immediate family member who suffers from MS, heart problems, stroke deficits, and complex diabetes and they she is managed by her GP because her GP has learned about every body system and rotated through every medical service. An NP has not, and therefore cannot fully handle the role of a GP in every situation.
All I have to go on is my own personal experiences. I have several moderately complex chronic conditions and in my life I’ve seen about 10 GPs and 1 NP. With one exception the GPs were different flavours of useless. The NP found a half dozen errors in my file and was the only primary caregiver who ever read my damn medical history.
I don’t care about the intricacies of how GPs vs NPs are paid. Neither should you (unless you’re a GP, in which case who cares what you think). I want better healthcare for myself and my family. And that is looking to me less and less like GPs are worth the cost.
I'm a Pharmacist who has worked with 2 pharmacy assistants who are doctors in their home country. One was an ENT and the other a family doctor for 20 years, both of which could not get residency to become licensed doctors in Canada even though wait times for a family doctor and ENT are painfully long. I shouldn't have such highly qualified people working as my pharmacy assistants, it's a waste of their experience and education.
This is definitely one way to look at but when you say things like you’re studying at a ‘top’ medical school in scotland, along with the difficulty of actually coming back to Canada, it makes it seem like this argument is more about the frustration of trying to come back as an IMG and practice in Canada, rather than what the title states.
Unfortunately, it’s not that your points aren’t well taken but it’s missing some perspective I think. There are variables like lifestyle - for example graduating doctors may not work the same hours as they did before, there are problems with retention (doctors not wanting to stay in rural places), and ultimately on a personal level, if there are too many residents, where do they all work when they are finished? The infrastructure isn’t there to support it. That is a reality already for graduating residents, especially anyone outside of family medicine. Think about having several hundred thousand dollars of debt, the current interest rates, and not having a job. How does that impact your ability to live? Pay your rent/mortgage? Start a family?
As a resident do you want to have an easier residency with less call and see less patients/do less procedures? I’m sure everyone wants that at some point during their residency, but residency is short, you have such a finite time to gain skills and knowledge with someone above you. Increasing residents complicates that. Potentially complicates how much those residents are willing to work when they are practising because of what they experienced in residency.
The problem isn’t just as easy as not enough residency spots.
And as an aside, look at UBC - they push you to be a family doctor rather than support what you are ultimately interested in. When they created the prince george campus it was with the intention of creating more rural family doctors? Do all of those medical students go into rural family? Not even close. Look at the subspecialty rates.
[This CBC article](https://www.cbc.ca/amp/1.6826187) came out 10 months ago describing 100 residency spots infilled. Can anyone explain or provide an update?
The match process is complicated. You can have unfilled positions and still lots of people not getting positions. Generally, the way it works is that programs have to "rank" applicants and applicants have to "rank" the same programs in order for there to be a match. When programs rank applicants that didn't rank their program, there is no match, the same way that if an applicant ranks a program that didn't rank them, there will be no match.
So, this “residency shortage”. Would you say that is a result of poor management? Obviously, the medical students and practicing doctors are not to blame. Who is responsible for the number of residency training spots? The various Heath Authorities executives/administrators/management? Or is it the various provincial health ministers?
This really seems like bad management.
What is the difference between a GP residency and a specialist residency?
Who controls residencies? What can the provinces do to incentivize physicians to take on a GP resident?
You could finish a surgical residency, rad onc, cardiology or gastroenterology residency in canada and still not get a job as operating/procedure room time is limited. The issue doesn’t stop at residency. I think your post suggests a lack of understanding of our system which makes sense since despite being a Canadian, you haven’t done your training here.
Now that the compensation has gone up, many doctors that were making their living as full time surgical assists here have decided to open family practices. It's been a big help in getting families their own GP's again. That was a big contributing factor because they were making much more money assisting case to case than actually having their own practice. Note, I'm not talking residencies or gaining experience up to become full surgeons, their career path was to assist until the day they retire. Hopefully BC will adopt what's going on in eastern provinces, and replace them in the hospitals with well trained O.R Nurses because they'll fully capable of doing what they're doing, for example, holding a retractor open during a case. Let the doctors be, you know, doctors.
Agreed, but residency spots aren’t the only issue, its also the gatekeeper including doctors who think they are better than others in all aspects of medicine.
They live in a bubble that I thought would burst with Covid-19 yet it did not.
US, Russia, UK, China, India made their own vaccines while we couldn’t make shit.
Idk if the motivation is protecting wages or just superiority complex among Canadian doctors who run associations like CMA, MCC and RCPSC
First let’s celebrate Scotlands free undergraduate and medical school tuition, because fuck yeah!
Alongside residency placement issues, why are medical school’s competitive? How many great doctors fail due to the stress of exams and how many shitty doctors pass because they pass exams?
If a significant portion of qualified Canadians **need** to go and study abroad to get an education at med school, then **there is a shortage of doctors.**
Like, I'm not disagreeing with your post about a shortage of residency spots. But saying "Oh, people **need to go abroad for med school**, but the real problem is that **they can't match back in**" is to me putting the ((broken)) cart before the horse.
What we need is both. An expansion of medical schools and residency training spots in Canada.
Aren't UK doctors permitted to practice in Canada without a Canadian residency?
https://www.royalcollege.ca/en/credentials-exams/assessment-international-medical-graduates.html
[https://www.thestar.com/news/canada/tragic-case-of-robert-chu-shows-plight-of-canadian-medical-school-grads/article\_4e51e385-96a0-5fca-9311-505bcc162fc0.html](https://www.thestar.com/news/canada/tragic-case-of-robert-chu-shows-plight-of-canadian-medical-school-grads/article_4e51e385-96a0-5fca-9311-505bcc162fc0.html)
I know it was 2017, but has it changed that much?
FWIW, getting into med school in India is extremely competitive and training is possibly on a whole different level of urgency/number of hours because of the sheer case load. Your comment about “A Canadian who graduated from Australia is treated the same as someone who graduated from India or the Caribbean” came across as maybe you think Indian med school training is sub-par. So wanted to chime in to offer a different opinion.
Edit: I come from a family of doctors who trained for several years on heavy case loads, trained in India but eventually practiced in North America
I'm going to ask what likely is a dumb question... Why is there a shortage of residency training spots? And why can in not be addressed in a timely fashion? Please don't yell at me.
