I moved to Ontario, Canada, a little less than a year ago, with a sense of adventure and a spring in my step. I was excited at the thought of being reunited with family, apprehensive about the hurdles in my path to becoming a practicing physician, but hopeful that there would be light at the end of the tunnel. There had to be.
I had been chief resident at an ACGME-accredited four-year emergency medicine program, where I had the privilege of being taught by, and later working alongside, some brilliant emergency physicians from all over the world (including Canada). I had worked in JCI-accredited hospitals and had nearly ten years of experience in both public and private practice. I was (am?) a board-certified emergency physician in the Middle East. However, after immigrating to Canada, the caduceus around my neck is the only reminder of what once was.
And I’m not alone. According to an article published by the CBC in February 2023, “as many as 13,000 medical doctors in Canada who are not practicing because they haven’t completed a two-year residency position — a requirement for licensing.” Even those who have completed the residency requirements, regardless of their background and experience, have to perhaps go through residency one more time because the last time it wasn’t in Canada. Still, they have the odds stacked against them when participating in the Canadian Residency Matching Service (CaRMS). In the 2020 R1 Match, Canadian and U.S. medical graduates had a 97.7 percent match rate, while international medical graduates (IMGs) only had a match rate of less than 23 percent. Even the specialties available to IMGs are limited to only a handful, while for Canadian medical graduates, Canada is their oyster.
It is not a matter of entitlement by virtue of citizenship. After all, Canadian citizenship or residency remains a requirement for application to residency/fellowship positions. It is one of discrimination against those who should have an equal right to care for their countrymen to the best of their abilities. It is also a matter of citizens being denied the right to access timely medical care. Nearly six million Canadian adults do not have access to a family doctor, and ERs have faced closure due to doctor and nurse shortages.
Most experts agree that IMGs are a major part of the solution to this looming problem, yet change has been slow in the coming, if at all. In December 2022, Ontario Premier Doug Ford announced the revival of a Practice Ready Assessment (PRA) program designed to fast-track the integration of internationally trained physicians into the struggling Ontario health care system by Spring 2023. And while the sunny skies and chirping birds would suggest that spring has indeed arrived, the only sound on the program is that of mine and other IMGs’ pacing footsteps anxiously awaiting its introduction.
But excuse me if I’m short on hope. When I first applied for immigration to Canada, the Practice Ready Assessment program had existed. My immigration request was accepted in a matter of weeks – a sure sign that Canada needed, and indeed welcomed, physicians. The PRA was later axed by the same government that promises to revive it this year. The disillusionment started soon after. During my first visit in 2018, a fellowship director who was kind enough to meet with me informed me that they only accepted sponsored applicants for residency/fellowship from the Middle East, which basically means that they are trained and temporarily included in the workforce while their countries pick up the tab. As an expatriate in my then-country of residence, sponsorship was not an option. In 2022, amidst staffing shortages and ER closures, I waited for every press release that promised health care reforms, in the hope that IMGs would be included as part of the solution. However, I was always disappointed.
Haunted by the possibility of not being able to practice, I put off immigration for as long as I could, wondering if I should even take the plunge. Eventually, though, the desire to reunite with family, to establish roots, and to watch my husband scale new heights in his career took over, and we made the move, wrapping up the last 30-something years of our lives.
And it is here, in the belly of the whale, with my fingers tightly guarding the caduceus around my neck, that I await the return to my calling.
Irma Faruqi is an emergency physician.