At a time when Canada has a shortage of doctors, and qualified Canadian and international medical graduates are waiting in the wings to be certified, concerns are being raised about the number of foreign visa trainees in Canadian residency programs.
The Association of International Physicians and Surgeons of Ontario President Dr. Joshua Thambiraj, for example, estimates that only 20% of qualified international medical graduates in the province are getting residencies each year.
Meanwhile, Canada is providing residency spots and “training hundreds of foreign visa trainees who go back to their own countries, so they're not able to solve the doctor shortage in the province, or contribute in any way to Canada.”
Thambiraj says that a logical solution to the backlog of international medical graduates waiting for residencies would be to place a moratorium on foreign visa trainees for 2 or 3 years.
Foreign visa trainees can be students in Canadian medical schools, residents, or postgraduate fellows. Many of them come from the Middle East, but they also come from Europe and the United States. Their governments typically pay their tuition and living expenses on the proviso that they return home to practise.
The Canadian Resident Matching Service pairs Canadian-trained medical school graduates with residency positions. No more than 1 or 2 visa trainees from any Canadian medical school can enter the match, which is generally restricted to Canadian citizens and permanent residents, says Danielle Cameron, an agent for the service. Sponsoring governments make arrangements directly with faculties of medicine.
According to the Canadian Post-M.D. Education Registry, Canadian medical graduates account for 69% of the total 11 961 residents and postgraduate fellows in Canada. International medical graduates — Canadian citizens or permanent residents educated outside of Canada — comprise about 12%. Visa trainees make up the remaining 19%.
That some are questioning their presence has not been lost on the visa trainees themselves.
Dr. Khalid Aba-Alkhai, who's doing a residency in cardiac surgery, understands why some people might want to refrain from accepting more visa trainees until the backlog of international medical graduates has been addressed.
But that doesn't absolve instructors of their obligations to the ones who are already here, he says. “If you accept someone, you have to treat him well until he graduates.”
The chief executive officer of the Royal College of Physicians and Surgeons of Canada argues there is no need for a moratorium, because foreign visa trainees don't take up positions that could otherwise be filled by Canadian citizens or permanent residents.
“I think that the misunderstanding is in this expectation that if they disappeared, then the ministry would fund additional positions, and that hasn't been shown to be the case,” says Dr. Andrew Padmos.
Meanwhile, visa trainees are “providing frontline, specialized health care services 24/7.”
“Their governments are paying to provide Canadians with some pretty impressive medical services while the trainees are in this program, so I think we gain tremendous value from these individuals,” he says.
Padmos says the solution is for governments to fund more residency positions for Canadian and landed-immigrant trainees. Postgraduate deans could then take fewer visa trainees as the funding for other trainees increased.
Dr. Nick Busing, the executive director of the Association of Faculties of Medicine of Canada, echoes that sentiment. “I would not want to reduce the number of visa residents without backfilling their positions with appropriately funded positions of Canadians and international medical graduates.”
Dr. Brian Day, past-president of the Canadian Medical Association, calls for balance.
“We don't want to deprive Canadian-trained graduates of opportunities to give positions away to foreign graduates. But, on the other hand, it is an economic reality that some of those coming from abroad help to subsidize programs that help Canadians in their training.”
That may be the case for residencies, since foreign governments pay the salaries of foreign visa trainees. But according to Busing, the subsidy doesn't extend to medical undergraduates.
Tuition fees for foreign visa trainees vary widely, but they average about $25 000 per year, a fee that does not cover the costs of training that individual, he says. Canadian medical undergraduates pay much less, between $2000 and $17 000 per year, with the balance of the cost subsidized through tax dollars.
Like Busing and Padmos, Day says the best solution would be to expand the overall number of postgraduate positions.
Jonathan DellaVedova, president-elect of the Canadian Federation of Medical Students, says that “where there are space limitations in the system, we think that Canadian medical graduates are the best suited for and the most deserving of postgraduate positions.” — Amanda Truscott, Toronto, Ont.
 | Figure. International medical graduates say a temporary moratorium on internships for foreign visa trainees should be introduced so as to help train more doctors who plan to stay in Canada. Pictured here is the graduating class of the Latin American School (more ...) |