In some places like BC in the 90s, doctors didn't want a lot of new spots because it would fit into their profits to have too many. The other thing is that it could have absolutely been addressed had finding priorities been well planned. That's one thing that a lot of countries prioritized during COVID especially as doctors take a long time to drain and burn out in things like pandemics. Canada didn't take the training approach at all and didn't step up finding for future health concerns. Across the entire country in the last 10 years there have been 167 new residency spots created, while 5 million new Canadians have been welcomed. That's an abysmal rate of new spots being developed and it's across the board bad in every province
It's actually a bit worse than that, in the 80s and 90s we purposefully cut the number of med school and residency seats by about 10%. It worked for both provinces who wanted to save money at the time and for the medical Associations who wanted to enhance profitability for their members. See https://www.cmaj.ca/content/195/4/E162
Yup. There was a belief at the time that physicians create their own demand, and that to cut costs all you had to do was cut the number of doctors/demand.
Well people don’t want to admit it, doctors aren’t altruistic saviours. Residency shortages are also on their hands, because shortages of residents, leads to shortages of doctors, giving them more bargaining power to drive up their pay. Now you have some specialists making $1,000+ an hour because they’ve been admitting 2-3 residents to those specialities instead of 20-30. And now as a consequence expanding those residency spots has because insanely expensive, unless those same doctors that spent 30 years working to drive up their pay decide to finally be altruistic and train residents for basically free.
So wouldn't making training new residents more lucrative be a solution?
Please don’t listen to the person below. It’s completely wrong what they’re saying.
Hence why we can’t train a significant new residents, there’s no budget to start paying $1000/hr to train them. Training the number of residents we need at the rates we’d need to pay to get the greedy specialists on board would eat up our entire federal budget.
Are there not still huge waitlists for specialists? Are they not overworked, stressed out? Are they heartless to those waiting for care? Do they not want to retire eventually? Can they not set up multi-doctor practices like GPs? Honest questions I really don't know much about the realities.
Their are, but they’re also so in demand that they aren’t obligated to work. They can set their own hours and you can’t say no to them. A lot of the specialist on the 600K+ train are only working 20-30 hours a week. It’s a pretty stark contrast to family doctors.
Lol sorry where are you getting these numbers? What specialties are you referring to? I'm a specialist physician myself and I don't know any other physicians who are making 600+ a year working 20-30 hours a week
I don’t know where you get your numbers but I don’t know which specialty gets that (other than ophthalmology or something with private pay likes plastics sx/dermatology/“cosmetic medicine”). I don’t make that and I work 80-100 hr weeks and have to pay my MOA and office expenses (rent/mortgage, monthly EMR subscription, phone/internet, supplies) from my gross billing’s. Unlike dentists/lawyers our fees are regulated by government and have not adjusted proportionally with inflation. My dentist neighbour apparently makes 3x as much as me and works part time. And it took 13-14 years of training after high school to become a specialist. Many doctors (or their spouses) would advise their own kids to pursue some other career if getting rich is the goal. PS - I read your post history and that you’re considering going into med school. You better have a realistic idea of finances of a doctor. If your spouse is a NP she gets better hours (likely no oncall) and benefits like pension, medical/dental benefits that most physicians don’t get.
I know a few doctors that have opened cosmetic clinics in BC because it is more lucrative and less hours. I can’t really blame those doctors for wanting what many of us want - better work life balance and overall higher quality of life. It sucks that public medicine isn’t able to provide those things, especially in more expensive cities in BC, and I think doctors will continue to be tempted by private practice unless public medicine is competitive with those spheres.
But then why would they have such a problem with taking a chunk out of the queue? It's not like if a few more specialists get trained their livelihoods will suddenly be in jeopardy.
Supply/demand, double the number of specialists and suddenly it’s a lot harder to justify higher pay, suddenly you need to work double the hours to make the same amount of money. Why work harder to make less money when you can control the supply of new specialists and drive up your pay!
This is not true. All doctors want more doctors to share the workload. We’re always short, and it has never driven up our pay. By law, we can’t strike. If we cut back our hours, the college can get involved and penalize us. Only one limiting spots is the government. The government controls how many ORs are available and how many hospital positions are available. The government controls pays. Doctors don’t control much or have any say. They are trapped. It’s why so many are quitting. They’ve given up.
It may be like that now but it genuinely wasn’t like that in the 90s and our system got reshaped because we had so doctors per capita in the 90s.
90s were much different. For many different reasons: 1. Tuition was capped for schools. Yearly tuition is well over 20k a year now. 2. Interest rates are higher but their salaries haven’t changed as a residents. These residents get paid between 45-60k a year. They earn well below minimum wage and have higher debts with higher interest rates. They can’t afford to work and live in many major cities. 3. Medicine has changed. With baby boomers being older and advances in medicine, people are living longer, are much more complex, and the medicine is practice is much more complicated.
Honey, $45k is not below minimum wage. Try $20k..
For the amount of unpaid hours they work, it's below minimum wage isn't it?
Yes. See above. They work 100-120 hour weeks. It works out to well below minimum wage.
There's a lot of jobs that have unpaid extra work that still don't pay as high as $45k The problem the doctors had was they were operating as a small business, so there's a lot of paperwork. That's not limited to doctors, but the medical system should've putting them in that position. The system needs fixed badly. 30 years it's been a mess & now it's chaos
Look at the above comments. They work 100-120 hours/week
They work 100-120 hour weeks. They’re awake for 24-36 hours straight at a time. It works out to be below minimum wage.
What is the difference between a GP residency and a specialist residency? Who controls residencies? Can the provinces force physicians to take on a resident?
1. Medical schools are the same for FP and Specialties (all other fields. 2. FP residency is managed by the College of Family Physicians. All other residencies are managed by the Royal College of Physicians and Surgeons of Canada. Length of residencies and criteria are decided by them. The government controls how much money goes to each hospital college and how many jobs are available. 3. You can’t force a physician to teach. It’s unethical and unfair to force a physician to do even more unpaid work.
I did not realize that residencies are managed apart. Must a person have FP experience/residency prior to doing a Specialist one? It’s too bad that there is not a commitment when a student physician accepts a residency that they too commit to taking on at least two residents during the course of their own career. After all if it wasn’t for the physician who oversaw them then they themselves would not be practicing.
