Health Committee on Oct. 28th, 2025

[Matt Strauss, Conservative, Kitchener South—Hespeler, ON]

In my years of writing the exams and then working at a couple of different medical schools teaching medicine, I don't recall anyone having old MCC exams. This is in contradistinction to the Royal College exams.

Is that your understanding? What accounts for that difference?

[Viren Naik]

I think the difference is that with respect to our examinations, we have many practice examinations available to candidates that are equivalent to the real examination.

In that regard, we hope that we create equity in the system by having that available to Canadian grads and to international grads.

[Matt Strauss, Conservative, Kitchener South—Hespeler, ON]

I think it does and I think you do, and thank you for that.

I have a couple of questions for Ms. Pawliuk.

You mentioned that of about 800 Canadians studying abroad who graduate every year from medical school, only 100-and-some apply to come back. Of that 100-and-some, what is their success rate in finding a residency here?

[Rosemary Pawliuk]

It depends on the year. For instance, when there were only 119, the success rate was quite good, with only 23—off the top of my head, give or take—not matching. However, the higher the number who come back, the lower the success rate.

[Matt Strauss, Conservative, Kitchener South—Hespeler, ON]

Of the 700 or so who don't apply to come back, where do they tend to land?

[Rosemary Pawliuk]

Almost all of the people who study in Australia end up staying there, not because they want to but because they feel they have no choice.

The next-largest group goes to the United States. More than twice as many CSAs end up training in the United States than in Canada.

[Matt Strauss, Conservative, Kitchener South—Hespeler, ON]

This is not a question. I just want to say that it's totally crazy that we're sending Canadian kids to pay a quarter of a million dollars to get medical training elsewhere and then leaving them to the depredations of the American health care system when they could be serving our country, when that's where they want to serve.

You mentioned a couple of times that there's a difference between residence seats and residency capacity. If these visa trainees are using an OR as an anaesthesia trainee and they have a preceptor, then they're taking capacity even if they bring their own funding.

You mentioned private funding a couple of times for Canadians studying abroad. What are the sources of this private funding?

[The Chair, Liberal, Hedy Fry]

You have 20 seconds.

[Rosemary Pawliuk]

They are municipalities, corporations, community groups, ethnic groups and non-profit foundations.

[The Chair, Liberal, Hedy Fry]

Thank you.

We will now go to the final questioner for the Liberals, Mr. Powlowski.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Let me start off by saying to Dr. Alexander in particular that we share your frustration. I'm a long-practising physician as well, but as a member of Parliament, it is certainly frustrating that there are a lot of communities in my riding, rural communities, that really want and need doctors, and we look at someone like you and say, what the hell...?

Part of the problem is the fact that a big part of the bottleneck in getting foreign-trained doctors credentialed is that they have to go through the provincial licensure before they can actually practise.

Interestingly, as Dr. Naik mentioned, the Medical Council of Canada was created by an act of Parliament back in 1912. In addition, the Royal College of Physicians and Surgeons sets national standards. Although the regulation of the professions is something within the provincial jurisdiction, it obviously has a federal component to that as well. As my good friend NDP member Don Davies often says, this is an area of shared jurisdiction.

Having said that—and I know, Dr. Naik, that someone pre-empted my question—what more can we do to address the problem of getting foreign-trained people credentialed? You talked about practice-ready assessments. I would note that the federal government, in 2023, gave half a million dollars to the Medical Council of Canada to assist in this.

You've talked about practice-ready assessments and making access to practice-ready assessments perhaps a condition of transfer payments from the federal government to the provinces. There are difficulties with that, because the feds can say they want this or that, but will the provinces actually do it and what can we do if they don't do it?

Since this is an area of shared jurisdiction and is something we want to address as we want to get more foreign-trained people credentialed, is there an avenue so that we could put federal money directly into trying to do more to have more people go through the practice-ready assessment program?

