firetown

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http://www.canada.com/national/nationalpost/financialpost/story.html?id=8662d420-2349-415f-8979-ed5f99bcda40


Examiner expresses dismay about poor quality of applicants

Doug Williamson
CanWest News Service


Friday, February 18, 2005


WINDSOR - Touted as a solution to Ontario's physician shortage, nearly half the foreign-trained doctors who apply to eventually practise medicine in the province do not make the first cut, according to figures from the Ontario Health Ministry.

As a result, the province was not able to reach its limited quota last year.

Concerns have also been raised about the calibre of the latest group of nearly 600 International Medical Graduates (IMG), who recently went through a round of clinical tests as the provincial IMG Ontario office narrows down the list to this year's quota of 200.

"Just participated in the IMG exam as an examiner along with some of my colleagues. I was utterly dismayed by the calibre of these finalists," reads an e-mail sent on Feb. 15 to a Windsor doctor by a colleague who helped evaluate finalists this month.

"Out of the 30 that went through my ... station, only two were practice-ready. Half failed to diagnose the straightforward case presentation and were functioning at a medical school level, the remainder were clerkship level.

"This is the underbelly of this politically correct movement. God forbid you express any clinical and scientific criteria to the process. These people will be passed through on the wave of political expediency. The government is playing a shell game with this and is likely to create a public health fiasco."

The e-mail was obtained by The Windsor Star. The name of the sender had been deleted.

The province is hoping that its full quota of 200 IMG candidates will qualify for residencies in Ontario medical schools with their affiliated hospitals this year, with 50 of them allowed to fast-track for a physician's licence after six months. Residencies usually last from two to six years, depending on the specialty involved.

That did not happen last year, when only 165 out of 1,088 original applicants got the spots, and only 14 were good enough to fast-track, a ministry spokesman said.

Results thus far are similar for this year's batch. Last November, 1,041 IMGs wrote exams at McMaster University, University of Toronto, University of Western Ontario and University of Ottawa. Only 559 of the foreign doctors passed and went on to take the clinical tests. The 16 separate tests involved different patient scenarios. Results will be sent to the candidates in April.

This year, a total of 855 residencies will be offered in Ontario medical schools.

"We're looking at the (IMG) candidates to perform at a level equivalent to a fourth-year medical student," Health Ministry spokesman David Jensen said.

He had no comment on the e-mail from the examining doctor.

"Why don't we wait and see what the results are of this? We were very curious to know what we're dealing with," Mr. Jensen said.

Dr. Albert Schumacher, president of the Canadian Medical Association, said 10% of Canadian-trained doctors fail their tough final examinations after completing residencies.

Kathryn Clarke, spokeswoman for the Royal College of Physicians and Surgeons, which ultimately licenses Ontario doctors, said the college is committed to licensing only those physicians who can qualify. "The important thing is to build a system. We want to increase the physician resources, but we want to do it responsibly and fairly."
 

sunny123

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Nice post. I was wondering what happened with the IMG testing.
 

docbill

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No surprise what so ever!

Ontario and other Canadian provinces have to realize they can't solve the problem by getting IMGs. The only way to do it prob is by training Canadians in Canada. I am going to the US, cause I was not accepted here. Even with a PhD from here.

Does Canada honestly think, I will be rushing back to work in this country?
 

f_w

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I think the situation in Ontario is somewhat unique. There seem to be boatloads of people who got their basic medical degrees in a variety of places who subsequently managed to get immigration papers for canada.

With the barriers into graduate medical education in canada, they are stranded. If you read around on the OIMG website, some of them ar outside of the medical system for 10 years.

The british are feeding their somewhat 'challenged' medical system with 'overseas qualified' physicians all the time, and so does the US. But both of these countries take people fresh out of medschool and train them to their respective standards.
 
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firetown

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sunny123 said:
Nice post. I was wondering what happened with the IMG testing.

