Canada's missing medical students


UCDToronto native Craig Stewart holds a bachelor of science degree from Queen’s University, and a master’s in behavioural neuroscience from Brock University in St. Catharines. From his early teens, he wanted to be a doctor.

But when he finally succeeds, it will be no thanks to Canada’s education system. Stewart, now 32, has never been granted so much as an interview by any Canadian medical school to which he has applied.

On the other hand, Ireland’s University College Dublin wanted him badly. Last September, it welcomed Stewart into first-year medicine.

Since the 1850s, this venerable European institution of higher learning has produced five Irish prime ministers and the great writer James Joyce.

Nowadays, it also routinely produces Canadian medical graduates.

A recent survey for Health Canada concludes that more than 1,500 Canadians are studying medicine outside of Canada and the United States. Most won’t return home to practise, the data shows. It’s paradoxical, given the perceived physician shortage in this country.

So many Canadians are studying medicine abroad, they could fill several med schools here. It’s not that they aren’t smart enough for this country. At Queen’s, which accepts about 100 first-year med students, “I could displace the 100 we take and put in the next 100 and the next 100,” says Dr. David Walker, dean of health sciences. “They’re quite capable.”

Although Canadian schools have expanded over the past decade, there are still four candidates for every undergrad MD spot. That has pushed many applicants toward offshore education. Their main destinations: Irish, Australian and Caribbean schools.

The Canadians are charged full freight, however. At University College Dublin, annual tuition is about 27,000 euros, or $41,000. Stewart estimates his debt, by the time he’s finished, will be $300,000.

After these four- or five-year programs, many Canadians enter residency — the required post-grad training years of medicine — in the U.S.

Returning to Canadian residencies is difficult.

Luke McCrone, 24, of Barrie is in his first year in Dublin after being rejected by several Canadian schools. He’d like post-grad training here when he’s done, but says, “It looks pretty tough to get medical residencies in Canada. Hopefully things will get better in the next five years.”

By the way, before he got to med school, he did an undergrad degree at Harvard.

Why can’t Canadians like him, paying through the stethoscope for the first part of their med studies abroad, at least get into their required post-grad training here? Mainly because the number of residency spots in Canadian universities is only slightly higher than the number of MDs graduating from Canadian schools. The students educated at Canadian universities are, themselves, competing for those finite spots.

To help the Canadians who have been studying undergrad abroad, provincial governments have reserved some residency space for “international medical graduates.” In Ontario, for instance, 200 spots are set aside — in exchange for the foreign-trained resident, upon finishing, working five years in a community that has a doctor shortage.

A second reason is that new Canadians or landed immigrants who were doctors in their original country are also vying for the 200 spots.

Third, grads from some offshore medical schools simply aren’t good enough for residency.

On its website, the Canadian Federation of Medical Students bluntly warns: “. . . enrolling in dubious, proprietary, for-profit medical schools opened specifically to cater to rejected applicants to medical schools in Canada or the USA is highly unlikely to be a path to practicing (sic) medicine in Canada.”

Many foreign schools are well-respected, University of Western Ontario med school dean Dr. Carol Herbert stresses. There are concerns about some Caribbean ones, however, “in that they do not have the same accreditation, the same standards for education, and so it’s a little more dependent on the individual students making sure they get what they need.”

Dr. Nick Busing, president of the Association of Faculties of Medicine of Canada, says our education system should allow Canadians studying abroad to do some of their MD training — ideally, their fourth and crucial undergrad year — in Canada “so they see the system; also so those in the faculties, who take on residents, get to interact and meet these people.”

There’s also discussion of trying to accredit foreign schools to Canadian standards.

Options have been discussed with Health Canada.

“There seems to be traction at Health Canada at one moment, the next moment they’re not so interested,” says Busing.

The feds have put money into dealing with international medical graduates, Health Minister Tony Clement recently told a Commons committee. “We are going to continue on that. I want to see some results.” He did not elaborate.

Canadian med students abroad don’t necessarily feel aggrieved by their fate.

Ottawa’s Greg Pukay, now in third-year at Australia’s University of Sydney, never applied in Canada.

“I was really fond of the idea of living in another part of the world while studying,” Pukay, 26, said in an e-mail.

“Getting a residency back home is kind of a hot topic these days,” Pukay wrote. “Hopefully the system will change to make it easier for Canadians studying abroad to return home.”

In Dublin, Canadian Chris Dowler, 25, of Victoria, says while Irish med school is hard slogging, he finds Ireland “very enriching” and more “loosey-goosey” than Canada.

“I’m a very lucky person,” says Dowler. “There have been a few roadblocks but it’s not a big deal. The Guinness is pretty good here.”


Estimated number of Canadian undergraduates studying in foreign medical schools (excludes U.S.): 1,500

Main reason given for studying outside Canada:

46% said they were not accepted to Canadian schools.

10% said they were accepted early outside Canada and not likely to be accepted in Canada.

9% wanted to expand horizons or life experience outside Canada.

Some international schools where Canadians study medicine in significant numbers:

St. George’s University, Grenada

SABA University, Saba (Netherlands-Antilles)

Royal College of Surgeons, Dublin, Ireland

University College Dublin, Ireland

University College Cork, Ireland

University College Galway, Ireland

University of Sydney, Australia

Flinders University of South Australia

University of Queensland, Australia

Source: Analysis of the 2006 survey of Canadians Studying Medicine and the medical schools training Canadians Outside of Canada and the U.S. Final report to Health Canada.)

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