[Viren Naik]

As I think Dr. Alexander and Rosemary and team have said, the CaRMS course is very clear. That's for the graduate who just finished medical school.

For the heterogeneity for the internationally trained physician to the practice-ready assessment, it's felt not just by the trainee, but by the practice-ready assessment programs themselves. I think they would like to be on side. For the governance of those programs, some are in regulator, some are in university and some are run by an external party. However, they are all hungry for a national approach—a national intake or a national matching process—so that they're not diverting resources to that recruitment and the challenges—

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Who do you see as the body that would take on that responsibility?

[Viren Naik]

I think that could be a consortium. We stand as stewards of the national assessment collaboration that started the practice-ready assessment in 2017. We have a working group, I'll say, and a committee that comes together, of the practice-ready programs. A desire for a centralized intake would be welcomed not only by them but also by the candidates: to have one application process, just like CaRMS, and know where those practice-ready programs could be available.

On the other end of practice-ready assessment, we could stand up national programs to support the graduates after they leave the practice-ready assessment. One of the biggest challenges, obviously, is their experience and how we best support them for success in rural and remote communities.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Do you think the provinces would be on board with such a national program?

[Viren Naik]

Again, I think the governance of these practice-ready assessment programs lives not with the government. I think the governance and the people who are running the practice-ready assessment programs would welcome it. If they are the ones who are the voices to the government, then it would be accepted.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

In terms of the top-up programs we've heard about from other witnesses, foreign-trained doctors need perhaps six months, a year or two years. I don't see a lot of provinces or teaching hospitals doing that. Do you know of anywhere where they have those sorts of top-up programs? What more can we do to add those as a way of getting foreign-trained doctors?

[Viren Naik]

I think Manitoba is the leader in this. It's a bridging program: both an on-ramp and an off-ramp for practice-ready assessment. We're seeing some uptake in other provinces, such as Nova Scotia, through hospitalist programs.

Where we have clinical assistants, which means essentially working under a supervised practice, as in British Columbia, that again is a marker of success when you move the person into a practice-ready, high-stakes assessment to move them to more independent licensure.

There are examples. We could absolutely nationalize that.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

I think we've come to the end of the session.

Before I thank the witnesses, I want to say, Dr. Alexander, that I know exactly what's happening with you. My son went to study at the University of Sydney against my better advice. He did that because he got a full scholarship from the University of Sydney. He stayed there.

They do a five-year residency program in emergency medicine. I now have to travel to Australia to see my grandchildren, and I feel your pain. I understand it. He actually decided to stay, because he was given all kinds of perks to stay in Australia.

Thank you very much.

Witnesses, thank you for your time and energy and for answering very complex questions.

I will now suspend to set up for the next hour.

Thank you very much.

[The Chair, Liberal, Hedy Fry]

We're starting at 30 minutes after 12. We will go to 30 minutes after one.

Again, everyone, please try to keep to your time. We went over the time a lot in the last round.

Are the witnesses all online?

Okay.

We have with us, as an individual, Dr. Arun Anand. Dr. Anand is online. Then we have the Canadian Post-M.D. Education Registry, with Geoffrey Barnum, senior manager. On internationally educated health professionals in Canada, we have, for the Canadian Medical Foundation, Eva Slawecki, adviser.

I'll tell you how the show runs here. You have five minutes, each one of you, to make your statement. I will give you a one-minute shout-out and then a 30-second one, so that you know to wrap it up. We will have a question and answer session after that. That will go until 1:30.

Thank you very much.

I shall begin with Dr. Anand.

You have five minutes, Dr. Anand.

[Arun Anand, Physician, As an Individual]

Good morning, Chair and members of the committee.

I am Dr. Arun Anand and I am an anesthesiologist practising in Alberta. I am the co-founder of several initiatives aimed at improving surgical access and workforce sustainability in our province.

I have also worked with indigenous and rural communities previously to strengthen access to surgical and dental care in Manitoba. I currently have or have had medical licences in Ontario, Alberta, New Brunswick, Manitoba and Saskatchewan.

