Ontario Alters Residency Rules, Impacting Family Doctor Recruitment

Physician advocacy groups in Ontario have sharply criticized the province’s recent decision to alter eligibility requirements for medical school graduates seeking residency in family medicine. This unexpected change, implemented by the Health Ministry on October 8, 2023, is seen as discriminatory and likely to exacerbate the ongoing primary care crisis in the region.

Under the new rules, international medical graduates (IMGs) must have completed at least two years of high school in Ontario to qualify for the initial round of residency placements. This requirement effectively excludes most immigrant physicians from consideration during the first matching round, significantly limiting the pool of candidates for family medicine.

Dr. David Barber, chair of the Section of General and Family Practice (SGFP) at the Ontario Medical Association, expressed deep concern about the implications of this policy. He stated, “We can’t afford to be turning away qualified physicians. We desperately need more family doctors.” The SGFP highlighted that approximately 60 percent of family medicine residency positions in Ontario are filled by IMGs, and estimates suggest that the number of eligible applicants could drop dramatically from about 1,200 to just 200.

The abrupt rule change has disrupted the residency plans of many medical graduates who have already invested significant time and resources into the application process. As a result, many strong candidates may look to the United States or other provinces to complete their training, further depleting Ontario’s efforts to increase its family doctor workforce.

In response to the backlash, a spokesperson for Health Minister Sylvia Jones defended the decision, asserting that the government is “delivering more opportunities for Ontarians who started their medical education abroad.” Ema Popovic emphasized that the policy aims to ensure a robust pipeline of Ontario-trained doctors, claiming that IMGs who do not meet the high school criteria can still apply in the second round of matching alongside other candidates.

The Canadian Resident Matching Service (CaRMS) conducts the matching process in two rounds each year. Students who are unsuccessful in securing their preferred specialty during the first round have the option to enter the second round for remaining positions. Notably, Ontario is now the only province with a high school requirement for prospective family medicine residents.

The Association of Faculties of Medicine of Canada issued a statement indicating that the new requirement was “not an anticipated change” and that it will be closely monitoring the situation. Ontario hosts seven of Canada’s eighteen medical schools, which account for 37 percent of the country’s residency spots.

The Internationally Trained Physicians of Canada is currently exploring legal avenues, arguing that the new policy violates the Ontario Human Rights Code and the Fair Access to Regulated Professions Act. This legislation mandates that public-service eligibility rules must be transparent, objective, and free from discrimination based on citizenship or place of origin. “ITPC is open to litigation, and we are consulting with a lawyer currently,” stated a representative from the organization, which has 3,000 members nationwide.

Dr. Chiebere Ogbuneke, IMG lead for the Black Physicians’ Association of Ontario, condemned the eligibility requirement as “discriminatory, inequitable, and fundamentally un-Canadian.” He pointed out that international medical graduates already face numerous challenges entering the Canadian medical field, including credential recognition issues and systemic barriers. The new policy effectively establishes a “two-tiered system” favoring those with Ontario high school credentials over equally qualified physicians who completed their education abroad.

Dr. Carla Henderson, chief of anesthesia at Peterborough Regional Health Centre, echoed these sentiments, asserting that many skilled professionals in her department would be excluded under the new rules. “At a time when Ontario faces unprecedented health-care challenges, this policy represents a significant step backwards,” Ogbuneke stated.

The Black Physicians’ Association of Ontario is urging the Ministry of Health and Ontario’s medical schools to reconsider and review the new eligibility requirements. Dr. Henderson emphasized the personal impact of the policy, recalling her own journey to becoming an anesthesiologist. “An IMG either is Canadian or a permanent resident. They’re not a foreigner. These are actual Canadians, and you’re literally restricting working in Canada on Canadians,” she said.

The implications of this policy change remain significant, as many in the medical community call for a reevaluation of eligibility rules to ensure a more inclusive approach that addresses the pressing need for family doctors in Ontario.