Re: New immigrants are the ‘hidden homeless'
The Ministry of Health and Long term care of Ontario made an independent commission consisting of two retired judges to investigate the problems of Immigrant doctors and they found many irregularities. The commission was formed in 2010 and the Ministry published their report in February, 2012.
The independent commission did not find English or any other language as a barrier. More than 2000 doctors who have qualified for the position but could not get the training have completed their English requirement which is TOEFl. Many of these doctors had to take the test several times not because they got low scores but because the score remains valid for only 2 years and many doctors are trying for a training position for more than 5-10 years.
The commission also discussed in details about the legal options for the immigrant doctors which I decided not to post.
If you have any interest in this matter you can read the report. To make your job easy I have made an excerpt of the report and posted this below.
Best Regards,
"Ministry Reports
Independent Review of Access to Postgraduate Programs by
International Medical Graduates in Ontario
by George Thomson and Karen Cohl
September 2011
http://www.health.gov.on.ca/en/public/publications/ministry_reports/thomson/thomson.aspx
“A commonly expressed concern is that immigrant physicians enter Canada without good information about the challenges they will face and how to overcome them. Others point out that Canada is such an attractive location for skilled immigrants that their desire to come is not dampened by any information about limited opportunities to practise their profession.” P-41, vol-1
“For many doctors with medical degrees from outside Canada or the United States, Canadian postgraduate training is an essential step on the path to medical practice in Ontario. Competition is stiff, and there are many more applicants than there are positions. In 2011, for example, more than 1,800 applicants vied for 191 first-year residency positions designated for international medical graduates (IMGs) at the Ontario faculties of medicine.
Despite many reforms by government, faculties of medicine, and regulatory bodies, IMGs have continued to raise concerns about the fairness of policies and practices that determine access to the medical profession. In October 2010, the Ministry of Health and Long-Term Care commissioned us (George Thomson and Karen Cohl) to conduct an independent review (the IMG Review), with administrative support from the Council of Ontario Universities.”p-3, vol-1.
“Among IMGs who immigrated to Canada after practising medicine abroad, there is a feeling that the door is now closing. One issue is that Canadians who studied medicine abroad (CSAs) obtain more of the first-year residency spots each year. At the same time, the number of advanced postgraduate positions seems to be in sharp decline. Immigrant physicians with extensive experience in another country have expressed frustration that alternative routes to practice are not widely available. CSAs also face challenges. Their numbers are expanding rapidly, reducing their chances of finding a position when they return to Canada.
Other challenges for IMGs include the length and cost of the process and the difficulty of finding opportunities to demonstrate clinical skills.”p-6, vol-1
“There are in effect two groups of IMGs. One is immigrant IMGs who obtained their medical degrees abroad, and in many cases practised abroad, before immigrating to Canada. The other is Canadians who studied abroad (CSAs). CSAs are Canadians citizens or permanent residents who left Canada to obtain a medical degree abroad. While some CSAs are also immigrants, the distinction is that they came to Canada before obtaining their medical degrees.
Immigrant IMGs are finding it increasingly difficult to compete with CSAs for first-year residency positions. CSAs are mostly recent graduates, many of whom apply in their final year of medical school. In that respect, they are similar to graduates of Canadian medical schools who apply for residency at the same point in their careers. Many postgraduate programs favour both recent graduation and North American clinical experience, which some CSAs are able to obtain as part of their undergraduate medical education.” P-7, vol-1.
“Due to the volume of applications, most programs apply one or more filters to determine which files to review in greater detail. The two most common filters are date of medical school graduation and exam scores. The joint family medicine selection process uses exam scores as the initial filter. Many specialty programs use date of graduation, either alone or in combination with exam scores.”p-12, vol-1.
“FILTERING BY DATE OF GRADUATION
Many programs consider recent clinical experience a predictor of success in residency. It is hard to disagree with this proposition and it seems to be supported in the research literature.1 Recent training (which almost always includes a clinical experience component) is an easy filter to apply electronically, using date of graduation from medical school. Identifying recent, relevant practice, however, requires a labour-intensive review of the file. Many specialty program directors told us that they use the date of graduation as an initial filter. Three years from graduation is common, but some use five or ten years.” P-12, vol-1.