I appreciate the opportunity to speak with you today about the systemic constraints facing our health care system and how federal policy can play a stronger role in aligning immigration, credentialling and infrastructure planning with the realities on the ground.

It is my observation that Canada’s immigration, credentialling and health system planning are running on separate tracks. That mismatch is now visible in workforce shortages, long waits and rising hospital deficits.

Federal leadership can help align these pieces.

First, immigration targets should be coordinated with health care capacity.

Canada plans for 395,000 permanent residents in 2025, with notional targets of 380,000 in 2026 and 365,000 in 2027, after posting the fastest population growth since 1957: plus 3.2% in 2023, with 1.27 million people. Our system capacity is not keeping pace.

Canada has 2.8 physicians per 1,000 people versus the 3.7 physicians per 1,000 for the OECD average, and 2.6 hospital beds per 1,000 versus the 4.3 OECD average. Immigration is nation building, but it has to be matched to training seats, OR time and beds.

Second, credentialling barriers block physician mobility. We've made partial progress. The Atlantic Registry shows regional mobility can work, but national portability remains patchy. A colleague of mine qualified through Alberta's practice readiness assessment cannot work in B.C., but somehow is safe to practise in Alberta. Clearly, this reflects inconsistent pathways between provinces. A pan-Canadian licence or true mutual recognition would at least partially help to address some of the workforce challenges.

Third, fragmentation is costly. Annual college fees alone are over $2,000 in Alberta and B.C. before professional association dues and CMPA premiums. Also, these costs multiply when you register across provinces to serve underserved or vulnerable populations. CMPA premiums also vary by region and scope of work, adding friction to interprovincial service. For example, for me to have my licence in Ontario, I pay double the CMPA cost and have thus considered abandoning my Ontario licence, despite travelling there often and picking up days in Ajax when I am available.

Fourth, Canada is losing momentum on training-to-practice pathways, especially in surgery. Royal College employment studies show that 14% to 19% of new specialists lacked specialist work at certification, in several years. In orthopaedic surgery, an average of 37% reported no job at certification between 2011 and 2018, citing OR time, beds and staffing limits, not lack of patients. Recent Canadian Journal of Surgery analysis confirms early career orthopaedic surgeons often rely on locums and part-time work due to insufficient positions.

When opportunities are constrained, graduates look to the U.S. In 2020, according to the Canadian Orthopaedic Association, 72 recent graduates in 2020 left to work full time outside of Canada. Clearly, there's a gap in our human resources and infrastructure planning, and it's not necessarily about credentialling foreign doctors. There are mismatches across all levels of all systems.

Fifth, federal health programs that are often considered uninsured or not covered by provincial health plans often cost our system substantially more money and require more resources, for several reasons. Namely, because services are not covered by provincial plans, physicians can bill up to five times more for their physician fees in these programs, including federal programs that support refugee claimants. Often, we need language lines and we keep translators online for extended periods of time. Additional time is required to obtain consent, dispel misinformation and communicate with these patients.

I want to make no mistake: I am empathetic to refugee claimants and other immigrants, being a child of immigrants myself. However, these efforts need coordination. When our health care system is already strained, this needs to be considered before we can safely allow an influx of additional families. It's basic human resource and workforce planning.

Sixth, finances are tightening. The Ontario Hospital Association reports—

[Luc Thériault, Bloc, Montcalm, QC]

A point of order, Madam Chair.

[The Chair, Liberal, Hedy Fry]

Excuse me. I'm sorry. Stop, please.

[Luc Thériault, Bloc, Montcalm, QC]

There's been a problem with the sound for 30 seconds, and interpretation is not available. The problem must be fixed, Madam Chair.

[The Chair, Liberal, Hedy Fry]

We will suspend.

You have 30 seconds left, Dr. Anand, but we will suspend until we get this fixed.