Integrating International Medical Graduates: The Canadian Approach to the Brain Waste Problem

The Canadian health care system has relied both historically and more recently on international medical graduates (IMGs), physicians educated in other countries, to help solve shortages in its health care system, particularly in underserviced rural and remote areas. Throughout the 1970s, roughly a third of Canada’s physicians were IMGs. Although this proportion has dropped to 23 % more recently, Canada still has a sizeable dependence on physicians trained in other countries. The profile of incoming doctors has also shifted. In the 1970s, physicians tended to come from English-speaking countries, such as Ireland and the UK. Similar educational systems and proficiency in English made the process of integration of these IMGs relatively simple since their credentials and training could be assessed according to Canadian standards and most were fast-tracked to achieve Canadian accreditation. More recent IMGs originate from a wider variety of source countries, making English language proficiency and credential equivalency key issues for medical regulators and certifying bodies. Reports of IMGs having difficulty completing the extensive licensing procedure needed to practice medicine in Canada are increasingly common. This process includes passing several costly standardized exams and often two to six more years of postgraduate medical training, to which there is limited access. This chapter draws on interviews with key policy stakeholders as well as IMGs to highlight the challenges to the integration of IMGs in Canada.