From Doctor to Uber Driver: The Struggle of International Medical Graduates in Canada
Dani Qiao
December, 2024
On a chilled autumn night, Khursheed Anwar Alam pulled up to the intersection of Wateroo Street and King Street. He knew there was a bus stop for intercity buses. As an Uber driver, this was his routine – waiting at the destination to pick up his next passenger, working day after day to make ends meet.
It was just another ordinary night. He drove through London’s streets, weaving through the city’s familiar roads. A young woman stepped off the bus and into his car.
London is a beautiful city. It’s vast enough for an Uber to race down Sarnia Road for miles under the night sky, yet crowded enough that Khursheed, who travelld across the sea to come to Canada, hasn’t been able to find a job in his professional field.
In his hometown Pakistan, Khursheed was a doctor. Here in Canada, he’s a full-time Uber driver and security guard.
His passenger today, that young woman, was me.
During that late-night ride, we had some casual small talks. When I mentioned I was studying journalism at Western, Khursheed glanced at me in the rearview mirror and said, “You should write a story about IMGs.”
IMG stands for International Medical Graduates. They are Canadian citizens or Permanent Resident of Canada who earned their medical degrees abroad. Khursheed was one of the thousands of immigrants in London with training and experience as doctors yet find themselves stuck in low-paying jobs, unable to make use of their medical skills.
Khursheed obtained his Permanent Resident and came to Canada in 2013. Before immigrating, he earned his Bachelor of Medicine degree from the University of the Punjab’s Rawalpindi Medical College in 1991. For more than two decades, from 1991 to 2013, he worked as a practicing doctor at Alam Hospital, a private facility in Pakistan, where he served as a family doctor and monitored pre- and post-operation care.
Disappointed by Pakistan’s laws, Khursheed decided to move to Canada, hoping for a better future. But the reality was far from what he had imagined. He spent a month working at Pizza Pizza and took up a job as a security guard later.
His wife, who was a gynecologist, sold clothes to make a living.
After one year in Canada, Khursheed went back to Pakistan, returning to his job of a practicing doctor for another four years. After that, from 2019 to 2021, he served as second supervisor in the Distric Headquarter Hospital, in Khushab city.
Now as Khursheed returned to Canada again, he decided not to go back to the position of physician, “if the pathway is not changed”.
The pathway for IMGs like Khursheed to practicing medicine in Canada is exceptionally challenging – not just because of the complicated process but also due to the eed opportunities available.
To qualify as a licensed physician in Canada, IMGs must first prove their language proficiency and undergo an international credentials assessment, conducted by either the Medical Council of Canada (MCC) or a provincial medical regulatory authority, to verify whether their medical education and training in home countries meet Canadian standards.
Once these steps are completed, IMGs must pass Part I of the Medical Council of Canada Qualifying Examination (MCCQE) as well as the National Assessment Collaboration (NAC) Exam to be eligible to obtain their medical license or apply for the Residency Match.
When they are matched with a residency program, they will perform medical practices under supervisor for usually three to seven years, before they pursue a career in hospital or clinic.
And matching with a residency program is where the biggest obstacle lies: the limited residency positions for IMGs.
“In 2013 and 2014, I met at least 10 of [IMGs] who has passed the exam, but were not enrolled in the program,” Khursheed recalled.
Today, the problem remains.
According to the 2024 CaRMS forum, only 425 spots were available for the 2153 IMG registrants on CaRMS, leaving more than 80 per cent of IMGs in Canada unable to secure the residency placements necessary for licensure.
In comparison, Canadian Medical Graduates (CMG) were provided with a quota of 3280 positions, while the total number of CMG registrants on CaRMS was only 3147 – falling short of the quota. The Canadian health care system privileges students who went do Canadian medical schools, turning away a majority of foreign-trained doctors.
For IMGs like Khursheed, who graduated years ago and was previously rejected by residency programs, the chances of re-entering the healthcare system remained weak. In 2024, only 34 per cent of IMGs who graduated more than three years prior secured a residency match. Notably, of the 2513 IMG registrants, over half had completed their medical training more than three years ago.
“ I feel left out,” said Khursheed. “From 1991 to 2023, I had been practising some profession day and night, 7 days a week… I am no more in that.”
When I interviewed Khursheed at a coffee shop, he seemed to be waiting for the right moment to let it all out. Aside from a brief pause when I asked him to clarify a term, he spoke for ten minutes straight, recounting his experiences since leaving his homeland. His words, filled with frustration about his current struggles and resignation about the path his life had taken, poured out.
“Just to get an easy going, I will work hard and try to prosper in the opportunities that I have been offered in Canada.” said Khursheed. “But I wish that hope that someday this merging system will take a shape, if not in my life, but for the coming IMGs.”
While IMGs struggle to find their place in Canada’s healthcare system, the country continues to face a critical shortage of physicians. According to Labour Market Data from Government of Canada, the demand for general practitioners and family physicians significantly exceeded the supply between 2019 and 2021. Reports showed that more than six million Canadians currently don’t have access to primary care physicians.
The future doesn’t look much better. Estimates suggested that between 2022 and 2031, around 40 per cent of new job openings for general practitioners and family physicians – approximately 19,500 positions – will remain unfilled. The demand for IMGs has never been higher.
And people rely on IMGs more than they realize. According to Canadian Institute for Health Information (CIHI), about one third of physicians in Canada are internationally trained.
However, Canada’s licensing and evaluation system for IMG is no easy task. Changes to the IMG licensing process are complex and difficult to implement.
Wenday Yen, the Executive Director of Touchstone – a non-profit organization working to streamline the IMG integration process in family medicine – explained the challenges: “This is a complex systems level question that is more than just IMG residency spots through CARMs; other factors include many physicians not choosing family medicine as a specialty, not producing enough domestically trained doctors, aging population, etc.”
Even so, Canada’s worsening healthcare situation underscores the pressing need to make it easier for IMGs to enter the system.
Ongoing efforts were made to help IMGs settle and obtain jobs that match their skills. In partnership with Touchstone, the Schulich School of Medicine and Dentistry admits 60 to 65 IMGs every year, providing learning programs for them to practice the competencies necessary for successful training in Ontario.
“Through competency-based programs, we offer curriculum, orientation, support and services to prepare participants from various training backgrounds for a successful transition into residency training,” explained Cynthia Fiazo, Media Relations Officer at Schulich.
Wendy Yen expressed her admiration: “I am always amazed that candidates shut down practices in their home countries and are willing to move their families to the other side of the world to start a new life in Canada.”
While meaningful progress has been made, hundreds, if not thousands, of IMGs like Khursheed still working jobs like pizza delivery or driving for Uber. If we hadn’t had the first conversation, I never would have guessed that the man in the oversized sweater behind the wheel was once a skilled doctor.
Even after several conversations with Khursheed, I keep coming back to what he told me during that late-night ride. He said, he loves Canada and he wants to contribute. Not in the way of driving Uber.
Khursheed has been waiting for ten years for the system to change, for a chance to return to the profession he trained so hard for.
How much longer will he – and others like him – still have to wait?