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Correspondence |
San Diego, California
To the Editor:
While there seems to be no general consensus about physician supply/demand ratio in both Canada and the United States, the steadily increasing participation of international medical graduates (IMGs) in North American medicine has recently become a politically charged/sensitive issue.1 Today, IMGs fill approximately one-third of internal medicine and pediatric residency positions, one-fifth of family medicine residency positions, and one in five physicians practicing medicine in the United States received their initial medical training in another country.2 Each year, many residency positions in anesthesiology and psychiatry remain vacant or are filled by IMGs. While possibly reflecting an overabundance of such residency positions, this situation may also suggest a lack of U.S. (and Canadian) medical student interest in these specialties.
Craig et al.3 studied the supply of physician anesthesia providers in Canada and concluded that the country was found well entrenched in a shortage of anesthesiologists. Yang et al. analyzed the anesthesia physician resources4 and concluded that the shortfall of anesthesiologist physician providers in Canada would worsen by 2005. The severe shortages of anesthesiologists in some Canadian provinces have led to recent consideration of significant policy changes designed to allow entry of specialist anesthesiologists from other countries.3 However, licensing requirements of most provinces make it difficult, if not almost impossible, for IMGs without Canadian training to obtain a permanent license to practice medicine in Canada.
In a recent article focusing on the Canadian medical qualifying examination (MCC) Ahmed5 raised two important questions; first, is MCC (or any other medical qualifying examination for that matter) a way of standardizing the delivery of health care?, and second, is it a way of deterring IMGs from entering practice in Canada? It seems that the correct answer to both is "yes." Is it therefore possible that countries like Canada and the United States whose success in great part stems from ethnic and cultural diversity, in which discrimination is illegal, and which seem to need foreign trained physicians (including anesthesiologists), may at the same time attempt to limit the influx of IMGs at the very entry (qualifying examination) level?
References
1 Kent H. College to appeal discrimination ruling. CMAJ 2000; 162: 854.
2 Fiscella K, Roman-Diaz M, Lue BH, Botelho R, Frankel R. "Being a foreigner, I may be punished if I make a small mistake": assessing transcultural experiences in caring for patients. Fam Prac 1997; 14: 112–6.
3 Craig D, Byrick R, Carli F. A physician workforce planning model applied to Canadian anesthesiology: planning the future supply of anesthesiologists. Can J Anesth 2002; 49: 671–7.
4 Yang H, Byrick R, Donen N. Analysis of anesthesia physician resources: projected Ontario deficit in 2005. Can J Anesth 2000; 47: 179–84.
5 Ahmed SN. MCC evaluating examination and the international medical graduate. CMAJ 2003; 169: 1146–7.
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