Mariana da Silva Jardim is an unemployed immigrant physician in what is now known as Vancouver, BC.
A while ago I saw an ad on the Internet from a physician, in Ontario, looking for an international medical graduate (IMG) to work, as a medical assistant, for $15 (Canadian) per hour.
I am an immigrant and an IMG, but my partner is neither. Born and raised in British Columbia (BC), and not a doctor, when he saw this wage offering, he was surprised. He hadn’t worked a job that paid that little since he was a teenager decades ago.
I left my family, my friends, my culture and my medical career in March of 2019. After I finished my medical residency, my partner convinced me to emigrate, saying “we need more doctors in Canada”. I have now heard the same speech from his family (his mother, a family physician herself), friends and from almost every Canadian I have met so far. But does the Canadian healthcare system need or want immigrant physicians?
As of 2019, 26% of Canadian physicians were IMGs (immigrants and non immigrants). In Saskatchewan, 1 in every 2 physicians is an IMG. At the same time, around 15% of Canadians still do not have a regular healthcare provider and Canada ranks 27th out of 36 OECD countries on number of doctors per 1000 population.
So, yes, it seems reasonable to say that Canada might benefit from people like me. And, in fact, our medical degrees, postgraduate training and experience as physicians count as valuable points facilitating our immigration to the country. So why, when we arrive, does it appear that our education and skills are undervalued?
As much as I imagine that the physician offering the job position was doing so with really good intentions, I could not avoid thinking: “Is this how much a foreign doctor’s knowledge and competency are worth?” – less than the minimum livable wage for the area. That is what we are worth, while spending thousands of dollars trying to become a practitioner in the country.
Every year, hundreds of immigrant physicians land in Canada, but for every inspirational story there are many more less successful ones. There are those who decide to postpone, or give up, their clinical practice dreams and there are those who end up driving taxis, babysitting or mopping as a way to get enough resources for paying all of the expenses in the path to become a clinical physician in Canada. And I am no different.
For a year, I worked in a homeless shelter in a lovely small town, in a position where I had to mop, cook, unclog and clean. There I learned about a side of Canada different from the untarnished facade – the homelessness, opioid crisis and marginalization of Indigenous peoples and minorities – and, although I am extremely thankful for the opportunity I had, that was also the place where I experienced my personal “brain waste”.
During that year I craved the challenge of an intriguing clinical case, the unique human connection of the physician-patient relationship and the rush of adrenaline when facing a human being who needs urgent care. I missed the clinical thinking and the feeling one has when receiving a “thank you” from a patient. I missed using parts of my mind I have been nurturing for the past decade.
As I had spent half of my year’s income on expenses related to (one day) practicing medicine in Canada, my partner and I decided to move to a metropolitan area in search of better opportunities for my professional growth. Here I found myself reading yet another interesting job position. “Medical Student Immunizer – COVID-19 vaccinations” for $28.33 per hour – this time in BC. I tried to apply but, as I am just an immigrant physician and not an enrolled medical student in Canada, I did not fulfill the requirements and could not get the job.
Some people might wonder: “Why don’t these doctors just go back to their home country?” The answer is very simple. When most of us emigrate because of socioeconomic or political situations and worry about providing the best life possible for our children, how does one go back? When those are the reasons why my Canadian partner did not want to stay in my home country, how do I convince him otherwise?
In the next three years, Canada’s government is planning to admit a total of 1,2 million Permanent Residents (PR). Immigrant physicians, inevitably, will be part of the sum. And the questions I am presenting will continue to exist for as long as there will be physicians with useable skills who are not allowed to practice in the medical field.
The truth is no system is fair, and Canada is seeking to make it better for immigrant physicians. But changes are only incremental and slow to be implemented. In the meantime, many of Canada’s doctors of tomorrow are mopping floors today and wishing to use their brains in the ways they spent so many years training for.
I came to Canada without a partner. I spoke English and not French. It took many years and low paid jobs for me (and at least other 5 IMG study partners) to eventually get in and through residency. It is definitely a rocky path. It is far from perfect. I even identified that IMG specialists have it easier than Canadian trained doctors who complete residency in certain circumstances.
