Data On Internationally-Educated Physicians in Canada2011 IMG SymposiumMonday 17 October, 2011

Toronto, Ontario, Canada

Steve Slade, VP, Research and Analysis CAPER-ORIS

Linda Bourgeois, Research Associate

Canadian Post-MD Education Registry

Association of Faculties of Medicine of Canada

Evolving IMG-IEP Context

• Many people, organizations, complex processes

• Balancing need for physicians with public safety

• Standards of Canadian vs. international medical schools (accreditation, curriculum, graduate preparedness, etc.)

• Growing domestic and international demand for UGME and PGME in Canada

• Ethical recruitment and treatment of IMGs

Evolving IMG-IEP Context

• Canadian Task Force on Licensure of IMGs - 2004– Increase capacity to assess IMGs– Work toward standardization– Expand/Develop programs to support IMGs– Develop capacity to track and recruit IMGs– Develop a national research agenda

Evolving IMG-IEP Context

• More recently:– Agreement on Internal Trade- Chapter 7- Labour

Mobility– Framework for Foreign Credential Recognition– National Regulatory Coordination

• Physician Credentials Repository of Canada• Application for Medical Registration in Canada

– National Assessment Collaboration

Data in an Evolving ContextPhysician to Population Ratio – Canada Vs. OECD Average

Data in an Evolving ContextPhysician to Population Ratio – Canada Vs. OECD Average

19941995

19961997

19981999

20002001

20022003

20042005

20062007

20082009

2010

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

CMGs + IMGs CMGs OECD average

Den

sity

Per

100

0 Po

pula

tion

Data in an Evolving ContextNumber of IMGs in the Active Physician Workforce, Canada, 1994-2008

Data in an Evolving ContextNumber of IMGs in the Active Physician Workforce, Canada, 1994-2008

Data in an Evolving Context Increased MD Program Applicants Per 100K Population

19

80

/81

19

81

/82

19

82

/83

19

83

/84

19

84

/85

19

85

/86

19

86

/87

19

87

/88

19

88

/89

19

89

/90

19

90

/91

19

91

/92

19

92

/93

19

93

/94

19

94

/95

19

95

/96

19

96

/97

19

97

/98

19

98

/99

19

99

/20

00

20

00

/01

20

01

/02

20

02

/03

20

03

/04

20

04

/05

20

05

/06

20

06

/07

20

07

/08

20

08

/09

0

50

100

150

200

250

300

350

400

450

500

550

600

MD Program Applicants Per 100,000 Population Aged 20-24 Years, by Sex, Canada, 1980/81-2008/09

Male Female

Ap

pli

can

ts P

er 1

00K

Po

pu

lati

on

Ag

ed 2

0-24

Source: ORIS,AFMC, 2011.Note: Male and female applicant rates are expressed in relation to the male and female population.

Data in an Evolving Context Increased First Year MD Program Enrolment

00/01

01/02

02/03

03/04

04/05

05/06

06/07

07/08

08/09

09/10

10/11

0

250

500

750

1,000

1,250

1,500

1,750

2,000

2,250

2,500

2,750

3,000

1763

1921

2028

2096

2193

2380

2460

2569

2660

2742

2829

First Year MD Program Enrolment, Canada, 2000/01 - 2010/11

First Year Enrolment, up 60%Source: ORIS, AFMC, 2011

Data in an Evolving Context Increased Number of First Year Post-MD Trainees

Source: CAPER, AFMC, 2010. Note: Excludes visa trainees.

1471 1436 1447 1579 1640 1799 1894 1976 20882273 2419

77 138 197185

289259

360404

416

467426

0

500

1000

1500

2000

2500

3000

2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11

Number of PGY1 Post-MD Trainees by Place of MD Graduation, Canada, 2000-01 to 2010-11

MD Outside Canada (up 453%) MD in Canada (up 64%)

Data in an Evolving Context Increased Number of Clinical Teachers

Family Medicine

Psychiatry

Internal Medicine

Paediatrics

General Surgery

Emergency Medicine

All Other Departments

0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000

3,498

617

573

440

357

245

2,875

Growth in the Number of Part-Time Faculty of Medicine Faculty Members, Canada, 2004/05 to 2008/09

Source: AFMC, ORIS, 2011.Note: Part-Time faculty includes paid and volunteer faculty members.

