Ethical Recruitment of International Medical Graduates

Timely access to health services is one of the most significant challenges facing our health-care system. Increasing the number of physicians practising in Ontario, including attracting international medical graduates (IMGs), is one of several strategies being used to help address issues around timely access to health services.

Access to care issues are not unique to Ontario; physician resource limitations affect many jurisdictions. Many developing countries are facing even greater health-care challenges than Ontario. It is important that all recruitment of IMGs occurs ethically.

The College is one component of a complex health-care system. The College’s primary role in improving access lies in its statutory function of registering physicians to practise medicine in Ontario. We are committed to finding creative ways to address physician resource needs without compromising registration standards, including developing strategies to provide greater opportunities for physicians to qualify to practise in Ontario.

In addressing Ontario’s physician resource needs, the College believes the following:

• Ontario’s health human resource strategy should balance the production and retention of domestic graduates with the proper engagement  IMGs, in order to meet the health-care needs of Ontario patients.
• IMGs are valuable contributors to the Ontario health-care system. Welcoming IMGs has been and must remain an important component of Ontario’s overall physician resource strategy. Notwithstanding this, Ontario should not be overly reliant on IMGs as a solution to our physician resource needs.
• While physicians should not be hindered or limited in their freedom to choose where they wish to live and work, international recruitment activities should not disadvantage other jurisdictions experiencing physician shortages. Any recruitment strategies should strive to balance physicians’ freedom of mobility and the impact physician mobility may have on the source jurisdiction.
• Of particular concern is the “active” recruitment of physicians from developing countries. “Active” recruitment is the systematic targeting of physicians from a particular area or jurisdiction with the intention of enticing them to relocate when they may not have otherwise done so. The College does not consider facilitating access for physicians who wish to immigrate to Ontario, or repatriating domestically or internationally trained Canadian physicians, to be active recruitment.
• To be ethical, active recruitment efforts must employ strategies that are cognizant of physician resource needs in source jurisdictions and adequately protect those jurisdictions and the recruited physicians.
• Collaboration at the local, provincial, national, and international levels is necessary to ensure principles of ethical recruitment are established and consistently applied. This should involve the coordination of efforts to protect and assist source jurisdictions with vulnerable health-care systems; including, where appropriate, establishing government-to-government agreements with these jurisdictions, with the goal of minimizing adverse effects on the source jurisdiction. Consideration should be given to establishing terms for compensating source jurisdictions for recruited physicians.

The College is committed to working with the Ontario government and other stakeholders to help ensure that recruitment of IMGs occurs ethically, and to facilitate entry to practise for physicians who meet the standards to practise medicine in Ontario.

Approved by Council June 2007