Report highlights systemic discrimination against International Medical Graduates in Canada

Despite a physician shortage impacting communities across Canada, thousands of International Medical Graduates (IMGs) continue to struggle for licensure to practice medicine here. Over the past 25 years, research, advocacy groups and immigrant service agencies have repeatedly called for changes to policies that discriminate against IMGs, but significant reforms remain elusive.

Newly disaggregated data highlights how systemic barriers impact different sub-groups of IMGs in distinct ways, based on factors such as racial or ethnic identity, country of origin, language of education, gender and age. A recently released report by MOSAIC found that only 13.6 per cent (114 of 771) of immigrant IMGs (I-IMGs) surveyed were licenced to practice medicine in Canada even though 84.7 per cent had an independent license to practice in a country other than Canada before moving here. By examining these disparities, policymakers and the public can better understand the inequities within the medical licensing system and push for meaningful change.

Who are International Medical Graduates?

IMGs are physicians who earned their medical degrees outside of Canada. They fall into four main sub-groups:

1. I-IMGs from approved jurisdictions whose postgraduate training is accepted.
2. I-IMGs from all other jurisdictions who must retrain or undergo a Practice Ready Assessment (PRA) if it is available to them. PRA programs offer an expedited route to licensure for IMGs who have completed their residency and have independent experience abroad. According to the Medical Council of Canada’s website, nine provinces currently operate their own PRA programs.
3. Canadians studying abroad (CASs): These are Canadian citizens or permanent residents who chose to study medicine abroad.
4. Visa trainees who are foreigners working as resident physicians through sponsorships purchased from faculties of medicine.

Disaggregated data shows unequal access to licensure

Until recently, most research on IMGs relied on aggregate data, which masked important differences in the experiences and outcomes of these four sub-groups. The disaggregated data compiled in the MOSAIC report – including a bilingual (English and French) online survey, immigration statistics, medical licensing databases and health-care workforce data – reveal troubling disparities:

• Discrimination in residency matching: Annual data from the Canadian Resident Matching Service (CaRMS) shows that between 2014-2022, IMGs generally matched to between 12-13 per cent of the residency positions, except in 2023 when they matched to 16.2 per cent.  The MOSAIC report highlights that many IMGs found the residency matching process to be opaque and discouraging.
• Age disparities: IMGs who graduated several years ago reported feeling disadvantaged by a system that offered more opportunities to recent graduates.
• Impact of country of origin and language of education: IMGs from countries in Asia, Africa and Latin America faced significantly lower match rates compared to those trained in Western countries, with many IMGs from these regions saying their qualifications were undervalued.
• Provincial variations: The chances of IMGs obtaining licensure under PRAs vary widely by province, with some regions offering more pathways than others. For example, in 2022, Saskatchewan offered 45 assessments and Alberta offered 92. British Columbia increased its number from 41 in 2023 to 96 in 2024.

Systemic barriers to licensure

Despite their qualifications, IMGs must navigate numerous systemic barriers:

• Despite the growing need for physicians, the number of residency slots allocated to IMGs is capped at around 10 per cent in most provinces. MOSAIC’s research found that 1,810 IMGs were waiting for residency placements in 2023, but only a few hundred positions were available. Of the 3,532 positions available across Canada, only 370 were available for IMGs in 2023.
• IMGs must complete multiple costly and time-consuming exams, some of which Canadian medical graduates do not face. For example, IMGs must pass the Medical Council of Canada Qualifying Examination (MCCQE) Part I (which costs $1,470) and the National Assessment Collaboration Objective Structured Clinical Examination (NAC OSCE) ($3,255) to qualify to compete for a residency training or a PRA. Despite passing both exams, IMGs are not allowed to compete for all residency positions – they are restricted to about 10 per cent of positions.
• Many IMGs report that employers and licensing bodies undervalue their international training, leading to discrimination in hiring decisions. The MOSAIC report questioned the justification that equates extra scrutiny of IMGs’ medical education with maintaining the higher standards of Canadian medical education and ensuring competence and public safety. Such justifications undervalue the development and role of the Foundation for Advancement of International Medical Education and Research (FAIMER) and the World Federation for Medical Education (WFME) that are established to enhance the quality of medical education worldwide.
• Lengthy and costly pathways: Many IMGs spend years in low-paying survival jobs while trying to complete licensing requirements, leading to financial and professional instability. The report notes that some IMGs have resorted to alternative careers in health care, such as medical administration or research, despite their qualifications to practice as physicians.

What can be done? Practical solutions for reform

Addressing these inequities requires systemic changes. The report proposes following solutions to address systemic discrimination against IMGs:

• Provincial and territorial medical authorities remove the requirement for language tests to be repeated every two years for I-IMGs living in Canada.
• All ministries of health identify paid opportunities in health care within every province, recognized by regulatory organizations, to support IMGs in maintaining currency of practice and obtaining Canadian experience.
• Employment Skills Development Canada (ESDC) and IRCC immediately reinstate the requirement for a Labour Market Impact Assessment (LMIA) for temporary foreign workers entering Canada and seeking working visas as medical residents.
• Ministries of health and faculties of medicine direct CaRMS to make all residency, speciality and sub-speciality postgraduate training positions available to competition for all Canadians citizens and permanent residents (i.e., Canadian medical graduates, I-IMGs and CSAs) on the same conditions. This includes all applicants, regardless of place of education, passing the same examinations as a prerequisite to applying to the match for residency positions, as has been successfully implemented in the United States.
• Ministries of health and faculties of medicine increase the number of residency positions.
• Provincial and territorial medical authorities, ministries of health and third parties approved to conduct assessments of IMGs provide individualized assessments in sufficient numbers for graduates of all international medical schools, including specialists who have medical degrees recognized by the provincial colleges and who have completed post-graduate training programs approved in the country from which they came.

Canada’s current system for integrating IMGs is inefficient, inequitable and contributes to the physician shortage. The data from the MOSAIC report confirms that systemic discrimination continues to hinder IMGs despite their qualifications. By acknowledging these barriers and implementing targeted reforms, Canada can build a fairer, more effective health-care workforce. Policymakers must act now to remove these obstacles. Qualified doctors should be practicing medicine, not struggling to navigate an exclusionary system.