IMGs in Canada ProjectNational IMG Database

The IMGs in Canada Project: Brief History

• Key Task Force Recommendations (2004)– Develop capacity to track and recruit IMGs

– Develop a national research agenda

• Phase I: 2005-2009– Foundational activities

• Phase II: 2010-2013– Maintain, enhance, create, support

– User guided

National IMG DatabaseData Collection Framework

• Medical Council of Canada (MCC)

• 7 IMG assessment centres

• 17 Faculties of Medicine

• The College of Family Physicians of Canada (CFPC)

• The Royal College of Physicians and Surgeons of Canada (RCPSC)

• Collège des médecins du Québec (CMQ)

• 9 regulatory authorities

National IMG DatabaseCurrent Data Status – Exam, Training, Certifying Bodies

CMQ

RCPSC

CFPC

FOM

MCC

2005 2006 2007 2008 2009

2005-2009

2006-2009

2005-2009

2005-2009

2005-2009

National IMG DatabaseCurrent Data Status - Assessment Centres

British Columbia (IMG-BC)

Alberta (AIMGP)

Saskatchewan (CPL)

Manitoba (MLPIMG, CAPE)

Ontario (CEHPEA)

Nova Scotia (CAPP)

NF and Labrador (CSAT)

2005 2006 2007 2008 2009

2005-2009

2005-2009

2005-2009

2005-2009

2007-2009

2005-2009

2005-2009

National IMG DatabaseCurrent Data Status – Medical Regulatory Authorities

QuebecBritish Columbia

AlbertaSaskatchewan

ManitobaOntario

New BrunswickNova Scotia

NF and Labrador

2005 2006 2007 2008 2009

2005-2009

2005-2009

2005-2009

2005-2009

2005-2009

2005-2009

2005-2009

2007-2009

2005-2009

National IMG DatabaseCurrent Data Status – Missing MRAs

Non-participants:• Prince Edward Island• Health And Social

Services, Government of Northwest Territories

• Health And Social Services, Government of Nunavut

Aggregate Data:• Yukon Medical Council

as of Sept 1, 2010

Sample of Data Variables Collected

Requested Data Variables

IMGs in CanadaEmerging Picture from the National IMG Database

Cumulative Number of Distinct IMGs in the National IMG Database

2005 2006 2007 2008 2009 20100

5,000

10,000

15,000

20,000

25,000

30,000

7,607 11,937 15,971 19,340 22,722 27,093

Source: National IMG Database, 2011

Most are non-Citizens, writing the Evaluating Exam overseas and/or training in Canada under Visa status.

Number of IMGs who passed MCC Examinations, by Self-Reported Citizenship, 2005-2009

EE QEI QEII0

2000

4000

6000

8000

10000

12000

8306 4414 2890

2666

1622

1305

Source: IMG Database, 2010.Note: Citizenship is self-reported by IMGs and not necessarily source-verified.

Number of IMGs who passed MCC Examinations, by Birth Country, 2005-2009

EE QEI QEII0

2000

4000

6000

8000

10000

12000

9789 5452 3829

1183

584

366

Source: IMG Database, 2010

Number of IMG Assessments in Canada, 2005-2009

CSAT-NL

CAPP-NS

CEHPEA-ON

MLPIMG-M

B

CPL-SK

AIMGP-A

B

IMG-B

C0

200

400

600

800

1000

1200

1400

1600

74

189

1549

557

132

791

385

Source: National IMG Database, 2010

First Year Post-MD IMG Trainees

2005 2006 2007 2008 20090

100

200

300

400

500

600

259 360 404 416 467

159

129108 111

94

Canadian Citizen/Permanent ResidentVisa Trainee

Number of IMGs Certified by College of Family Physicians of Canada, Royal College of Physicians and Surgeons of Canada, College des Medecins du Quebec, 2006-2009

2006 2007 2008 20090

50

100

150

200

250

300

350

400

450

500

275251

326

258

375

417433 439

29 28 3243

CFPC RCPSC CMQ

Source: IMG Database, 2010

Number of IMGs Certified by College of Family Physicians of Canada, Royal College of Physicians and Surgeons of Canada, College des Medecins du Quebec, 2006-2009

