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A shortage of doctors? Not really

January 28, 2023

By Vancouver Sun

Politicians in every province and territory in Canada keep acknowledging the critical shortage of doctors, and keep saying how they are doing everything they can to find more and train them.

But are they? Nearly 3,600 international medical graduates are now permanent residents, according to Immigration Canada, but it is estimated that fewer than 40 per cent have been licensed to practise here.

They and their advocates don’t think enough is being done, and Rosemary Pawliuk has data to prove it.

“From where I sit, on critical analysis, each and every one of the initiatives the government has introduced is flawed,” she told me. “The question is whether the built-in flaws which retain the barriers is a result of incompetent design or deliberate design.”

Pawliuk is a lawyer and executive director of the Society of Canadians Studying Medicine Abroad.

Since she doesn’t believe health administrators are stupid, Pawliuk has concluded that these barriers are an intentional extension of decades of policies aimed at limiting health-care spending by restricting the number of doctors. They are also policies that reflect a degree of professional protectionism that informs physicians’ various licensing and regulatory bodies.

Here’s one telling example of a flawed initiative:

All medical school graduates — including international physicians and specialists who have years of working experience — need to complete a Canadian residency before they can be licensed. Placements are done through the Canadian Resident Matching Service. But the number of placements, plus the specialities for which internationally trained physicians can apply, is set by provincial governments and the Canadian medical schools.

In 2020, there were 1,822 applicants for 325 placements available to them. Two years later, there were 1,661 applicants and 331 placements.

On the other side of the ledger, graduates from Canadian and American schools had a shot at 3,072 placements in 2020. There were 3,071 applicants. Last year, only 2,985 applied for 3,075 positions.

Those 90 unfilled residency spots were not offered to internationally trained physicians.

In B.C., international graduates are restricted to residencies in family medicine, internal medicine, pediatrics, and psychiatry. But there is another condition placed on them as well.

Foreign-trained physicians must sign a “return of service” contract that requires them, after completing their residency, to work an equal period of time in the same health region where they did their training.

Failure to comply to complete the residency or remain in the region for the required period can result in penalties ranging from $525,725 for family physicians to $986,693 for psychiatrists.

In seven provinces (including B.C.), practice ready assessments are another pathway for foreign-trained family doctors to getting licensed.
In November, B.C. announced that it is tripling the number of practice ready placements.

Tripling! It sounds great until you get to the details. With 32 placements now, it will be March 2024 before that increases to 96.


Since 2015, only 188 internationally trained physicians have qualified through the B.C. program because, as Pawliuk points out, applicants must have two years of post-graduate training (i.e. a residency) in another country.

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