PHOTOGRAPH BY SIMON HAYTER
Amie Dmytryshyn did everything right. She volunteered to counsel patients at Vancouver General Hospital on Thursday nights. She spent three days a week assisting a quadriplegic teenager. On weekends, she attended intensive all-day MCAT prep and on weeknights she squeezed in two extra hours of studying to prepare for the exam. She did it all while maintaining an A average in her chemistry-heavy human kinetics program at UBC. “Then I got one letter and my dreams were crushed,” says Dmytryshyn, now 30.
Erik Vakil, 28, was so determined to get in that after being rejected from a dozen programs in 2006, he marched straight back to Dalhousie and retook every class in which he didn’t have an A. The following January, he was rejected again. “It was only after the second rejection that I realized I wasn’t going to get in,” says Vakil. A friend suggested he try Ireland. He stayed up late that same night to finish his application. Weeks later, he was called for an interview with the Royal College of Surgeons in Ireland (RCSI).
Considering only one in five of the nearly 11,000 students who apply to medical schools across Canada each year are admitted, Dmytryshyn and Vakil are not alone. Some apply again. Most move on to other careers. But for students who see medicine as a calling, who can’t imagine doing anything else, there are other options. Six years after she got that fateful letter, Dmytryshyn is preparing to take over as chief resident of pediatrics at B.C. Children’s Hospital in her hometown, Vancouver. In August, she married her long-time partner, Byron Hyttenrauch, and the couple are planning a honeymoon in Tahiti. Meanwhile, Vakil is entering his fourth year of med school in Ireland with contacts at the Cleveland Clinic and the Mayo Clinic already in his address book.
It was a gamble, but both students are glad they applied overseas. “Originally, it was Plan B,” says Dmytryshyn, who attended St. George’s University on the Caribbean island of Grenada (pop. 110,000). “But as soon as I got there, I realized that everyone’s there because being a doctor is all they ever wanted to do. Think of the passion that comes from people willing to go halfway around the world to study.”
It certainly takes passion to go to an international medical school. An estimated 1,500 Canadians were studying at foreign medical schools in 2006. While there’s no clear 2010 estimate, medical schools in the big three countries where Canadians study—Australia, Ireland and Grenada—all report triple the number of Canadians just four years later. Admissions aren’t as tough in these countries, but tuition can be jaw-dropping. St. George’s, for example, costs $200,000 for a four-year degree, compared to the $80,000 it costs to attend the University of Toronto. On top of that, most international medical graduates (known as IMGs) are unable to return home for several years after graduation, because—despite a doctor shortage—the number of residencies in Canada is tightly capped. What’s worse, provincial governments and medical schools give first pick of residencies (three to five years of post-graduate training) to Canadian-trained doctors and leave only scraps for the often-discouraged IMGs. This spring, 88 per cent of graduates from Canadian medical schools got their first choice of residency; only 21 per cent of IMGs received a position at all.
Dmytryshyn wasn’t even allowed to apply for the first round of residency placements in her home province of British Columbia. She could have found a spot more easily if she had been willing to sign a “return of service agreement” that says she would work for five years in an area of the government’s choice (usually an isolated northern community) in exchange for a spot. A northern town is not the type of place Dmytryshyn could see herself spending five years, especially considering her husband works in shipping, a field that requires him to live near the ports of Vancouver. She knew her chances weren’t good, but she crossed her fingers and held out hope for a spot near home. “I lost sleep over it, of course,” says Dmytryshyn. “When applying back to Canada after being in school for eight years, you really hope you can be near your family.” Dmytryshyn is one of the lucky ones.
What’s frustrating for many IMGs is that, even with the small chance of getting a spot, the equivalency process can be gruelling. In Quebec, equivalency includes both language tests and the Medical Council of Canada Evaluating Exam (MCCEE), an advanced, $1,500 test that Canadian graduates don’t have to take. Students say the process requires taking a year off after graduation to complete. Even more frustrating for IMGs is the fact that residency spaces reserved for domestically trained doctors sometimes go unfilled without ever being offered to them. Joe Schwarcz, a Ph.D. chemist and head of McGill’s Office for Science and Society, sits on the medical school’s admissions committee. He says it’s a “torturous job” to choose 160 students for first-year medical school each year, because it means rejecting “at least as many equally qualified applicants.” Considering those painful decisions, he wonders why IMGs can’t apply for leftover spots reserved for students at Canadian universities. “These students are getting residencies in the U.S., so why are they good enough for the U.S. but not Canada? It’s crazy,” says Schwarcz.
Melody Ko, 27, dreams of a residency at McGill, where she received her bachelor’s degree, but won’t even bother applying in Quebec because her chances are so low. Ko seems like a good candidate. She’s a multilingual (English, French, Mandarin and Taiwanese) Montrealer who fell in love with Quebec after arriving from Taiwan at the age of 10 and is willing to take family medicine over a specialty. Instead of a residency in La Belle Province, she says she’ll apply to work in New York after graduation from St. George’s, because she doesn’t want to take a year off to pass Quebec’s equivalency requirements for only a small chance at getting a spot. “I feel like I’ve been exiled, to be honest. A lot of us want to go home, but they make it too hard.” Ko considered working in a rural area of Ontario in return for a residency spot (Quebec has no return of service program) but, much like Dmytryshyn, she doesn’t want to “be trapped for five years.”
Schwarcz says he used to believe that Canadian provinces were unwelcoming to Canadians who studied medicine abroad because they perceived the quality of their graduates to be lower. But now that he’s travelled to St. George’s (where he was paid to teach a course), he believes the quality is the same. Schwarcz says the pass rate for the United States Medical Licensing Exam (USMLE) Step 1 should be evidence enough that foreign-trained grads are usually capable doctors. The overall pass rate for graduates from St. George’s was 88 per cent between 2001 and 2008—only slightly lower than the typical pass rate of 92 per cent rate for MD students trained in Canada and the U.S.
That’s not to say that degree mills don’t exist, he says. An American study of graduates from Caribbean schools found students from some countries, like Grenada, did well on the USMLE over a 15-year period, but students from other countries were extremely unprepared. For example, only 19.4 per cent of Saint Lucia’s grads passed the test on their first try, compared to 84 per cent of St. George’s grads during the same time period.
It shouldn’t be a surprise that St. George’s graduates do well on the test, says Ko. They use North American textbooks and, often, North American professors. Ko was taught by several medicine professors visiting from the University of Western Ontario in London, Ont., a school where only six per cent of applicants were admitted in 2007.
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