Health Committee on Oct. 28th, 2025

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair.

Hello again.

Medical schools do not have to prove that no Canadians are available to occupy the residencies. That's what you said when you were talking about revoking Bulletin 230. Meanwhile, there are Canadians studying abroad who cannot return to work in Canada as they would under normal conditions. That's the problem you've identified.

We know that this practice exists because schools need money. These international students make a significant financial contribution to medical schools. The real problem is that federal and provincial governments are not investing in training people. Our own people aren't being offered positions because health transfers are inadequate.

[Rosemary Pawliuk]

What's interesting is that there are organizations that have offered to fund residency positions for Canadian immigrants and Canadians studying abroad. These include municipalities, large corporations that work in areas where they can't get employees because they don't have a doctor, and ethnic communities that want a doctor who will be sensitive to their culture.

The ministries of health have a monopoly over the funding. They do not allow other funding, and the faculties say that they won't train. They prefer foreign training. They turn on the tap, and when they're done, they turn it off. That means if I wanted five today and the ministry of defence wants 20, they have to coordinate, and it's going to be different every year. It is much easier just to turn on the tap and turn it off, rather than train Canadians.

There's funding outside the government. I'm not talking about the funding to the universities. That's another matter.

I do not think that funding is the issue. There's private funding, and certainly the ministries of health could do better. The issue is training capacity, according to the faculties of medicine. They say that they simply can't do it.

They're using our training facilities—

[Luc Thériault, Bloc, Montcalm, QC]

The training capacity of medical schools depends on resources. The reason they prefer international students is that they can bring in more revenue. The federal government's responsibility is not to withdraw from funding. For health care, the government's share is 21¢ per dollar, whereas it was initially supposed to be 50¢ per dollar.

In the Quebec film La grande séduction, a community tries to find a family doctor who is willing to come and practice in their part of the country. The reason communities are forced to do such things is that someone is not chipping in their fair share for health care in Canada. Would you agree?

[Rosemary Pawliuk]

I guess the question is that if the government funded more, would that change what the faculties are doing, or are they happier with just having money that they can use at their discretion, as opposed to monies?

I don't know the motivations of the faculties, but yes, there should be more funding. We certainly encourage them to fund more so that there can be more residency training, but if there were more funding, is funding to the universities at the root of this? They don't use the funding for training; they use it at their own discretion.

I did a freedom of information request to find out whether or not it was related. The funding is not used for residency training. It's used elsewhere by the universities, for what they want.

[Luc Thériault, Bloc, Montcalm, QC]

Do you think that a certain form of corporatism emerged in the medical community when the decision was made to remove quotas for the profession and training?

[The Chair, Liberal, Hedy Fry]

Thank you. We've gone over time with this question.

I'm going to move on to the next person and the second round, which is a five-minute round.

We will be starting with the Conservatives.

Ms. Konanz, you have five minutes.

[Helena Konanz, Conservative, Similkameen—South Okanagan—West Kootenay, BC]

Thank you all for coming today.

My question is for Dr. Alexander.

Dr. Alexander, thank you for your heartfelt story. It sounds like it's been a difficult road, especially since any Canadian who's listening to this knows we need family medicine and psychologists throughout the country. We're desperate for them, in fact.

After you completed your medical education in Australia and decided to return to Canada, did you know you wouldn't be able to practise? That is my first question.

[Scott Alexander]

In a way, no, I believed that I would still keep applying for residency positions. I took other work in the interim to try to sustain my family for that time, while still trying for residency. It was when the examination requirements changed so that I was no longer eligible that I had to permanently shift.

[Helena Konanz, Conservative, Similkameen—South Okanagan—West Kootenay, BC]

You were given false expectations about your ability to practise in Canada after you arrived here. I'm sure you're not the only Canadian who has practised abroad who was also given those false expectations.

[Scott Alexander]

To a certain extent, after the two years of applying for residency with no success, it did feel like the rug had been pulled out from under me, because now there were new requirements for me to even have the privilege of applying for a residency in Canada.

[Helena Konanz, Conservative, Similkameen—South Okanagan—West Kootenay, BC]

Did you receive an offer to stay to work in Australia in their health care system?

[Scott Alexander]

Yes, absolutely.

I had to make a personal choice. I had an internship lined up in a rural hospital in Australia. I made the active commitment to come home so that my wife and I could have our family closer to our families. That was the sole reason that we came home.

[Helena Konanz, Conservative, Similkameen—South Okanagan—West Kootenay, BC]

That's amazing. Thank you for doing that.

