This story is part of Welcome to Canadaa CBC news series about immigration told through the eyes of people who have experienced it.
Imelda Ramirez says she never expected to trade her white medical coat for a McDonald’s uniform. Although she trained as a family doctor in the Dominican Republic, she ended up working at the fast food chain for eight months after moving to Quebec in 2022.
She is one of thousands of internationally trained doctors, or ITPs, living in Canada, the vast majority of whom do not work as doctors, according to advocacy groups.
“As many international doctors, we are willing to work hard and do whatever it takes to reach our ultimate goal,” Ramirez said.
Despite changes to the process aimed at increasing the number of internationally trained doctors working in Canada, ITPs still face significant obstacles including navigating a complex system, lack of opportunities and requirements that force some to leave the country temporarily.
Millions are without a family doctor
The Canadian Medical Association (CMA) says more than 6.5 million Canadians don’t have access to a family doctor, a number that is growing.
“We’ve seen a lot of burnout during COVID, with a lot of doctors reducing their hours or leaving the profession entirely,” said CMA President Dr. Joss Reimer, adding that many doctors are also approaching retirement age.
“So there is an increasing demand for physician care and fewer of us are able to provide care,” she said.
It’s unclear exactly how many people live in Canada, but advocacy groups in Ontario, Quebec and Alberta tell CBC News there are more than 5,000 internationally trained doctors in those provinces. The vast majority of them do not work as doctors, the groups say.
Reimer says the first complication they face is going through a difficult process.
“As president of the Canadian Medical Association, I have a hard time understanding the different options and how they work,” she said.
All thirteen provinces and territories in Canada have separate licensing requirements. These requirements can also vary depending on where the international doctor trained.
Depending on the province and path they choose, ITPs can take up to four preliminary exams, all while trying to build a life in Canada, get a job, and pay the bills.
The tests can be expensive, with one test costing $3,255.
Quebec non-profit Les Anges de L’Espoir has worked with more than 1,100 ITPs since 2016, and says only 10 per cent of them have obtained their licences. She does everything she can to help them, including preparing for exams and interviews.
“Most of them have passed the Canadian exams,” says Executive Director Marie-Ange Goudy. “They have proven themselves.” “They suffer from social and professional isolation, which takes a toll. It’s unfortunate given the demand that exists.”
After moving to Canada, Imelda Ramirez got a job at McDonald’s and worked tirelessly to pass her Canadian medical exams. But she was unable to obtain residency, a crucial stage for doctors to obtain practical experience. The lack of residency is a major barrier to recruiting more internationally trained doctors.
Limited accommodation
Ramirez has passed her qualifying exams but still has one more hurdle to overcome: she is trying to secure a residency where doctors get hands-on training in hospitals and clinics.
This process takes place only once a year, and the majority of places are reserved for graduates of Canadian medical schools.
Last year, 2,936 graduates from Canadian medical schools went on to obtain residency, while only 671 international programs were successful.
Canadians studying abroad also compete for those limited ITP spots.
Ramirez was not selected for residency, and says she did not receive any feedback on how to improve her application.
“We don’t want any shortcuts, we don’t want any gifts, we want to work hard,” Ramirez said. “I think it should be more transparent (with) what we have to do.”
There is an increase of 59 slots allocated to ITPs this year compared to last year, with several provinces adding or planning to add more slots including Newfoundland and Labrador, New Brunswick, Ontario, Manitoba and Alberta.
Modern Senate report He says the federal government should fund 750 places for ITPs annually. These doctors could then provide care to about 1.1 million Canadians, she says.
But Stephanie Price of the Federation of Medical Regulatory Authorities of Canada, a body that brings together all provincial and territorial medical schools, says funding more places isn’t the only problem — there’s also a shortage of licensed doctors to train new doctors.
She says medical schools are trying to find different ways to evaluate internationally trained doctors. Price says that before colleges wanted people to look “just like Canadian-trained doctors,” but that has changed.
“There’s more recognition of the risk of not having enough doctors, so we’re looking for competence, not parity. This doesn’t actually change the standard, we’re still looking for a competent doctor, but it broadens the range of people who (can) apply.”
An alternative and faster route
Counties are looking for ways to speed up the licensing process. All of them, except Prince Edward Island, have now offered what is called a Practice Readiness Assessment, or PRA.
The program is a 12-week intensive clinical assessment in the workplace where ITPs are evaluated under the supervision of a licensed physician.
How and where the program is delivered and administered and the exact duration varies across each province. Most programs aim to become a family physician.
Dr. Viren Naik says forcing experienced ITPs to resettle in Canada is not the best use of resources. He is CEO of the Medical Council of Canada, which administers medical testing and works with provinces on their PRA programs.
“This is a way to accept highly qualified candidates and integrate them more quickly into our Canadian health care system,” Naik said.
But there are potential obstacles.
ITPs must agree to certain conditions to obtain a full license. In Ontario, for example, they must work in a rural or northern community for three years.
Leave Canada to meet requirements
Another challenge that ITPs face is that in order to qualify for a PRA, they must have worked as a doctor for a certain period of time. Many districts require approximately six months of practice in the last three years.
Ognefegwu Akpomi worked as a family physician in Nigeria before moving to Canada in 2016.
She passed her medical tests but was unable to get a place to stay.
She has returned to Nigeria several times, including for four months in 2023, to gain this latest experience.
“It is a big challenge because there are a lot of things coming back home, it is not safe,” Akpomi said. “You can’t leave the kids here alone, so it’s a challenge.”
“I feel like we’re letting talent go to waste,” she says. “It’s not fair because you can already get that experience even here in Canada.”
Ognefegwu Akpomi worked as a family doctor in Nigeria before moving to Canada in 2016. Although she passed her medical exams in Canada, she was unable to get a place to stay. In 2023, she returned to Nigeria to practice medicine for four months to gain modern experience.
Gain Canadian experience
Akpomi now works as a clinical assistant in Ontario. Ramirez, ITP in Quebec, works as a medical assistant. Both jobs are unregulated, meaning they can perform some limited tasks under the supervision of a licensed physician.
Other provinces, such as British Columbia and Alberta, have introduced associate physician programs for ITPs, which allow them to perform more tasks while working with the physician.
But Naik says that the experience gained from working in these positions is not considered recent medical experience.
He says there are discussions to change that.
“(It’s) also an opportunity for them to learn about some of the orientations of the Canadian health care system in the clinical assistant role or physician assistant role so they can get used to the important cultural competencies that are unique to Canada,” Naik said.
“I don’t see any hope”
Faiza Amer says she moved to British Columbia in 2022 because she heard about the doctor shortage in Canada and thought she could help.
She has more than 15 years of medical experience in Pakistan and UAE.
Amer says that in Dubai, she obtained her medical license three days after passing her exams.
Faiza Amer has worked as a family doctor in Pakistan and the UAE for more than 15 years. She came to Canada because she heard about the doctor shortage. Amer says that she was initially excited to obtain the license, but after learning about all the challenges, she began to lose hope.
In Canada, she has passed one test and is preparing to write another, all while trying to find a job. She says she was rejected several times because she was told she was “too qualified.”
“Before I came here, I was very active, and I was more hopeful that I could do something now for me, for my future, for my kids, or to relieve some of the pressure (on) the Canadian health system. But now, I can do it,” she said. “I don’t see any hope.” “We are financially drained.”
Amer says if her situation doesn’t change, she may have to leave Canada, and she’s likely not alone.
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