2006 2007 2008 20090

50

100

150

200

250

171160

192185

109 110

136

155

24 25 2632

CFPC RCPSC CMQ

Source: IMG Database, 2010

Excluding Visa Trainees

Number of First-Time Licenses Issued to IMGs By Medical Regulatory Authorities, 2005-2009

CPSNL CPSNS (07-09)

CPSNB CMQ CPSO CPSM CPSS CPSA CPSBC0

100

200

300

400

500

600

700

128

3

166145

507

196

72100

160

299

107130

262

433

207

515

586

498

Full/Regular All Other

Source: IMG Database, 2010. Note: “All Other” includes provisional, temporary, academic, locum and other types of non-full licenses.

2005-2009

2005-2007

Post MD training

411

Assessment Centre

218

Certifying Body

97

Regulatory Authority

77

MCC EE1491

Following the Progress of a Cohort of Canadian Citizen IMGs

62

Source: IMG Database, 2010

2 35

Cohort Progress to Post-MD Training

Entry to Post-MD Training Gender Number Average Age

(years)

No Female 558 39.59Male 522 38.87

No Total 1080 39.24

Yes Female 185 36.52Male 226 35.57

Yes Total 411 36.00Grand Total 1491 38.35

Source: IMG Database, 2010

Cohort in Post-MD Training

Gender PostMD Total% of Gender

Group % of Total

Female

Family Medicine 97 52.4% 23.6%Laboratory 6 3.2% 1.5%Medicine 72 38.9% 17.5%Surgery 10 5.4% 2.4%

Female Total 185 100.0% 45.0%

Male

Family Medicine 98 43.4% 23.8%Laboratory 10 4.4% 2.4%Medicine 87 38.5% 21.2%Surgery 31 13.7% 7.5%

Male Total 226 100.0% 55.0%Grand Total 411 100.0%

Percent of Cohort Entering Post-MD Training, By Country of MD Graduation

Source: IMG Database, 2010.Note: Countries with >=10 IMGs in MCC EE 2005-2007 cohort.

Irela

nd

United K

ingdom

Austra

lia

Czech

Rep

ublic

Poland

South A

frica

Trinid

ad a

nd Tobag

o

Saint K

itts

and N

evis

Nether

lands

Antille

s

Ukrai

ne

Roman

ia

Domin

ican

Rep

ublicIn

dia

Isra

el

Alger

ia

Domin

ica

Grenad

a

Pakis

tan

Caym

an Is

lands

Iran

Russia

China

(PRC)

Bosnia

-Her

zegovi

na

Hungary

Philippin

es

Egypt

Bangla

desh

0%

10%

20%

30%

40%

50%

60%

70%

Percent of Cohort Entering Post-MD Training, By School of MD Graduation

0%

20%

40%

60%

80%

100%

Source: IMG Database, 2010.Note: Countries with >=10 IMGs in MCC EE 2005-2007 cohort.

Cohort With Full or Provisional License

Licensed (Full or Provisional)

77

Certification(CFPC/RCPSC/CMQ)

35 (46%)

QEII (Not Certified Yet)

23 (30%)

QEI (No Cert, No QEII Yet)

9 (12%)

No Cert, QEs, Assessment

10 (13%)

31 QEI & II

23 QEI7 Assessment

4 Assessment

? Provisional? Data Timeframe

? Missing Data

2 PGME

43/77 (56%) PGME

License Status by Field of Practice

Source: IMG Database, 2010.

Practice location at 2 and 5 years after PGME graduation, 2000-2004

2 years 5 years 2 years 5 years0%

20%

40%

60%

80%

100%

77.1 78.1

91.7 91.6

22.9 21.9

8.3 8.4

Outside CanadaIn Canada

IMG CMG

Source: CAPER Database, 2010

Distribution of Licensed IMGs in Urban/ Rural Canada

Large Urban Centres

Small Cities Towns Rural Places and Territories

0%

10%

20%

30%

40%

50%

60%

70%62.5%

4.8%

16.8% 15.9%

44.0%

5.4%

25.0% 25.6%

Full licenses All other licenses

Source: IMG Database, 2010.

Thank you

This project is funded by the Government of Canada's Foreign Credential Recognition Program.