Malcolm M. MacFarlane is a retired psychotherapist, and a volunteer with the Society for Canadians Studying Medicine Abroad
In March, the Canadian Medical Association released its first policy on equity and diversity in medicine. This policy advocates “opening the conversation to include the voices and knowledge of those who have historically been under-represented and or marginalized.” It supports “reduc[ing] the structural barriers faced by those who want to enter the medical profession.”
This policy is encouraging for International Medical Graduates (IMGs). IMGs comprise an ethnically diverse group and many experience marginalization in the Canadian Residency Matching Service (CaRMS) process. To apply to CaRMS, all IMGs must be Canadian citizens or permanent residents, no different from Canadian Medical Graduates (CMGs). They should be entitled to be treated equally to CMGs. They are not.
The CaRMS eligibility criteria set by the provincial faculties of medicine and the provincial Ministries of Health streams IMGs to a limited number of residency positions. This is consistent with a 2006 resolution by the Association of Faculties of Medicine of Canada and accepted by the provincial faculties of medicine that “all graduates of Canadian medical schools be assured access to a residency position in Canada.” The justification often given for this resolution is that CMGs’ undergraduate medical education has been subsidized by taxpayer dollars, and that this investment would be wasted if CMGs didn’t progress to residency training.
IMGs clearly face discrimination in the CaRMS Match. In the 2020 Match, there were 3,072 positions for 3,011 CMG applicants and 60 US medical graduates (USMGs). In contrast, there were only 325 IMG positions available for 1,822 IMG applicants. The positions available to IMGs are limited mostly to family medicine, internal medicine, psychiatry, and a few positions in pediatrics, while CMGs can apply to the full range of specialties. IMGs are also required to demonstrate their competence to practice medicine by passing the MCCQE1 and the NAC OSCE examinations before they can apply via CaRMS. CMGs are not required to sit the MCCQE1 until after the Match is completed and can proceed to residency even if unsuccessful. According to the Medical Council of Canada, about 3% to 5% of CMGs fail this exam each year. Yet IMGs have demonstrated competence through objective assessments prior to applying to CaRMS. If the goal of the CaRMS Match is to select the most competent medical graduates to progress to post graduate medical education, then why are IMGs who have objectively demonstrated their competence not permitted to compete equally for all positions?
The economic justification offered for these different application streams is the protection of taxpayer investment in CMG undergraduate medical education. Taxpayers fund education that leads to various professional degrees, but discussions of taxpayer investment or efforts to protect these graduates do not generally arise outside of medicine. One might argue that this is because education is an investment in society, not an investment in specific individuals. Best business practice and the best interests of taxpayers is arguably to advance the most qualified candidates through competition on the basis of the competence of the individual. Economists call the desire to protect money already spent without analyzing quality or ultimate productivity the “sunk cost fallacy,” and they consider it poor practice.
The objectives of the current CaRMS eligibility process are in conflict: selecting the most competent applicants to progress to post graduate training versus protecting those educated in Canadian and American medical schools. And the issue is not discussed openly and transparently with input from all stakeholders, despite public interest in the issue. Instead, the decision to prioritize CMG access to residency is being made by the provincial faculties of medicine, who would seem to be in a clear conflict of interest advocating for their own graduates. Prior to 1993, which marked the end of rotating internships, the provincial Medical Colleges had responsibility for setting eligibility criteria for residency and entry to practice. Perhaps it is time for these Colleges, who are mandated to regulate in the public interest, to reclaim their authority over this process.
The CMA Policy on equity and diversity in medicine invites a transparent and public dialogue about the CaRMS process for IMGs. A more open dialogue would solicit public input regarding the conflicting public interest objectives described. It might examine the impact on IMGs – many of whom are also Canadian – of being unmatched. It could explore the public cost of underutilizing 1,400 competent unmatched IMG applicants when there are five million Canadians without a family physician. It might look at how the current CaRMS process aligns with Canadian immigration policies, how it intersects with policies and objectives regarding international labour mobility, how current CaRMS policies fit with established principles for recognition of international credentials, and whether the policy contravenes human rights and the Canadian Charter of Rights. There is much to discuss.
