Health committee  So they can take that immediately, and we offer that six times a year.

Health committee  I'm not sure I can answer that totally accurately, Madam Chair, but the current cost of the evaluating exam is $1,200. The current cost of the qualifying exam part one is $800, and the current cost of the qualifying exam part two is $1,600, which in terms of the cost is almost the same as the three-step examination the U.S. administers.

Health committee  They're eligible as soon as they... We do not require their documents to be source-verified prior to taking the exam.

Health committee  I don't know the people who don't take the exam; I only know the people who do. But I would say on the issue of the cost that we are a not-for-profit charitable organization, and at this moment all the exams are cost-recovery, except for the qualifying examination, which is subsidized by an endowment the council has.

Health committee  First of all, I think people should be encouraged to take this exam offshore so that they are not in the position of having to find alternative work. My advice to international medical graduates, if they're here, is to keep going back to their home countries to practise, so they're at least presenting themselves as fully practising physicians during the time that they're waiting for the exams.

Health committee  If you look at the performance on the part one exam--and they have to have passed the evaluating examination to have done that--about 90% to 95% of Canadian graduates will pass, and it's somewhere in the neighbourhood of about 65% to 70% for IMGs if they pass part one the first time.

Health committee  Yes. Thank you, Madam Chair. I think it would be inaccurate to say that something's going wrong because the percentage of international medical graduates has decreased to 22%. During that same time, the output of Canadian medical schools has almost doubled. So the relative percentage has decreased, but if you look at the actual numbers, the numbers have been either steady or slightly increasing.

Health committee  This is another issue. And thank you for opening that one up, because I think one of the major problems we have not discussed in this country is the fact that it may not be the numbers of doctors that is essential, but how the system works, and we're not talking about other health professionals and their roles in the health care of populations.

Health committee  I'll jump in, Madam Chair. First of all, I think assessment is absolutely crucial, and if it can be done in the country of origin and given some sort of direction, that's wonderful. What I think is perhaps lacking in Canada at this moment is the capacity to provide remedial training for individuals who have taken a long time to move through the exams and need some catch-up time, maybe because they have spent two years learning French or English and therefore are no longer eligible for licensure.

Health committee  Health is a very tricky issue in Canada, Dr. Bennett, as you know. I'm a former dean of medicine, and I would have loved to have had the federal government paying some residency slots when I was in Newfoundland and Labrador. However, I'm not sure my government at the time would have appreciated that intrusion.

Health committee  Thank you very much, Madam Chair. I really appreciate the opportunity to appear once again before this committee on behalf of the Medical Council of Canada. As Madam Lefebvre noted, we really do not have a single Canadian licensing system; rather, we have 13 independent jurisdictions.

Health committee  Chair, perhaps I can add to that. The committee is probably aware that, unlike the United States, where every international medical graduate has to go through a residency program, about half of the physicians, international medical graduates, entering practice every year go directly into practice without going through a residency program, and about half of them entering go through a residency program.

Health committee  I can give you some numbers, Madam Chair. At present, about 4,000 people a year are coming through the physician repository. Don't hold me to that exact number, but it's about 4,000. Over the last few years, the number of people writing the Medical Council's evaluating exam, which is the requirement for entering into residency and the minimal requirement for entry into practice, has been dropping off.

Health committee  I'd just add that the reason for the clear flow to Australia is that Australia actually acknowledges our assessment process. One of the things that perhaps need to happen is this mutual recognition of assessment processes. We had been working with Australia for a while. They've just changed their whole process around.

Health committee  Madam Chair, thank you. I had covered one of the areas, which was the repository. I was about to tell you about the second step that an international medical graduate can take before coming into Canada, which is the Medical Council's evaluating examination. Since 2008 we have gone to a computer-based examination, which is now delivered in 500 sites in over 70 countries and offered six times a year.