International Medical Graduates: Welcome to Canada?

M. WatanabeACMC, Calgary AB

April 30, 2002

Canadian Physician Workforce: Two Main Policy Levers

• Undergraduate Medical Enrolment

• Immigration Policies of International Medical Graduates (IMGs)

• Post-MD Trainees – tied to UGME• Practice Communities - distribution

40 45 50 55 60 65 70 75 80 85 90 95 00

Year of MD Degree

0

500

1000

1500

2000

Nu

mb

er

of

Gra

du

ate

s

Total Men Women

MD Graduates of Canadian Medical SschoolsData from Association of Canadian Medical Colleges

8081

8283

8485

8687

8889

9091

9293

9495

9697

9899

00

YEAR COMMENCING

0

500

1000

1500

2000

NU

MB

ER

Canadian/Landed Immigrants Foreign Visa Students

FIRST TIME FIRST YEAR ENROLMENTIn Canadian Medical Schools

Data from Association of Canadian Medical Colleges

8182

8384

8586

8788

8990

9192

9394

9596

9798

9900

Year Commencing

0

100

200

300

400

500

Num

be

of

Stu

den

ts

Other Student Visa Landed Immigrant

Non-Canadian Students, All Years Enrolled in Canadian Faculties of Medicine

Data from Canadian Medical Education Statistics, ACMC

8687

8889

9091

9293

9495

9697

9899

00

Year of MD

0

500

1000

1500

2000

# M

D G

radu

ate

s

Above Quota

Student Visa

LI

CC

MD Degrees AwardedBy Legal Status at time of Entry

Data from Canadian Medical Education Statistics, ACMC

8687

8889

9091

9293

9495

9697

9899

00

Year of MD

0

1

2

3

4

5

6

7

8

% o

f to

tal G

rad

ua

tes

Above QuotaStudent VisaLI

MD Degrees AwardedBy Legal Status at time of Entry

Data from Canadian Medical Education Statistics, ACMC

Canadian Policy Framework

• Immigration Policies– Initially preferential immigration status for

IMG physicians– Preferential status later removed

• 1975 National Committee on Physician Manpower – future needs can be met by domestic supply

69 71 73 75 77 79 81 83 85 87 89 91 93 95 97 99

Year Ending December

0.5

1

1.5

2

2.5

3

Ind

ex

ed

to

19

69

Canadian MD Graduates International MD Graduates

Active Physicians in CanadaData from Southam Medical Database, CIHI

6970

7172

7374

7576

7778

7980

8182

8384

8586

8788

8990

9192

9394

9596

9798

9900

Year ending December

22

23

24

25

26

27

28

29

30

31

32

% I

MG

sActive Physicians in Canada

By Place of GraduationData from SMDB, CIHI

70 75 80 85 90 95 00

-100

0

100

200

300

400

500

600

Nu

mb

er

of

Ph

ysic

ian

s

Unknown Non-Canadian Canadian

International Migration of Canadian PhysiciansNet Loss by Medical School of Graduation 1970-99

Data from CIHI

90 91 92 93 94 95 96 97 98 99 00

Year ending December

0

10

20

30

40

50

IMG

as

% o

f C

oh

ort

s

In Practice Moving Abroad Returning Net Loss

International Migration of Physicianswho are Graduates of International Medical Schools

Data from CIHI

IM DE

NE

PE

PM PS

PH

EM

OM AN

NM DR

RT

MG B

IM

IP

A TO

GS

CV

NS

OG

OP

OT

OR

PS

UR

0

10

20

30

40

50

% I

MG

s

Specialties

Physicians in Active Practice in Canada 2000who are Graduates of International Medical Schools

Data from Southam Medical Database, CIHI

95/96 96/97 97/98 98/99

12

14

16

18

20

22

24

Pe

rce

nt

of

Ph

ysic

ian

s

Canada US Outside NA

Source: NPDB, CIHI

Primary Care Physicians in Rural CanadaBy Place of Graduation

Canadian Workforce Policy: Roadmap and Milestones

• 1992 Conference of Provincial/ Territorial Ministers of Health and NCCPMT– Reduce UGME by 10%, starting 1993– Maintain 50:50 specialist:FP/GP ratio– Maintain or reduce physician:population ratio– Reduce PGME by 10%; reduce visa trainees– Reduce Canada’s reliance on IMGs

