B.C. is in a massive doctor shortage, with residents across the province calling for an increase in the number of medical professionals. But despite this urgency, the federal and provincial governments continue to set up barriers for would-be doctors who graduate outside the country.
Nobody knows this better than Sandrine Kakieu Djossi, who came to Canada after completing medical school, a year-long internship and four years of pediatric residency in Nigeria. Political unrest in the country forced her to make the move in 2016 — before officially completing her residency — due to an ongoing rebellion from the terrorist group Boko Haram.
Djossi, who moved from Cameroon to Nigeria for medical school, says she had to leave the country quickly because of the increasing danger.
“I came to Canada because I wanted for a better life. Before the war … things were peaceful,” she says.
International medical graduates face hurdles, hidden costs
Although she didn’t complete her residency placement in Nigeria, Djossi arrived in Canada under the impression that gaining a residency placement and practicing as an international medical graduate (IMG) was attainable.
In hindsight, she says the labyrinth of hurdles Canada and B.C. force international graduates to navigate in order to practice as a physician makes those expectations unrealistic.
IMGs must pass a series of standardized exams to ensure they meet the country’s minimum education standards and have the skills required to start residency training before even applying to the Canadian residency matching service (CaRMS).
CaRMS is a not-for-profit, fee-for-service organization that matches medical school graduates with residency training programs.
Djossi explains that the tests are expensive and often require graduates to travel to prepare for and take them.
“I can’t stress enough how high the costs are,” she says. “Exams run anywhere from $2,000 to $3,000. With travel included … things add up.”
Djossi says that after moving to Canada, she immediately sought to complete the necessary exams and did so in under two years. By 2018 she was ready to apply for a residency placement but realized the limits Canada places on IMG admissions minimized her chances.
Residential placement favours domestic, American graduates
Djossi isn’t the only IMG who has encountered significant barriers after moving to Canada. Hundreds of international medical graduates are awarded visas each year, or return home to Canada after graduating from medical school elsewhere, and are met with improbable chances of earning residency placement.
The various Canadian faculties of medicine and provincial ministries of health determine eligibility criteria for participation in the CaRMS match.
The CaRMS website explains that the R1 main residency match has two iterations. In the first iteration, Canadian and international medical graduates do not compete, meaning both groups participate in separate streams. Alberta and Ontario, for example, choose to segregate CMG and IMG streams.
In the second iteration, Canadian medical graduate (CMG) and IMG streams are blended depending on the province, meaning both streams compete for the same residency positions.
In B.C., CMG and IMG streams are blended. This makes the process all the more difficult for IMGs because the CaRMS match process is structured to ensure domestic graduates “be assured” access to a residency position in Canada.
Because residency positions are limited, prioritizing CMGs excludes a majority of international applicants from accessing residency positions and, in turn, practicing medicine. Further, residency positions available to IMGs are limited in comparison to positions for Canadian and United States medical graduates (USMGs).
According to a presentation from CaRMS, 3,072 positions were offered to 2,998 Canadian applicants and 47 American applicants in 2020.
95.2 per cent of 2020 CMGs were matched with a residency on the first iteration of the R1 residency match. In comparison, only 325 positions were offered to 1,433 IMG applicants, resulting in a 61.3 per cent match rate for international graduates on the first iteration.
To make things even more complicated, IMGs are mainly limited to family medicine, internal medicine, psychiatry and pediatric positions when applying to the CaRMS match process, Djossi says. In contrast, CMGs can choose from over 70 recognized specialties and subspecialties, including higher-earning positions such as cardiac, vascular, plastic and general surgery.
While matches are limited for IMGs in Canada, the U.S. boasts nearly 40,000 residency placements for which both IMGs and USMGs can apply.
Djossi says it’s imperative B.C. offers more support to international medical graduates and reassesses the eligibility criteria for participation in the CaRMS match.
Were Djossi placed in a residency, Kamloops could have another doctor by now. The city sorely needs more — staffing shortages in the medical field have caused emergency room delays, postponed surgeries and in-demand family doctors. But in August, dissatisfied with Canada’s placement system, Djossi moved from Kamloops to the United States in the hopes she’d have better luck there.