The MD degree is a ticket to ultra secure employment, is nothing less than reasonably well-paid, and can provide a pleasing lifestyle.

Additionally there is some status conferred on the holder of the MD which can provide a variety of benefits including everything from better treatment by others to better health. As such it will be a sought after credential and the medical schools will be oversubscribed even if they boost enrollment.

I do not equate any specific student/person getting what they want for a career/lifestyle with achieving adequate health care for Canadians. In fact the best thing might be that we reduce medical school enrollment in Canada and open some affiliate schools in the Philippines that Canada controls.

The students can do their rotations and residency in Canada and our costs will be a fraction of boosting enrollment in Canadian medical schools. Canadians who want the MD degree could go to the Philippines. Stop whining about having to go to the U.S. and feel lucky about being qualified to get a residency there. The U.S. is an excellent place to work in the world of science/medicine/technology and quite frankly has a number of beautiful geographies with desirable climates. Additionally they attract the best scholars and practitioners for others to learn from.

Many recent Canadian MD graduates elect to complete at least some of their postgraduate studies in the U.S.

A friend just went through this very hassle. Had to spend 2 years in the USA to then be offered one of two spots in Canada. Utter freaking baloney. The Canadian Medical Association has a strangle hold on the supply of doctors. Keep supply low = big pay cheques. Basic micro-economics.

If the government deregulated the medical INDUSTRY like they did air travel, we would not have to drop public medicine. The costs would go down and we'd have doctors. This lady could get into Canada no problem.

I know people (doctors mostly) will rant about standards and safety, but West Jet fans, your planes are safe DESPITE deregulation.

and don't get me started on Canadian banking!!!

While Harper whines about not having enough doctors in Canada - so that he can finally put an end to medicare - he makes sure that very few qualified individuals ever make it into Canadian medical schools because there are just not enough spots in medical schools in Canada.

Shame on Mr. Harper! At a certain point, it will become clear even to Mr. Harper, that having fewer doctors to treat patients will mean having more and sicker patients who will be more expensive to treat in the long run.

But then that is the point of the Conservative exercise, gut medicare. However, medicare is the sacred cow of Canadian governance and thankfully Canadians will not tolerate the medicare system being gutted.

A campaign focused on creating more spots in medical schools to create more Canadian doctors, would be a winning party platform - Liberals are you listening?

The shortage for openings in medical school and positions for residency is driven by the unwillingness of the college of physicians and surgeons to change things. They fear the result of a adequate number of doctors will drive down the value we place on their skills.

There is something seriously wrong when there are bright students being turned away from med school when there is such a high demand for grads.

Perhaps med school should be free with the condition the new doctor practices in Canada for a period after graduating.

You played the game. You knew you had ridiculously better odds going overseas...and would require much much less university (and probably also cost because of that). AND YOU KNEW AT THE OUTSET YOU PROBABLY COULDN'T PRACTICE IN CANADA!

To now complain about it is absurd self-interested whining and has nothing to do with improving Canada's healthcare system.

Yes we need to fix our healthcare system and have more GPs. But we don't need to fix it by letting in whiny undergraduates who chose to go to the UK because they couldn't compete with Canadian kids and their parents could afford to work around it.

She's not a "'free' Canadian doctor!"

She wants a residency position in Canada. That makes her very, very expensive.

Yes it IS expensive to train a resident - but if we have a shortage of doctors, why isn't more money put into this so that we CAN afford to train extra residents, and who better than Canadians trained at recognized schools overseas who want to come back to Canada to practice? Would rather they came here than go to the States, or stayed in the UK... doesn't help us out very much. I think many people are missing her point, that, or they didn't actually read the article - she is getting at a lack of doctors in Canada and suggesting solutions... I wouldn't call that 'whiny'

Nonsense. The author bypassed the normal route of entry of medical school in Canada by not even attempting a four-year undergraduate degree: in her words, "to avoid waiting out four years of an undergraduate program to find out if I might get into medical school in Canada against the odds".

