Ashok Kumar Biswas was working as a geriatric public health specialist in 2017 when he met a Canadian immigration official who encouraged him to apply to come to Canada.
The official said Canada
needed doctors
and the Indian physician had the kind of qualifications
they were looking for
, including two post-graduate specialist medical degrees, in geriatrics and public health, a decade of global experience and excellent English skills. His application, he was told, would be expedited as a skilled worker.
He came to Canada in 2019. Today, Biswas lives in Ottawa and is a proud Canadian citizen, but he is
no closer to practicing medicine
here. And after a recent change to the system that matches medical graduates to resident positions in Ontario, his dreams of doing so are fading.
After years of preparation, Biswas learned about the new eligibility criteria for internationally trained doctors in Ontario via email in early October while he was in the process of applying for residency opportunities. The system was already stacked against internationally trained physicians, with costly hurdles to overcome to compete for a small number of residency positions open to them. The recent change for those applying in Ontario, says Biswas, is the cherry on top of what was already a system in which discrimination against internationally trained doctors had been normalized.
The recent change blocks most internationally trained physicians from participating in the first round of the highly competitive residency matching process required to practice medicine in Ontario, known as CaRMS (the Canadian Resident Matching System). The only exception is for internationally trained physicians who completed at least two years of high school in Ontario – a group that mainly includes Ontario residents who attended medical school overseas. The remainder of internationally trained physicians can compete for any positions left unfilled in the second round. By then, most of the positions are filled. If they are unsuccessful and wish to continue, they must try another year.
At first, Biswas couldn’t believe it. When he asked why the eligibility was changing, he was directed to speak to provincial politicians.
That change dashed Biswas’s hopes of being able to work as a specialist in geriatrics and public health in Canada, something he has experience in and is passionate about.
Critics call the change arbitrary and discriminatory and say it could worsen Ontario’s doctor shortage and prevent highly trained foreign doctors from coming to Canada. Some internationally trained doctors say it sends a clear message that they are not wanted in Ontario.
For Biswas, who is 35, the new barrier to practising medicine in Ontario came as a blow.
“It took away my dreams. I am devastated.”
Biswas spoke about his experience trying to work as a doctor in Ontario at a Tim Horton’s coffee shop not far from where he lives and works in Orléans. It was one of the first places he applied for a job when he first arrived in Canada. The medical grad, who excelled as a student in India and the Netherlands, was told he was overqualified.
Since then, he has worked in numerous jobs – including as a receptionist at a retirement home during the early years of the pandemic, a caregiver and, now, an education assistant working with students with developmental needs at a high school — while studying for required exams. He completed an Algonquin College program in digital health, but was unable to find work in that field because he does not have Canadian experience. He also does volunteer work, including with public health during the pandemic.
Biswas arrived for our interview after work, wearing a cardigan dotted with happy faces and a prominent Canada flag pin.
At times, he has worked three jobs at once in an effort to pay the bills and try to save money for the thousands of dollars required for paperwork, tests and assessments that are part of applying to work as a doctor in Ontario. He scored above the 99th percentile on the theoretical exam to practice medicine in Ontario. Internationally trained physicians must pass the test before they apply for a residency.
Biswas was also among the cream of the crop of medical graduates in India’s highly competitive system. He received a full scholarship to medical school because of high entry exam marks and was later selected as the only candidate from his country to do a post-graduate medical degree at a prestigious university in the Netherlands. That is where he met his partner, a European-trained nurse who is also working to get a license to practice in Ontario.
Biswas, who is gay, chose to leave India so he and his partner could someday have a family.
But he had no idea about the length and cost of the process to become a licensed physician in Canada. In other countries where he had worked before coming to Canada, he went through a licensing process and then was able to work as a doctor.
“You are given an exam, you prove yourself, and you get a license. Here it is more complex.”
Canada’s process takes much longer and costs money at every step. Unlike other countries, it sends most internationally trained physicians, even those with specialty experience, back to the basics or creates so many barriers that some give up on practising medicine.