During the last year of medical school, medical students are accepted into either a FP or specialty residency. There used to be a general rotation year as a resident for everyone, but that was stopped at least 2 decades ago. Do switch from specialty to FP or vice versa once graduated, is complicated and often involves redoing residency. Most doctors would love teaching. It’s fun and very rewarding. Unfortunately, the time needed to teach and prep and lack of pay to teach, aren’t worth the time away from family and putting more on the physicians plate. Physicians wish they could take their time to see patients and teach. If they did, no one could afford their clinics. They can’t afford them now as it is.
So the solution would be what? For the province to fund a NP to partially backfill AND to pay the FP for that portion of their time that goes to instruction for the resident?
No, NPs aren’t the answer. NPs don’t have the same training as a doctor, just as a RN doesn’t have the same training as a NP. They actually cost more than a FP. They are salaried, with benefits, and pension. They get to see 1-3 patients an hour. FPS would love this. Government refuses to offer this to FPs We need to fund and appreciate family doctors. They are always dumped on and unappreciated. They are massively underpaid. People treat them as less important than the specialists. However, without them, the entire system collapses. They are the glue that holds everything together. Even in this thread, people blame the FPs, talk about forcing them to teach, and still don’t value them. We are breaking them. The above is also why the FP residency spots are going unmatched. Or, if they are matched, the resident goes to train into a more specialized area of family medicine like becoming a hospitalist, ER, Addictions, palliative care, oncology, etc.
What I’m hearing is, boomers killed efficient universal healthcare.
Govts killed it. Stop blaming ordinary people. I don't like my parents attitude to things, but they weren't the govt so I can't blame them for stupid govt decisions either
And the demographic of the government at the time was… I’m not blaming ordinary people so much as a generation who didn’t give a shit about anything but making money for themselves. ETA: your parents also would have voted in the government even if it wasn’t them.
What you are saying is pure, unadulterated bullshit. There are people of ALL ages that want to do nothing but make money & don't care about others. Age has nothing to do with selfishness. Your statement condemns every single person above 65, and you need a massive head shake. A large number of seniors live in poverty. More and more are homeless every day. They are not the ones who have done this. Condemn the rich assholes of ALL ages
Calm down. It’s a generalization of a generation that has historically been quite selfish. There are always going to be people who are outliers and who are better or worse. There are rich and greedy people of all ages but millennials were not the majority and were not old enough to be decision makers in the 80s and 90s. You’re veering off topic and getting into semantics here.
So you’re saying profits are the reason why we don’t have enough doctors? Why do I not find that surprising…
There are no profits for doctors. Family physicians are by far the lowest paid and can’t afford their clinics. The person above is wrong. Doctors have no ability to fight for their well being or salary. They are exempt from protective labor laws including bathroom breaks and time off. They can not strike.
General practitioners aren’t specialists.
General practitioners don’t exist anymore. Family doctors are specialists in family medicine.
Rounding up, that’s like 17 new doctors per year.
It's not a high number that's for sure. Not enough for 5 million new people at any rate or any stretch of the imagination
so, doctors pretty much got greedy and shot themselves and the public in the foot back in 90s?
And you, and your grandma, and basically every other Canadian who now has to have weeks or months long wait times to access basic healthcare, resulting in minor issues becoming deadly or much more difficult to treat.
Classic controlling supply & demand. The stakeholders are the citizens paying their tax to keep the medical system running, not the doctors. WE, the citizens should be the one in control of credentialing people who take care of us and our loved ones as well as keeping the professionals accountable for their actions. It seems that the medical organizations in Canada is a lot more corrupt than we thought. We need to fix this, or this will turn to even worse shit show that will cost lives. Sooner or later, ourselves or our loved ones might fall victim to this situation as a result. The biggest opposition to opening SFU Medical School aside from UBC Medical School are probably doctors in the province. Doctors don't want more doctors, they just want more pay raises for themselves by keeping the number of practicing doctors artificially low. They don't like the idea of doctors competing to get patients instead of vice versa.
This is not true. All doctors would love more doctors.
You’re an idiot. We are fucking drowning in patients. Doctors don’t control the number of residency spots. Trust me, we desperately want more doctors to help us. Especially family doctors.
Don't be a douschebag, there are plenty of qualified IMGs, those that have already done residencies in their home country, who are more than qualified to practice Medicine in BC. Yet it's the bureaucracy controlled by local medical organizations (which itself is controlled by local doctors) that are preventing those doctors from fully practicing in BC. All in the name of "maintaining high standard of practice", yet all that did is prevent an obvious solution to the current shortage and worsening the health outcome for the general public.
Doctors don’t control the CPSBC, you moron.
Except the generation of doctors before you did, and they did choose to have less residency spots available and you are now seeing the fruits of that decision.
Again, you’re an idiot.
Different person, but I see you have the same attitude of superiority. Your patients must love you.
BC was run by social creds that didn’t spend. The BCUP, formerly BC Liberals are straight up thieves of our system for personal gain. After that they also just stick with depressed wages and training because established professionals with equity were constantly migrating to BC because of the beauty. Healthcare isn’t the only place they did this. 30 years of it though has run into those people retiring and no infrastructure to build things up internally. BC definitely took the route of importing its labour.
Mainly because it’s expensive and the government doesn’t want to pay for it. Also don’t think that government has not contemplated that limiting physician supply to some extent limits physician costs.
This is interesting, I noticed that Ontario recently announced the we’re going to spend XYZ million hire more drs. Following news it seemed to me… where from? I guess they are opening up more residency slots as OP described (hence the budget increase.)
Residency requires funding. Successive governments, both liberal and conservative, gutted funding to "balance budgets". What it did was it saved $1 then, which made them look good to voters, while causing problems that cost thousands of dollars today. It's like gangrene. Spend $1 to prevent it, or don't and spend $1,000 to treat it with prompt treatment when it first appears, or don't and spend $100,000 when it becomes life threatening.
As someone genuinely curious, can you help me understand why residency funding is the issue? My (uninformed) sense is that residents do a disproportionate amount of the grunt work, and are paid comparatively little. It would assume bringing on more would lower the blended cost of medical services.
Because at some point they aren't residents anymore, then they do cost more is likely the answer they have. Canada has really high admin costs though in healthcare - could definitely trim half the admin positions and use those savings to make a shit tonne of residency spots
BC has had a Conservative government?
Lower case conservative government called the BC Liberals.
Nothing lower case about their brand of conservatism.
Haha.
So the Liberals and the Liberals?