This is simply galling, not only to current Canadian med students, but also to the 100% of applicants who completed at least two years (and usually four) of university prior to getting in. It is further insulting to the many applicants who applied multiple times; they were willing to put in the time and work, unlike this person, who evidently has access to significant financial resources.

Even worse, she has the temerity to suggest that she ought to be entitled to a residency spot by virtue of her citizenship. For someone who never even applied to a Canadian medical school, her comments ring false and thoroughly self-interested.

The "shortage" does exist, but it is absolutely not "dire" by any reasonable measure. Getting in to medical school is not "pure luck" - strong marks, a decent MCAT result, solid reference letters, and some degree of extracurricular involvement are necessities. The rest depends on the interview.

Now, it's true that some applicants just fall slightly short and don't make it in the first or even second or third time. That's predictable in an imperfect system with a fair degree of competition, but such applicants do tend to get in eventually.

(Disclaimer: I am a current medical student at a Canadian school. I got in on the first try, but I'd say I did my research and prepared appropriately. Had I not gotten in, though, I'd have tried again. At no point would I suggest that government policy be designed to suit my own career ideas or vanity.)

Perhaps you should've actually worked hard for a four year undergraduate degree and then applied to medical school like the rest of us. I'm sorry the system doesn't suit your needs, but a four year degree before medical school is how it works in North America and if you're too lazy to do it, you don't deserve a spot in the US or Canada. Stay in the UK where you belong.

This is not about Dr. Hickey. Honestly, she will benefit wherever she goes. It's our country that's losing out from the brain drain that occurs when she and many like her take their expertise elsewhere.

Unlike the author, I am one of the "lucky" medical students here in Canada who secured a spot with merit.

The author of the article sounds very angry. I think the anger is misdirected somewhat. She should be angry at herself for having made a decision to study abroad.

The author's point is lost in her emotional accusations and obvious attempts to pull at the heart strings of hockey fans and Tim Horton's coffee drinkers. The author should base her opinion piece more soundly on fact than emotional pleas... this is how medical literature is published.

It is true that there is a shortage of physicians; however, there is also a serious problem of human resource distribution. If the author's plan is to return to Canada so that she can practice in a major metropolitan area then she is doing very little for the current physician shortage.

To the author: you have not made any friends with your future Canadian colleagues by describing the admission process into Canadian medical schools as a luck of the draw. Unlike you, I earned my spot.

I agree that the negative and insulting comments directed at Ms. Hickey are inappropriate and unproductive. Sadly, the institutions of our society, including that of medicine which I am a part of, are rarely open to any criticism of any kind. Having said this, there are complexities around the issue of our medical system that cannot be easily summarized as so many often try to do. This will be a lengthy post, so bare with me.

I am a Canadian Citizen living in this country since 1987, when I started undergraduate post-secondary education. I, rightfully, did not get into medicine after my first few tries, partly because I was young and foolish in my first year of University and the poor grades I got were difficult to recover from, and partly because I was a recent immigrant without enough experience in this society to be able to fully grasp the issues of the day, and hence did not perform well in the few interviews I got.

After completing a Master’s in Physiology and doing research for a year after my Master’s, I tried again. This time I took every aspect of the process much more seriously (from studying my butt off for the MCAT, to spending weeks preparing my essays and other non-academic aspects of the application process, to preparing for interviews) and I got into several schools and chose Queen’s University. I am now a GP-Anesthetist living in Toronto, but practicing primarily in several small, rural communities in Ontario as a locum physician.

There are a good number of issues that I’d like to address. First, I want to clarify a common misconception. The number of training spots for medical school and residency is NOT controlled by the Canadian Medical Association or the College of Physicians and Surgeons.

Although there are some practices by some of the medical regulatory bodies in Canada (I won’t even get into the complexities of the various stakeholders in medical education and licensing in Canada, just take my word that it’s ridiculously complex) that leave a lot to be desired, the medical school and residency positions are controlled by the provincial governments only.

