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The International Medical Association (IMA)

IMA is dedicated to supporting and helping international medical doctors,and students,pass the relevant licensure examinations and to obtain training to practise medicine in Ontario,Canada,and the USA.

In 1985,our President participated in the very first meeting of Foreign Medical Graduates,at a period when IMGs competed openly with CMGs for training.Then,in 1987,after a discrimination lawsuit by a Polish group,the Ontario government created the Ontario Pre-Internship Program (now called the Ontario International Medical Graduate Program),to offer pre-residency training to only 24 IMGs/yr,out of unemployed hundreds,graduates of schools outside of Canada/USA,who apply each year.

Since 1991,the President,after passing,at the first sitting,the Qualifying Examination(combined Parts 1 & 2) of the Medical Council of Canada,has been petitioning the authorities for more training positions for IMGs.He first met with Ontario Ministry of Health officials in 1991,when he introduced his Underservice Proposal, whereby willing international doctors,who passed the relevant Licensure Exams may be approved/sponsored for Residency training/licensure status,before contracting to work in rural areas of Ontario suffering from chronic doctor shortages. However,in the face of the Barer-Stoddart (Fraser-Douglas Institute)report,timid resistance from some,and apathy from others,this President's proposal was shelved by the Ministry,et als. Eversince, this President persisted in pushing the cause that IMGs can be trained to fill the void in areas abandoned by local graduates .He demonstrated his plans via letters,and at meetings with Advisors to Hon.Jim Wilson, Hon. Elizabeth Witmer(both former Ministers of Health),Asst.Deputy Bigenwald, Ms.Jane Bertram(former Executive Director(Ag)of the Min. of Health),The Ont.IMG Program,among others.

In 1997,the President took the Ontario IMG Program,et als.,to Court to,inter alia, quash the 4-time rule of limits and its retroactive application excluding IMGs from applying to same.One result is that the rules changed in 1999,allowing IMGs to attempt the Program's MCQ screening process more than 4 times.Collaterally,the Ministry of Health increased the number of Pre-Residency positions from 24 to 36 in 2000,to be further increased in later years.

Over the years,this President has also laboured vigorously for IMGs who are willing to serve in rural communities by dogging the MPP's with his Underservice Proposal,the seeds of which he sowed,on behalf of all IMGs,in 1991.But his not so precocious voice was a lone cry in the bureaucratic wilderness until the germ/stem cells of his proposal were photosynthesized by the McKendry/George(Expert Panel)reports, which came out recently. Consequently,the Ontario Ministry of Health and Long Term Care,in May,2001,approved plans to fund the CPSO/COFM, who will launch a new IMG Assessment & Training Program, whereby,40 IMGs/per session,will be selected to receive fast-tracked evaluation for 6 months,at one of the 5 Ontario medical schools, before being allowed to either challenge certification exams (CCFP/RCPSC)or,pursue more training,which upon completion,will be followed by restricted licences/permits and contracts to work in underserviced areas(over 100 of them at 200 km outside of Toronto.)Details of this New OIMGC Program(see note on 2004 update,below)and the New Rules of Licensure,together with names and addresses of central/regional/ local underserviced area offices for enquiries,and this president's oral presentation to the standing committee{in Ottawa's Parliament} on the experiences and credentials of foreign-trained professionals, in the House of Commons on April 21,2004,etc.,can be found in the latest edition (Sixth) of the book,"Getting Into Postgraduate Medical Training in North America" [click on "MEDTEXTS" link below for information about where and how to order your copy of this and other titles].

This appears to be better news as IMGs need jobs and the rural areas need doctors.Isn't it about time that unemployed IMGs be trained to be part of the solution (not the problem),to the doctor shortage problem?

Nothwithstanding,it remains to be seen if tax-paying international doctors,already residing/rooted in Ontario,will be guaranteed above-mentioned opportunities,as per legitimate expectations of IMGs,as opposed to the active poaching of foreign specialists from other countries[through recruiting agencies operating both locally and abroad].It is the humble opinion of this president that once the dust settles,the majority comprising the 40 will be specialists recruited from favoured countries,to the detriment of IMGs,already settled locally.Recall that many other provinces/countries won't allow Ontario IMGs into their jurisdiction.Manitoba,for instance,requires IMGs to have lived in that province for at least 3 years.Similar exclusion policies exist for other areas such as Nova Scotia, B.C. etc.[2002 Update:Despite the foregoing,the CPSO has indeed developed orientation packages,etc for out-of-ontario IMGs and physicians,even though a substantial number of local/indigenious IMGs are without training/jobs]

What future lies ahead for the IMG in Ontario?