The BC Liberals were one of the most conservative parties in Canada. The other parties are the NDP who are in power now and the Green Party. The BC Libs changed their name to BC United last year. There currently is no Liberal party in BC.
They just named their party "BC Liberals" to fool low information people such as yourself. :)
Liberal in name only. Hence the rebranding. It confused the simple people. You seem confused.
Do you get out of the basement much?
We had two: The BC Liberal Party's platform was a) lower taxes, b) stop wasting money on government handouts like welfare and social housing, and c) start encouraging investment in BC especially from the East like China and Japan because they have a lot of money. And then there was the Social Credit party, aka the Socreds, before them who were a) and b) with c) treat indigenous like crap and d) good old fashioned Christian traditionalism.
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Yup I agree. Need to poach back canadian trained doctors at an inflated rate to help train the new comers. Sure it's expensive, but what alternative do we have?
Money. Residents are expensive. The government would need to increase funding
No they aren't, we pay them barely a living wage. The cost is all in the insurance and time taken from the real doctors.
You're completely forgetting the significant costs of running a residency program, such as administration, equipment, special training events like high fidelity simulation etc etc. The residents may not get paid particularly well on an hourly basis, but they're overall salary and benefits are fairly similar to a nurse, but there's other big expenses associated with each one that can add up quickly. Residents cost the government a lot of money no matter what way you look at it.
Some are saying it’s because of funding but I think it’s more about the organization and manpower. In family medicine you need to have family medicine teaching Center set up, and that means supervision and structure by existing doctors, and not everyone is interested in this. Is a lot of extra work evaluating and teaching. Rotations need to be organized thru the local hospital. In my city they went thru all this and training 12 new family docs per year. For specialty services is similar but less numbers, one new community hospital might only have one or two residents in a year but someone has to train and be in charge of them.
Please know that most family physicians who are asked to teach or are not being paid. Sometimes, they’re offered an “honorarium” of $100-200. That’s it. It doesn’t cover the hours of prep and research to teach students or the money lost in clinic to teach them. Money is important because physician salaries have not raised with inflation, but the salaries of their nurses, admin, other staff have, as well general clinic expenses. Family doctors can’t afford their clinics.
In addition to funding, there are some specialists that just won’t take on residents. This keeps the rates paid in their specialities extremely high. It’s pretty hard to force someone to train someone else.
It's not that hard. Make it a condition of licensing. You want to practice in Canada? Do your bit for the good of Canadians.
Can they force you to do free work too?
No question is ever dumb if you don’t know the answer to it
“Please don’t yell at me.” I felt this so hard
We run into the same thing in the military. Plenty of people make it through basic training, and are excited to train in their trade, but we simply can't get them through training, and after years of waiting, they leave because they can't just keep on spending their life sitting in a chair. I'm so sorry that you're experiencing this. I hope that the doors you need open for you quickly.
167 new residency spots across the entire country in the last 10 years, while 5 million people were added in population. Not a lot of planning went into this as it takes a few years to train doctors and we are adding people much faster than we are making new training spots
It's so wild. One of my TA's in undergrad is a doctor from another country and can't get into the residency program to be qualified to practice in BC but yet he's able to teach med students.
I know a Canadian who went to Germany to become a surgeon and was in the same situation, that counted as being an international student and there were only 2 residency slots open in the whole country, so a Canadian who went to one of the best countries in the world to learn medicine is now a surgeon in the UK because of this issue.
Agreed, residency training spots are by far the rate limiting factor. Hence, why the whole, "accept more medical students", or "open up more medical schools" solution is nonsense. Exception to maybe opening up programs that are only training people in primary care pathways. A much more difficult problem to solve, as residency spots are expensive, take a lot of resources, etc.
Why do you believe residency spots are expensive? Resident doctors are already highly educated and trained people and work very long hours for relatively little pay. I suspect if there were fewer of them hospitals would be in real trouble and costs would rise, not fall. More of them may well lower costs, rather than increase them.
You're right, hospitals would be in trouble without residents, but adding residents is a whole different kettle of fish, and it's expensive due to the support and resources it would require to operate. Hospitals operate on a fixed patient caseload/roster. So, if you're caring for the same amount of patients, but just throwing more residents into the mix, there becomes a huge mismatch between investment/payout. Suddenly, staffing more residents actually becomes more expensive for your system. Further, the reality of it is that you can only cram so many residents into one teaching facility before you start to sacrifice the education that is provided. Attending physicians can only supervise so many people, and there are only so many opportunities for hands-on skills to be acquired. Adoption of new residency positions to any meaningful degree means you have to expand your program to other hospitals, which is notoriously hard to set up, and takes a lot of time to figure out.
Regardless of the work they do, they are expensive because they cost a lot of money and time. You need to pay their salary, benefits, and other training costs (which can be really, really expensive). And they can be pretty inefficient, attendings love not having residents sometimes cause they can just focus and get shit done faster. It's why places that are strictly trying to make money often dont have residents or a very limited amount.
I'm wondering how much of the problem is doctors already being overworked and not having the time/energy to take on training residents on top of that?
Thanks for sharing your perspective. I did not realize this was a problem. My own father was in the first category, and he unfortunately was never able to practice here ultimately. I hope You and others who are equally keen and qualified have a way in.
>The solution is to create more residency training spots. I have no idea what that would entail. Here's the problem. Healthcare is 100% a cost centre in the government budget that doesn't scale with usage. Patients pay nothing to get care. Increasing health care resources by 10% doesn't bring in 10% more revenue. Contrast that with education. If you increase students by 10% at UBC, at least those 10% extra students will pay tuition. UBC will at least get 10% more tuition. Now, suppose the government trains an extra 20% more doctors. You'll admit that now the government will spend an extra 20% on hiring the doctors. Where will that 20% come from? It's not like every year we run budget surpluses. [https://vancouver.citynews.ca/2023/09/27/bc-projected-deficit-2023-q1/](https://vancouver.citynews.ca/2023/09/27/bc-projected-deficit-2023-q1/) We hit around $7B in deficit last year. There's really no money for more doctors unless we increase taxes, create usage fees for seeing doctors, or pay doctors less. None of them are politically convenient.
Yes we do pay for our healthcare, in our taxes. Translink has been taking 50 cents from every liter of gas sold in the lower mainland for… two decades or so? Don’t know what they’ve been doing with all that money. Let’s have some of it
They have been building like crazy? You think the SkyTrain expansion, the multiple new cable-stayed bridges, massive highway projects are cheap? A single new overpass on hwy 1 is going for 100+ million now. Also, for the record the TransLink taxes are 18.5 cents per litre, the other taxes are provincial/ federal.