I am not going to repeat what others have said, except to stress the fact that Canadians deserve the best physicians available. If that was the case, our system would be fully transparent and competitive, which is not the case at the present moment. It is quite clear that it is in the interest of “the establishment” to keep the status quo where there are two classes of Canadians : them and us. As a former federal public servant who has worked for the good of this country all of my life, I am not proud of this state of affair and for this reason I am dedicating time and energy to Socasma’s mission. But let me introduce another element. As a francophone, French speaking Canadians deserve to have physicians that can serve them in French – something that is particularly important when discussing matters that are as personal and critical as our health. At the present moment, Quebec loses many of the French speaking physicians that it trains to other provinces and other countries. Being a Franco Ontarian, I can tell you that my community is very far from getting their health services in French despite the fact that this right is spelled out in a provincial legislation (Ontario’s French Languages Act). Yet, there are many fluently bilingual Canadians who go and study medicine abroad and who would be more than happy to serve fellow Canadians. Time are changing: there are many anglophones who have learned French.
What are we doing to tap into this resource? I have been in contact with the Government of Quebec and I can tell you that there’s a need for Quebec to update their message with regards to the eligibility of Canadians residing outside Quebec (information really confusing and in fact, not accurate on the Canadian Medical Council web site as it does not consider the parallel 2nd tier recruitment system in Quebec). There’s also a need for the Government of Quebec to dismantle old roadblocks that are preventing Canadians who have studied medicine abroad (both Quebecers and candidates outside Quebec) from applying in Quebec. I am referring here to the need for le Collège des médecins to attest that one’s degree is legitimate – an additional unecessary step as the ECFMG system already has that role. Why duplicate and why delay the process for applicants? Every year there are more than 20 positions that go unfilled in Quebec and every year we see francophones and other bilingual candidates leaving Canada to practice in other countries. That is the case of my daughter, une francophone jusqu’au bout des doigts qui a fait son chemin en médecine malgré son propre pays. I am happy and proud of her, but I am sad for my community and I am disapointed in my country.
I am writing in response to Rosemary Pawliuk’s October 2nd comment and Dr Laura Blew’s October 4th comment. Both raise the question of whether the CMA “will honour equity in practice or only on paper.”
Certainly the linked correspondence included in Ms Pawliuk’s post seems to give some legitimacy to this question. I remain hopeful that CMA will take a leadership role in inviting and fostering the conversation and dialogue about these important issues raised in their excellent Policy on Equity and Diversity in Medicine. I am grateful to CMAJ for publishing this Blog, and for hosting the active conversation it has elicited. I would welcome participation in this conversation from CMA leadership and other organizations involved in these issues including the Association of Faculties of Medicine of Canada (AFMC) and CaRMS.
From reading CMA literature, the issues raised in my Blog seem central to CMA’s core identity and its leadership role in Canadian society. The CMA Policy on Equity and Diversity in Medicine describes itself as “consistent with the CMA Code of Ethics and Professionalism and the CMA Charter of Shared Values.”
The CMA Code of Ethics and Professionalism has an entire section on managing and minimizing conflicts of interest. Surely the AFMC (who’s members I presume belong to the CMA), and the provincial faculties of medicine (who determine CaRMS eligibility criteria), must recognize their position of conflict of interest in establishing CaRMS eligibility criteria that prioritize CMGs and marginalize IMGs. This conflict of interest would seem to be inconsistent with the principles outlined in the CMA Code of Ethics. Does CMA have a position on this matter? Should it?
The CMA Charter of Shared Values, much like the Policy on Equity and Diversity in Medicine, speaks of a “commitment to valuing a culture of diversity.” It is difficult to see how the current CaRMS eligibility criteria are consistent with valuing a culture of diversity when approximately 1,400 IMGs from diverse ethnic and educational backgrounds are marginalized and prevented from competing equally for entry to practice residency positions each year.
To me, these issues seem central to the CMA and its professional identity. I believe for CMA to be congruent with its expressed values, it is critical that it take an active leadership role in promoting conversation consistent with its “commitment to promoting a culture of inquiry and reflection” as stated in its Charter of Shared Values. I am extremely curious about the way that CMA leadership and CMA members regard these issues, and I would welcome their participation in the dialogue this Blog has engendered. I look forward to hearing their voices.
Malcolm M. MacFarlane
I am most grateful to Dr. Macdonald for addressing some of my arguments and clarifying the philosophical points which separate us.
These differences are expressed most clearly, I believe, in his treatment of those principles which unite us. For instance, Dr. Macdonald recognizes a valid apprehension of real social harm in the following phrase :
“Mr Friesen is not alone is his concerns about the impact of migration of qualified physicians from developing nations to first world countries.”
