We have been forced to recognize the reality that the discrimination against Immigrant/Refugee Internationally Trained Physicians (IR-ITPs) is illegal but entrenched to such an extent that decades of public policy dialogue, academic papers, research, and advocacy have changed the rhetoric but not reality—discrimination against IR-ITPs has not abated. COPSIPE has reluctantly had to accept the reality that a declaration of illegality is necessary to create a foundation from which systemic and cultural barriers that immigrants and refugees face can become dislodged so that the stated objectives of Charter and human rights can be realized instead of serving as feel-good rhetoric.
Facts about discrimination
To view and/or download a PDF document that includes the facts about the discrimination international medical graduates have been facing in access to resident physician jobs, please Click Here.
Medical establishment rationale for segregation debunked
To view and/or download a PDF document that debunks the rationale provided by the medical establishment for segregation and protection of residency positions for graduates of Canadian and American medical schools, please Click Here.
GOVERNMENT STATEMENTS ON FAIR ACCESS TO LICENSING vs. THE FACTS
On May 4, 2020, Deputy Prime Minister Freeland stated:
“This is Canada and we don’t discriminate on the basis of which country they come from and which country they studied; they all are treated the same and share the same platform once they are Canadian citizens. We don’t discriminate. They are Canadians and Canadians only.”
In fact, international medical graduates face systemic discrimination after proving that they have the knowledge and skills that meet the Canadian standard.
The Canadian Medical Association’s Policy on Equity and Diversity in Medicine, 2020 sets out the most fundamental principles of what it means to be a Canadian. Highlights include:
“The principles of equity and diversity are grounded in the fundamental commitment of the medical profession to respect for [sic] persons. This commitment recognizes that everyone has equal and inherent worth, has the right to be valued and respected, and to be treated with dignity. When we address equity and diversity, we are opening the conversation to include the voices and knowledge of those who have historically been under-represented and/or marginalized.”
“Equity in the medical profession is achieved when every person has the opportunity to realize their full potential to create and sustain a career without being unfairly impeded by discrimination or any other characteristic-related bias or barrier. To achieve this, physicians must 1) recognize that structural inequities that privilege some at the expense of others exist in training and practice environments and 2) commit to reducing these by putting in place measures that make recruitment, retention, and advancement opportunities more accessible, desirable, and achievable.”
In fact, despite adopting these words which reflect how much Canadians value equality, when the CMA was asked to take steps to make these words a reality, they declined. COP SIPE endorsed this submission, but the CMA was not prepared to engage in the conversation they said they wanted to start with us. Empty words.
Dr. Linda Inkpen of the Federation of Medical Regulatory Authorities of Canada explains the fact that thousands of Canadians who graduated from international medical schools are not licensed because of lack of “credential recognition” and concerns for “public safety”.
In fact, thousands of Canadians who graduated from international medical schools have overcome the barriers and proven their medical credentials remain unlicensed. They have proven that they have the critical medical knowledge and skills to practice competently and safely in Canada, but that is not good enough. They are prohibited from applying for 90% of the entry level jobs in medicine in Canada for no other reason than they are graduates of international medical schools and considered less worthy of becoming licensed to practice as physicians than graduates of Canadian and American medical schools.
The government policy is to ensure that virtually every graduate of a Canadian or American medical school can become licensed as a physician by giving them the entry level jobs, called residency positions, which are a pre-requisite of becoming licensed as a physician. Provision of residency positions to these Canadians is irrespective of these graduates’ medical knowledge and skills. Approximately, 3 to 5% of graduates of Canadian and American medical schools fail the exam (the MCCQE1) which is designed to determine whether a graduate has the critical medical knowledge and decision-making ability expected of a graduate. This failure rate is likely a function of the policy of Canadian and American medical schools not to fail students. For a graduate of a Canadian or American medical school, failing the MCCQE1 is not a bar to working as a resident physician who diagnoses and treats patients.
On the other hand, Canadian citizens and permanent residents who graduated from international medical schools are held to a different standard. These Canadians must pass the MCCQE1 and at least one other exam (NAC OSCE), more in some provinces, to be considered qualified to apply, let alone work, as a resident physician in Canada.
Access to residency positions does not seek out the most qualified Canadian. The foundation of accessing work as a resident physician is not founded in competence or a concern for public safety. This is despite the fact that resident physicians are the work horses of the Canadian hospital system.
If competence and public safety were the primary concern, graduates of Canadian and American medical schools would have to pass the MCCQE1 and the NAC OSCE before being allowed to compete for entry level jobs so that when they diagnose and treat Canadian patients, the public could have confidence that resident physicians have the requisite knowledge and skills to do so safely. Failing the MCCQE1 and practicing would not be an option.
Deferring the requirement to pass the MCCQE1 for graduates of Canadian and American medical schools until after the competition for residency positions is necessary to avoid an objective basis from which to compare the critical medical knowledge and skills of all Canadians who are considered qualified to practice as resident physicians. An objective basis of comparison of individual knowledge and skills must be avoided to prevent eroding the culture which perpetuates the superiority, privilege, and importance of graduates of Canadian and American medical schools.
If competence and public safety determined access to medicine, Canadians who are graduates of international medical schools would not be segregated and prohibited from competing against graduates of Canadian and American medical schools. Of 3397 resident physician jobs in Canada in 2020, 3072 (90%) are protected for 3071 applicants who are graduates of Canadian and American medical schools. The 1822 Canadians who graduated from international medical schools who applied for a residency position in 2020 are restricted to applying for 325 resident physician jobs.
Segregation and protection is necessary to continue the status quo, because despite the prejudice they face, when Canadians who are international medical graduates are allowed to compete against those who graduated from Canadian and American medical schools, they have taken residency positions away from less able graduates of Canadian and American medical schools who could not stand up to competition on the basis of individual merit. This displacement of the weaker candidates by stronger is deemed inappropriate considering the preference for graduates of Canadian and American medical schools.
Imposing a quota on access to residency training positions on Canadians who graduated from international medical schools ensures that they will remain in the minority. By (a) imposing this quota on Canadians who graduated from international medical schools for residency training jobs, and (b) by only recognizing training from primarily white Commonwealth countries such as the United Kingdom, Ireland, Australia, and the United States, governance of medicine by organizations such as the AFMC, CaRMS, FRMAC, CPSBC, among others, is able to retain the culture which perpetuates the systemic discrimination against graduates of international medical schools who are mostly racialized.
It is by careful messaging and design of those in authority in medicine in Canada that international medical graduates, with the exception of tokenism, are restricted to residency jobs in the underserviced disciplines (primarily family medicine) which generally do not pay as well. Oppression is also curried in most provinces which only allow Canadians who are international medical graduates to obtain residency positions, if they sign an indenture agreement which requires them to work in underserviced regions for a requisite number of years. Failure to do so can result in penalties as high as $897,000. Graduates of Canadian medical schools whose education is heavily subsidized by the taxpayer are not required to sign these onerous “agreements”. They are provided the full palate of opportunity. They face no restrictions on mobility.
Is this marginalization of Canadians who are international medical graduates legal? It is not. It is long-standing, but its day is approaching as 5 brave immigrant physicians take systemic discrimination in the medical establishment to the human rights tribunal.