This February, Veronica Silva was one of an unprecedented
550 international medical graduates(IMGs) taking clinical
exams to qualify for residencies in Ontario. The aspiring
pediatrician, fresh from eight years of medical training
in El Salvador, is concerned that intense competition
for Ontario's 200 IMG residency spots will leave qualified
doctors out in the cold.
"We're in a crisis situation where
there aren't enough doctors to go around," she says,
"but we have all these highly trained IMGs who probably
won't be picked because there are so few residencies."
VAST
TALENT POOL
The situation has improved in recent years. In 2003,
the number of residencies available to IMGs increased
from 90 to 200. In 2004, IMG-Ontario (initially called
the 'Ontario IMG Clearinghouse') replaced the Ontario
IMG Program; in their first year of operation only 165
out of a possible 200 candidates qualified for residencies.
This was partly due to a very short time given to the
IMGs to deal with the beastly bureaucratic side of things.
This year they decided to extend the application deadline
plus increase the number of clinical exam spots —
as a result, there were twice as many exam takers this
year as compared to last.
But there are still problems. According
to Joan Atlin of the Association of International Physicians
and Surgeons of Ontario, many candidates never make
it past the preliminary written exam. "What we'd like
to see is that everybody who qualifies gets to take
the clinical exam. It's hard to make a proper decision
about who the best candidates are unless everyone gets
the opportunity to take both."
Brad Sinclair, executive director
of IMG Ontario, agrees, but points out that it's a problem
of logistics. "Ideally, we would offer every candidate
who meets the basic eligibility criteria the chance
to do both, but practically speaking, that's just not
possible, because there are so many candidates —
we had 1,150 applications this year — and we simply
don't have the wherewithal to run the exam for that
many people."
WHAT
IT TAKES
Each candidate is evaluated based on consultations with
sixteen standardized patients. Since an examination
may include up to seven streams of candidates all being
tested simultaneously, each site hosting an exam has
to provide approximately one hundred consulting rooms,
each equipped with an examiner and a standardized patient.
Until last year, the exams had always been held at Princess
Margaret Hospital in Toronto. At that solitary hospital,
testing any more than 150 candidates per year would
have been a logistical nightmare, if not impossible.
The challenge for IMG-Ontario was
to increase that number. "We had a brainstorm and said,
well, we have five universities," says Mr Sinclair.
"Why don't we run the same exam, on the same day, at
the same time? How many people could we accommodate
using that rubric? And the magic number was 559."
RURAL
RESIDENCIES?
Good, but not good enough, says Ms Atlin. "While increasing
the number of spots in the exams is a good thing, it
doesn't change the number of positions that are available,"
she says. "It's not really a policy change." She favours
expanding the resident training system from major teaching
hospitals to hospitals in underserviced communities.
For Ms Silva, though, a star-spangled
alternative beckons. In the U.S., a surplus of residencies
means competition is far less intense. "I don't want
to go through all these exams more than once —
I could be stuck here for years, waiting," she says.
"Whereas if I go there, I know that once I pass my exams,
I'm guaranteed a spot. It's like walking down a dark
tunnel, versus knowing there's going to be a light at
the end." According to Mr Sinclair, IMGs like Ms Silva
should know their results sometime in mid-March.
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