However, he immediately continues as follows :
“Despite this concern, we do live in a global economy. Individuals from other countries have, as a matter of basic human rights, the right to immigrate to other countries.”
In other words, “Despite this concern … the impact of migration of qualified physicians (sic) be damned !”
There is provided, to justify this position, a clear hierarchical ranking of moral and social interests, in which the over-riding axiom (to trump all others) would hold that “Individuals from other countries have, as a matter of basic human rights, the right to immigrate to other countries.”
Apparently then, this highly contentious (and in fact extraordinarily radical idea) is taken, by the author, to constitute an accepted, incontrovertible truth of sufficient authority to permit us, as stated, to simply ignore the real social harms which would actually result from it’s categorical and uncritical application.
(I will not clutter up the discussion, in this place, with a demonstration of just how radical Dr. Macdonald’s view of international migration “rights” really is. Suffice it to say that the most cursory examination of existing immigration laws around the world — including our own — should make any such demonstration unnecessary. Let us simply recognize, rather, that sovereign states can (and do) : define, promote, and restrict the rights of potential immigrants, in any way that is deemed desirable.)
In any case, Dr. Macdonald tacitly admits the insufficiency of his moral claims, when he attempts to appeal to the Canadian sense of self-interest.
“we … live in a global economy … and … Canada, through established immigration policies, attempts to attract talented immigrants from other countries for the contribution they can make to Canadian society.”
So now indeed, we may cut to the chase : Is the potential contribution made to Canadian society (by International Medical Graduates) of a globally beneficial nature ?
Do we need more doctors in Canada ? Not, that is to say, would more doctors be beneficial for the population, but rather : Are we actually willing to pay for more practicing physicians in Canada ? And if we were decided to increase the total number of physicians, would we wish to do that by importing the finished product, or by developing the human material here, with all of the attendant advantages in research, development and the satisfaction of domestic educational ambition ?
Clearly, if we are already maxed out on the number of doctors we are willing to pay, there is no advantage to Canadian society in importing more. And similarly, if we want to grow our own developmental base in order to train more doctors (and incidentally allow more Canadian children to accede to that professional status), there is no advantage either.
So, in light of these considerations, let us take up the specific issue of competition (and protection) which has been broached by Dr. Macdonald in his recent article.
In the current situation, there is a critical choke-point in the developmental pipeline, which is found in the residency “matching” process. At the present time (according to the numbers provided), there is exactly one matching spot open for each of 3072 Canadian and American graduates. There is, therefore, a one to one potential success ratio for each Canadian graduate. Now, however, let us add in international graduates (and the matching spots currently reserved for them) whereby we obtain a total of 4894 candidates for only 3397 opportunities, or otherwise stated, an average success rate, for each individual candidate, of only 70 %.
Many of the people who may, hopefully, be reading this, know from firsthand experience what it is to qualify as a practicing physician. I would therefore wish to ask these people (apart from doctrinal purity) to consider whether there is any set of humanitarian principles which could justify enrolling young people in a program of study, of such severity, when it is understood that for the fully formed and entirely satisfactory product, there exists only a 70% chance of entering this crucial phase of residency matching ?
Of course not. Nor are people stupid enough to undertake such absurd career paths.
There are already all sorts of reasons that are playing against the choice of medicine as a career in Canada.
Without doubt, if Canadian children are to undertake such a daunting commitment, they must be treated fairly. And being treated fairly does not include being bumped, at their moment of victory, by some one (of roughly seven plus billion potential) candidates, suddenly appearing to “compete” for what should already belong to the other by earned privilege.
(The whole proposed paradigm is a little like the opening episode to that silly Netflix “Viking” parody where a penniless mercenary suddenly gains rich landed status — and a wife to boot — through the ancient Nordic custom of “holmgang” whereby he claims the “right” to fight a prosperous farmer, in single combat, winner takes all, for the combined possessions of both…)
One can easily see the advantage to the international graduate. One can scarcely imagine any benefit, at all, for the Canadian child.
Notorious extremist Chrystia Freeland (and her somewhat less articulate associate, Prime Minister Justin Trudeau) do indeed espouse the same categorical moral imperatives outlined by Dr. Macdonald. They also view reality exclusively through the prism of individual migrants’ rights (in harmony with the dictum of renowned ethics scholar Monty Python, to the effect that “every sperm is sacred”). They apparently have no regard for the collective interests of Canadian society.