It is this President's hope/goal to help all indigenous/ domiciled doctors pass the relevant licensure exams,such as the EE/QE 1 & 2/OSCE,etc.His cathectic efforts presupposes a dream,to which he has been totally devoted,that deserving IMGs should become contributing members of this society.Support from the IMGs at large, from all stakeholders,and from the target population,is critical.

It makes fiscal sense that this gov't will wish to avoid spending money in opening medical schools,to finance education of future MDs from scratch,when it could easily tap into the IMG pool, teeming with ready-made MDs, who,by passing the Medical Council of Canada Exams, have proved that they are ready and capable for training to fill any health-care void.What will become of the accumulating excess of IMGs, who will continue to immigrate here as long as Canada desires it?Will they/should they,all settle for pizza delivery and taxi-driving?

Exasperated,this President,despite being black-listed and persecuted by the authorities for his efforts,continues to give free lectures, at the U of T campus,to international doctors preparing for the Canadian (EE/QE Part 1 & Part 2,OSCE)as well as the American licensure exams(USMLE Step 1 & Step 2/CSA).The lectures go on all year from the first Saturday in July to the end of June.Admission is loosely restricted to members of the Association.For membership,mail your resume,plus a money order for $20 registration.Members receive all pioneering,breakthrough news regarding current routes to licensure and legislations such as Bill 189,which received 2 readings before it was prorogued by the PC,but which has since been abandoned after the Liberals won the October 2,2003 provincial elections in this Province.

NOTE:[2004 update:both the new IMG Assessment Program and the OIMGP/Clearinghouse has been subsumed into what is now "IMG Ontario".]

Our first annual Free lecture series commenced circa 1990.Our latest, (15th) fifteenth,Lecture series,began in July,2004.To join our force, send in your resume,etc.,at the next availability,and we'll despatch to you,all information about the next lecture schedule/meeting dates?

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please see french translation which follows

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The following is a manuscript about the 2003 CaRMS match and Doctor Shortages,which was first submitted on March 26,2003,to the Canadian Medical Association Journal(CMAJ),for publication.Needless to mention,the CMA did not run it.They did, however,post another article/letter by H.Ramlall,in an earlier issue of eCMAJ,which follows the below manuscript.

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Matching by CaRMS:A Dog and Pony Process?

The (CaRMS) match is the process of filling residency training positions at teaching hospitals with medical students/graduates.It consists of 2 stages:the first,Iteration 1 begins in September each year when students/would-be doctors,start the application process and begin arranging for interviews,ending with the first match results;this is followed by the second stage, Iteration 2,in January/February which is for all those canadian medical graduates not matched in iteration 1.

International Medical Graduates (IMGs)who are Canadian citizens/landed immigrants,and who have passed the relevant Canadian Medical Council exams (MCCEE and/or MCCQE 1 & 2),are only allowed to enter the second half,Iteration 2,with little/no time to arrange for interviews,etc.

Last year[2002],53 positions went unfilled after the second iteration of the match.This year at least 28 positions went unfilled. Yet many like this writer [who applied to 22 programs at $15.00 per position,plus registration fees,to a total of more than $513.50],are still unmatched,leaving the process very questionable.

Of course I have a lot of questions:How many Canadian medical graduates still remain unmatched?How many positions went to US medical students?Should these Americans be given preference over Canadian IMGs?Is the division of the matching process into 2 stages/ Iterations reasonable?Should IMGs be allowed to apply for matching only after the first stage/Iteration 1?Is this segregation any different from putting IMGs to sit at the back of the bus?

No one would answer our questions.Sandra Banner,the executive director of CaRMS,abdicated in no uncertain terms that the hospitals and program directors are responsible for the selection of applicants.

When contacted about queries regarding unfilled positions from this writer,Carol Herbert,Chair of CaRMS and also Director of the Association of Canadian Medical Colleges(ACMC),wrote to UWO's President,where she is also Dean of the medical school,as follows:

“Paul…[Dr.Paul Davenport]... Postgrad will look at this. Sounds like an international medical graduate. CaRMS process is a matching process - there is no guarantee of a placement. Our med school follows the CaRMS process assiduously,therefore I do not think we have any liability to an individual..”