I do understand your frustration… I shared it for many years…. put your efforts in languages and passing the MCCQE1 and NAC… apply all over Canada! Do observerships! There are many different ways to success! … and true, it is not easy
An advise that I knew from a friend that she did clinical observership at these facilities for 12 weeks and received LOR and assisted her to be matched in FM in Ottawa 2021. Visit this website as might assist you: http://www.Canadianobserverships.com
Hey Mariana, I am an IMG myself, but in a different situation to yourself: I am a Canadian who went overseas to study medicine in Australia, did a few years of residency there, then came back to Canada and was only able to get a FM residency here. After having trained in two different countries, here’s what I can tell you: Canada’s medical training system sucks especially for IMGs. It is inherently unfair to IMGs, even though IMG candidates are often way better than CMGs in my experience. This often due to the fact that IMGs usually have prior training overseas. Also, training in Canada isn’t very good/thorough, I personally found training overseas to be way better.
As has been mentioned by a few others docs on here, try to shift your focus to completing US/UK/Australian exams and complete your training there. Those countries have way more Residency opportunities, and train you to become a better physician quite frankly. I know this may be difficult depending on your family situation, but Canada is just a country with few opportunities in Medicine. Also, if you haven’t already done so you may want to look into provinces like Saskatchewan and Manitoba who previously offered a “Practice ready” pathway to certification for those who have completed residency overseas. It usually involves working under supervision for a while, but you would still have to sit the Canadian licensing exams
Either way, good luck and don’t give up hope!
My name is Gloria, and I am also planning to study medicine in Australia. IMG residency matching has been a concern for me when deciding if I should make the move to Australia or not. I was just wondering if we could have a breif chat? It would be amazing to hear from you!
Please let me know!
I agree with you on many levels, including the main point: either remove physicians from the “skilled worker” category or reform the system of the postgrad medical training. I’m an IMG myself, but I did the residency and fellowship in the States. I practised in Canada for 9 years on the restricted license despite dual certification (American Boards and Royal College) and passing the assessment of practice. The more I read about CARMS, the clearer it becomes that the IMGs have better chances of winning a lottery than getting a residency position. When I read the articles about further decreasing the number of residency positions to match CMGs, I want to ask people making such suggestions: why do you treat IMGs as lesser beings?
If you have means and time, try to match into the US residency. You’ll have better chances there.
Mariana da Silva Jardim
I would like to thank everyone for their responses. My intent with this post was to bring to light, once again, this topic. I do not want to pretend that there is an easy solution or that the solution is to just let all immigrants practice medicine without making sure we all have the ability to do so. I am not a specialist on this topic and do not want to pretend to be one. By writing this blog post I was wishing to share a personal perspective to a worldwide condition so others could take this in consideration when forming their own reflections and opinions.
I would also like to point out that I was living in a small, rural, ten thousand people area and had to move to the biggest city in the province so I could get all the opportunities that other people, applying to the same spots as I, are having (which sounds counterproductive considering some Canadian governments inclination on wanting skilled immigrants living in less populated areas) and that no one, no matter what schools they went to, the degrees they hold, the place they were born or what skills they have, should be offered a wage lower than what is considered to be a livable wage.
Since I arrived in Canada some things became very clear to me:
First: Canada is one of a kind and privileged country. The reality is that many brilliant things I have seen and experienced here are decades away from happening in most other countries. But Canada is not as perfect as I imagined and problems do exist.
Second: if you have a voice, use it! I have been very impressed on how even the most unpleasant topics are been (or have started to be) discussed here. I have been impressed how different opinions are brought to light and discussed in an argumentative, but yet polite way.
So I decided to use my voice and share my own personal, anecdotal and punctual perspective to highlight a global phenomenon. One that will, probably, increase in Canada in the next few years.
I do not want to pretend that this is the only or the rightest perspective for this topic. Or that it reflects the reality of all IMGs. And I would like to encourage those who are interested in understanding this topic better, to research more about it. There is one particular Canadian research that I found quite interesting and brings to surface the exact opposite of some of my arguments here (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4749883/?report=reader) . (I have many other interesting articles about this topic saved if anyone is interested in, but a pubmed research can also be easily done).
And I would also like to encourage Canadians Studying Abroad – CSA – to take this as an opportunity to try to share their own perspectives here, as mine has the bias of not exposing their reflections as IMGs.
For those who suggested some options, I am very aware of the private organization success stories and also have been connected with all the government support I could get so far.
I feel extremely happy that, by sharing my personal reflection and experience, a small discussion commenced. So thank you cmaj blog on publishing this and thank you everyone who commented.
ps.: I hope my mistakes can be forgiven as, this time, I did not have the help of my supportive partner who, different from me, has English as his first language. I tried my best to catch all my grammar mistakes, but sometimes they are not as obvious to me.