Limitless cut-throat competition, based on limitless rights-entitled migration, is clearly not in the interests of either what we are now, or of what we would wish to become. At the very outside limit, that sort of international academic octagon-cage-fight mentality might serve the interests of extremely brilliant people having no interest whatever in any but their own existence. However, from the moment one has to consider others, from the moment that one consciously identifies with a collective destiny — from the moment for instance, where one has children who must be raised and educated, not as production widgets, but as human beings — all of this thinking deteriorates into nonsense.
As a last parting point : It is frequently maintained that we should not suppress (or limit) competition, because we must always benefit from the very “best and brightest”. And in answer to that, I would reply that the average Canadian med-school grad is perfectly adequate to the task, and that we have absolutely no need of destroying the harmony of our homes and institutions in order to attain something marginally “better”.
Gordon Friesen, Montreal
To all Canadian Doctors – please take a moment to examine your privilege, your assumptions, and to perhaps challenge the system you’ve been told is the best way to hire Canada’s next generation of Doctors (despite the clear conflict of interest in a system run by Canadian universities that protects graduates of…Canadian universities). This is a moment to consider who pats the price for the privileges and protection of those who get into to a Canadian medical school. We don’t want “getting in to med school” to be the last real test of a Canadian doctor.
What I take away from Dr. Friesen’s long thesis Is that he believes that today’s residency system, which is patently designed to protect and advance one “class” of privileged Canadians at the expense of another “class” of Canadians is justified based on the privilege (or lack of) of ones Canadian birth.
I also rethink he believes therefore that Canadian patients are better off with a system that is NOT designed to select the best qualified Canadian doctor because it instead prioritizes place of education.
It would follow then that he also questions the capability of the MCC exams to demonstrate equivalency of training for IMGs.
As a Canadian citizen I agree that Canada deserves the BEST person for the position. If this is a CMG vs an IMG then fantastic! However let’s create even playing field for all Canadian citizens and permanent residents. Let students take the same exams, at the same time. Let students become colleagues and positive role models for each other. Instead of allowing CMGs to be superior. Are we all not Canadians? Canada prides itself on inclusivity yet in the medical profession there is no inclusivity. We discriminate against our own, to protect the current system. We need to do better!
The fox guarding the hen house comes to mind. To hand the decisions about entry into the medical profession over to the faculties of medicine immediately renders the decisions virtually unchallengeable- which only demonstrates even more what an unfit process this is. The question of who should secure residency positions in Canada should be answered simply by those who are the best suited and qualified for the positions – not by, only those who graduated from faculties of medicine in Canadian universities.
Unfortunately, although the current practice is blatantly unfair and is contrary to any definition of equity between just Canadian citizens, let alone immigrant doctors who have passed all the required examinations, – the practice continues. Those who are directly adversely affected are insufficient in numbers to warrant political attention and so the universities and the Colleges are allowed to continue in this Faustian pact.
As noted in the article above- the taxpayer argument is a myth and if that should be a concern- note that physicians educated abroad have cost the taxpayer nothing having completed medical training at their own expense. Also note that in discussing physicians trained abroad – what is included are physicians trained at medical schools of prestige and distinction around the world- many of which rank higher than many Canadian medical schools. They are also schools where training is based upon rigorous testing and grading- something that is not always evident in Canadian medical schools.
This systemic inequality is not tolerated in any other profession in Canada. The legal profession was told by the Supreme Court of Canada that it could not limit entry to the Canadian legal profession by discrimination. Why is this tolerated in the medical profession? The ultimate loser is the Canadian health consumer.
Dr Laura Blew
The policy is theoretically encouraging for the many examination-proven competent, Canadian citizen and permanent resident IMGs.
Now the CMA must demonstrate integrity and apply their policy.
This will mean opposing much of the medical establishment by advocating for common examination timing and insisting residency selection be based solely on merit and not location of education.
Will the CMA honour equity in practice or only on paper?
The public and ALL eligible residency candidates deserve no less than very best physicians and colleagues.
Please take this bold action now.
Dear Dr. Macfarlane (and Ms. Pawliuk)
I believe we must be very clear what we are talking about.
If a person is born in Canada, or even comes to Canada and gains naturalized citizenship (not mere residency), and then for some reason studies abroad (not simply goes back to graduate), then yes, perhaps that person should benefit from parity with those Canadian citizens (or permanent residents) who have studied within the country.