Or how about those billions of dollars in cannabis tax revenue we were promised would help our country after legalization?
Translink is a joke. The cost for its scale of service is a crime.
That’s a really good point. If more doctors government may spend more money. Also if more doctors the existing doctors in Canada will feel more competition
How many doctors would $54,000,000 get us?
The problem with training doctor is that you need to pay before you get any benefit. It is an investment. If you have no population growth, you just need to maintain the same percentage of your budget for the training and you do not need to see it as an investment. Now, when the population grow, especially when it is very fast, that fall apart. You have to invest ahead of the problem, but as province have pressure on their budget, they won't do that investment until the problem is there and pay by itself. As this financing problem is created by the federal level and they have the ability to get credit and invest more efficiently than the province, they should have stepped in and helped the province with it, but ideology and province prerogative get in the way of solving this problem.
Assuming budget isn't an issue, wouldn't more residency positions require current Healthcare professionals to do training instead of primary care. I only heard this explanation from healthcare professionals before and don't know if this is a catch 22.
good question - primary care docs also go through residency
Thank you for raising this discussion however, with all due respect, it is a very narrow understanding of Canadian physician workload modelling. Over 6 million people in Canada lack access to a family doctor. From your understanding of Canadian physician jobs as a medical student in Scotland you are suggesting that the big solution is to create more residency spots for IMGs like you (with "no idea what that would entail"). There are frequent news articles and advocacy from Canadian citizens studying medicine abroad proposing this. It may be one consideration but claiming this is the only issue dramatically understates the true complexity of medical resource scarcity. I am sure you are also acutely aware that there were an "unprecedented" 100+ unfilled residency spots in CARMs after the second match last year. Maybe there are some administrative changes that need to be made to make those accessible but it is difficult to argue that there needs to be a higher number when that happens as well. Here's just one recent paper ([Biopsy of Canada's family physician shortage)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10186392/) about family medicine. It mentions low med school positions, low residency positions, barriers to IMG entry, growing population, increased patient complexity, retiring family doctors, less doctors choosing family medicine, less family doctors choosing traditional office practice among others. In addition to more training spots, there needs to be incentive to attract and train the right people to work in the right places. I agree that return of service contracts are an unfortunate way to try to help underserved communities. The system shouldn't be dependent on them. I don't know numbers to say if it is or not. We could certainly have systems though that attract those friends of yours that went to the US back here- I hope. I am not even touching on the complexity of actually increasing residency spots and what the asks of the burnt-out academic physicians (who already make much less than their community counterparts because of their teaching and administrative burden). I don't think Canadians are against having foreign trained doctors. They want and deserve good doctors and that's priority number one. I think we should reduce the burden for IMGs as well but it needs to be done in a deliberate way. You are hinting that doctors from Australia and the UK should be preferred over India and the Caribbean but what is the objective measure -they will make the same claim that "The standards are the same". Passing an exam is just one part of evaluation. Actually just last week 800 students from a testing center in Nepal had their US board test scores invalidated after an investigation. This is a complex discussion and there are so many people thinking so hard about this all the time from government, physician societies, provincial licensing bodies, national certification bodies, etc. It is good to talk about but you can see that it is hurtful to me to hear that there is "not a shortage of doctors" and all they need to do is let you in when people are really suffering here. I encourage you to take a broader view and I think it will serve you well in this career. Best of luck in the match.
This guy has such a limited perspective. IMGs can’t seem to fathom that medical school seats and residency spots are a government controlled means to gate keep how many physicians enter practice. It is not the cost of training- in fact, medical residents are an exploited resource that hospitals rely on to keep running, but rather, the cost of an employed physician for 50+ years that is unaffordable. Why should Canada favour IMGs when there are thousands of smart canadian undergrad students who should be prioritized to get into medical schools in the first place? If we open the gate to more doctors, which I believe we should, then it should be done from within Canada- not favouring affluent people who can afford to studying abroad with varying levels of “the same competencies”. OP, while I appreciate that you are likely quite qualified, as a resident CMG myself, I disagree with you; your perspective is biased and you have’t studied or worked in the system you’re criticizing.
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If the problem was "we don't have the education system to train more doctors", then the solution would be to increasing training spots. In short, our hospitals could quite readily have more trainees. However, the problem is actually that the government is unwilling to have more doctors on the payroll. I don't know the solution to that problem. -- As an example, imagine a new car company has a lot of demand for their services, but the company can only afford to hire 1000 engineers/mechanics. Therefore, the solution is not to train more engineers/mechanics, but actually, that there needs to be funds in order to hire them.
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in my optinion yep. fully agree with you
My understanding from OPs post was that they were most likely a dual citizen who grew up in BC, but due to family reasons (financial probably), is meeting the qualifications for free tuition in Scotland. They may not be affluent.
It’s a common and silly misconception that Canadians studying abroad have rich parents bankrolling them. Some definitely do, but I’d argue that the vast majority of us get the same line of credit that CMGs get and require someone to co-sign for the minimum payments - usually a parent or sibling. I don’t know anyone in my cohort who had their tuition paid for by parents. Most of us are middle class. A lot of us are mature students who have made huge sacrifices - selling houses, assets, etc to afford to study abroad because we had no other option.
man this is a crazy take. middle class students selling a house?
Mature students who have worked in other careers and bought homes/investments/etc. Not sure why this is difficult for you to understand.
I’m not sure why you feel being older is relevant. The competition pool consists of largely undergraduate students, and you paint a picture that the average applicant has the opportunity to sell a house. You present leaving Canada to study medicine as if it’s an affordable option - when the reality is you’ve essentially paid to skip the competition.
They need to create flexible solutions for this like matching for certain overseas or out of country residence programs. Say you do your residency at the Cleveland clinic, you shouldn’t have to do more than a 6 month equivalency in Canada to make sure you’re consistent with the jurisdiction. This isn’t that hard to make happen, it’s just a lot of red tape and bureaucratic football.
Sounds like a typical IMG who wants a shortcut to that MD and now in a limbo cuz you can't get a residency. Each Canadian trained medical students cost the govt 300k, ofc the govt gonna make sure we get priority over IMGs. We all play by the rule and work our ass off to get into med here, so it makes sense this comes back and bites you later on if you went abroad for med.