“The effect of this practice on immigrant IMGs is potentially enormous. CSA applicants are mostly recent graduates, often applying in their final year of medical school. Most immigrant IMGs graduated much earlier. Looking at 2011 statistics, it is clear that the more recent the date of graduation the programs use as an initial filter, the more immigrant IMGs would be eliminated from the competition.” P-13, vol-1.
“We do not believe that date of graduation should be used as a proxy for this factor. Instead, we encourage the medical faculties to work with CaRMS to determine whether it is possible to develop a more reliable indicator that would not require extensive additional manual work.” P-15, vol-1.
“It is here that we face the reality that letters of reference and personal statements (and interviews) have not been shown to be highly reliable methods of distinguishing among applicants and predicting success in medical school or residency.2 This is true for Canadian graduates as well as IMGs. Program directors acknowledge the limits of these criteria, but rely on them in the absence of other tools to distinguish among applicants.
A common theme in our discussions with program directors was the difficulty of assessing reference letters from abroad and personal statements from a very diverse group of applicants. They recognize that CSAs, particularly those who have completed Canadian electives, are better able to score high on these elements. In fact, several rating sheets explicitly recognized the importance of North American clinical experience or local electives, with additional points for letters of reference confirming that the experience was positive. Once again, for understandable reasons, the advantage lies with the CSAs. Even though their clinical experience is at the undergraduate level, CSAs can be in a better position at the file review stage than immigrant IMGs who have more extensive experience but not in North America.” P-17, vol-1
“Canadians Studying Abroad and Immigrant IMGs
Of the matched group of IMGs across Canada, the percentage of positions matched to CSAs rose from 26.9% in 2008 to 47.9% in 2011. The percentage matched to immigrant IMGs dropped from 73.1% in 2008 to 52.1% in 2001.
Source: CaRMS National Match Results for Active IMGs, 2008-2011
In 2011, CSAs represented approximately 1/4 of the IMG applicants and obtained just over 1/2 of the first-year residency positions filled by IMGs at the Ontario faculties of medicine
Source: CaRMS Data Tables, 2011 Main Residency Match (R-1)” p-17, vol-1.
“Making observerships more available also seems unrealistic—and of little help, because they do not carry weight with program directors and offer little or no opportunity to demonstrate clinical skills.” P-23, vol-1.
“IMMIGRATION
Some immigrant IMGs have been accepted to Canada as principal applicants under the Federal Skilled Worker Program. Under the current rules for that program, applications will not be processed unless the principal applicant has a valid offer of arranged employment or has had one year of paid work experience in an eligible occupation on the Ministerial Instruction List. “Specialist physicians” and “general practitioners and family physicians” are both on the list and a cap is imposed on the number of applications that will be processed for each occupation. Eligible applications are assessed under a system that assigns points for education, language ability, work experience, age, arranged employment, and adaptability. Other immigrant IMGs may have come to Canada as family members of the principal applicant, as refugees, or under the family reunification program.
Principal applicants can feel betrayed when their education and professional experience help them to immigrate to Canada but their qualifications are not recognized when they get here. Even if warned beforehand that a residency position or a medical licence is far from guaranteed, many immigrant IMGs feel that they will be the ones to succeed on the basis of their past accomplishments, determination, and hard work.” P-17, vol-2.
“Many immigrant IMGs take every possible exam to improve their chances of obtaining a postgraduate position. This includes the clinical exam, for which Part 1 of the Medical Council of Canada qualifying exam was, until recently, a prerequisite. We heard of and met with others who had also successfully completed Part 2 of the qualifying exam to obtain the MCC Licentiate. Those who had done so felt that this credential proved them more than equivalent to graduates of Canadian medical schools. This added to their frustration when they were nonetheless unsuccessful in gaining access to the profession. Every exam added to the cost and to family pressures”. P-18, vol-2.