However, speaking as a Canadian citizen, the idea that someone, as a citizen of another country, should study elsewhere, then come to Canada, gain residency (or even citizenship), and then expect to compete on an equal basis with Canadian children from Canadian schools is simply appalling.
The only rationale for such a claim, would be to define Canadian professional status, and in fact Canada in totum, as a shared world resource. As though Canada were some kind of upscale world neighborhood to which upward mobile individual residents of other “neighborhoods” might migrate and instantly access all benefits, and actually displace prior residents from their economic opportunities.
This notion might sound very appealing for the talented individual migrant, however, it is morally wrong, in my estimation, from the collective point of view of both the society of origin and the society of destination.
Considering first the society of origin : The very last thing the world needs is for Canada, USA and a couple of other highly coveted destinations to suck up all the medical talent from all over the less advantaged world. That is a recipe for permanent destitution in those places, just as hardcore under privileged neighborhoods in our own Canadian cities are disadvantaged by the flight of those people who have the capacity to do better. At the neighborhood level, perhaps there are policies we might find to avert the worst, at the national level, however, this dynamic is an absolute disaster.
As things are now, knowing that they will have less access, only a small number of international graduates will come. To grant equal treatment would be to open the flood gates above any capacity not only for Canada to assimilate, but for the communities of origin to replace.
Now as for the society of destination, which is to say Canada : to allow unbridled equal access to foreign graduates (once they have completed the formalities of residency or even citizenship) is to ask Canadian youth to compete with migrants from the whole world, over (as my metaphor would suggest) the benefits of their own global “neighborhood”. The inhabitants of no other society are being asked to make such a sacrifice. A normal resident of any other society can expect to grow up and enjoy whatever benefits their country has to offer. The most talented of those people have the opportunity (and I would suggest the duty also) to become the leaders of those societies, and to contribute to their future progress. The idea that Canadian youth (and only Canadian youth) should have to defend themselves competitively against the best and brightest from around the world, simply to maintain their birthright position in their own community is, as I began this letter in saying, simply appalling.
No. It is not going to happen. Not now. Not ever.
For one thing, the individuals who are fighting so hard to gain this purely personal advantage, will reverse their stance in twenty years in order to protect the futures of their own children.
Gordon Friesen, Montreal
P.S. This statement in particular is misleading: “the public cost of underutilizing 1,400 competent unmatched IMG applicants when there are five million Canadians without a family physician”.
I often notice this line of reasoning being used to confuse people. Actually, we are talking about a limited number of slots in the pipeline. It is the limited capacity of that pipeline which impacts the total number of doctors, not who is allowed to enter it.
I’d like to thank Mr Friesen for taking the time to read and discuss the concerns outlined in my Blog. Clearly he has strong views, and he raises a number of important points that merit further discussion, which is what my Blog was designed to accomplish.
First, I’d like to acknowledge Mr Friesen’s point that, “The very last thing the world needs is for Canada, USA and a couple of other highly coveted destinations to suck up all the medical talent from all over the less advantaged world.” Mr Friesen is not alone is his concerns about the impact of migration of qualified physicians from developing nations to first world countries.
Despite this concern, we do live in a global economy. Individuals from other countries have, as a matter of basic human rights, the right to immigrate to other countries. Further, Canada, through established immigration policies, attempts to attract talented immigrants from other countries for the contribution they can make to Canadian society. They can’t contribute if they can’t gain access to work in their profession.
Where I differ most strongly from Mr Friesen is in his argument that, “as a Canadian citizen, the idea that someone, as a citizen of another country, should study elsewhere, then come to Canada, gain residency (or even citizenship), and then expect to compete on an equal basis with Canadian children from Canadian schools is simply appalling.”
To accept Mr Friesen proposition would be to create two classes of Canadian citizens, those who were born in Canada, and those who immigrated to Canada, and to relegate those who immigrated to second class status by restricting their opportunities for competitive employment in their field, even though they are fully qualified. In effect, this is what the current CaRMS matching process does, and to me, that is appalling.
Prime Minister Trudeau has said, “A Canadian is a Canadian.”. Minister Chrystia Freeland has said, “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.”
This is consistent with Canadian values. It is time the CaRMS matching process was aligned with these internationally respected values and human rights legislation.
Gordon: You are speaking about nationhood. I agree jobs, training positions, and education in Canada should be for Canadians first. But the current system of access to medicine is not designed or intended to support nationhood. It is a system that is founded on institutional nepotism.