For instance, in Ontario, the government reduced medical school positions in the early 1990’s by nearly 100 spots with the absurd idea that having fewer doctors would stop the ever increasing cost of medicare. The logic was: fewer doctors, fewer patients seen, fewer tests ordered, fewer nurses needed, etc, etc. Residency spots were reduced by an equivalent number.

This trend only started to be reversed earlier in this decade. We have about 1000 fewer doctors in Ontario because of that little stunt alone. Similarly, residency spots are controlled by the government. Of course, there is a limit to how many can be trained. But that limit is not the bottle neck; government funding is.

For instance, there are a huge number of “off-shore” residents being trained currently in Ontario. These are mainly from Saudi Arabia and medical schools like them because not only their salaries are paid by their home country; their country actually pays the medical schools a hefty price per year for training them.

Thus, if the provincial government wanted to increase residency spots in some specialties, all they would have to do is tell the medical schools that they are no longer allowed to take off-shore residents, and that the government would pay an equivalent amount in order for more Canadian applicants to be trained (and that could include those graduating from non-canadian med schools that demonstrate an appropriate degree of competence).

Therefore, it is far too simplistic to blame the apparent physician shortage on the doctors’ “guilds” and us controlling the supply (and physicians are NOT the only group that are in short supply). Although I can’t undertake a full debate here about my understanding of the various issues that have led to the shortage of physicians, I believe that there are many issues apart from the number of medical school\residency spots, including:

1. An aging population that needs more medical services, while doctors are also aging (so more and more are retiring). So, we have increased demand and reduced supply.

2. The huge increase in female physicians over the past few decades to about 50% of new graduates. This is NOT a criticism, but just a statement of fact because females often work fewer hours or part-time, take maternity leave, and have a higher incidence of disability leave (as evidenced by higher disability insurance rates). So that again means reduced supply.

3. Lack of any appropriate public policy to encourage appropriate use of the healthcare system, which leads to much abuse and waste.

4. In line with #3, the lack of sufficient emphasis on health education, health promotion, and preventative health initiatives.

5. The successful manipulation of societal perceptions and the healthcare system by for-profit entities (pharmaceutical and medical device companies among others) leading to creation of a “need” for health services where there may have been none previously.

The second issue I’d like to address is the North American system of expecting a minimum of 3-4 years of undergraduate university education prior to going to medical school. Many European countries and Australia accept students directly into medical school from high school. Of course, medical school is longer there to compensate, but still ends up taking less time than in Canada or the US. Although I could say that only some of the vast amount of knowledge of medical sciences I had prior to going to medical school was directly helpful, the overall life experiences that I gained in my two degrees was certainly extremely valuable in terms of preparing me for becoming a well-rounded physician. It is difficult to put a price on that.

Do we just want physicians in Canada that are good mechanics of the body, having learned what knowledge they need about the “machine” in medical school (either here or abroad), or do we want to move our healthcare system towards truly treating patients as beings whose physical and mental health involves much more than addressing the machine?

Although I have to say that I am overall dismayed that our profession has much more progress to make in terms of bringing together the science, art, and spirituality of healing, it is much less likely that any progress could be made in this regard if more and more of our graduates have not even been through our training system. In my opinion, medical training, particularly during early years in medical school, has a lasting effect on the practitioner’s view of healing and their future practice style.

And having candidates that have had several years of life experience (whether through previous university education or by other means) would be beneficial compared to just accepting students coming out of high school as many other countries do. Indeed, some medical schools in Canada, such as McMaster University, do accept mature candidates with valuable experiences and a decent academic score, even if there are other candidates that scored better on academics alone.

The medical admission system in many other countries relies on grades only, and this includes first world countries (such as France) as well as many developing countries. Therefore, although I am sure that the quality of medical knowledge of medical graduates in many other countries is probably as good or better than that of Canadian graduates, medical knowledge in only one part of producing a good physician for the 21st century and having local graduates gives us more control on what type of physicians we wish to produce.