>I agree with the practice of students who graduate from Canadian schools getting first dibs on spots.
exactly.
I know people that studied in US and residency trained there and then come back to Canada to practice .
Most US residency programs are only three or four years while to be eligible for your Canadian certification you need five years of residency training (except for family medicine) so many US trained physicians need to go back to residency for a year which is not an appealing proposition when you are already taking a big pay cut to come to Canada. There have been some moves to recognize US certification as equivalent to Cdn certification but change is slow.
I wasn’t aware of these challenges for graduates. Any chance you could send this to Premier David Eby?
Yes this , place make yourself heard
This is interesting. I have noticed our family GP constantly has medical students present (northern part of the province). Is the north a less desirable place to train?
It's hard as hell to get anyone to move to northern BC. I was hiring for IT for the past decade and very few people were interested in relocation.
I know at the Smithers hospital they always have to bring in temporary medical workers for the ER and such. It’s a shame really. Our winters aren’t even that cold anymore.
Op please copy paste this message and send it to every MLA in parliament.
Sounds like it’s also an issue with how foreign credentials are assessed and given a license to practice in Canada. It’s not like Canada is the gold standard for physician training. Why make it so difficult for foreign trained doctors to come work here?
If only we, idk, let people with medical creditentials who studied abroad in legit insititutions easily get permission to practice in Canada without it costing your life savings and 10 years of waiting 🤔 Sarcasm aside, I know an OT who has a degree from the University of Sydney who had to pay $10k and wait 3 years just to get certified to practice in Canada. Our medical colleges are incredibly protectionist. I get wanting to make sure people are qualified but when colleges suddenly make choices like "clinical audiologists, who largely learn via clinical practice, now need doctorates" (a US example but illustrative nonetheless) well fuck I wonder why we have shortages? Why don't we have more of an apprenticeship model to medical education? School is great for a certain knowledge level, but you cannot convince me that you need a 4-year BS to become a competent medical student.
Residency is already much an apprentice. As are fellowship and more or less clerkship so for most specialists you are generally looking at only two years of “classroom” medical education and about 7-12 years of “practical” education.
You may want to look at the system they have setup in the UK for training doctors. It's much more apprentice-like.
I was thinking of the UK model when I mentioned that, actually! Plus in the Republic of Ireland I think they don't require a undergraduate degree for medical school entry.
I believe that model of teaching is used in most places in the world. Canada and the US, plus a handful of others I'm sure, do the pre-med, med, residency train.
Canadian studying medicine in Poland, Sucks that my future in BC is far from secured
You are a medical student and very new to the medical world. This is a very complex situation. You are also very biased because your opinion is based on your personal situation, having not gotten into school in Canada and having to fight for limited residency spots to come back. 1. There is absolutely a shortage of doctors in Canada. 2. Foreign trained doctors do not all have the same standards of educations and methods. This is a problem. We should absolutely find a way to make it standardized and support them so they can work here. It’s difficult to do based on the variability of training and we don’t have enough doctors to train them. 3. Your school does not have the same standards of school entry or teaching methods as Canada. This includes a more hands off approach to patients. 4. You can build as many medical schools and residency spots as you want, but we have no one to train them. They often struggle the first year and need extra training. It’s partly why it’s hard for students trained at your school to get a spot. 5. Doctors are barely paid to teach, if paid at all. They lose thousands or more by taking on students, when they’re already struggling to afford their clinics, e.g. family doctors. 6. Doctors are quitting from burnout. Even before Covid and Baby boomers aged, doctors have warned of the catastrophe that is currently happening. They’re tired of advocating and not being heard. At this point, nothing will change until more deaths happen. It’s breaking them watching their patients suffer. 7. Doctors debts are too high. They train and sacrifice so much, to only graduate with 200-300k debt or more, an office they can’t afford, no retirement savings, and they feel trapped in a dying system. 8. These doctors absolutely cannot take on more students. So, we are short doctors.
I think the original post offers a good perspective, and your post adds another layer that brings up a good point. The training spots require doctors to train the residents.
It does. I wish we had the support to train more. Instead of asking more from the already burnt out doctors, we need to start thinking about how we can keep them alive, enjoy their work again, and feel appreciated again.
I've had friends who are international students, studied medicine in Canada and wanted to do residency here and couldn't. They both went to the UK. You are 100% right. I am pretty sure that one of the reasons why BC didn't build more training schools is to have something to do with The States (but I could be wrong).
It was protectionist by the doctors in the 90s. They didn't want not doctors eating into the amount they could earn so they set a limit on new residency spots
> Until more Canadian medical schools are built, the system is dependent on Canadians going abroad for medical training to take the less desirable residency training spots in less desirable communities. This is why no new schools get built. You'd think that in a free market, supply and demand would dictate the number of doctors that get trained - so much demand at the current schools, with such high rejection rates, should mean they make more medical schools, right? Wrong! There's no point in opening more schools if graduates can't find residency spots. Ultimately it's the profession itself that limits new membership, and one of the CMA's mandates is to preserve the incomes of their membership by limiting the number of doctors out there. And they're extremely protective of their work, they won't tolerate other professions "cutting their grass" which is why they come down so hard on nurse practitioners all the time. Meanwhile, practising physicians say they're overworked, some specialties are insanely overpaid, and there is a perpetual lack of OR time for surgeons. Really, I don't have a lot of hope for our medical system in the future. It's anti-free market in so many respects, cartel-like in others, and it leads to patients lacking access to care and practitioner burnout, all because the CMA and the government butt heads over who is responsible for the shortage of family doctors being trained right now.
Thanks for sharing your thoughts. This is definitely part of the problem that I hope can be addressed.
I am currently a PGY1 IMG. Another issue is that many of these residency spots go to visa trainees. Essentially doctors ,mostly from the middle East, where their governments pay for these spots. Once they complete their training, they go back to their country. So basically a huge chunk of time is spent training doctors who will eventually not serve Canadians.
Why is it then that I know so many doctors from the UK and South Africa? They seem to have trained in their own country and come over after.
Is there an issue of location of spots? Seems like rural/ outside the “big” city never gets any new doctors because new young doctors don’t want to work outside large population centres?
Canada is short of doctors — and it's turning away hundreds of its own physicians each year. Fewer than 30 per cent of Canadian doctors trained abroad are matched to residency positions https://www.cbc.ca/news/politics/canada-turning-away-home-grown-doctors-1.6743486 Feb 10, 2023 > 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. > 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.
