Just keep on trying for all the provinces. Don't limit yourself to one province. Especially look at the Ontario IMG which now have positions for up to 200 people. Though it is a tough competition as applicants keep on increasing every year. Other provinces like Nova Scotia, Manitoba and Newfoundland have other programs apart from Carms which you can also try. The key is networking. Write to other IMG's practicing in Canada for contacts during the Carms match. Make use of everybody you know or do not know. For CARMS match (2nd iteration for IMG's), get a very good score on the MCCQE1. Have a very good resume and personal letter on hand. If possible seek professional help on this. Do everything that you can to get some observerships with practising doctors. Talk to practising physicians. Some them will allow the observership. If you have a family doctor, start from there or talk to any practising doctor that you might know. At the end of each observership ask for reference letters that you can submit to Carms. Send each of the program directors for the programs that you have applied for in Carms, an email selling yourself. I know some people who have used this process and it has worked for them and there are in residencies now in Canada. Mind you these people had their medical degrees from Africa and Asia which normally would have been impossible for them to get through as graduates from UK, Ireland, Australia and unmatched Canadian graduates are given preference by the programs. However, network I would say works best and look at the Ontario IMG program which at the moment looks like the best chance for IMG's in Canada.