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This story is a part Welcome to Canadaa CBC News series on immigration told through the eyes of people who experienced it.
Ismelda Ramirez says she never expected to trade her white doctor’s coat for a McDonald’s uniform. Despite training as a family doctor in the Dominican Republic, she ended up working at a fast-food chain eight months after moving to Quebec in 2022.
She is one of thousands of internationally trained physicians, or ITPs, living in Canada, the vast majority of whom do not practice as doctors, according to advocacy groups.
“Many of us international doctors are willing to work hard and do whatever it takes to get to the bottom line,” Ramirez said.
Despite changes in the process aimed at increasing the number of internationally trained physicians working in Canada, ITPs still face significant barriers including navigating a complex system, lack of opportunities and requirements that force some to leave the country temporarily.
Millions without a family doctor
The Canadian Medical Association (CMA) says more than 6.5 million Canadians do not have access to a family doctor, and that number is only growing.
“We’ve seen a lot of burnout during COVID, a lot of doctors have either reduced their hours or left the profession altogether,” said CMA President Dr. Joss Reimer, adding that many doctors are also approaching retirement age.
“So there is more demand for medical care and fewer of us can provide care,” she said.
It’s unclear exactly how many ITPs 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 groups say the vast majority do not work as doctors.
The first complication they face is managing the difficult process, Reimer says.
“As president of the Canadian Medical Association, I find it challenging to understand what the different options are and how they work,” she said.
All 13 provinces and territories in Canada have separate licensing requirements. These requirements may also differ depending on where the international doctor was trained.
Depending on the province and path they choose, ITPs could take up to four initial exams while trying to build a life in Canada, get a job and pay the bills.
The tests can be expensive, with one costing $3,255.
Quebec-based nonprofit Les Anges de L’Espoir has worked with more than 1,100 ITPs since 2016 and says only 10 percent of them have been licensed. He does everything he can to help them, including preparing for exams and interviews.
“Most have passed the Canadian exams. They have proven themselves,” says executive director Marie Ange Jeudy. “They go through socio-professional isolation, which takes its toll. That’s unfortunate given the demand that’s there.”
After moving to Canada, Ismelda Ramirez took a job at McDonald’s and worked tirelessly to pass her Canadian medical exams. But she failed to get residency, a crucial stage for doctors to gain practical experience. The lack of places for specialization is the main bottleneck for the recruitment of more internationally trained doctors.
Limited places to stay
Ramirez passed her qualifying exams, but still has one more hurdle to overcome: trying to find a residency where doctors get hands-on training in hospitals and clinics.
The process only happens once a year, and most places are reserved for graduates of Canadian medical schools.
Last year, 2,936 graduates from Canadian medical schools received residency training, while only 671 ITPs were successful.
Canadians studying abroad also compete for these limited ITP spots.
Ramirez was not selected for the residency and says she did not receive any feedback on how she could improve her application.
“We don’t want any shortcuts, we don’t want any gifts, we want to work hard,” Ramirez said. “I just think it should be more transparent (with) what it is that we need to do.”
This year there is an increase of 59 dedicated ITP slots compared to last year, with several provinces adding or planning to add more slots, including Newfoundland and Labrador, New Brunswick, Ontario, Manitoba and Alberta.
Recent Senate Report says the federal government should fund 750 ITP places a year. He says those doctors could then provide care for about 1.1 million Canadians.
But Stephanie Price of the Canadian Federation of Medical Regulatory Authorities, 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 colleges used to want people to “look exactly like Canadian doctors,” but that has changed.
“There’s more recognition of the risk of not having enough doctors and so we’re looking for competence, not equality. It doesn’t really change the scale, we’re still looking for a competent doctor, but it expands the number of people who (can) apply.”
An alternative and faster way
Provinces are looking for ways to speed up the permitting process. All of them, except PEI, have now introduced what is called “Practice Ready Assessment” or PRA.
The program is an intensive 12-week clinical assessment in the workplace where ITPs are assessed under the supervision of a licensed medical practitioner.
How and where the program is delivered and implemented, and the exact length, varies from province to province. Most programs are 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 the chief executive officer of the Canadian Medical Council, which administers medical examinations and works with the provinces on their PRA programs.
“This is a way to take very 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 in order to be fully licensed. In Ontario, for example, they must work in a rural or northern community for three years.
Leaving Canada to meet requirements
Another challenge for ITPs is that in order to qualify for the PRA, they had to work as doctors for a certain period of time. Several provinces require approximately six months of practice in the last three years.
Oghenefego Akpomi worked as a family doctor in Nigeria before moving to Canada in 2016.
She passed the medical examinations, but did not manage to get a place of residence.
She returned to Nigeria several times, including for four months in 2023, to gain that recent experience.
“It’s a big challenge because there’s a lot of stuff coming back home, it’s not safe,” Akpomi said. “You can’t leave the kids alone, so that’s a challenge.”
“I just feel like we’re letting talent go to waste,” she says. “It’s not fair because you can actually get that experience even here in Canada.”
Oghenefego Akpomi worked as a family doctor in Nigeria before moving to Canada in 2016. Despite passing the medical exams in Canada, she failed to get a place of residence. In 2023, she returned to Nigeria to work for four months to gain new experiences.
Gaining Canadian experience
Akpomi now works as a clinical assistant in Ontario. Ramirez, an ITP in Quebec, works as a medical assistant. Both jobs are unregulated, which means they can perform some limited tasks under the supervision of a licensed physician.
Other provinces, such as British Columbia and Alberta, have introduced physician associate programs for ITPs, which allow them to multitask while working with a physician.
But Naik says experience gained working in those positions doesn’t count as recent medical experience.
He says there are talks to change that.
“(It’s) an opportunity for them to get some familiarity, exposure to the Canadian health care system in a clinical assistant or associate role so they can get used to 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 shortage of doctors in Canada and thought she could help.
He has more than 15 years of medical experience in Pakistan and the United Arab Emirates.
Amer says that she received her medical license in Dubai three days after passing the exams.
Faiza Amer has worked as a family physician in Pakistan and the United Arab Emirates for over 15 years. She came to Canada because she heard about the shortage of doctors. Amer says that at first she was energetic about getting the permit, but after learning about all the challenges, she lost hope.
In Canada, she passed one exam and is preparing to write another, all while trying to find a job. She says she was turned down several times because she was told she was “overqualified.”
“Before I came here, I was so energetic, I was so much more hopeful that now I can do anything for myself, for my future, for my children, or relieve some pressure (on) the Canadian health care system. But right now, I don’t I see no hope,” she said. “We are financially exhausted.”
Amer says if her situation doesn’t change she may have to leave Canada, and she’s probably not alone.