“Immigrant IMGs, including those with the highest of qualifications and practice experience, often do not know why they did not get an interview or why, if interviewed, they did not get a position. As a result, they feel unable to improve their chances in the next round.” P-18, vol-2.
“Perhaps the most difficult moment for immigrant IMGs comes with the realization, at the end of the matching process, that they are facing at least one more year of delay—often with little sense of why they were not selected or what they might do to improve their chances the following year. They do know that another year out of practice is almost sure to weaken their position in the next year's competition, unless they can find a clinical opportunity that is more than just an observership. While a small number of highly skilled specialists are able to obtain clinical fellowships, and a few others secure employment that has some relationship to medicine or clinical practice, most find that there simply are no opportunities in Ontario. Some choose to return for a time to the countries where they are licensed to practise in order to stay active in the profession.” P-19, vol-2.
“Comparing IMG candidates is a challenge. It is not as though they are apples and oranges—they are not even the same fruit. It is like comparing an apple with a fire truck with a chocolate bar.”
–Faculty member. P-20, vol-2.
“For example, should there be a preference for younger applicants who, like CMGs, will practise medicine for many years? Or should there be a preference for older, more experienced physicians who will have a shorter career in this country but bring a rich diversity of experience? Programs do not want to discriminate on the basis of age. At the same time, they worry about how well an older individual who has been in practice for some time will adapt to being back in a first-year residency position, at the bottom of the hierarchy and facing many physical demands. Some also wonder whether scarce resources should go to persons who will have a much shorter period of practice here compared with recent graduates.” P-23, vol-2.
“SELECTION CRITERIA
Selection criteria, and how they are weighted, depend on the nature of the medical specialty and the perspective of the person in the role of program director. For example, should there be a preference for younger applicants who, like CMGs, will practise medicine for many years? Or should there be a preference for older, more experienced physicians who will have a shorter career in this country but bring a rich diversity of experience? Programs do not want to discriminate on the basis of age. At the same time, they worry about how well an older individual who has been in practice for some time will adapt to being back in a first-year residency position, at the bottom of the hierarchy and facing many physical demands. Some also wonder whether scarce resources should go to persons who will have a much shorter period of practice here compared with recent graduates”.p-23, vol-2.
“We should be able to search on CaRMS for the candidate's latest true clinical work.”
–Program director
“Four of the five schools used year of graduation as an initial filter for internal medicine, but each did it differently. Two schools used three years from graduation and a score of over 300 (McMaster) or 325 (Queen's) on the evaluating exam. The University of Ottawa used three years from graduation as the first filter, and then manually reviewed files to add 20 applications back in on the basis of high internal medicine subscores on exams or significant experience and training. The University of Toronto used five years from graduation as the first filter and evaluating exam scores as a second filter. A preliminary manual review of the files then added a few applicants back in on the basis of clear evidence of recent, active engagement in internal medicine.
The University of Western Ontario did not use year of graduation as an initial filter. Instead, they filtered on the basis of evaluating exam scores.
None of the programs used scores from the clinical exam available at the time (CE1) as an initial filter, although some looked at the results during the manual review they undertook as part of the initial filtering process. The clinical exam scores of many less-recent graduates were never seen, no matter how high, because the graduation date filter eliminated them at this initial stage”. P-58, vol-2.”
Important Recommendations:
“Date of graduation should not be used to eliminate applicants without first checking to see if the individual has recent, relevant clinical experience. The faculties of medicine should work with CaRMS to develop a reliable electronic filter that would make it easier to identify applicants with recent, relevant clinical experience. “ p-51, vol-1.
“The Ontario government, the faculties of medicine, and others should test the feasibility of offering opportunities for IMGs to demonstrate clinical skills in a Canadian setting. This could take the form of a short, structured clinical placement or a more formal program that would assess clinical skills and offer bridge training opportunities. Eligibility would be based on high national clinical exam scores or percentiles. “ p52, vol-1