The third point I’m going to address is the suggestion by Ms. Hickey and others that the fact that she was born and raised in Canada should give her precedence over other IMG applicants. I would point out that IMG applicants, at least in Ontario, are usually Canadian Citizens as well. Most are immigrants who have become citizens by the time they jump through all the hoops needed prior to being able to apply for residency spots in Canada.

As far as I understood, there is only one type of Canadian Citizen with equal rights to any other Citizen. Considering the incredible sacrifices people have to make to come to this country as immigrants, and the fact that Canada actively recruits immigrants from around the world as a long-standing policy, I do not agree that a Canadian born and raised here should expect to get precedence over those who are Citizens by immigration.

Remember that anyone who grew up in Canada already has a huge advantage over any immigrant because of language issues and a deeper understanding of the culture, which goes a long way when it comes to preparing admission documents and performing well in interviews.

So, Ms. Hickey, if you come back to Canada and jump through the hoops like other IMGs, you will be able to apply to residency positions and should have no trouble getting one, especially if you will be content with a family medicine position (although there are also many specialty spots available to IMG applicants).

The very last issue I would like to address is the suggestion by someone that just because “the public pays” they should be able to dictate to physicians where we live and work. As a physician who, proudly, provides services to underserviced communities despite not living in one, I still find this statement insulting and infuriating. Physicians are one of the most highly trained and most talented groups in our society.

I will, without shame, assert that no other profession in society makes sacrifices that come even close to ours in training as well as actual practice. The number one thing that has gone into producing me as a physician was not the money spent on my education, but my own abilities and an incredible amount of hard work and perseverance. I will be damned if anyone is going to try and dictate anything to me that I do not choose. Mike Harris tried that, and failed miserably.

This is a free, democratic, and fair society. People choose all kinds of things including where to live. That includes those living in areas that are medically underserviced. Why should a physician lose the right to make choices just because others have made their choice to live somewhere lacking in medical services? Would you force mechanics in society to move to northern Ontario or to Nunavut if there is a mechanic shortage there?

Come to think of it, some of the small towns I go to could really use some nice restaurants with good ethnic food. Perhaps we should force some of the many restaurant owners in Toronto to move there. Yes, these analogies probably sound absurd, but no more so to me than the suggestion that the government try and force onto me my location. What then would be the difference between us and a country like China that would do exactly that if needed?

To suggest that the “public paying” allows us to decide as a society to take away the rights of a group of professionals is ridiculous. After all, it is always the public that pays, whether through taxes or not. If there are doctors working and living in big cities, it’s because there’s still a demand for their services.

If you want more of them to go to more underserviced areas, you do it through incentives, not by forcing them (which you can’t anyway, because worse comes to worse, they’ll just go elsewhere, as happened during Mike Harris’ rule in Ontario). Use the carrot, not the stick.

Which, by the way, the government in Ontario has been doing over the last several years and there have been slowly some improvements in drawing physicians to rural areas. However, it will take much more time. You can’t address a problem created over decades in just years, regardless of how good a policy you have.

Quoted for truth:

"You are a Canadian citizen, but you chose not to jump through Canadian hoops, so you now have to deal with the choices you have made."

Fascinating comments.

It is true that we have too few med school seats. Nothing is really gonna be done about it though, as there is no political will. So, for the meantime, people will put their lives on hold, but even more will move elsewhere for their training.

I have personally been accepted to a few US schools. I'm waiting for a few more rejections from Canadian schools before I go to the bank, get a line of credit, and start the next chapter of my life. I am planning on going the US route since graduates of LCME accredited schools (Canadian AND American med schools) are able to enter the 1st iteration of the Canadian Match. This is not true for Australian/UK/Scotland/Ireland/etc.

It's really interesting though-at all of my interviews last year, I met multiple Canadians. At each and every med school. Some were even from my school. It was quite amazing and eyeopening.

One other interesting fact; it seems that the average Canadian school 'reject' turns out to be an above average US applicant and average/above average matriculant. Just some food for thought.