Hi Mariana, my name is Zarema. I am IMG came to Canada long time ago, I spent so much time and money to pass evaluations exams and after I realized
Sorry I will continue my story, after a couple years I realized that in Canada to get IMG residency position is not possible at all. I worked here as a caregiver for many years. In 2017 I took a pathway to become a registered practical nurse, now those programs are cancelled making harder even to become a nurse. I became a nurse after completing RPN program at George Brown college. I regret that I didn’t take a nursing program right away when I came to Canada and today I would have 20 years experience as a nurse but I was too stubborn to do so. Later I am planning to become RN. I passed nursing license exam from first time it was easy for me since I am IMG but anyway I am making good money enough to pay rent and for groceries and that’s all what I need. If I were you I would go take a nursing program instead of working for $15 per hr. All the best!
Do not waste any more time writing articles and mopping floors. You have a lifetime to do this if you do not match. Successful IMGs focus on the exams first, pass Qe1 and NAc with high scores, put together a great application. BC is one of the best place for IMGs in Canada: apply for Clinical observership, apply for CAP BC . Pass IELTS , volunteer or work in research to get papers and posters. In case your scores are not high and do not match all this effort will help to get a better position in an alternative career. Every second you waste removes you from the graduation or independent practice. Look at our success stories Starmed medical Education Programs
While I imagine your comment is meant to be helpful, you are missing the point. Dr da Silva Jardim (who happens to be my partner) was working at the homeless shelter to pay for those exams that you list (which cost many thousands of dollars). She has now passed those exams and earned a score on the MCCQE1 well above that of the average Canadian Medical Graduate (and she has already published papers in the field and presented posters in medical conferences and is currently awaiting CPSBC approval for a clinical observer license), but that does not negate the issues eloquently explained by Rosemary Pawliuk, Malcolm M Macfarlane and Dr Laura Blew in their comments down below. They have explained the barriers better than I can, so I direct anyone interested to read their words and join in the conversation.
You fail to say where are you from which medical school you graduate from. Please go the nearest college of physicians office and seek their advice how to become a physician in Canada. There are some examinations and clinical assessment program you must go through with few examinations one must pass before anyone qualifying outside North America.
Is it irrelevant to the point being made? Passing the examinations and proving one has the knowledge and clinical skills expected of a graduate of a Canadian or American medical school does not result in equal opportunity to work in entry level jobs to medicine. There is nothing an international medical graduate can do to get equal opportunity to licensing. Having an international medical degree colours you and places you at the back of the bus. As Dr. Blew eludes to below, there is a double standard. IMGs must pass the MCCQE1 (designed to determine whether a graduate has the “critical medical knowledge and decision-making ability expected of a graduate of a Canadian medical school”) to be eligible to compete for a job as a resident physician, and must excel to get an interview. CMGs can fail the MCCQE1 and work as resident physicians.
Malcolm M MacFarlane
I’m assuming Dr Sangaralingham’s intention with this post was to be helpful in directing Dr da Silva Jardim to appropriate resources. Unfortunately Dr Sangaralingham’s assumption that Dr da Silva Jardim’s difficulty gaining access to the medical profession is due to her own ignorance of available pathways comes off as somewhat patronizing and tends to blame the victim and perpetuate the myth that IMGs are marginalized because they are not as qualified as Canadian Medical Graduates, or alternatively that they feel entitled to enter Canadian medical practice without going through the proper steps to be evaluated and licensed.
I fact, this is not the case. There are clear systemic barriers that prevent most IMGs from entering Canadian medical practice. The most egregious of these is the current practice in the Canadian Residency Matching Service of streaming IMGs to a limited number of residency spaces and limited opportunities for specialization.
Each year about 1,800 IMGs who are Canadian citizens and permanent residents and have passed objective examinations that demonstrate competence equivalent to their CMG counterparts, are streamed to a limited 350 IMG positions. Because of these restrictions, each year about 1,400 qualified IMGs are unmatched and, without a needed residency, are unable to practice medicine. Their skills and abilities are lost to Canadian society.
This is the real issue.
Let’s make it even simpler. These CaRMS applicants are all Canadian citizens and permanent residents, and yet they are being discriminated against, treated unequally, and effectively barred from equal competition for entering Canadian medical practice where their skills are needed. This marginalization happens for one reason, and one reason only: their degrees are not from Canadian medical schools.
This is just plain wrong, and flies in the face of Canadian efforts to attract skilled immigrants, as well as established principles for evaluating international credentials such as the Lisbon Recognition Convention,to which Canada and all provinces are signatories.
These rules have been made by Canadian faculties of medicine to protect the interests of their own graduates, and for no other reason. These rules are not in the public interest.
These rules have nothing to do with the competence of IMG physicians. These rules are tolerated and accepted by other medical organizations who should be challenging them such as the provincial Colleges of Physicians and Surgeons and the provincial Ministries of Health who do have a responsibility to act in the public interest.
