HEALTH

DOCTORS FOR HIRE

Half of the Canadians trained in Ireland don’t come home

ANNE KINGSTON May 19 2008
HEALTH

DOCTORS FOR HIRE

Half of the Canadians trained in Ireland don’t come home

ANNE KINGSTON May 19 2008

DOCTORS FOR HIRE

HEALTH

Half of the Canadians trained in Ireland don’t come home

ANNE KINGSTON

The sick state of the Canadian health care system can be seen very clearly from Ireland, where close to 400 Canadians currently study medicine—up from 100 in 2000. These aspiring doctors are part of the estimated 1,500 Canadians driven outside North America to medical school by the same supply-demand imbalances that underline the country’s medical system. Despite a dire doctor shortage, Canada offers just over 2,400 first-year medical school slots annually, slightly more than seven per 100,000 people. (By comparison, the U.K. has 13 openings per 100,000 people.)

Irish medical schools have become a go-to destination. The submission process is oiled by the Atlantic Bridge Program, a Newport Beach, Calif.-based agency that coordinates all North American applications, a service paid for by the schools. To meet ever-increasing demand, the University of Limerick set up a medical program last year.

The calibre of Canadian candidates is high, says Peter Nealon, Atlantic Bridge’s Dublinborn director, who terms selection criteria “ephemeral.” Medical College Admission Test (MCAT) results are important, he says, though two schools don’t require them. Unlike Canada, only one school—Dublin’s Royal College of Surgeons in Ireland—requires an interview. Two schools offer a six-year program for students attending straight out of high school, the norm in Ireland. One-fifth of North American applicants select this route, among them Toronto-born Greg Klar, who will be graduating from RCSI this year at age 24. Like many, Klar speaks of the experience glowingly: “The best thing I ever did,” he says.

The rub? Well, for starters, fees are at least three times those of Canadian schools. (Charging non-EU students tuitions anywhere from $50,000 to $70,000 allows Ireland to offset the free medical training provided to its own citizens.) A higher cost of living ups the financial burden. Most students rely on some family support; the few students financed solely by loans can face debt bordering on half a million dollars. The greatest frustration for many, though, is the prospect of permanent professional exile. Canadians schooled abroad are considered International Medical Graduates or IMGs. As such, they compete with non-Canadians for a limited number of IMG

residency positions, many of which require a five-year payback work stint in Canada.

Between one-half to three-quarters of Irishschooled Canadians don’t come home. Six of the 30 Canadians graduating from RCSI this year have secured Canadian residencies, says 27-year-old Andrew Wyatt of Ottawa, who snagged a spot in orthopaedics at the University of Toronto. There’s frustration with the system, he says. “People say, T paid for my own education while students in Canada are subsidized. Then they’re making me go to the boonies for another five years.’ ”

U.S. AND AUSTRALIAN RESIDENCY PROGRAMS COURT GRADS

Andrew Burkett, a 27-year-old fourth-year medical student at the University College Cork, acts as a mentor to Canadians applying to the school. His experience has been fantastic, he says. Yet he advises students to keep reapplying to Canadian and U.S. schools. “Five years is a long time to be chronically stressed out about your future,” he says.

American and Australian residency programs court the Irish graduates, says Burkett. So do some remoter Canadian communities. In January, Herb Jacques, mayor of The Pas,

Man., visited Irish schools, offering to cover tuition costs for future graduates willing to practise there. Klar, who is returning to an anesthesiology residency in Manitoba, which does not require IMGs to sign a five-year service contract, says that a lot of his classmates secured great residencies in the U.S. “There’s less hassle,” he says. Ontario, on the other hand, is viewed so problematic that no students from Trinity College’s 2007 graduating class bothered applying.

“Ontario is obstructive to IMGs,” says David MacPherson, a family practitioner in Kingston, Ont., whose son Jeffrey graduated from Trinity in 2006. The Canadian Medical Association is amenable to the idea of accrediting select offshore schools, says president Brian Day. “Until more openings exist in

Canadian schools, repatriation of Canadian students is a cost-effective way of addressing the shortage.”

Lines are blurring, somewhat. Burkett says he’s been told not to complain about the difficulty of returning. “The message I’m getting is ‘Listen, shut up. You’re from an Irish school. That’s practically Canadian. These rules don’t apply as much to you as they would to somebody from India.’ ” If that’s the welcome mat, don’t expect a fresh crop of Canadian doctors to beat down the door. M