International medical graduates (IMGs), or doctors trained outside of North America, already make up a significant part of the North American physician workforce. According to information from the American Medical Association, in 2005, 23.3% of practicing US physicians were IMGs. Similarly, an article published on April 26, 2005, by CTV News reports that more than one in five doctors in Canada were trained abroad.
However, the road to residency, licensure, and medical practice can be a long one for IMGs.
Evaluation Exams
IMGs must complete evaluation exams in order to qualify for residency and postgraduate medical programs.
Residency
After passing their evaluation exams, IMGs must complete an accredited residency or postgraduate training program. The Canadian Resident Matching Service (CaRMS) is responsible for many residency placements in Canada, while the United States offers the National Resident Matching Program (NRMP).
Applying to residency programs usually requires additional tests, interviews, and written and oral language tests (for example, TOEFL or TSE).
State, Provincial, or Territorial Licensing
In Canada, IMGs must pass the MCCQE I and MCCQE II to qualify for a license. IMGs who wish to practice in the US must pass the three-part United States Medical Licensing Examination (USMLE).
Individual states, provinces, and territories have different licensure requirements. After completing the national licensing exams, applicants must apply to the licensing body in the state/province/territory where they intend to practice. For more information, see our articles Licensing: MDs – Canada and Licensing: MDs – USA.
The United States – The Fifth Pathway
The Fifth Pathway Program is an American-standards medical training program taught outside of the US. Eligible students complete all but their final year of training at an institution listed in the World Health Organization's World Directory of Medical Schools. Students then complete their final year of medical training in the United States, and receive a "Certificate of Completion," which acts as their medical credential. About 1% of practicing US physicians entered the workforce through The Fifth Pathway Program.
Note: According to the American Medical Association's page licensure board requirements for IMG: "As of June 30, 2009, through action of the AMA Council on Medical Education, the Fifth Pathway will be discontinued. The Council will no longer support the Fifth Pathway as a mechanism for eligibility to enter the first year of ACGME-accredited graduate medical education programs."
Some provinces and territories offer a special form of licensure for physicians who plan to work in under-serviced areas. For example, under the Manitoba Licensure Program for International Medical Graduates (MLPIMG), qualified individuals can apply for conditional registration with the College of Physicians and Surgeons of Manitoba. The conditional registration allows the IMG to work as a general practitioner in under-serviced areas of Manitoba, under the supervision of a medical practice advisor. The IMG must complete the MCCQE within five years and the certificate of the College of Family Physicians of Canada within seven years. The MLPIMG Program also offers additional medical training to IMGs.
Prospects
Getting into a residency program is usually the biggest hurdle for IMGs. In general, IMGs in the United States have an easier time than in Canada. According to a paper published on October 27, 2005 in The New England Journal of Medicine, the demand for residency staff exceeds the number of US medical graduates by 30%. This gap is usually filled by IMGs. Programs also exist to attract IMGs to under-serviced areas of the country.
In Canada, eligible IMGs have only recently become able to be considered for some of the "first iteration" residency vacancies in most provinces. Conditions may apply to those IMGs accepted for first iteration positions. The second iteration is offered for positions and applicants who were not matched in the first and also includes applicants who have had previous North American postgraduate training who wish to apply for an R-1 position in Canada.
On April 25, 2005, the Canadian government announced that $75 million dollars will be spent over the next five years to speed up the integration of IMGs into the Canadian healthcare system. Much of the money will be used to increase the number of residency positions available. In 2005, British Columbia announced plans to increase the number of residency positions for IMGs from six to 18. Ontario was even more ambitious, and increased the number of residency positions for IMGs from 65 to 200 in 2004.
Beating the Odds
Here are some tips on how to improve your chances:
- Work to improve your English (or French) language skills if they are less than perfect.
- Make sure that all of your test scores are as high as possible.
- Be persistent! Due to the limited number of positions available, the majority of IMGs do not land a residency position the first time they apply. Polish your CV and develop your verbal skills to help you shine during residency interviews.
- Familiarize yourself with the American or Canadian medical system any way you can. Participate in an observership program, apply for non-physician jobs in healthcare settings, or volunteer at a local hospital. Try to develop a network of professional contacts that you can turn to for references, information, and advice.
- Read medical journals to keep up-to-date with new developments.
- Consider other options. Many IMGs ultimately choose other career paths due to changes in their financial or family circumstances, or because they are unwilling to go through additional residency and other medical training. Some pursue training and certification in allied health, research, nursing, or other fields.