Canadians should be allowed to fund their medical residency

Most Canadians are aware Canada needs more medical doctors. What they might not realize is that residency issues are creating a real bottleneck for Canadian doctors who are educated abroad to come home to set up practice.

That must change, and one way to achieve that is to allow citizens who have received medical training in other countries to self-fund their own residency, a concept that is currently not allowed in Canada.

To explain why Canadians go abroad to study medicine, a recent Globe and Mail article noted, it is “nearly impossible to get one of the 2,800 first-year seats in the country’s 17 medical schools – where roughly nine out of 10 applicants are rejected.”

Aspiring physicians instead go to foreign schools accredited by the Royal College of Canada. The list of countries with these schools is quite small, limited to Australia, New Zealand, the United States, Ireland, Israel, Hong Kong, Singapore, South Africa, Switzerland, and the United Kingdom. After finishing their schooling, many grads hope to return to Canada to work.

Fierce competition for medical residencies

But before they are given a certificate of practice, they must complete at least a two-year residency at one of Canada’s teaching hospitals. As they will discover, the competition for those residency spots is as bad or worse as being accepted in a Canadian medical school.

The Globe notes that a 2010 study by the Canadian Resident Matching Service (CaRMS), a not-for-profit organization that pairs medical school students with postgraduate training residencies, an estimated 3,500 Canadians go abroad for medical training each year. Of those, 90 per cent want to return to Canada to work. Most of them will be disappointed. As the article notes, of the 3,295 medical graduates matched to residency training programs in Canada this year, only about 13 per cent were educated at medical schools outside the country, “making this process highly competitive.”

“The messaging for so long has been that it’s nearly impossible to get a bloody residency in Canada if you’re an international graduate,” says a CEO of an admissions organization for North Americans who want to attend medical school in Ireland. “These people are the cream of the crop, and they’re simply going elsewhere because they’re in demand. You tell people to go away long enough, and eventually, they go away.”

But some countries get around the competition by offering training hospitals funding if they accept medical residents from their country. As Dr. Brian Goldman noted in his blog for the CBC radio show White Coat, Black Art, “A scholarship program set up by Saudi Arabia pays roughly $100,000 per trainee per year. In return, the Saudi graduates get to complete a high-quality residency training program in Canada in disciplines that include orthopedic surgery, internal medicine, obstetrics and gynecology, pediatrics and others.”

Many Saudi residents do no stay

While these Saudi residents provide valuable health-care services as they receive training, I believe it is fair to ask why citizens of some countries are allowed to jump the queue simply because their governments provide lavish funding. In my health-law practice, I see many of these Saudis return home after completing their residency, taking their Canadian-taxpayer funded skills and training with them.

And as this Queen’s University professor points out, “Canada and Saudi Arabia are not aligned on very fundamental issues of human rights and this has led to disruption of relationship between the countries at many levels.”

Should Canadians be able to self-fund a residency?

Higher education is not free. We all have to pay for post-graduate education and training.

So here is an idea. If the Saudis are allowed to fund Canadian residencies for their medical students, why can’t Canadian medical students do the same? If Canada has resident positions available for Saudi residents, why aren’t they first offered to Canadians who can find their own sponsor for $100,000.00 or otherwise afford to pay that cost?

However, if you look at medical residency information on such medical schools as the University of Toronto and McGill University, the same line comes up: “Charitable foundations, private corporations or self-funding are not considered acceptable sources of funding.”

Why? By the time they are applying for a residency position, Canadians studying abroad have already spent $80,00 or more a year on their education and are now deeply in debt. They should be allowed to spend another $100,000 to get a certificate of practice and start making some money, and more importantly share their education and skills with Canadians.

I believe that our hospitals should not be allowed to get paid to take in residents from foreign countries until all qualified Canadians have been given a chance.

Canada does not have enough doctors

According to the Canadian Medical Association (CMA), we have too few doctors in the training pipeline to meet the country’s needs, particularly with our aging population. The CMA says that according to statistics supplied by the Organization for Economic Co-operation and Development (OECD), Canada has 2.7 physicians per 1,000 population (including residents) compared to the OECD average of 3.5 (2017 or the nearest year).

If it is any comfort, we are ahead of the United States, Chile and Turkey.

According to the Professional Association of Residents of Ontario (PARO), the annual salary in 2022 for first-year residents in 2022 was $68,327.66. It increases by $4,00 to $5,000 every year until topping out at $102,986.79 for specialists in their ninth year of residency. Hospitals also financially benefit from residents since they can bill OHIP for any services they provide under the supervision of the staff physician, so the funding issue is a bit of a shell game.

To return to the Globe article, I agree with the physician who notes, “There’s a deal to be made here, but the problem is it’s still so incredibly difficult to find postgraduate work in Canada. It’s a real chokepoint.”

That must change, and allowing the self-funding of medical residency would benefit everyone involved. Allow me to explain how that could work.

Under the current system, medical residents in Ontario bill OHIP for the work they do in hospitals, through the OHIP number of the physician supervising them these OHIP fees are paid to the staff physician. Why not give residents who want to self-fund their residency a restricted OHIP number with lower fees for service than physicians on independent certificates of practice.  Then any payment for any services they perform will be returned directly to them, allowing them to earn money for their residency on a fee for service basis and no salary requirement, as they provide the medical services our country so desperately needs? The money stays in the health-care system and patients reap the benefits. A win-win for everyone.

• Tracey Tremayne-Lloyd is the founder of TTL Health Law.