Can international medical graduates help solve Canada's shortage of rural physicians?

© 2009 Society of Rural Physicians of Canada 120 T he shortage of health care professionals providing services to rural and remote regions has long been recognized as a significant problem in the delivery of Canadian health care. Rural Canada encompasses 99.8% of Canada’s land mass and about 21% of the population, yet is served by only 16% of its general practitioners (GPs) and 2% of specialists. In 1998, the average Canadian ratio of patients per GP was 896:1 in urban settings, compared with a ratio of 1214:1 in rural settings. These shortages are exacerbated by challenges in the delivery of care across vast and re mote distances, and are likely to intensify in the future, with a projected 33% decrease in the overall supply of Canadian physicians, due to physician attrition and lack of adequate replacement by recent graduates. Canada has historically relied on international medical graduates (IMGs) to augment its supply of physicians, particularly in rural areas. In the 1970s, 30%–35% of Canada’s physicians were foreign-trained. Estimates in 2007 indicate that 21.9% of physicians were trained outside of Canada or the United States, with the highest proportions in provinces with predominantly rural populations, including Saskatchewan (54.8%) and Newfoundland (41.7%). A cross-sectional study of family physicians in southeastern Ontario found that IMGs, in comparison with medic al graduates trained in Canada, were more likely to practise in small towns (32.9% v. 28.3%) or rural communities (20.0% v. 17.6%). Similarly, a US study found that IMGs were more likely than US graduates to practise in medically underserved locations. Increasing opportunities for IMGs to practise in the Canadian health care system has been suggested as a potential solution to help mitigate Canada’s shortage of rural physicians. Important con siderations include assessing the equivalency of medical training, ethics involved in recruiting physicians from developing countries, long-term retention rates of IMGs in rural communities and political barriers such as differing provincial licensing requirements, varying regional recruitment strategies and a lack of federal–provincial cooperation. This paper aims to address the following question: Will increased licensing of IMGs help solve Canada’s rural physician shortage in a sustainable and ethical manner? Obtaining a medical licence is a major barrier for IMGs wishing to practise medicine in Canada. Physician licensing falls under the jurisdiction of provincial regulatory authorities and there are wide variations across provinces with respect to access and granting of medical licences. Requirements for a full licence are similar across provinces, contingent on successful completion of Licentiate of the Medical Council of Canada evaluating and qualifying examinations and Canadian postgraduate training. However, because of the limited availability of residency positions, many IMGs are unable to obtain full medical licences. Podium: Doctors Speak Out La parole aux médicins