The IMG Testing is still in progress. The results will be in about a month or two I think. Up to 200 positions are available for IMG's. Last year they could not filll all the 200 positions. They were only able to fill about 165 positions.
 

f_w

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> Last year they could not filll all the 200 positions

I think the more precise wording would be: 'last year they didn' want to fill the 200 positions with the candidates they had before them.'
 
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firetown

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f_w said:
> Last year they could not filll all the 200 positions

I think the more precise wording would be: 'last year they didn' want to fill the 200 positions with the candidates they had before them.'

I have to agree with you. If they wanted to fill all the positions, they could have done that.
 

roo

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The problem is the best candidates won't go to Ontario.

Why bother? Lets take a newly minted grad from Ireland.
You have a broad range of residencies available to pick from and a broad range of places to go to in the USA. One application for them all via ERAS. Why would a good candidate go through the hassle of flying into Ontario for a province-only examination, have no assurance of available spots for candidates, and when only some specialites have immediate entry after completing medical school (the rest have some extra months of unpaid training to "bring up to par", which is a joke especially since already Ireland is 5-6 years of med school vs. 3-4 years of med school in Canada).

What happens is the best candidates go to the USA or to other provinces (like Sask, Nfld) that don't have extra province-only exams. What is left behind, for the most part, is candidates who aren't really competitive in the USA or other provinces, so keep hacking away at Ontario, while they live in an urban center because of the availability of many other non-medical jobs.

There might a handful of good candidates (as the article mentions), but the rest of the good candidates fly right over Ontario on their way to Sask or New York.

Sad state of affairs for Ontario people, especially considering their new few-hundred dollar extra tax for healthcare.

Cheers,
roo
 

docbill

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roo said:
The problem is the best candidates won't go to Ontario.

Why bother? Lets take a newly minted grad from Ireland.
You have a broad range of residencies available to pick from and a broad range of places to go to in the USA. One application for them all via ERAS. Why would a good candidate go through the hassle of flying into Ontario for a province-only examination, have no assurance of available spots for candidates, and when only some specialites have immediate entry after completing medical school (the rest have some extra months of unpaid training to "bring up to par", which is a joke especially since already Ireland is 5-6 years of med school vs. 3-4 years of med school in Canada).

What happens is the best candidates go to the USA or to other provinces (like Sask, Nfld) that don't have extra province-only exams. What is left behind, for the most part, is candidates who aren't really competitive in the USA or other provinces, so keep hacking away at Ontario, while they live in an urban center because of the availability of many other non-medical jobs.

There might a handful of good candidates (as the article mentions), but the rest of the good candidates fly right over Ontario on their way to Sask or New York.

Sad state of affairs for Ontario people, especially considering their new few-hundred dollar extra tax for healthcare.

Cheers,
roo
Good point.

On the radio in Toronto you now here CMA advertizing how we need doctors and how the government should do something about it.

Well I say, solve your own problems. Don't pick up IMGs, figure out a way to train enough doctors. I don't want to leave Ontario or Canada for that fact.. but I will have to.

And like I said before... it would be very difficult, personally, to come back and work as a FP in a rural area just because of the regulations. Especially when I may have multiple great offers in the US.
 

moo

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I have a friend who graduated from HS when he was 13. Too young to be accepted to med school in North America, he went to Ireland for med school. Now he's a resident in ENT at UCLA. He's obviously very smart, but Canada won't take him...
 

f_w

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I was toying with the idea of going to canada after I finish my training. After many emails back and forth with CPSO and the ministry of health, I essentially told them to f&^% themselves.

Either you have a physican shortage, or you don't. Other provinces faced with the same issues are working on solutions, either by increasing their own output of physicians from rural areas (e.g. northern BC medschool), or through aggressive import of trained FMG's. In ON you see a lot of 'brownian motion', (movement without a net vector), but nothing really happens. I am under the impression that most of the talk about a physician shortage in Ontario is political bu*(*&$$, furthered by people with their own agenda.