After exasperatingly reading the above email,I thought:"Ok, so Western and Ontario seems a hopeless waste of money and time.How about applying to the other schools/programs with unfilled positions after the second iteration of the 2003 CaRMS match..."

But any such illusions were quickly shattered!

Anne Greengrove,programme director at McGill University wrote that: "while they do have unfilled positions after the match,all IMGs have to be approved by the College des Medecins du Quebec first".(Here,fluent French,inter alia,is mandatory.)

In addition,the family medicine program at Memorial University also had vacancies after the match,as do that of the University of Alberta at Grande Prairie,as well as rural family medicine programs at the Universities of Manitoba, McMaster, Western Ontario,and Ottawa,etc.

Is there any chance that this writer will be considered for one of these 28 vacancies?

Not According to Linda Kirby who emailed stating that: “the Family Medicine Residency Program at Memorial University of Newfoundland has decided not to fill the position remaining after the second round of the CaRMS Match”.Oops,I thought again,there goes $15 dollars and a bucketful of hopes down the drain.

Does this “bait and switch” technique really work?Why would these medical educators in conjunction with CaRMS take our money in advance regarding application for job/training positions,which they subsequently render void?Can any other business get away with such discrepancies?Why should CaRMS,and its accomplices,all claiming to be not-for-profit organizations,be condoned for same?

In a similar manner,Bonnie Motyka’s email from Alberta University stated that: “ The Family Medicine Residency Program is not taking applications for the Family Medicine Resident Position in Grande Prairie at this time”...This made me scratch my head again,asking myself:"how can they get away with this broken promise of offering a position,one which applicants acted upon and paid CaRMS to apply to,which now turns out to have been non-existant all along?"

What is CaRMS doing about this?Nothing,from my many previous communications about same to them-eversince my first negative result from the match in 1991.CaRMS only collect the application materials,leaving the selection of candidates to the medical schools/universities.At the other end,the Program directors are not obligated to any individual,not even to process/policies.

The dictates of CaRMS restrict IMGs from applying for training to certain provinces such as the Atlantic provinces,Ontario,among many others.For example,even though McKendry and Peter George [Expert Panel]reports severe doctor shortages in Ontario,IMGS are not permitted to apply for training positions such as residency to Ontario teaching hospitals.Is this rule fundamentally different than the "NO Coloured allowed" signs put up sometime back by restaurants owners and lawmakers by our neighbour down South?

The Programs at Ontario universities took the position spelled out by the Council of Ontario Faculties of Medicine (COFM) which is epitomized by Tom Crichton and Pierre-Yves Boucher,both at the University of Ottawa,who stated categorically that all IMGs must go through the Ontario International Medical Graduate Program(OIMGP).This has been the policy of COFM since the inception of the OIMGP in 1987.IMGs must first pass the Canada Medical Council Exams then compete for 24,[now 50]pre-residency training positions at the 5 Ontario medical schools.To this end,the OIMGP has administered its own exams,even to those IMGs who have already passed the MCC QE (1& 2).

The OIMGP screening exam is composed of only 5% of questions in psychiatry and public health,and it had (around the time this writer applied) a 4-time limit in the number of attempts IMG candidates are allowed to make application to same.(This writer,for instance,who passed the Qualifying Exam {equiv. Parts 1 and 2},has been precluded from applying to the OIMGP,even though he sought to be grandfathered from same as he graduated from medical school,from McMaster University,and has lived/worked in Ontario,etc long before the inception of this [OIMG]Program in 1987.)

The Ontario programs,therefore,has been denying consideration to IMGs[with some nepotistic exceptions to favoured candidates]outside the OIMGP ,even to those like this writer,who have passed the MCCQE,the same exams used to screen canadian medical school graduates.Is the MCC QE 1 & 2 only reliable if passed by a canadian medical graduate?Is it of no value if passed by an IMG?

