But the greatest equalizer, say both Dmytryshyn and Ko, is the final two years of the St. George’s program, called a clerkship, which takes place in U.S. hospitals alongside Ivy League students from Cornell University. The source of Ko’s degree was never an issue in training, though Dmytryshyn can remember one time when a supervisor inquired as to her alma mater. That was after a cardiologist passed around an electrocardiogram print-out and she was the only resident to recognize the rare case of Wolff-Parkinson-White syndrome. “Where did you go to school?” he asked, obviously impressed.
In fact, researchers have studied whether IMGs (both Canadian and immigrant) have different patient outcomes. In a 2005 study of 130,000 heart attack victims treated in Ontario over an eight-year period, those treated by IMGs had identical rates of survival after one month and one year as patients treated by Canadian-trained colleagues.
Plus, international medical schools mean international experience. Dmytryshyn realized this when she started her clerkship at New York Methodist Hospital in Brooklyn. “In the Caribbean we’d serve the local population, who are more than happy to have med students doing breast exams and blood pressure,” she recalls. The Cornell students didn’t appear to have had any such hands-on experience. She also realized that because of different laws, she had gotten more practice with cadavers than her North American colleagues. “The school practically has keys to the morgue,” she says, with a laugh. She also saw more knife and gun wounds than she would have seen at any Canadian hospital—a thrill, she says.
Vakil concurs. He says that experience in international hospitals was the best surprise about studying abroad. RCSI has placed him at hospitals in Ireland, Jordan and across America. Soon he’ll try a South African hospital. “My friends who got into medical school in Canada say they get maybe one chance to study abroad,” says Vakil.
But in some ways, RCSI is more like Dalhousie than Vakil had expected. There was another student from his hometown of Victoria in his first semester, one of 700 fellow Canadians studying medicine in Ireland right now. There are also annual Canadian-themed parties. During the men’s gold medal hockey game at the Vancouver Olympics, Vakil felt especially close to home. Dozens of fellow Canucks packed into a pub near the university in Dublin and clanked pints of Moosehead to celebrate Sidney Crosby’s winning goal.
Although Vakil wants to come home, he says his chances of landing an internal medicine residency in B.C. are so unlikely that, like Ko, he probably won’t even apply. He says Ontario’s return of service agreement program has made it much easier for IMGs to return than it used to be, but it’s not the right choice for him. “Let’s say I bring my girlfriend so I can do a residency in Toronto. That becomes our life. Then after that’s done, if I’m asked to move to Thunder Bay, Ont., for five years, do I leave my girlfriend behind?” asks Vakil. On top of that, Vakil plans to be an internist and IMGs have more trouble getting into specialty programs like internal medicine, where the competition is fierce. He says he’s resolved himself to working in the U.S. where he’s already made contacts.
It’s Canada’s loss. Vakil says he’d much rather work in the Canadian medical system because it’s a system he supports. But as he prepares for a minimum of five years of training in the U.S., it’s difficult for him to say when, if ever, he’ll return to Canada.
That’s a shame, but it’s nothing new, says Ah Yin Eng, the head of the Association of International Physicians of Canada and a veteran GP in Pembroke, Ont. “Governments complain of a medical brain drain,” says Eng. “But with IMGs, year after year, we lose them to the States.” In the case of Quebec, Health Minister Yves Bolduc says that while the doctor shortage is a problem, he has no fears that Quebec is losing doctors to the U.S. “I think we will have enough family doctors in four or five years,” says Bolduc, who says equivalency processes and allotment of spots are fair. Eng says there’s another reason health ministers aren’t accommodating IMGs who want to come home. “I think they have a hidden agenda,” says Eng. “In Ontario, they’re trying to use nurses and pharmacists to replace doctors. They’re hoping to save money that way, but it won’t work.” With both doctors and patients aging, Canadians are going to demand more doctors, says Eng. In other words, it’s only a matter of time before they try to lure IMGs back from the U.S.
In the meantime, the increasing number of ambitious young Canadians studying medicine abroad can only hope he’s right. Dmytryshyn says she will encourage applicants who don’t get into Canadians schools to apply for training abroad like she did. Being a doctor has been as rewarding as she expected. One recent patient reminded her why she had worked so hard. A 10-year-old boy who had spent much of his life on dialysis recently received a kidney transplant. “When he came to from surgery, he was able to pass urine for the first time,” says Dmytryshyn. She saw the look of amazement and relief at the yellow liquid he’d produced. He cried. “It’s amazing to see someone so happy just to do something we all take for granted every day.” On days like that, she’s glad she didn’t take getting into a Canadian med school for granted.
Top five destinations for Canadians studying medicine abroad
Ireland: Roughly 700 Canadians are currently studying at Ireland’s six medical schools, including the prestigious Trinity College and the Royal College of Surgeons in Ireland.
Grenada: Canadian students—over 620 of them this fall—get to snorkel, sail and barbeque lobster on the beach after exams. The first two years of their program are spent on the island, where students help out at local medical clinics. The second two years are spent at hospitals in the U.S.
Australia: There are 232 Canadians at several Australian medical schools.
Students who hold a bachelor’s degree from Canada usually take a four-year graduate program with clinical experience mixed in with coursework throughout the entire four years.
Poland: There were roughly 61 Canadians studying at Poland’s seven English-language medical schools in 2006.
Netherlands Antilles: Dozens of Canadians study medicine at six campuses spread out across the three former Dutch dependencies of Aruba, Bonaire and Curaçao, just north of Venezuela.
Sources: Peter Nealon of Atlantic Bridge, Bob Ryan of St. George’s, the Australian Trade Commission, Sandra Banner in CMAJ (2007)
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