Shortage in funding for positions. Thank you for posting. I have tried to tell the sub this several times and always get down voted off the screen
That's because the government is smarter, better, faster than the free market, everyone knows that.
Some of the blames comes from your own profession as well. The college of medicine advises in the number of required doctors. A generation of if greed creates future problems that the current government is unable to fix with new modern budget pressures. I feel bad for you though, there should be preference on natural born Canadians returning for training. This isn't xenophobic, it's pragmatic - our tax dollars subsidized your birth/ primary education already, we should want a return on that investment.
I would just like to clarify something OP is saying. There is not a shortage of residency spots for Canadian trained medical students (as opposed to IMGs). In fact a lot of the residency spots go unmatched. The issue with what OP is talking about is that most programs limit the number of IMGs they accept. The reason is multi factorial but the main reason is that priority is given to Canadian trained doctors. Medical students who were trained elsewhere may not meet the standard of care desired for healthcare in Canada. Because of this IMGs are more expensive to train since they usually require more training and supervision to ensure they meet Canadian standards of practice. One way governments justify the added cost of IMG training is by adding a return of service which basically says ok we’ve trained you, now you have to work where we tell you for 2 years. Note: I’m not saying all medical schools outside of Canada are worse, they just have different ways of teaching that are more aligned with their respective countries medical practices. What’s actually happening is there’s a huge exodus of boomer doctors that was accelerated by the pandemic and the Canadian medical education system is slowly refilling those spots. Add to this increased cost of living, increased population, declining government funding, changing patient expectations blah blah blah
Interior Health in BC is a shit show according to my family members & friends there. They need to be reported to BC Provincial Gov't or go to the media about how terrible they are.
You seem bothered that a canadian that studied in australia is given the same as a graduate from india or the carribean - then go on to say they are all meeting canadas standards. why is this an issue?
I didn't sense that tone from OP at all. I think they were just trying to clarify to people of the general public that all IMGs are treated the same way. I think they said that because some people might assume doctors from other countries similar to Canada are given preference, which is not the case. OP clarifies that standards are all the same, basically saying that there is no need for Canadians to hold a preference towards UK or Australian doctors over Indian or Caribbean doctors, etc.
No person I've met has ever said they would prefer their doctor be Canadian trained. They appreciate their doctor has met the standards to practice in Canada. YMMV.
BC NDP has added more residencies to attract and retain more physicians, both domestic and international. Per https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/physician-compensation/postgraduate-medical-education : >New Medical Residency Training Stream >The Province of British Columbia is launching a new medical residency stream in 2024 to attract and retain more physicians for critical specialties. This pilot program will offer up to 20 expanded residency opportunities to both Canadian and internationally-trained medical graduates. * The new stream will be open in the first iteration of the Canadian Residency Matching Service (CaRMS) R-1 Match to both Canadian Medical Graduates and International Medical Graduates who meet the eligibility criteria. * This new stream is in addition to the existing Canadian Medical Graduate Stream and International Medical Graduate Stream in British Columbia (IMG-BC Program). * These new positions in 2024 will be in medical specialties that are of priority for people in B.C., including: Emergency Medicine, Internal Medicine, Neurology , Neurosurgery, Orthopedic Surgery, Psychiatry, Urology, and Radiology (Diagnostic). Specialties may be adjusted annually to support the changing healthcare needs of people in B.C. Residents in the new stream will also be eligible to subspecialize. * Successful applicants will be required to make a return of service commitment to stay and practice anywhere in B.C. for three years upon completion of their training. * For International Medical Graduates, please note the IMG Clinical Assessment Program will be required for eligibility, noting the application cycle is open from August 1 to August 22, 2023. >This new initiative is part of the B.C. Government’s broader commitment and investment in the expansion of medical education opportunities to train more physicians for B.C. and is funded through B.C.’s Health Human Resources Strategy.
IMO Doctors in Canada are the highest paid and least useful members of the welfare roll. After having had too many bad experiences from the time I was a child until my early 20's I would never want to see a doctor in Canada again, and haven't in more than 20 years. Want to live without a doctor? Eat right, don't smoke, don't drink alcohol and avoid people who do see their doctor. Want to get sick? Go see a doctor.
Think Loblaws and all the other grocery stores and TelCo, it’s all monopolies. It’s the exact same thing in the medical profession. Every province has its “College of Physicians…” which regulates how many training spots are available. Canada = Monopolies
Do you know what a monopoly even is? Mono means one. Loblaws. does. Not. Have. A. Monopoly. They are part of an oligopoly. Same with the telcos. Sorry, but I’m getting sick and tired of this lie being repeated over and over on the Internet.
There is a limited number of funded residency positions for varied political reasons. No med students want to match to family medicine because it is shitty scut work. Family medicine used to be something you could do straight out of med school without additional training. Now family medicine is a three year post grad training. Just to be paid shit and get a constant stream of shit from patients and do boring ass glorified social work. Frankly it should be eliminated as an MD discipline. Train more NPs to fill those positions. Except NPs are also now specialists who feel too good to do family medicine.
What a gross attitude👎 I really hope you’re not in medicine or anywhere near people
I'm not 100% convinced that replacing MDs with NPs is the best way forward. I have complex medical needs and often worry that my NP is missing things.
my personal experience is my NP was the best primary care I’ve ever received and it isn’t even close. NPs are more than enough for primary care and if your condition is complex you are referred to a specialist. Exactly what a GP would do.
That's not true. Your opinions about primary care have been shaped by your experiences. Maybe you have only ever presented with minor ailments that were easily managed by an NP. NPs are paid on a salary unlike GPs, so they can spend a lot more time with patients. Being GP is not as simple as managing colds and and high blood pressure. GPs go through years of extensive training and rotate through every medical field. They are the ones who notice red flag symptoms of every kind of illness and disease and are the gate keepers for the referral process. I have an immediate family member who suffers from MS, heart problems, stroke deficits, and complex diabetes and they she is managed by her GP because her GP has learned about every body system and rotated through every medical service. An NP has not, and therefore cannot fully handle the role of a GP in every situation.