• Implement two pathways to licensure– MCC, ACMC, FMLAC

71 73 75 77 79 81 83 85 87 89 91 93 95 97 99

Year

60

70

80

90

100

110

Ph

ysic

ian

s/1

00

,00

0 p

op

ula

tion

Primary Care Specialists

Physicians in CanadaPhysicians per 100,000 population, 1971 - 2000

Data from Health Personnel in Canda and CIHI, SMDB

69 71 73 75 77 79 81 83 85 87 89 91 93 95 97 99

Year

49

50

51

52

53

54

Pe

rce

nt

in P

rima

ry C

are

Physicians in CanadaPercent Primary Care 1969 to 2000

Data from Health Personnel in Canda and CIHI, SMDB

8081

8283

8485

8687

8889

9091

9293

9495

9697

9899

0001

Years, November

0

2

4

6

8

10

Thou

sand

s

Nu

mb

er o

f p

hys

icia

ns

Non-Ministry Ministry

Funding of Postgraduate Trainees in CanadaResidents and Fellows, all years

Data from ACMC, CAPER

8081

8283

8485

8687

8889

9091

9293

9495

9697

9899

0001

Years, November

0123456789

10

Thou

sand

s

Nu

mb

er

of

ph

ys

icia

ns

Fellows Other years Year 1

Post-MD Trainees in CanadaResidents by Level of Training and Fellows

Data from ACMC, CAPER

90 91 92 93 94 95 96 97 98 99 00 01

Years, November

0

200

400

600

800

1000

1200

1400

Nu

mb

er

Non-Canadian MD Canadian MD

Post-MD Fellowship Trainees in CanadaBy Place of MD Degree

Data from CAPER

8081

8283

8485

8687

8889

9091

9293

9495

9697

9899

00

Year Commencing

0

1

2

3

4

5

6

7

8

9

Thou

sand

s

Num

ber

Visa LI, IMG CC, IMG CC, MD Canada

Post-MD Trainees by School of Graduation and Legal StatusData from Canadian Medical Education Statistics, ACMC

8081

8283

8485

8687

8889

9091

9293

9495

9697

9899

00

Year Commencing

0

500

1000

1500

2000

Nu

mb

er

Visa LI, IMG CC, IMG

Post-MD Trainees by Legal StatusGraduates of non-Canadian Medical Schools

Data from Canadian Medical Education Statistics, ACMC

1697 1725 1718 17001770

1998 1999 2000 2001 20020

500

1000

1500

2000

Num

ber

of P

hysi

cian

s

IMG, Visa

CMG, Visa

IMG, CC/PR

CMG,CC/PR

First Time, First Year Post-MD Trainees in Canada1997-98 to 2001-02

Data from CAPER

CC-CMG CC-IMG LI-IMG Visa

Legal Status

0

20

40

60

80

100

120

% o

f C

oh

ort FM

Lab

Surg

Med

Post-MD Trainees from 1996-2000In All Years by Legal Status and Field of Training

Data from Canadian Medical Education Statistics, ACMC

93-9494-95

95-9696-97

97-9898-99

99-0000-01

Year

0

500

1000

1500

2000

2500

Num

ber Visa

IMGs (CC+PR)

Can Reentry

Can MD First

Practice Entry Cohorts Exiting All ProgramsBetween November to November of Each Year

Data from CAPER

93-9494-95

95-9696-97

97-9898-99

99-0000-01

Year

0

100

200

300

400

500

600

700

800

900

Num

ber Visa

IMGs (CC+PR)

Can Reentry

Can MD First

Practice Entry Cohorts Exiting Family Medicine ProgramsBetween November to November of Each Year

Data from CAPER

93-9494-95

95-9696-97

97-9898-99

99-0000-01

Year

0

10

20

30

40

50

60

70

80

90

Num

ber Visa

IMGs (CC+PR)

Can Reentry

Can MD First

Practice Entry Cohorts Exiting Laboratory Medicine ProgramsBetween November to November of Each Year

Data from CAPER

IM

GIM

Res

p

Car

d GI

Rh

eu

Ped

G P

ed

Car

d

Neo

Cri

t

Su

rg

G S

urg

Ped

Th

or

Car

d

Specialty/Subspecialty

0

20

40

60

80

100

120

% o

f tot

al VisaLICC

Post-MD Trainees in 2000-2001In all Years by Legal Status

Data from Canadian Education Statistics, ACMC

Questions about IMGs

• Whom do they serve? – Canada’s professional care needs – their own professional needs

• Are the post-MD training programs serving their needs– Rural practice, specialties – choice of specialty needs in their own country

Thank you!