Doctor shortages have reached a critical level in Canada. At last estimate, the country produces 17 new doctors per 100,000 people annually, meaning that millions of people lack access to a regular provider.

Structural factors may be contributing to the physician shortage. Residency slots are limited, some provinces have strict medical licensing requirements that include extra fees and arduous application processes, and practice eligibility requirements can become expensive. The situation is challenging for Canadians who have a passion for medicine but few options other than to seek education, residency spots, and jobs abroad.

Many Canadian physicians who’ve ventured outside the nation’s borders say that they have found flexibility, better quality of life, and higher salaries. Though they miss their families and friends, many say they won’t return. They consider the hurdles to practicing in Canada to be too high.

Practicing Down Under

The “mental math” was not adding up, Gavin Dalgleish, MBBS, general practitioner at Royal Perth Hospital, Perth, Australia, told Medscape News Canada. He graduated from the Med Plus program at Brock University in St. Catherines, Ontario. Med Plus is a 4-year cocurricular track that prepares students for health sciences careers. Dalgleish quickly realized that for most students going into health science, an interest in medicine might not lead to a career as a doctor.

Rather than take chances, he applied for and was accepted to the Atlantic Bridge program in Ireland, which provides streamlined medical education and residency placement assistance in North America and abroad.

“A small proportion of my colleagues stayed in Ireland. Most went back to Canada or the States, and I came down here” in 2022, said Dalgleish. “I had a relatively good inkling that I wanted to do general practice and family medicine. But how do you know for sure without going out and getting more exposure by working and solidifying what you want to do? I’m in the general practitioner training scheme here, in hospital medicine. I’ve been gaining work experience and building my CV.”

Moving to different places can be intimidating, Dalgleish acknowledged. “I’m not unfamiliar with the concept of packing myself up and going to a brand-new place and not knowing anyone, which is a huge barrier for a lot of people. There definitely are opportunities if you are willing to look,” he said.

Dalgleish works 40-hour weeks, has a great work-life balance, and is paid handsomely. He said that the strongest pull back to Canada would eventually be his aging parents. He returns for annual visits, but all in all, the grass is greener in Australia, he said.

A European Embrace

Though he focused on social sciences throughout university and later worked in event planning and television, Montreal-born Karim Ben Harbi, MD, said that becoming a doctor was always in the back of his mind. But because his studies did not meet the academic requirements for medical school in Canada, he looked elsewhere.

“I tried to think of countries where language was not an issue, where money was not an issue, basically anywhere in the world where I could enter and study medicine,” he said. His fluency in four languages was an asset. “I applied in five or six different countries, and the first place where I was accepted was Rome, Italy.” The path was not easy; Ben Harbi said that he competed against roughly 4000 people for 1 of 400 slots.

After practicing independently as a general practitioner in Italy for several years, Ben Harbi moved to Belgium. He recently started a program that allows him to move from general practice to family practice.

One benefit of obtaining a medical license in Europe is that it’s accepted across the EU, he said. “I didn’t necessarily think about doing a program elsewhere that’s going to automatically make me able to go back to Canada and practice. Now, it’s going to be difficult; there are a lot of barriers.” He pointed to the need to take the Medical Council of Canada Qualifying Examination, which not only costs $10,000 and takes 2-3 years but also makes it impossible to practice during that time.

Going abroad to practice is “much easier than you think,” said Ben Harbi. He noted that many universities in Europe now offer an international program in medicine that is taught in English, so language should not be the largest barrier for Canadians considering their options. “The human body is the same in every country,” he added.

US of Mind

In July, eight provinces (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia, New Brunswick, and Prince Edward Island) loosened licensing restrictions for US-trained and board-certified physicians, allowing them to practice without additional exams or certification. But Canadian expatriates who studied outside the US and currently working in the US might not meet these qualifications.

Stephen Sebastian, MD, general internist at a rural hospital in Virginia Beach, Virginia, will begin working as a hospitalist at MedStar Georgetown University Hospital in Washington, DC, in December.

Born in Alberta, Sebastian went to university in British Columbia. He was unable to get into medical school in his home province because of the lack of interprovincial agreements on credential recognition at that time. Instead, he opted for Ross University (previously based in Dominica, now in Barbados), which, he said, has agreements with hospitals in the US and the UK. These agreements facilitate a smooth residency matching process. Ross reports a 96% residency attainment rate.