If the answer is yes,then why administer this exam [at more than $650 for Part 1;more than $1000 for part 2] to IMGs?If the answer is no,then why do IMGs who pass said exam,have to re-take similar,if not inferior exams,forced upon them after passing the MCC QE.Saskatchewan and Manitoba (which requires one to live in the province for the previous 3 years) uses a Clinical Assessment and Professional Enhancement (CAPE)process to assess IMGs; B.C.,Ontario, and Alberta uses,inter alia, an Objective Structured Clinical Exam (OSCE);while the Atlantic Provinces use a Clinical Skills Assessment and Training (CSAT) program such as the one developed,inter alia,at Newfoundland’s Memorial University to further screen IMGs.

Why are the authorities continuing to discriminate against IMGs who have passed the same screening exams as Canadian graduates?In this age and time in the twenty-first century,why are we forced to obey nuanced and archaic and racist rules masquerading as regulations?Who are the vested interests making these rules?Are most of these regulatory legislations as imopacted against only foreign-trained professionals truly embedded racism masquerading as law?

Does the lone IMG,jobless and penniless as they are,get any help?Needless to mention,the few colleagues who managed to climb the success ladder to medical licensure status,quickly kicks the ladder down.IMGs have no one to turn to,and are thus forced to depend on a brutal system run by self-serving and ruthless medical associations/ colleges headed by doctors-turn-bureaucrats.Battling in courts is futile as judges defer to the colleges.And the politicians turn away as the IMG population makes no dents in the voting curve.

A long overdue act,came about this past fall,when the Ontario Legislature introduced Bill 189,which specifically forbids discrimination against all foreign trained professionals.This Bill supercedes the policies set by CaRMS and COFM,unelected bodies as these are.It also replaces any previous regulation on the subject!

But do the Ontario programs acquiesce?

Pierre-Yves Boucher, Secretary of the University of Ottawa, gave this writer a message almost exactly-worded as those received from (i)William C.Leggett,Principal and Vice-Chancellor of Queens University,and from (ii)Kenneth A. Harris,associate dean of postgraduate medical education,at UWO,as he wrote:

“According to the public bills index of the Legislative Assembly of Ontario, Bill 189 has not passed and is not law. In Ontario, [IMGs] enter postgraduate training following successful completion of the Ontario International Medical Graduate Program…”

This writer,however,begs to differ,and assumes the position that [pending] royal assent of Bill 189 nothwithstanding,it is the legislative intent of the elected [ratification] members of the Ontario Legislature that matters.Besides,section 6(2)(b) of the Canadian Charter of Rights and Freedoms,being part 1 of the Constitution Act,1982,"allow citizens the freedom to pursue the gaining of a livelihood in any province",and s.15(1) of same Charter, "guarantees equal protection and equal benefit of the law,without discrimination,to all..."

One has to look at the big picture here.For decades IMGs have been thrown one obstacle after another;they (but not canadian grads) have had to take exams such as the Evaluating Exam,which is same as the QE Part 1,one of the exams used to screen all canadian grads[which IMGs also have to take];then after passing these exams,they have been cut off from opportunities as the medical and other authorities throw up new frustrations in their path.Is exclusion of IMGs from the first stage/Iteration 1,by CaRMS,ACMC,etc any different from putting blacks to sit at the back of buses[see Brown vs. Board of Education]?Is this segregation a move forward by these medical authorities?

Is Canada a progressive society?Compare how other countries treat their foreign-trained professionals.The USA,for instance,have one single exam system [USMLE)to evaluate/screen both american and international medical graduates;the NRMP,unlike CaRMS,evens the playing field for both american and independent applicants in their matching process.As well,the various states comprising the USA have no restrictions,unlike their counterparts here in Canada,eg.Ontario, Atlantic Provinces,etc.And once one passes the relevant USMLE,the US teaching hospitals give equal preferences to americans, and domiciled IMGs alike.They do not neglect/ignore their local/indigent,duly qualified/certificated,IMG population,in preference to poaching specialists,etc from third world countries such as South Africa,which are themselves in dire need of their own doctors!

Some educational cohorts[eg The University of Michigan Law School-cases of Grutter v. Bollinger;Gratz v. Bollinger]in other jurisdictions/the USA(Regents of the University of California v. Bakke),have put affirmative action and other promotional programs in place to even the playing field,and to boost the chances of the economically/educationally underpriviliged/disadvantaged,and bring those deserving up to par with the mainstream.Has this idea caught on in Canada?Not a chance:In fact,just the opposite is true in Canada,as more and more hurdles are set up by self-appointed gatekeepers of the professions,even those facing life-threatening shortages!