In your experience at the University of Queensland, how many other Canadians studying abroad do so with the intention of returning to practise in Canada, but end up accepting positions in systems such as those in Australia or the United Kingdom?

[Scott Alexander]

That's a very good question.

I would say that when we walked in, the majority of Canadians—and I can at least speak for the 60 Canadians who were in my cohort—had the expectation to come back home after graduating, but I think that after going through the process of going to school and then understanding the requirements for coming home to Canada, more prepared themselves to go to the U.S. through the step programs and try to get residency in the U.S., as opposed to trying to come home to Canada.

Then others settled on the fact that the lifestyle in Australia was very equivalent to Canada's and that they could happily practise there after graduation.

I would say that by the second or third year out of the four years in medical school, most of the Canadians had already made up their minds that they were not going to even try to come home.

[Helena Konanz, Conservative, Similkameen—South Okanagan—West Kootenay, BC]

I think you mentioned earlier that 58 out of your class of 60 ended up staying in Australia or going to another country. Were you actively recruited by the Government of Canada or a medical association to come back?

[Scott Alexander]

No, I made that choice to come back on my own and to try to, I guess, get lucky in the residency matching system here in Canada.

I knew my chances were quite low. I think what I fully understood was that it was about 10%, based on the number of applicants versus available positions, so I took the risk. I had assumed I would have more time to try for the residencies—more time, as in more than two years—but that was not afforded to me.

[Helena Konanz, Conservative, Similkameen—South Okanagan—West Kootenay, BC]

I'm guessing that you would have loved to stay in Canada to do your studying instead of going abroad.

My next question for you is about the visa trainees.

In this program, international medical school graduates receive postgraduate opportunities in Canada. They study here and take up seats, but they have to leave after they study. I believe one person on the panel mentioned that 1,117 Saudi Arabians were now in those seats. Does it concern you that you weren't able to study here and that those seats were taken for study?

[Scott Alexander]

It does, absolutely.

For a Canadian who funded themselves to go abroad, get the equivalent training and do the equivalent exams in order to be able to come home and practise in their home country, to find out that foreigners are paying their way to come to Canada and are taking up training positions.... I know it's not necessarily a residency position per se, but it takes the same training seat from a physician, and then it is not available to someone in my position.

It reminded me of 2018-19, I think, when the Saudi Arabian government had issues—

[The Chair, Liberal, Hedy Fry]

Please wrap up, Mr. Alexander. We're over time.

[Scott Alexander]

—with Canadian physicians, and there were hospitals in Ontario that were going to shut down because of it. That was really the first time that I heard about the foreign-trained visa program and the risk that it posed to the Canadian health care system.

[The Chair, Liberal, Hedy Fry]

Thank you very much. We've gone 36 seconds over time on that question. I want people to try to stick to their time.

Mr. Eyolfson, you have five minutes.

[Doug Eyolfson, Liberal, Winnipeg West, MB]

This may be a change since I was there. When I was in residency in the 1990s, we had some of these international residents, particularly from Saudi Arabia.

If I understand correctly, at the time I was there, these people were not taking up spaces that residents could use. These were extra spaces created because of the extra funding and the money top-up to the medical schools to help fund their programs.

Has that changed, or are extra spaces still being created for them that are not taking available spaces from training programs?

[Rosemary Pawliuk]

“Extra” is a very interesting word, because their argument to Immigration, Refugees and Citizenship Canada was that these are extra because somebody else is funding them. Canadians aren't funding them, and there's no Canadian funding, so they're extra.

In fact, they're not extra, because when Canadians ask for more training and for funding to be made available so they can train Canadians, they say, “Sorry; we don't have the training capacity to do that.”

In my respectful submission, “extra” is a narrative. How could it be extra if there are more than a thousand Canadians who are ready to fill that job, and we're using our training resources in order to do that?

This “extra” stuff is like McDonald's saying they only have money that they're going to dedicate to foreigners, and therefore they're extra—

[Doug Eyolfson, Liberal, Winnipeg West, MB]

I'm sorry. I don't mean to cut you off, but I have limited time.

Who is making these decisions? Is this a federal government decision? Is it the universities? Is it the provinces? Who is making this decision?

[Rosemary Pawliuk]

Do you mean to exempt from the LMIA process? That decision was made by Immigration, Refugees and Citizenship Canada and Service Canada on the request of the faculties of medicine, who wanted to use this as a means of income generation.