Universities have harmed the medical profession and the public when they have been allowed since 1993 to set up discriminatory barriers and other rules which have the effect of regulating medicine by controlling entry level jobs to the profession.
1. A free and democratic society is based on the premise that all members of the society are entitled to equal opportunity in accessing jobs, training, and education. Yet Canadians who have studied abroad are denied the right to apply for 90% of resident physician jobs in Canada AFTER proving that they have the necessary qualifications and meet Canadian standards. They are limited to mostly practicing in the general fields such as family medicine, psychiatry, internal medicine, and pediatrics.
2. The current system compromises competence and standards in the medical profession. The system is designed to ensure the protection of even the weakest graduates of Canadian and American medical schools. Each year 3 to 5% of graduates of Canadian and American medical schools (which have a policy not to fail students) fail the Medical Council of Canada Exam Part 1 which is designed to demonstrate whether one has the critical medical knowledge expected of a graduate of a Canadian medical school. They are allowed to work as resident physicians, nevertheless. Canadians who are international medical graduates cannot compete for resident physician positions without passing this examination.
3. The current system displaces Canadians in favour of foreigners. Firstly, foreigners accepted into Canadian medical schools can through a federal program become eligible to compete in the stream which has 90% of resident physician jobs and will give them the opportunity to work as any kind of doctor they want. Canadians who studied abroad are denied this opportunity. Secondly, the universities train hundreds of foreigners from Gulf States, primarily Saudi Arabia because they pay well. Studies demonstrate that 53% of these Gulf State nationals come back to Canada to practice medicine. Meanwhile municipalities, corporations, the Ministry of Defense, ethnic communities, and other Canadian entities are denied the ability to sponsor the training of Canadians who studied abroad because the universities claim they do not have enough training resources for more residency positions. Thirdly, because Canada does not educate or train enough Canadians to meet its needs, it hires hundreds of foreign physicians from South Africa, United Kingdom, United States, Ireland, etc. Canadians who chose to study medicine abroad are forced out of Canada or drive the proverbial taxi.
Where you and I differ, Gordon, is in respect to immigrant physicians. There are immigration laws that let us decide who can and cannot immigrate or otherwise come to Canada and whether their presence will support our workforce needs or displace Canadians. We can say no, but when we say yes, that immigrant is entitled to full membership as a full Canadian.
P.S. As you state, we are talking about a limited number of slots in the pipeline. But I would suggest that the limited slots are a function of health care rationing, not limited capacity. Secondly, I would argue that when there are limited slots, it is even more vital that the Canadian who gets the job is determined on the basis of competence, not place of education.
As you will have noticed, I am mostly a big picture guy. And of course, reality does not often cooperate with clean broad strokes. It is therefore fairly easy to catch me in contradictions. And that is also why I can not (always) relate to the application of absolute principles proposed by others. Especially when they lead to absurd results.
I most appreciate some of your individual examples, especially how foreign students are able to buy their way into our “pipeline”. That is, in my view, absolutely scandalous.
You say I am talking about “nationhood”. But I am not sure that modern circumstances permit us to think about that kind of cohesion any longer. And yet, we must still think of the reality of some kind of organic population unit.
Canada is critically dependent upon immigration. But at the present time, that relation has become unhealthy. As a place which is assumed to be a “good” one to come to, there is a lot of demand. And Canada, in my opinion, has been deluding itself in thinking itself clever in manipulating that demand in ways which are not only immoral, but self destructive.
To explain : we commonly accept that “Canadians” are too lazy to harvest their own food, and too fussy to wipe the bums of their own elderly. These are serious problems. We think we are getting something for nothing. We are not. It is very possible that slightly more expensive fruits and vegetables would be much preferable to the eventual effects of assuming that certain foreigners can be used as sub-human cheap labour.
In fact, if worse comes to worst, the idea of mandatory national service (aside from the military and disaster preparedness benefits) could clearly get a lot of food harvested, and a lot of bums wiped. It would also bolster the morale of idle and drifting youth.
That example comes from the base of the economic ladder.
At the top, there are schemes like the foreign students being used to pay for medical schools while squeezing out the share of domestic students. And at every level of industry the idea that workers can be imported rather than developed (which saves a lot of money on development), and even then be paid less when they are imported. This has played havoc with the middle class.
