Nouvelles et analyses Shut out at home, Canadians flocking to Ireland’s medical schools — and to an uncertain future Patrick Sullivan anada has a 17th medical school. C It’s located several thousand kilo- metres east of Newfoundland, and it has become a haven for Canadians who find it difficult or impossible to enter 1 of Canada’s 16 schools. The Atlantic Bridge Program, which recruits North American med- ical students for the Irish schools, says more than 100 Canadians are currently enrolled in medicine at University Col- lege Dublin, University College Cork, Trinity College Dublin and the Royal College of Surgeons in Ireland. They outnumber the first-year students at 9 of Canada’s 16 medical schools, and their total is roughly double the size of the first-year class at the University of Saskatchewan. Twelve of the more than 100 Canadians now studying medicine in Ireland These young expatriates — most are in their mid- to late 20s — appear un- And there may be reason for at least Canadians’ are more likely to be suc- deterred by annual tuition fees of some optimism. “It is difficult to pre- cessful than some others.” $30 000, high living costs, the prospect dict where we are going as far as oppor- She also notes that completion of a of huge debt loads and uncertainty tunities for IMGs [international med- Canadian residency is not the only route about their professional future. None of ical graduates] in Canada are to a practice in Canada. “If they have the students interviewed by CMAJ ex- concerned,” says Sandy Banner, execu- completed some postgraduate training pressed any doubts about the route they tive director of the Canadian Resident somewhere, they should remember that have chosen, but all have doubts about Matching Service. “I believe there will more than 700 limited licences [they re- whether they will ever be allowed to be an expansion of our postgraduate strict the location of practice and/or practise in Canada. Still, the outcry training complement in the near future, type of practice] were granted to IMGs over the country’s physician shortage and as there are no additional Canadian in Canada in the last short while.” has left many of these “Irish Canadians” grads yet, these positions will be filled All of this is good news for Ontario feeling optimistic. by more and more IMGs. But remem- natives Michael Bengough, 25, and Kim “I expect at some point to have the ber, that’s just a prediction — none of Wynd, 26, who are in the third year of a option of practising in Canada, whether this has come to pass.” 6-year program at University College I do my residency there or elsewhere,” However, support for such a move is Dublin (UCD). Odds are good that this says Jason Blair, 28, of Manotick, Ont., growing. Last fall the Canadian Med- married couple would eventually have a second-year student at the Royal Col- ical Forum, which includes the CMA, been accepted by a Canadian school — lege of Surgeons in Ireland. “I say this issued a call for an increase in the num- their respective MCAT scores were 34 because I believe there will be a short- ber of government-funded training po- and 30, both had first-class honours age of doctors, even if the government sitions from the current level of 100 while undergraduates and both hold acts now to increase enrolment. slots per 100 medical school graduates master’s degrees. Bengough had received “In the coming years, I think the to 120/100. an interview at Queen’s and Wynd was government will have to attract doctors Banner notes that there was no ex- on the waiting list at Western. from outside the country. In a sense, I pansion for the residency match that So why Ireland? “Chances were not bet on this by deciding to go to school took place earlier this month. However, good that we would both be accepted abroad. This could turn out to be she says a few more IMGs are being into the same [Canadian] school in the overly optimistic, but I am an optimist.” matched each year, “and the ‘Irish same year,” says Bengough. “Moreover, 868 JAMC • 21 MARS 2000; 162 (6) © 2000 Canadian Medical Association or its licensors News and analysis every year that we spent reapplying to from UCD in 1999 and is completing dent at UCD, replied: “On the con- Canadian schools pushed the com- an internship year at St. Vincent’s Hos- trary. I feel like I’m getting the best of mencement of our real lives — home, pital in Dublin. “The medical schools both worlds: studying medicine and family, et cetera — back by a year.” here are of tremendously high quality.” learning about another country and Maureen Keenan, 28, another third- Jason Blair agrees. “Someone said culture. I think we’ll bring something year student at UCD, offers similar rea- that for every spot in medical school in back to Canada from the Irish approach sons. She had been interviewed by UBC Canada, there are 4 qualified candidates. to medicine and life.” and was encouraged to reapply because I simply see myself as 1 of the 3 who lost But will Canada want them back? she was considered “a very strong candi- the draw. As far as the training I receive Dr. David Hamilton hopes so. date.” When she was accepted by UCD, here, I feel that it is as good as or better she decided to take that offer rather than what I would receive in Canada. Stuck in limbo between than risk rejection again. This school has been training some of Syracuse and Thunder Bay Is there a stigma attached to having the world’s best doctors for 250 years.” to attend school outside Canada? “I do Asked whether she felt there was a Even though his career is currently not feel inferior at all,” says Calgary na- stigma attached to her education, 25- on hold as he awaits word of a resi- tive Dr. James Stone, 29, who graduated year-old Sara Junaid, a second-year stu- dency in Canada, the wait is giving him “If Canada doesn’t want us, somebody else will” How did Victoria resident Ilana train in Canada have a better chance of ski will ever hang her shingle in Porzecanski end up in the fourth year of getting a residency position than Cana- Canada, even though that’s what she’d a 6-year medical program at University dian citizens who train abroad. love to do. “As an Irish graduate, I College Dublin? “Two reasons,” she “Right now, the situation is this. We would be welcome in New Zealand, says. “Mainly, they accepted me, and I cannot get residency training in Australia and Europe,” she says. “If I didn’t know when or if UBC would. Canada, except perhaps in our end up specializing, I will go to the US. And I was desperate to study medicine. province of origin.” Porzecanski says I am thinking strongly of moving there I didn’t want to settle for anything less she would have to spend 1 year estab- permanently.” than my dream of being a physician.” lishing residency, then 36 weeks doing Has the tough and expensive road Porzecanski, 28, was to medical training been probably on the borderline worth it? Porzecanski isn’t for acceptance at a Cana- sure. “I thought my problems dian school — she ended would be over once I got into her undergraduate years medicine, and life would be with a B+ average and had a perfect. But now I feel that the combined total of 26 in the problems are just starting.” 3 major components of the She has wondered if she MCAT. Since moving to Ire- should have entered another land in 1997, she has been profession such as law, which in the top 20% of her class. would have allowed her to stay Porzecanski expects to in Canada and receive Cana- owe $175 000 by the time dian financial support. But she she graduates. She receives says her attitude always about $6000 a year in fed- changes after she spends a day eral student loans, which “in the clinics. I’m so happy helps cover living expenses, Ilana Porzecanski: “Don’t forget about us.” and energized then that I’m but she is ineligible for sure I made the right choice. provincial funding because she is a clinical rotations, then write an exam “Would I do it again, knowing what medical student studying overseas. and do a clinical skills exam. “Then, I know now? Yes. All of the Canadians Her tuition costs $28 000 a year, only the top 4 candidates get to do a 6- here are optimistic that things will work while living expenses amount to $1400 month pre-residency rotation. Then, out in the end, because if Canada does- a month; her interest payments cur- only the top 2 candidates are offered a n’t want us, somebody else will.” rently total $350 a month. She is not 2-year family practice residency.” (She Does she have any message for sure if she will ever practise in Canada, outlines her own proposal in a letter to Canada’s doctors? “Don’t forget about where both her parents are physicians, the editor in this issue. — Ed.) us,” she says. “Give us a chance to and is bitter that foreign nationals who So odds appear slim that Porzecan- come back to Canada to train.” CMAJ • MAR. 21, 2000; 162 (6) 869 Nouvelles et analyses a chance to spend time with his wife Paras Naik, MD: How Scotland produced and 2 young children and to reflect on the differences between medicine in Canada’s youngest physician Canada and the US.