The US is full of well trained docs stuck in less than attractive positions. Many of them would probably consider a job in Ontario if offered. Many of the 'area of need' positions are actually in midsize cities, not so much different from the places many FMG's in the US have to look for anyway.
But for any of these folks to move north, it would require CPSO to get their a** in gear and to come up with a less idiotic credentialing program.
 

moo

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f_w said:
I was toying with the idea of going to canada after I finish my training. After many emails back and forth with CPSO and the ministry of health, I essentially told them to f&^% themselves.

Either you have a physican shortage, or you don't. Other provinces faced with the same issues are working on solutions, either by increasing their own output of physicians from rural areas (e.g. northern BC medschool), or through aggressive import of trained FMG's. In ON you see a lot of 'brownian motion', (movement without a net vector), but nothing really happens. I am under the impression that most of the talk about a physician shortage in Ontario is political bu*(*&$$, furthered by people with their own agenda.

The US is full of well trained docs stuck in less than attractive positions. Many of them would probably consider a job in Ontario if offered. Many of the 'area of need' positions are actually in midsize cities, not so much different from the places many FMG's in the US have to look for anyway.
But for any of these folks to move north, it would require CPSO to get their a** in gear and to come up with a less idiotic credentialing program.
The CPSO and many Canadian students/physicians pretend to be all altruistic and say "oh we're not like the US which steals physicians from other countries." Well, I don't think it's called stealing when you bar your own citizens from coming back to practice medicine. Or when you invite people to immigrate here from other countries and bar them from working. How's that any different? It's a bunch of lies and broken promises to immigrants. That's why you have so many skilled physicians from India, China, Egypt, etc. in the US.
 

f_w

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> It's a bunch of lies and broken promises to immigrants.

Did they ever promise anybody that they would be able to practice medicine ?
The first time I looked into going to the maple plantation was in the early nineties. Back then they basically had a big stamp on every piece of paper they sent you stating: 'physicians, irish and funny looking people need not apply' :)) Back then, beeing a physician effectively disqualified you from immigrating to canada !

I think many people just went to canada to escape their oppresive native countries. Not necessarily to practice as physicians, more to avoid beeing run over by a tank (china) or stoned to death for wearing a mini-skirt.
 

docbill

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f_w said:
> It's a bunch of lies and broken promises to immigrants.

I don't believe anywhere on any immigration document does it say that physicians can work in Canada. To my understanding they have always said MDs are not required in CAnada and will have difficulty getting practice rights.

A big part of it is BS and College of Physician and Surgeons and other CMA are trying to get the public worked up against the government. That way the gov follows through and delivers more money. But beware.. if you push too much.. you may just break the system. My thoughts.. but I am not an expert nor do I know what I am talking about.
 

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Foreign-trained doctors provide equal care: Study


FROM CANADIAN PRESS

Doctors trained outside Canada provide the same standard of care for heart attack patients as home-grown physicians, a finding that should reassure patients as well as policy makers seeking to ease the country's doctor shortage, Ontario researchers say.

The study by the Institute for Clinical Evaluative Sciences found that despite concerns over quality of care, international medical graduates are no slouches when compared to their Canadian-trained counterparts, said lead author Dr. Dennis Ko, a cardiologist at Sunnybrook and Women's Health Sciences Centre in Toronto.

"Our study shows that the care is similar, and so I think it reassures patients that — particularly in a heart attack — that their care has been shown to be similar to Canadian graduates," Ko said Monday.

The paper, appearing in this week's issue of the Archives of Internal Medicine, examined the health records of 127,000 heart attack patients admitted to Ontario hospitals between 1992 and 2000. The researchers found that the rates of patient deaths at 30 days and one year were virtually identical for both foreign- and Canadian-educated doctors.

"And also the use of life-saving medications . . . were very similar between people who were trained in Canada versus people who were trained from outside," said Ko, citing the use of such standard treatments as ASA tablets and cholesterol-lowering drugs.

Joan Atlin, head of the Association of International Physicians and Surgeons of Ontario, said she's pleased to see solid evidence that international grads selected to qualify for the health-care system are of equal quality to Canadian-trained doctors.