“It was a lot more expensive for me to go to Ross,” said Sebastian. But it would have been harder for him to find a residency spot in Canada because he needed certain elective credits in that country. At the time, he also would have been required to spend thousands of dollars on medical exams to practice in Canada, which would have added more debt to his existing obligations.

Staying in the US offered Sebastian a good salary and provided a faster path to working as a doctor. “I’ve been an internal medicine physician for 3 years now. The means to the end was a lot easier,” he said.

He has recently received a few solicitations on LinkedIn to entice him to return to Canada. But Sebastian has few regrets; practicing in the US has offered greater opportunities than he might have found in Canada, he said.

“I’m double-boarded now in internal medicine and obesity medicine,” he said. His life is also settled; he is now married, has friends, and is thoroughly established in his life in Washington, DC.

Like Sebastian, Vancouver-born Nathani Yashas, MD, paved his medical path through the Caribbean, attending the American University of Antigua. The primary attraction was the ability to spend his first 2 years of premed and medical school in India, where he was born, and then return to complete his board exams and clinical rotations in the US.

“At the time, foreign medical school graduates, even Canadian residents or Canadian citizens, were not, for the most part, considered in the first round of residency spots,” said Yashas. “Unfortunately, the process of getting into residency is superseded in difficulty by trying to get back to Canada once your training is done. If I were to have gone back to Canada to do pediatrics, I would have faced 4 years of residency (versus 3 in the US) and a year or 2 of vetting and paperwork. And I would have had to work under someone to audit my work, despite having equivalent training and board certifications. It wasn’t viable or realistic.”

Today, Yashas is a pediatrician and specialist in pediatric emergency medicine in the Dallas-Fort Worth area of Texas and has an American wife and children. Given the dearth of children’s hospitals in the Canadian healthcare system, there are few opportunities for pediatric emergency medicine specialists in that country, he said. Moreover, his wife, who is also a clinician, would face challenging hurdles to practicing medicine in Canada.

“I’m fully aware of the public relations campaign that is going on. But it’s still not as easy as it should be for somebody who’s a citizen of [Canada] to come back and practice with the type of experience we bring,” said Yashas.

Financial Struggles

Many expatriates feel that the benefits of working outside of Canada outweigh the risk for not being able to return easily. Others, like Nimara Dias, MD, are not as sure.

Dias graduated from the University of Toronto, Toronto, with honors, having completed a double major in neuroscience and cellular molecular biology. She also spent time volunteering to improve her medical school eligibility. She thought she was the optimal candidate for a medical school slot but faced 3 years of rejections after graduation. Finally, she was accepted at the University of Queensland Medical School in Brisbane, Australia.

The challenge, said Dias, was securing tuition money (more than $300,000). Her parents guaranteed the first $200,000, and the third portion came through at the last minute, although Dias had to work two jobs on top of her studies simply to make ends meet.

Dias has since graduated from medical school and currently works as a locum junior house officer, flying to remote regions in Australia to fill short-term staffing needs. She has a Canadian partner, and they would like to return home to start a family.

“I initially worked at Toowoomba Base Hospital in Queensland, and in my second year, I wanted to return to Canada,” said Dias. “I learned what it was like to try to apply and come back. It’s ridiculous. It’s like jumping through hoop after hoop after hoop.”

“I’m mad because I graduated from medical school, and they recognize my degree. So why do I have to pay thousands of dollars to take more exams?” she said.

At the same time, Dias said that she is paid more than Canadian doctors are, can still advance in her field and become a specialist, and can start a family. “Canada rejected me every step of the way. So, coming back would feel like a slap in the face.”

Seizing Opportunities

It’s unclear how many Canadians are working abroad and how many foreign-born doctors are in Canada but unable to work. Today, Canada has 18 accredited medical schools across eight provinces and anticipates the addition of three more in 2026. Despite its shortage of physicians, its workforce planning is significantly lagging, critics say.

Many expatriates want to return to Canada to work but can’t afford to do so. Others are so turned off by the hurdles that they would not return. “If you really want to be a doctor, then it’s definitely within your grasp to do it,” said Sebastian. “Just know that you are choosing a different life. But you’re not going home to practice,” he said. “You have to be willing to make that decision.”

Dalgleish, Ben Harbi, Sebastian, Yashas, and Dias reported having no relevant financial relationships.

Liz Scherer is an independent health and medical journalist who frequently writes about health issues in Canada and Europe.