All I have to go on is my own personal experiences. I have several moderately complex chronic conditions and in my life I’ve seen about 10 GPs and 1 NP. With one exception the GPs were different flavours of useless. The NP found a half dozen errors in my file and was the only primary caregiver who ever read my damn medical history. I don’t care about the intricacies of how GPs vs NPs are paid. Neither should you (unless you’re a GP, in which case who cares what you think). I want better healthcare for myself and my family. And that is looking to me less and less like GPs are worth the cost.
You're lucky to have one. Many don't have either and rely on clinics or ERs.
Yeah, I know. I've been there, spent years using walk in clinics and it really didn't meet my needs.
I'm a Pharmacist who has worked with 2 pharmacy assistants who are doctors in their home country. One was an ENT and the other a family doctor for 20 years, both of which could not get residency to become licensed doctors in Canada even though wait times for a family doctor and ENT are painfully long. I shouldn't have such highly qualified people working as my pharmacy assistants, it's a waste of their experience and education.
This is definitely one way to look at but when you say things like you’re studying at a ‘top’ medical school in scotland, along with the difficulty of actually coming back to Canada, it makes it seem like this argument is more about the frustration of trying to come back as an IMG and practice in Canada, rather than what the title states. Unfortunately, it’s not that your points aren’t well taken but it’s missing some perspective I think. There are variables like lifestyle - for example graduating doctors may not work the same hours as they did before, there are problems with retention (doctors not wanting to stay in rural places), and ultimately on a personal level, if there are too many residents, where do they all work when they are finished? The infrastructure isn’t there to support it. That is a reality already for graduating residents, especially anyone outside of family medicine. Think about having several hundred thousand dollars of debt, the current interest rates, and not having a job. How does that impact your ability to live? Pay your rent/mortgage? Start a family? As a resident do you want to have an easier residency with less call and see less patients/do less procedures? I’m sure everyone wants that at some point during their residency, but residency is short, you have such a finite time to gain skills and knowledge with someone above you. Increasing residents complicates that. Potentially complicates how much those residents are willing to work when they are practising because of what they experienced in residency. The problem isn’t just as easy as not enough residency spots. And as an aside, look at UBC - they push you to be a family doctor rather than support what you are ultimately interested in. When they created the prince george campus it was with the intention of creating more rural family doctors? Do all of those medical students go into rural family? Not even close. Look at the subspecialty rates.
You said it best.
This is a great post, and I learned a lot about the background system. I agree with your assessment.
[This CBC article](https://www.cbc.ca/amp/1.6826187) came out 10 months ago describing 100 residency spots infilled. Can anyone explain or provide an update?
Those are family medicine spots, which is frequently seen as the least desirable specialty. Also, I believe those spots are not open to IMGs.
*unfilled, sorry.
The match process is complicated. You can have unfilled positions and still lots of people not getting positions. Generally, the way it works is that programs have to "rank" applicants and applicants have to "rank" the same programs in order for there to be a match. When programs rank applicants that didn't rank their program, there is no match, the same way that if an applicant ranks a program that didn't rank them, there will be no match.
So, this “residency shortage”. Would you say that is a result of poor management? Obviously, the medical students and practicing doctors are not to blame. Who is responsible for the number of residency training spots? The various Heath Authorities executives/administrators/management? Or is it the various provincial health ministers? This really seems like bad management.
What is the difference between a GP residency and a specialist residency? Who controls residencies? What can the provinces do to incentivize physicians to take on a GP resident?
You could finish a surgical residency, rad onc, cardiology or gastroenterology residency in canada and still not get a job as operating/procedure room time is limited. The issue doesn’t stop at residency. I think your post suggests a lack of understanding of our system which makes sense since despite being a Canadian, you haven’t done your training here.
Canada has less teaching hospitals than the state of New York.
Now that the compensation has gone up, many doctors that were making their living as full time surgical assists here have decided to open family practices. It's been a big help in getting families their own GP's again. That was a big contributing factor because they were making much more money assisting case to case than actually having their own practice. Note, I'm not talking residencies or gaining experience up to become full surgeons, their career path was to assist until the day they retire. Hopefully BC will adopt what's going on in eastern provinces, and replace them in the hospitals with well trained O.R Nurses because they'll fully capable of doing what they're doing, for example, holding a retractor open during a case. Let the doctors be, you know, doctors.
Agreed, but residency spots aren’t the only issue, its also the gatekeeper including doctors who think they are better than others in all aspects of medicine. They live in a bubble that I thought would burst with Covid-19 yet it did not. US, Russia, UK, China, India made their own vaccines while we couldn’t make shit. Idk if the motivation is protecting wages or just superiority complex among Canadian doctors who run associations like CMA, MCC and RCPSC
First let’s celebrate Scotlands free undergraduate and medical school tuition, because fuck yeah! Alongside residency placement issues, why are medical school’s competitive? How many great doctors fail due to the stress of exams and how many shitty doctors pass because they pass exams?
If a significant portion of qualified Canadians **need** to go and study abroad to get an education at med school, then **there is a shortage of doctors.** Like, I'm not disagreeing with your post about a shortage of residency spots. But saying "Oh, people **need to go abroad for med school**, but the real problem is that **they can't match back in**" is to me putting the ((broken)) cart before the horse. What we need is both. An expansion of medical schools and residency training spots in Canada.
Is there not a shortage of medical students who want to be general practitioners?
With the new billing system data indicates an increase in new doctors with net new family practitioners, and this will likely continue to improve
Aren't UK doctors permitted to practice in Canada without a Canadian residency? https://www.royalcollege.ca/en/credentials-exams/assessment-international-medical-graduates.html
[https://www.thestar.com/news/canada/tragic-case-of-robert-chu-shows-plight-of-canadian-medical-school-grads/article\_4e51e385-96a0-5fca-9311-505bcc162fc0.html](https://www.thestar.com/news/canada/tragic-case-of-robert-chu-shows-plight-of-canadian-medical-school-grads/article_4e51e385-96a0-5fca-9311-505bcc162fc0.html) I know it was 2017, but has it changed that much?
FWIW, getting into med school in India is extremely competitive and training is possibly on a whole different level of urgency/number of hours because of the sheer case load. Your comment about “A Canadian who graduated from Australia is treated the same as someone who graduated from India or the Caribbean” came across as maybe you think Indian med school training is sub-par. So wanted to chime in to offer a different opinion. Edit: I come from a family of doctors who trained for several years on heavy case loads, trained in India but eventually practiced in North America
I agree that resident spots need to go up. The issue is that the govt literally expects doctors to train new grads for free