Which brings us to the concluding questions:What happened to all those unfilled positions?How can this process be truly called a Match when there still exists unfilled positions,on the one hand, with unsatisfied,unemployed,neglected (not interviewed,etc) candidates, on the other hand?

by H.Ramlall,BA.,MD.,DOHS

Founder/President,The International Medical Association.

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This is the end of the first manuscript,as per above;please read below for the second article:

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-----------------------"Far From Perfect Matching by CaRMS"------------------------

In an article by Shelley Martin in the Canadian Medical Association Journal (CMAJ,168,212-a),she wrote about International Medical Graduates (IMGs) and how they fare in the Canadian Residency Matching Service (CaRMS).

In order to address the assertion that 1 in 6 IMGs were matched,one must take into account the database of same.Are these hyphenated IMGs who hail from within hybrid programs such as the Ontario International Medical Graduate Program (OIMGP),or similar programs in N.S.,Manitoba,N.B.,Saskatchewan,N.F.,or BC.[These IMGs are already part of the Canadian medical school system as after retraining,they will get canadian MD degrees].If so,then these double cohorts are not IMGs in the real sense,and the data is skewed.

If one looks at the whole history of matching by CaRMS (known as the Canadian Intern Matching Service [CIMS] before 1994),it is geared only for canadian medical graduates.IMGs do not get into the match until all canadian grads have been matched. IMGs take the leftover positions,if any,with only an everage of 1% of IMGs matching successfully.And this percentage does not take into account all the hundreds of unemployed IMGs who cannot afford the cost of applying for the match,or who missed the deadline or those who simply see it as a futile endeavour,and so on.

And this is only the tip of the iceberg.In addition to above obstacles,IMGs face restrictions in several provinces.In Ontario,for example,hundreds of IMGs are forced to compete for 24,now 50 (since 2000) retraining spaces by the OIMGP which started to operate in 1987.IMGs are not permitted,[as per Council of Ontario Faculties of Medicine (COFM) rules],CaRMS,and the Association of Canadian Medical Colleges{ACMC}etc.,to apply to any programs [of the teaching hospitals] in Ontario,[under archaic,hidden,and nuanced discriminatory regulations embedded as law]

And these exclusionary rules as against IMGs,even apply after the Ontario legislature have introduced Bill 189,one that directly forbids discrimination against all foreign trained professionals!I say that council for the cpso,COFM,et als are not publicly-elected entities,and as such,these must not make rules which go against legislative intent.Restrictions in Ontario must be removed as soon as possible.

On a personal note,this writer have graduated from medical school,lived/worked in Ontario,etc.,long before the inception of the OIMGP in 1987.Now CaRMS,COFM,ACMC,etc has forbidden him to apply to Ontario programs. Shouldn't he be exempted from the OIMGP as per the grandfather clause?This writer passed the MCC QE(equiv. Parts 1 & 2) in 1991, and eversince have applied annually for matching to an average of 20 programs in family medicine or psychiatry,to no avail,and indeed without so much as a call for an interview...One cannot help but wonder if after taking the fees,whether or not CaRMS sent any of his documents to any of the 20 programs.One thing I know for sure,is that in 1991,I was volunteering at Doctors Hospital in Toronto,my first choice for matching that year, but they never received my documents from CaRMS.

Last year[2002],CaRMS refused my application because I unknowingly missed the new computer registration deadline by a few days.I had checked their computer site in Jan.2002 which indicated I had until some date in February to apply.This was their custom regarding IMGs who are only permitted to apply after the first iteration ends.However,when I subsequently returned to the carms site,the registration page was deleted.I sent my fees and application over the surface mail a couple of days later,but CaRMS turned same down stating that registration was closed.Later it turned out that many positions (at least 53) remained unfilled,even after the second iteration of the match was completed for 2002.

This year[2003] I checked the CaRMS application site again at or around the customary deadline date of January only to learn that they have once more made sudden changes by moving the deadline to December 16,2002.The canadian medical graduates knew this change through their Dean's office,but how do IMGs get such information? Should CaRMS suddenly make new rules without informing the IMG community?Should CaRMS have emailed changes to IMGs who previously applied for matching?

