Thank you, Doctor.”
“You are welcome. Come back and see me in three weeks for a follow-up.”
As the patient closed the door behind her, Dr. Jorge Mario Canela Magallan sat alone in his office preparing to see his next patient. Feeling a sense of pride and fulfillment, he smiled. He was living his dream.
Dr. Canela had prepared all his life for a career in medicine. Hailing from a family of doctors, he was sure that helping people to feel better was what he was born to do. People travelled great distances from remote districts in his region in Mexico seeking relief from their ailments. He felt blessed and humbled that he could offer medical care to his patients.
Fast forward six years. Now an immigrant living in Canada, Dr. Jorge Canela is a doctor without a practice, without patients.
But how did this come to pass? Dr. Canela says he vividly remembers the day his life shifted into a new reality. He had come home from working at the hospital and asked his wife Denisse Luna González what she thought of moving to Canada. They were both well-established in their medical careers, both doctors and open to advancing their careers. They hadn’t yet started a family, so it seemed like the perfect move—a new challenge wrapped in the great adventure of moving to another country to expand their professional horizons.
Overhearing a colleague practicing speaking French for a French exam was the start of it all for Jorge. Upon inquiry, Jorge’s colleague explained that she was learning French to move to Canada. His curiosity piqued, Jorge began investigating what a new life in Canada might look like.
In fact, Jorge and Denisse did extensive research on a few other countries before deciding that Canada was the place where they would like to live and raise their family. They considered many factors, including language, the proximity to Mexico to visit family, and whether or not there were friends and family in the region they would move to. Having recently completed his masters’s degree in occupational health, Jorge wanted to focus more on improving workplace health and safety standards. Canada tipped the scales as the destination of choice when he learned that Canada was known to have one of the best occupational health and safety cultures worldwide. The couple enlisted the services of an immigration specialist to advise and assist with their personal and professional transition into Canadian society.
With the information Jorge and Denisse had gathered, along with the consultant’s support, they thought they were as prepared as they could be. They estimated that it would take about three and a half to four years to establish permanent residency and for their medical recertification process to practice in Alberta. That timeframe seemed bearable for the young couple, and they were excited about the prospect of the new experience of living in a diverse, multicultural society.
Taking the leap
Eager to build their life in Canada and provide medical expertise and care to patients internationally, the couple finally made the decision to move to Canada and felt that the fastest way to begin the process was via student visa status. They also believed that attending university could help improve their English language skills. In April 2016, Doctors Canela and Gonzalez arrived in Edmonton, Alberta, ready to walk the path of becoming doctors in Canada.
Only a few weeks later, it was apparent that nothing was going to be as they had expected. Like any other decision, the path chosen had its own complications and surprises, and the transition process was not as simple as Jorge and Denisse had hoped it would be. Born and raised in Mexico as native Spanish speakers, the couple understood English but did not speak the language fluently. This was the first critical hurdle, particularly because the ability to understand and speak one of the official languages of Canada was necessary to prepare for the qualifying exams. It is not uncommon for newcomers to underestimate the difficulties in acquiring high-level fluency in English, and this was true for Jorge and Denisse as well.
But this challenge paled in comparison to the loss of identity they both experienced; their identity as doctors felt like it had been completely erased. This was a new reality that Jorge and Denisse were totally unprepared for, and they felt the loss sharply. Immigration had birthed a new life for the couple, but it seemed that in order to succeed, they must shed the life they had enjoyed in Mexico. For Jorge, this meant that “you must tell yourself that you are not a doctor anymore. You are a new immigrant, and you must start from zero, and that part is tough.” With no family members or friends close by and no familiarity with the local culture, Jorge and Denisse felt adrift.
Earning adequate income to support their living expenses here in Canada was yet another challenge the couple—accustomed to the dual salaries of medical professionals—had to navigate. As their savings dwindled, Jorge and Denisse needed to find work to manage their financial obligations and the significant fees for the recertification process. Again, expectations brushed up against a harsh reality. The couple had assumed that they would be able to secure some type of work in the medical field, but the couple’s search for work revealed that passing qualifying exams and taking local training were also requirements for most roles in the medical industry. Cleaning jobs and entry-level positions were the only professions that they could undertake immediately. Faced with this situation, Jorge and Denisse had to decide which one of them would work and which one would study to pass the qualifying exams.