Investor class immigrants, also, buy their way in, some actually creating economic activity, but often not. In many cases, they just buy a little failing business with no hope of making any money, and just write off the loss (in their minds) as the cost of getting into Canada. No one cares. That is just another million dollars that has been injected into the local economy like a tip to the bouncer at the door.. Now that it is gone, let’s bring in another.
Basically, then, you see a lot of foreigners paying a price, in dignity or money, in order to get access to the land of “milk and honey”. And “Canadians” apparently are assumed to be benefiting from that trade. But are they ? What happens to the offspring of those immigrants in a generation or two ? At that point, they are the “Canadians”. They also will be facing the same problems : no viable jobs at the bottom ; a very tight market at the top, already half full of imports ; downward wage pressure in the middle.
Our indigenous peoples have staked out a model whereby some of them will never be absorbed into the general population. Their distinct status is becoming their meal ticket. In this view : they were here before and anybody else is in the position of paying rent and royalties on the privilege of coming here later. It is a clever model on one level, but it is also a recipe for poverty and stagnation. So is this now to become the whole Canadian model with regards to the world and immigration ? A kind of infinite Ponzi scheme ?
Rome sometimes comes up as an example. There are large differences, but instructive parallels as well. Just as we import guest workers and other cheap labour, so the Roman elite imported slaves. And not only low-end slaves, but educated ones as well. And that left the mass of the Roman population unemployed. They were citizens. They were taken care of. “Bread and Circuses” and all of that. But they did not have work and they were poor. They just lived off the fact of being “Romans” in the same way a lot of our aboriginals (and a growing urban underclass, and a lot of new rural poverty zones) are just living off the fact of being “Canadians”.
This is not a healthy developmental model. With all of this talk of sustainability, there should be some consideration of what creating a humanly sustainable organically cohesive Canadian population would look like. The kind of place where teenagers would learn to be useful harvesting food and wiping bums. The kind of place where the smartest kid in elementary school would eventually learn to do both, AND confidently expect to come back to his own community as a doctor or an architect.
Someone said that Canadian students never fail (once they get in the door). And that is a big part of the problem. No one is allowed to fail at all. And thus very few develop the skills required to succeed. In the old days, the lazy rebellious kid ended up as a “ditch-digger”. Today, that does not happen. We import the ditch-digger, and the rebellious kid just goes homeless or goes to jail. There is always a safety net, but relying on the safety net leads only to poverty.
I am way off topic here, but we have to get our act together. As things are now, we have a huge undeveloped space, and a tendency to just live off selling access tickets to it. Naturally the people coming in despise us. Our parents and grandparents handed off something of inestimable value. We aren’t even thinking of “handing off”. We are too busy consuming the capital retained, and when that fails borrow more, and to pay the interest on that, tax the few productive business units left into the ground. Swear in new citizens and then tell them how much they owe.
Ultimately, lose the whole thing to China as seized collateral on our failed loans, and then, just do whatever we are told.
As I said, not healthy. Not sustainable.
I personally think we should cut back significantly on immigration. Like detox. Turn off the artificial wealth, cheap labour faucet. Insist on a self-sustaining economy. Live within our means. Let the creative and industrious people (and there are many) get out and make it happen. And once we have done that, THEN we can figure out how to harmoniously add in and assimilate foreigners in a way that does not insult them AND does not threaten the integrity of the organic structure in place.
Stop the pyramid. Wash our own dishes. Heal our own sick. Bathe our own kids. Heck. Start by HAVING kids.
Gordon Friesen, Montreal
The CMA policy states: “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.”
It will be interesting to watch what, if anything, the medical profession does to align CMA policy with the current practice of restricting IMGs’ access to medicine via residency training to 10% of the residency positions available instead of having all positions open to all qualified Canadians. It is going to be a tough go considering that the vast majority of CMA members are CMGs who benefit from preventing Canadian citizens and permanent residents who are IMGs from competing against CMGs on the basis of the individual’s competence for the purpose of ensuring all CMGs become licensed.
IMGs, the public, and the profession will all benefit when Canadian physicians are chosen on the basis of individual competence rather than on the basis of having attended the “right” school”. But that is far from a reality at this time.
To judge for yourself whether there is any heart to make the policy more than paper, read the dialogue attempting to open the conversation with the CMA at https://socasma.com/general/socasma-calls-on-its-members-to-question-cmas-application-of-its-new-equity-and-diversity-policy/.