Can anyone figure out why this only happens to IMGs,at a time when the whole nation agrees that more doctors are needed,at a time when the authorities are poaching doctors from the third world while local,tax-paying IMGs,like yours truly,stand idle without residency due to discrimination against my foreign status? Does this make sense?Isn't a bird in hand worth anything?

[N.B:After initially refusing this writer's application for '03 matching,CaRMS have,after many protests,acquiesced.But alas,it was to no avail,as this candidate was again left empty-handed,even though at least 26 unfilled positions-mainly at UWO, McMaster,Ottawa-remained after the match!]

H.Ramlall,BA.,MD.,DOHS.

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BELOW IS SOME CORRESPONDENCE REGARDING THE NEW IMG ASSESSMENT PROGRAM,followed by a response from the College of Physicians and Surgeons of Ontario,(CPSO)to the Ontario College of Family Physicians(OCFP)..................

PRESIDENT'S MESSAGE TO the cpso,ocp ccfp,MOHLTC,et als.,

To all concerned: re.The cpso decided to POSTPONE/temporarily waive the pass requirement of the MCC QE exam before granting restricted licensure as a move to "remove barriers" for IMGs.

My respectful submission follows:

1.These so-called efforts to "remove barriers" to licensure for IMGs is nothing less than a nuanced ploy to milk more government funds.It dips below standard medical practice levels,not to mention the fact that it casts aspersions on the qualifications of certificated IMGs.

2.Legitimate,truth-positive IMGs are fully capable of passing relevant licensure exams.They,especially those who have not spiked-up/enhanced their resumes,need no favours here.In the past,most of us who have passed the MCC QE,etc.,have been/are being laid out to pasture,instead of being given residency training.What IMGs wish for/need are more residency positions,free from redundant and costly efforts such as the checkered OIMGP exam requirements.This and other like programs are obsolete as far as screening IMGs,who have already passed the more wholesome MCCQE.It is only another costly hurdle along the path towards IMG licensure.The most damaging aspect of the OIMGP screening exams which take only 24 out of hundreds applying each year,is that it leaves international doctors feeling like losers,through no fault of their own.Notwithstanding the damages to the psyche,self-esteem,etc of these fine men and women,this process also negatively influences the public perception of internaional doctors.This places additional,unfair burdens on our members.

3.Really,honestly,if the cpso,et als.,want barriers to be removed-then they should dismantle the policy of carms/cofm/acmc which,inter alia,block IMGs from applying either directly or via carms,to local teaching hospitals in the Province of Ontario.Do away with the dichotomous components[Recall:IMGs are only allowed into the second iteration 2] of the carms match.It's about time to give IMGs some equity.Let all those qualified [IMGs and CMGs alike]compete on an equal basis/footing for residency.Treat IMGs who pass the QE equally as CMGs who pass the QE.Things were working fine before the questionable,[Douglas-Fraser Institute] reports back in the 1980s,pushed their cause/assumption/prediction/prejudice/bias about doctor surplus when exactly the opposite was the case.No one bothered to seek the truth then,because the medical associations were/still are,too strong.It was all about more patients equals more money. Now,these watchdogs are backtracking/posturing,oscillating the standards,as the government dangles its public purse in front of them,amidst palpably chaotic,life-threatening,doctor shortages!!!

4.Applying for postgraduate training posts via carms,for instance, or directly to the medical schools will be less costly,will involve less red tape,etc.,etc.This is the method used to match CMGs,and it works well for them.Why can't above work for IMGs too.)!!(Recall:the basis for the implementation of gatekeeping programs such as the OIMGP in 1987[which restricted IMG intake in the Province of Ontario,to only 24/yr out of thousands who apply] was/is,a false one...Not all of the thousands of IMGs can be squeezed through the 24 or 36 or 50 hurdles of the OIMGP in Ontario,or the 2 slots in N.S.,B.C.,Manitoba, etc. Think how many millions can be saved if the MCCQE/CFPC/RCPSC,rather than the redundant OIMGP/OIMGC exams, are used to screen IMGs,just like it is used to screen Canadian Medical Graduates(CMGs).Besides,it has been shown time and again,that MCQs used by the OIMGP et al,to screen IMGs are not reliable.This was reinforced by none other than the dean of the famous Chicago Medical school who demonstrated extensive research showing that multiple choice questions are not good for evaluating medical doctors,especially since it does not measure essential traits such as caring, dedication, integrity, empathy,etc).This writer,for instance,has passed the respectable MCC QE (Both parts) in his very first attempt in 1991,yet has not been able to access the OIMGP. Consequently,he stands qualified,and certificated,but unlicensed.

