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 47 per cent of IMGs surveyed had been in Canada for more than 10 years but were still unable to practice medicine. 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. Immigrant IMGs (I-IMGs) from Approved Jurisdictions: These are IMGs from four countries (Australia, Ireland, United Kingdom and the United States) whose postgraduate medical training is recognized by the Royal College of Physicians and Surgeons of Canada under the Approved Jurisdiction Route (AJR). Despite their training being accepted, they still face bureaucratic hurdles in securing licensure.
2. I-IMGs from Non-Approved Jurisdictions: These IMGs must either complete a residency program in Canada – competing for a very limited number of positions – or undergo a Practice Ready Assessment (PRA) – a 12-week clinical workplace-based assessment under the supervision of a trained physician. Although nine Canadian provinces offer practice assessments, these are not available in Prince Edward Island, Yukon Nunavut and the Northwest Territories.
3. Canadians Studying Abroad (CSAs): These are Canadian citizens or permanent residents who studied medicine outside of Canada. Despite their Canadian status, they often face challenges similar to immigrant IMGs in securing residency placements and licensure.
4. Visa Trainees: These are foreign medical graduates who work as resident physicians in Canada through sponsorships, where positions are purchased from Faculties of Medicine. Their pathway to long-term licensure remains precarious and uncertain.

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: Data from the Canadian Resident Matching Service (CaRMS) shows that in 2022, only 28 per cent of IMGs successfully matched into a residency program, compared to 95 per cent of Canadian Medical Graduates (CMGs). The MOSAIC report highlights that 63 per cent of IMGs found the residency matching process to be opaque and discouraging.
• Gender and Age Disparities: Female IMGs were more likely than male IMGs to face additional barriers due to caregiving responsibilities and biases in the selection process.
• 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 78 per cent of IMGs from these regions saying their qualifications were undervalued.
• Provincial Variations: The chances of IMGs obtaining licensure under the Practice Ready Assessment (PRA) vary widely depending on the province, with some regions offering more pathways than others. For example, in 2022, Saskatchewan offered 45 assessments and Alberta offered 92. British Columbia increased the 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 more than 3,000 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 that CMGs 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. Passing the former is not a requirement for CMGs to work as resident physicians in most Canadian provinces. They don’t even have to take the NAC OSCE. Despite passing both exams, IMGs are not allowed to compete for all residency positions – they are restricted to 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. Potential solutions include:

• Increasing the number of residency positions for IMGs that can help alleviate physician shortages while providing qualified professionals with a fair chance at practicing in Canada.
• Implementing clear, uniform standards that apply to both CMGs and IMGs.
• Following models from other countries that streamline licensing for doctors from accredited institutions abroad. The MOSAIC report suggests a tiered accreditation system that differentiates between high-, medium- and low-risk medical schools based on performance outcomes.
• Expanding access to these programs in more provinces to provide an alternative pathway for IMGs without requiring full retraining
• Making residency selection, licensing requirements and exam evaluations more transparent by reducing bias and discrimination. The MOSAIC report recommends publishing detailed statistics on residency application outcomes and implementing independent oversight committees.

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.