No less than five provinces in Canada have legislation governing fair registration practices for health professions. The current system of access to the medical profession, and in particular the CaRMS streaming practice is pattently unfair and violates these legislative fairness principles, yet the current system goes unchallenged.
In a time of heightened focus on equity, its past time for this system to change and for all Canadian citizens and permanent residents to be treated as equals in accessing the profession of medicine in Canada. This is what our Canadian value system regarding equity and fairness demands. After all, a Canadian is a Canadian, right?
Dr. Laura Blew
In addition to Dr. da Silva Jardim being an immigrant and IMG, she is our physician colleague. Undervaluing IMGs is counterproductive to the needs of under/unemployed IMGs, unattached patients, patients languishing on wait lists and to overworked practicing physicians. Our prejudice is harming us all.
Dr. da Silva Jardim says ” Canada is seeking to make it better for immigrant physicians.” Her optimism may be as generous as her gratitude for mopping floors, as I am unaware of any such changes being underway. I see the AFMC and their provincial counterparts fiercely and unapologetically protecting a discriminatory two stream match process to serve their own conflicted interests, without consideration for those of patients and physicians.
I encourage physicians shocked and saddened by this story to request of your MPP and Minister of Health increased funding for added post graduate training positions. We all know more physicians are needed, yet our governments insists they are not. There are literally 1000’s of qualified Canadian citizen/permanent resident IMGs ready to fill them and put their medical education to use for our benefit.
At present, residency positions are awarded to very near all Canadian graduates (despite being unexamined and not yet proven competent, up to 5% go on to fail the exams each year but proceed to residency never the less) with a much smaller number of positions in only some specialties designated for the highest exam performing IMGs.
Please ask your College to eliminate discrimination based on location of medical degree and to require all candidates be examined prior to competing as a single group based on merit. We owe it to Canadian patients to train the best candidates, regardless of where then went to medical school, and to stop the IMG brain waste the present entrenched system promotes.
Thank you for telling your story. As sad as it is, the medical profession has a long history of elitism where Canadian and American graduates have come to believe themselves superior to physicians educated and trained elsewhere. In part this culture has developed because the pathways to licensure have institutionalized the higher worth and privileged position of CMGs over IMGs. For IMGs proving they have the critical medical knowledge, decision-making ability, and clinical skills expected of a Canadian graduate is not enough to provide them with equal opportunity. Despite proving competence at the Canadian standard, IMGs are prohibited from competing for 90% of resident physician jobs which are a pre-requisite to licensure. The heart-wrenching harm that IMGs experience from this institutionalized stratification and marginalization of citizens and permanent residents is something we prefer not to see. Until we look inwardly and objectively at what we rely on to justify in our minds stripping international medical graduates of their constitutional and human rights of freedom and equal opportunity, this aberration from fundamental principles of justice in medicine will continue. But it is difficult to see clearly and to analyze impartially when one spends 4 years of university learning that one is the best and the brightest; when graduation from a Canadian medical school guarantees a person access to an entry level job to the profession with protection free of competition from other Canadians who given a chance to compete on individual merit might displace a CMG; when it is acceptable to have two standards of competence where IMGs must excel in the MCCQE1 to be considered for an interview for a residency position, while CMGs are free to fail the MCCQE1 and work unimpeded as resident physicians; when it is in the best interest of those in positions of authority to control the number of physicians as this keeps income high and prevents unemployment amongst our CMG colleagues and allows the ministries to control access to health care and hence the budget; and when the system provides a pool of less less deserving” Canadian citizens and permanent residents who it is “acceptable” to restrict to underserviced disciplines, and to force to work in underserviced regions. So long as there is no effective IMG representation (tokenism aside) in medical organizations and on committees where decisions that affect IMGs and public healthcare are made, it is easy not to be exposed to reality– to poverty and pain, to the point of mental illness and even suicide, that IMGs endure in Canada. As stated in this well-articulated article, Canada is the poster child of inclusion. But for those of us who get close enough to pull back the coverings, there is a lot of inequity beneath. When will IMGs be given a voice to speak for themselves? Faculty members who work with IMGs “to present the IMG perspective” is not “representation”. When will we have a system which selects resident physicians on the basis of the individual instead of which school they attended? When will we stop the façade that IMGs sign return of service contracts “voluntarily” when in reality their choice is “sign this agreement or forfeit your right to your career”? When will the privilege, prejudice, and racism that is embedded in access to and within the medical profession be recognized for what it is? When will the discussion and the work begin?