Some international medical graduates could be shut out from the best residency spots after the shift from Doug Ford’s government.Frank Gunn/The Canadian Press
Last week, the Ontario government decreed that, going forward, only medical school graduates who previously completed at least two years of high school in the province will be eligible to apply for medical residency spots in Ontario.
It’s a seemingly simple change that has huge implications.
The greatest beneficiaries of the new policy will be Ontarians who studied medicine abroad, in places like Ireland, Poland and the Caribbean, where they pay annual tuition fees of $80,000 or more. This small, wealthy group will now be treated on a par with graduates of Canadian medical schools, instead of being treated as international medical graduates (IMGs).
The big losers in this puzzling shift from Doug Ford’s government will be other international medical graduates, most of whom will now be shut out from the best residency spots by virtue of the fact that they completed high school elsewhere, regardless of where they live now, where they completed their undergrad studies, or whether they have a medical licence from another country.
What this will all mean in the long run is unclear. But in the short term, it will almost certainly mean fewer family medicine residents. That’s right: this change is likely to lead to fewer, not more, doctors in Ontario.
Introducing new roadblocks at a time when the country has a crisis in access to primary care seems disconnected from reality. Some 6.5 million Canadians lack a family doctor or nurse practitioner, including about 2.5 million Ontarians.
The way graduating medical students “match” to residency spots (a resident is a doctor-in-training) is complex and byzantine, a process overseen by a group known as the Canadian Resident Matching Service, or CaRMS.
There are traditionally two streams of applicants: Canadian medical graduates (CMGs) and international medical graduates (IMGs). But the latter category has two distinct subgroups: Canadians studying abroad (CSAs) and IMGs who are residents of Canada but graduated from medical schools in other countries. They are often referred to as internationally trained physicians (ITPs).
At the end of medical school, newly minted doctors apply to work and train as medical residents including between 2,900 and 3,000 CMGs and thousands more IMGs vying for spots every year.
Each graduate lists their preferences – the programs and institutions where they want to work. The institutions then review the candidates available and make their choices.
Graduates of Canadian medical schools have an inherent advantage because they are a known quantity. It can sometimes be difficult to judge the skills of a doctor trained abroad, given there are 3,900 medical schools of varying quality around the world.
If a student doesn’t get their first choice in CaRMS, they bump to the second, third, and so on. In 2025, there were 3,942 positions available across Canada, and more than 90 per cent of them were filled in the first iteration by new graduates from Canadian schools. After the remaining spots were filled by new IMGs as well as CMGs and IMGs from the previous year, that left only 367 spots to fill in the second iteration, with 145 filled by CMGs, 153 by IMGs, and 118 unfilled. (It’s unclear how many IMGs studied abroad.)
When all is said and done, 96 per cent of graduates of Canadian medical schools get a residency spot. Fewer than 40 per cent of international medical graduates do.
Many, beginning with Mr. Ford, will praise this “Ontario-first” approach to allocating jobs in medicine.
Last year, the province decreed that 95 per cent of seats in medical schools be reserved for Ontarians, a policy that was all show because almost all students were already from Ontario.
The new residency-application criterium is a whole different kettle of fish. Requiring the completion of two years of high school in the province is a ridiculous metric. Many Ontarians who did not study high school in the province still have deep and meaningful ties to Ontario and to Canada. They should not be treated as second-class citizens.
Besides, IMGs are a cornerstone of medicine in Canada. Almost one-quarter of our doctors were born elsewhere, and they are the only thing keeping the health system from collapsing entirely in rural and remote regions. It makes no sense to have immigration policies that actively invite medical professionals, only to see provinces like Ontario put up discriminatory barriers once they’ve arrived.
Positions in medical residency, and medicine more generally, should be allocated based on merit, not postal code. Who cares where a doctor did high school?
Mr. Ford should be ashamed. In an apparent bid to satisfy a small cadre of well-connected medical students wealthy enough to study abroad, Ontario is leaving thousands of other internationally trained physicians by the side of the road.