Thank you very much.
My name is Dr. Peter Nickerson. I am past chair of the Association of Faculties of Medicine of Canada, dean of the Max Rady College of Medicine and a professor of internal medicine at the University of Manitoba.
As an overview, I want to highlight that at the completion of an undergraduate medical doctor degree, graduates are matched to residency positions in Canada via the CaRMS match. People in residency positions are considered paid employees of the health care system in the province where they are working, and residents are also registered learners in an accredited training program in an approved medical school affiliated with the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada.
International medical graduates are individuals who have graduated from a medical school outside of Canada. They are allowed to apply for residency in Canada if they meet criteria. They are matched to a residency program, again via the CaRMS matching process.
One in three international medical grads applying to CaRMS is a Canadian or a permanent resident who has undertaken medical school abroad due to a lack of space in medical schools in their home region in Canada. The ability to accommodate international medical graduates in a CaRMS residency match is dependent upon sufficient provincially funded residency training capacity for both Canadian medical school graduates and international medical graduates.
Visa trainees are foreign-born trainees whose home country is often paying for them to undergo clinical training in a Canadian residency program. These individuals are accepted by Canadian medical schools and health systems only after Canadian medical grads and international medical grads fill all provincially funded residency positions and there remains residual capacity for training in the health system. In 2023-24, there were 3,140 visa trainees working and learning in Canada.
Internationally trained physicians are physicians who are fully certified to practise medicine in their discipline outside of Canada. To enter practice in Canada, they must meet provincial regulatory standards. This may be a simple review of their training and practice record or a formal assessment of their skills before obtaining a licence to practise.
To give context to this discussion, I have prepared three slides for your review.
On the first slide, you will see Manitoba's medical school training capacity, which in 1982 was 95 seats per million population. Government decreased funding in the 1980s, such that by 1994, the incoming class size was 60 seats per million population. By 1998, in recognition of the physician gap that was created, the seat capacity was progressively increased, reaching 90 seats per million by 2009.
However, in 1999, while the medical school class was expanding, the province stood up a formal internationally trained physician program, especially in family medicine, either as a practice-ready assessment, or PRA, or as a one-year training program to get them ready to practise in Canada.
Unfortunately, as the Manitoban population grew after 2009, there was no expansion in medical school training capacity to keep our seat number at 95 seats per million population. In essence, since 1980, Manitoba, by not maintaining its training capacity steady at 95 seats per million, missed the opportunity to train over 800 physicians. When you look at the gap in Manitoba physicians per million population relative to the Canadian average, you start to understand why we have a shortage in Manitoba.
This is not unique to Manitoba. The same pattern occurred in Canada as a whole.
As one potential solution to the health workforce problem, we can increase the training capacity of medical schools in Canada. Slide two shows the capacity by province. While we have increased our seats across Canada, there's a marked regional heterogeneity. Of note, only one in five applicants to medical school is admitted. Many of those not admitted are quite capable of undertaking the training, but there isn't funded seat capacity to train them. Hence, many Canadians go outside Canada to train.
We could also increase the funded residency positions in Canada. The fact that we're able to accommodate externally funded visa trainees tells us that there's further training capacity in the health system, but the provinces are not funding this capacity.
In slide three, you see the national ratio of residency training spots relative to Canadian medical graduates. In 2018, the ratio is essentially 1:1, and it has increased gradually back to 1.12 in 2025, meaning there are only 12% more funded residency positions than there are Canadian medical graduates. This 12% affords the capacity to accommodate international medical graduates in Canada while meeting the needs of our own medical graduates. In Manitoba, we've actually created our capacity at 1.3 as a ratio, going up to 1.72 as of late.
The third solution is to increase capacity to assess or train internationally trained physicians. Provinces can improve recruitment and retention of internationally trained physicians by enhancing practice-ready assessment capacity or, as in Manitoba, by developing a one-year training program in family medicine for ITPs who require exposure and experience to accommodate to the Canadian health care system.
Thank you very much.