In July 1999, Minister Witmer appointed Dr Robert McKendry as a fact-finding Commissioner to examine and define the scope and cause of the the physician supply and distribution problems in Ontario. In August, the FTDA made a submission to Dr McKendry highlighting the needed changes to allow effective and equitable integration of international physicians and surgeons. Physicians for Ontario: Too Many? Too Few? For 2000 and Beyond is the outcome of Dr McKendry's commission. To read the executive summary and/or full report, go to: www.gov.on.ca/health/english/pub/ministry/mckendry/mckendry.html

Below are AIPSO's responses to some of the key points made in the report which affect international physicians and surgeons already in Ontario.

AIPSO's Response

AIPSO welcomes the increase of places available in the International Medical Graduate (IMG) Program from 24 to 36, however, this increase falls alarmingly short of addressing the critical shortage of physicians in Ontario and does not deal with the structural issues of access for unlicensed international physicians in Ontario. The selection process for the program does not rely on an objective assessment of knowledge, skills and experience, but rather acts primarily as a gatekeeping mechanism.

On 3 December 1999, approximately 275 international medical graduates who had already successfully completed the Medical Council of Canada Evaluating Exam wrote the competitive entrance exam for the IMG program. There is not a standard pass score for this exam. It is believed that approximately 90 candidates have been invited back for a clinical exam in January, from which only 36 will be admitted to the program. This process of elimination stands in contradiction to the overall intention of Dr McKendry's report which puts forward proposals for "attracting" trained doctors to Ontario. While incentives are being designed to attract Canadian graduates for re-entry (see recommendations 5.1.3 and 5.1.4. below), IMGs are continuing to face a process designed to limit access without regard to qualification.

Two key recommendations for IMGs refer to practice eligible routes available through the College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC). In the first instance, the CFPC requires that IMGs are already in active practice in Canada, which continues to exclude those IMGs who have successfully completed various levels of exams, but have not been admitted to a residency or pre-residency program because of arbitrary gatekeeping mechanisms. The pilot program of the RCPSC is restricted to those IMGs recruited from outside Canada or the USA. This means that costly overseas recruitment is being given preference over utilizing the valuable resource of IMGs already in Ontario. However, it is recommended that the program be expanded in the future.

AIPSO welcomes recommendation 3.2.5 which states that the Ministry should fund a limited number of postgraduate training positions for community-sponsored IMGs who do not qualify for the practice eligible route to licensure. The details of the proposal and the extent of the program are not provided.

It is important that in this report, the Ministry is officially recognizing not only the problems of distribution, but also the actual shortage of physicians and surgeons in Ontario. However, missing in this report is the expressed and explicit willingness of IMGs currently in Ontario to work in underserviced areas.

It is the position of AIPSO that it is critical, as long-term solutions are being developed, that IMGs be formally represented on the expert panel to be chaired by Dr Peter George, President of McMaster University.