Jorge recalls how difficult it had been six years ago to explain to their family and friends the decision to leave behind their comfortable life. In Mexico, as in many other Western societies, practicing medicine is a highly regarded career. A medical career in Mexico is not only rewarding financially but also confers a certain social status on the physician. Back home, Jorge and Denisse had owned their own home and vehicles and had substantial savings in the bank. “The social pressure is hard; it’s tough. There are times that your family and friends ask if you are crazy to leave behind such a good life,” admits Jorge.
Committed to the cause
Jorge is still pursuing his recertification. The dream of practicing medicine in Canada lives on in his head and heart, and his motivation has grown even stronger with the birth of his daughter, who has given him a new purpose and an unwavering drive to succeed. Jorge now works during the days and studies in the evenings and on weekends while Denisse cares for their young daughter. Jorge is nostalgic for the time not too long ago in Mexico when the certainty of a lifelong medical career was his indicator of stability, but he holds tight to the lifeline of hope that one day soon he will once again be known as Dr. Canela: “I work during the day and study at night to prepare for my exams. I will become a doctor in Canada”.
Unfortunately for Jorge, and for Canada’s overburdened medical system, passing the qualifying exams is but the first step in a somewhat complex process.
After successfully completing the qualifying exams, an International Medical Graduate (IMG) still has to find a residency under a practicing doctor who will eventually declare the IMG fit for medical practice. The National Assessment Collaboration exam is a one-day exam that assesses the candidate’s readiness to enter a Canadian residency program. However, even if deemed ready for a residency, an IMG is not guaranteed a residency placement in Canada. In fact, residency matches seem to be the sticking point for most IMGs. Not only are there fewer residency spots designated for IMGs than there are for Canadian Medical Graduates or (CMGs), but there also seems to be a shortage of viable match options. The Canadian Resident Matching Service’s 2021 report shows 410 matches for IMGs out of 1358 participants, a 30% match rate. This compares to a 96% match rate for CMGs in the same period. Despite all his work and the time and financial investments he will have made to get to the residency stage, Jorge will likely end up playing a match lottery.
With these multiple barriers and residency uncertainties, it shouldn’t be surprising that many experienced, skilled, and capable doctors pivot out of medicine after arriving in Canada.
Better laid plans
Looking back on what can easily be considered an arduous journey to earning a license to practice medicine in Canada, Jorge wishes he had gathered more information on the reality of the process before leaving Mexico. He acknowledges that improving his English so he could communicate fluently was one step he would have taken much earlier. Jorge is certain the process would have been shortened by a few years if he and Denisse spoke English fluently.
Beginning the Express Entry profile process as soon as possible is another bit of information Jorge wished someone had shared with him. Express Entry offers a fast-tracked pathway to permanent residence for certain eligible skilled workers, which includes doctors.
Jorge also would not have waited until he arrived in Canada before creating his profile on physiciansapply.com, the online document validation process for internationally trained doctors. While the qualifying exams must be taken in Canada, the validation process, which generally takes a few months, can be started anywhere in the world. Jorge believes those months would have been better spent with he and Denisse earning their usual incomes in Mexico to increase their savings and to additionally prepare for the move and potential period of unemployment or underemployment once in Canada.
Eye on the prize
In the context of Canada’s deteriorating medical system and disappearing family medicine practices, the barriers for IMGs to practice medicine exacerbate a growing problem. Most advocates champion initial steps such as increasing residency spots for IMGs and recognizing the work experience of internationally trained doctors.
Jorge and Denisse, the Mexican doctors who decided to migrate to Alberta to live, work, and raise their family, have had to reimagine their professional journeys many times over the past six years, and may do so again in the coming months. Currently a health and safety consultant for Pinchin Environmental in Victoria BC, Jorge remains focused on his upcoming qualifying exams and a return to the identity that has been hidden but not erased.