For Biswas, every step seems to push his dream further away. At 35, he now fears his age and the length of time since he last worked as a physician will reduce his chances of being accepted into a residency.
“It has been a long marathon. It takes five to eight years.”
Biswas is also looking at applying to become a physician in Saskatchewan, but would prefer to stay in Ontario, which is his home.
The situation leaves him feeling like a third-class citizen. He calls it anti-immigrant, racist and un-Canadian.
“Am I not Ontarian enough? I’ve been paying taxes for five years. I am contributing to the economy. I am helping people and I have worked in the sector (caregiving) where people don’t want to work,” he said.
“It is hard. You were a doctor and a specialist — and suddenly you are changing diapers. Every day you go home and think, ‘Is this my life? ’”
Biswas, who has licenses to practice in India, Pakistan and throughout the Middle East, says he is a Canadian and his skills are needed here.
“It is so complex and frustrating. I raised my hand and took an oath in front of the court and a judge. I have a Canadian passport. When will you accept me wholeheartedly?”
The abrupt move by the Ontario government has been widely criticized. Critics say it contradicts other policies aimed at attracting more physicians to the province.
Ema Popovich, a spokesperson for Health Minister Sylvia Jones, said the move would deliver “more opportunities for Ontarians who began their medical education abroad to complete their postgraduate training in Ontario. We know that medical school residents are likely to practice in the region where they receive their training, and this will ensure Ontario has a strong pipeline of world-class, Ontario-trained doctors for years to come.”
She added that international medical graduates who did not attend Ontario high school for two years “will continue to be eligible to participate in the second round of the residency match.”
The Canadian Medical Association and the College of Family Physicians of Canada are calling on the Ontario government to reconsider the policy change, saying it will have a potential negative impact on the supply of doctors. The Society of Rural Physicians of Canada has also warned that the change could worsen already serious inequities in rural areas.
Dr. Sarah Giles, president-elect of the Society of Rural Physicians of Canada, said the organization is “shocked and concerned” by the new eligibility requirements.
“This came out of nowhere. I am not sure what problem it is aiming to fix.”
She noted that 58 per cent of internationally trained physicians go on to become family doctors, and we desperately need family doctors. We also know that a lot of these doctors work rurally, and we desperately need rural doctors.”
She said the eligibility change means that competitive applicants who trained internationally are not going to apply to work in Ontario “just for the leftovers.” Giles, who works as a family physician in Kenora, Ont., is also an associate professor of family medicine at the Northern Ontario School of Medicine University.
Many internationally trained physicians say they will no longer apply to work in Ontario.
One internationally trained physician, Lucy Chantal Nakibuuka, said she has changed her mind about applying for CaRMS this year after a long preparation because she no longer qualified for the positions she is interested in — either dermatology or public health. She, like others, said the second round will be “just the leftovers” and not the highly competitive residency positions. Nakibuuka did her medical degree in Uganda. She later did a post-graduate dermatology degree in Wales and a master’s in public health in Newfoundland, where she now lives.
“I am just in limbo like everyone else. I don’t know what to do. Previously, it was about the best candidate, but now it is about (where you went to) high school.”
Another internationally trained physician, who studied medicine in Nigeria, got a license to practice in Canada through a Saskatchewan program that assesses international medical graduates and allows them to practice through a return of service agreement to work in high-needs parts of the province. That physician called Ontario’s changes to the residency matching program “a scam” and said it is driving international medical grads away from the province and the country.
Biswas, meanwhile, remains deeply frustrated but continues to look ahead.
He recently took an Uber ride and learned the driver, a man in his 50s from Syria, had worked as a neuro-musculoskeletal surgeon in his home country, doing the highly technical work of rebuilding damaged nerves. He told Biswas he was too old to go through the lengthy and expensive process of trying to get a license to practice in Canada.
“But you are young,” he told Biswas, “you should keep going.”
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