"It will certainly help to debunk the idea that somehow by allowing internationally trained physicians into the system that we're lowering the standard of care — when clearly we're not," said Atlin, whose Toronto-based organization advocates for and supports foreign-trained doctors.

Ontario has begun building a system to assess international medical graduates and slot them into training and residency programs, she said. Today there are 200 spots — far above the 12 available about six or seven years ago.

But with more than 2,000 foreign-educated doctors in Ontario alone hoping to practise their profession in their adopted country, there's still a huge problem, Atlin said. "Two hundred, that's certainly not enough. But it's a move in the right direction."

Meanwhile, those trained outside Canada — many of whom spent years caring for patients in their countries of origin — are taking whatever jobs they can get.

"People are doing anything and everything, from folding laundry in hospitals to working in parking garages," Atlin said. "Some who have been here longer have managed to get positions that do use some of their medical skills, in medical research or medical insurance adjudication, things like that.

"They came to Canada as immigrants, they've come and brought families here on the assumption that, knowing there's a doctors shortage here, that they would have the opportunity to be assessed and get into the system.

"So there's a real sense of betrayal for many people."

That's akin to how Abu Yakub feels after coming to Canada in 2001 from Bangladesh: he practised family medicine there and in Iran for 20 years. After writing Canadian qualification exams, he is still waiting for one of the precious retraining or residency spots before he can be licensed to practise.

"I feel very bad and very frustrated," said Yakub, 49. "I'm sure I'm able to do whatever is done here in family medicine, but still I don't get an opportunity."

But once he obtains a licence, he'll likely have to move from his home in Mississauga, Ont., just west of Toronto: foreign-trained doctors in Ontario must spend five years in an underserviced area of the province, a requirement not applied to Canadian-educated physicians.

In the meantime, Yakub works part-time in a doctor's office and as a clinical observer in a Toronto hospital, but it is difficult to make ends meet for him, his wife and children.

"I tried, but it's very difficult to give up my professional work in a different field," said Yakub, who worked as a telemarketer for awhile. "It doesn't really give you satisfaction for living."

Still, he is glad to hear that the study on heart attack patients has vindicated some foreign-trained doctors, who make up about 20 per cent of Ontario's physicians.

"I feel very proud of myself because I think I'm one of that group."
 

johnny_blaze

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This IMG thing in Ontario pisses me off as well. The more research I do on how to come back to Ontario… the more I want to go down south. I probably would even go for a residency spot outside of Ontario and the only reason I want to practice in Toronto is because it’s my home. However, I’m slowly starting to realize that it wouldn’t be so bad working in North East US and travelling home for breaks.

I hope Ontario makes some changes before I finish med school or they’ll lose another kick ass doctor (me :D ) to the US!
 
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johnny_blaze said:
This IMG thing in Ontario pisses me off as well. The more research I do on how to come back to Ontario… the more I want to go down south. I probably would even go for a residency spot outside of Ontario and the only reason I want to practice in Toronto is because it’s my home. However, I’m slowly starting to realize that it wouldn’t be so bad working in North East US and travelling home for breaks.

I hope Ontario makes some changes before I finish med school or they’ll lose another kick ass doctor (me :D ) to the US!
Ditto. I am pissed off, I might as well do the same. Rotations-Residency-Work in the U.S., somewhere close to the border - and go back to my home sweet home for vacations.

I still have another three more years until rotations come along, maybe by then....just maybe, Ontario would make some changes? :luck:

Regards-
 

mdsadler

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For all of you Canadians in med school in the US and planning on doing residencies in the US and then staying to practice there, what kind of citizenship do you have? Are you able to easily get working documents to stay in the US if you are only a Canadian citizen without any added special US citizenship (ie if you only have student visas to work in the US how easy is it to continue working there once you are finished residency)?

I am still waiting for acceptances in Canada and one in the US, however, I was more impressed with the school in the US and would really enjoy going to school there if accepted. I don't mind doing residency or even working in the US in the end but I would just like more info on what it takes to get the documentation to live and work in the US