5.It is time to stop treating IMGs like second class human beings, much less like second class citizens.IMGs are sick and tired of trying to aspire to frustatingly oscillating standards,to unjustly jump virtually sky-high hoops due to the paranoia of public/medical officials,making colourable decisions;and to see disparities displayed before our very eyes.IMGs also despair over paying more money(to carms,MCC,etc) for less opportunities.We can overcome all obstacles,reach the required standards if given a fair break.This initiative taken by the CPSO is made only to fulfill its own financial agenda,to carry out "ad hoc" distribution of licenses to favoured candidates,etc.

6.What a turn-around this turned out to be at the cpso.Just a couple of years ago,IMGs were written off as incompetent,The cpso would not even allow us to use the title of Dr. in front of our name;but,now that the cpso is promised government money,it is willing to make an 180* turn,and recklessly drop its standards like a hot potato,and to waive exams of the MCC/CFPC/RCPC.Want to ring the gov't. till some more,anyone,then prolong the period/process for IMG licensure!

7.Enough already is the common denominator at play!Removing barriers does not mean lowering the standards of medicine;it means giving all IMGs who pass the relevant MCC exams, the same opportunities to obtain a livlihood,etc.,as CMGs who are screened by the very exams.

8.Forgive us,but we are simply trying to get our dignity back.History is/will be on our side,even if the authorities,and the judiciary,etc have been blindfolded.

9.Our association represents the lone cry in the wilderness,against above injustices.We may stand alone,but we stand firm.We will push for this when this president meets with the government/MOH next and resubmit his proposals in detail...

regards,

H.Ramlall


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-----Original Message----- From: Ontario College of Family Physicians Sent: Monday, December 15, 2003 To: HRLAL Subject: FW: img can do it as well

Thank you for your email. Since CPSO is the organization overseeing the changes, I forwarded your email to Dr. Klass at CPSO. This is his response. If you have any further questions, please contact Dr. Klass at CPSO directly.

Jan Kasperski Executive Director & CEO

Ontario College of Family Physicians


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-----Original Message----- From: Daniel Klass Sent: December 15, 2003 4:02 PM To: Ontario College of Family Physicians Cc: Jill Hefley Subject: RE: img can do it as well

The Council of the CPSO gave preliminary approval to a new policy for the Registration Committee which will make it possible for candidates for licensure to be recognized for their past track record of achievements in practice in the absence of having obtained all of the formal qualifications. This new policy in no way ends the requirement of independent practitioners to succesfully complete the MCC (or CFPC/RCPS specialty) requirements. It will be possible now, however, for experienced doctors to undertake supervised/monitored/restricted practice until they have completed these formal requirements.

This step was taken as part of a general effort to remove barriers to licensure in Ontario, and to improve access of foreign trained doctors to practice in the province. Taken by itself, this new policy may appear to be unbalanced especially for that group of physicians already in the province who do not qualify for practice for a variety of other reasons. However, it is important to know that other initiatives are in place to improce access to registration for this group as well. Principally, a large increase of slots available in post graduate and undergraduate training positions are being made available specifically to deal with these candidates.

I hope this answer is clear and helpful.

Dr.Daniel Klass, College of Physicians & Surgeons of Ontario.

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This President's REBUTTAL:

Nepotism and favouritism aside,THERE IS STILL A BIG GAP IN THE SYSTEM.In the 1970's and 1980's 0nwards,countless indiginous canadians who could not get into medical school in Ontario and other regions of Canada,have elected to study same abroad.They returned here to be classified as IMGs,only to find insurmountable problems. These IMGs were starved for training posts by the medical associations/cpso/cofm/acmc,etc who assumed gatekeeper status and launced severe rules,policies and politics to stem the flow of IMGs into licensure status.[Now this recent rule fluctuation,applied by the cpso,on an ad hoc basis,is once more raw-dealing this cohort by the cpso's preference for third-world "specialists"].Recall the cpso/carms/ acmc/cofm etc are not publicly-elected bodies and may not unilaterally make new regulations/laws.Only the legislature can.

This adds salt to the wounds of this cohort.These IMGs did everything asked of them-took and passed MCC exams,unsuccessfully applied to carms,and used up their 4 attempts at the OIMGP,waiting patiently for new programs/positions to open up,etc.,all to no avail..

None of the current programs accomodate these taxpaying ontarians/canadians-save and except for the OIMGP which is being subsumed as I write.The newly-created Phase 1 OIMGC demands at least 1 year of postgraduate training outside of north america.This is fine for foreign grads originating from outside Canada.Their home country provides this training to them.But Canada does not do the same for its citizens who ventured to study medicine off its shores.

Hence,it is a fact that despite promises,these so-called new projects[the new programs as per the cpso,cofm,etc.]which all received funding from the federal and provincial governments,have been actively recruiting,more like poaching, "specialists" from outside Canada,at the expense of this cohort.Where do these local, indiginous IMGs fit in,after their 4 attempts to grab one of the coveted 24 slots(as the situation then existed)at the OIMGP,and like programs have expired?Many of these IMGs concentrated all their money and energies towards passing medical council/specialty exams, as this was so dogmatically emphasised by the OIMGP,CPSO,COFM,etc, only to be NOW told by these same bodies that "sorry,you waited too long,you knocked on too many doors and pissed off too many folks,you lack canadian experience,etc;now we will give licenses to visitors, refugees,immigrants,et al,coming fresh from outside Canada,that experience of any kind outside north america,is the current criteria"-such experience heretofore witheld from us!

This writer has no choice but to direct this government's attention to his original Underservice Proposal(USP)submitted and re-submitted since 1991 to all relevent delegated regulators,self-appointed medical authorities,self-appointed gatekeepers,etc whereby a "first come/first pass licensure exams" adage holds.And Instead of the government investing millions of dollars each year on Programs such as the OIMGP and its replacement,the OIMGC etc., it should invest in the provision of more training slots at teaching hospitals whereby IMGs who passed the relevant Medical Council of Canada,and/or the College of Family Physicians of Canada,and/or the Royal College of Physicians and Surgeons of Canada,licensure exams can be accomodated via matching, without having to undergo redundant competitions at the provincial level,such as the OIMGC.For example,IMGs can challenge the licensure exams:Those who pass both parts 1 & 2 of the the MCCQE should enter residency same as CMGs;Those certificated by passing the CFPC/RCPSC exams may be allowed to practise their particular specialty,and so on.Recall that these exams involve,inter alia,the use of simulated patients!This system is used by the USA and it works-Once the USMLE is passed,for instance,all certificated IMGs in the US are permitted to enter residency via central electronic matching,same as american graduates. Why can't a similar system apply to Canada?Why are IMGs discriminated against here,in Ontario and Canada,when the Romanov and other reports show epidemic shortage of health care services/doctors!

To this end,my USP proposal provided a quick and cheap solution as IMGs who have been given postgraduate training,above-mentioned would contract to work in rural,underserviced areas for at least 5 years...

There was a lot of hoey some years ago (circa 1987) by the authorities insisting on giving "all IMGs no matter who they are"[sic]local screening exams[even to those of us who passed the central MCC qualifying exams].The rationale was to maintain a high standard of medical practice.This was their justification for introduction of the OIMGP and like obstacles,(n'cest pas?).They wanted "only the youngest,the best and the brightest".But even after skimming off these lucky ones,thousands of other candidates who have been refused admission into the group of 24 at the OIMGP have gone on to become successful doctors in the USA,proof positive that such checkpoints as the OIMG Clearinghouse et al.,are not only expensive,but are redundant when applied against certificated IMGs.And now that the highly financed cpso have turned around and started giving restricted license "ad hoc" to some candidates who have failed, or not even attempted the Canadian licensure exams,what happened to the so-called "high standards"-that which was brutally used as a weapon by the OMA/cpso/cofm,et al to justify keeping the majority of us out of medical training and thereby cheating a naive,unsuspecting public out of dire medical care?

Warmest regards,Merry Xmas,Happy new year[2005]to one and all... h.ramlall,ba.,md.,dohs

Kindly send your comments,requests for information,purchase order for books,etc (click on the MEDTEXTS link) to the President of this,the pioneer association,at the below address:


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MEDTEXTS.:

H. Ramlall,BA.,MD.,DOHS.

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