Canada has a doctor shortage, while thousands of foreign-trained physicians living here still face barriers

This story is part of Welcome to Canada, a CBC News series about immigration told through the eyes of the people who have experienced it.

Ismelda Ramirez says she never expected to swap her white doctor's coat for a McDonald's uniform. Despite training as a family doctor in the Dominican Republic, she ended up working at the fast-food chain for eight months after she moved to Quebec in 2022.

She's one of thousands of internationally trained physicians, or ITPs, living in Canada, the vast majority of whom are not working as doctors, according to advocacy groups.

"A lot of us international medical doctors, we are willing to work hard and to do what it takes just to get to our final goal," said Ramirez.  

Despite changes to the process aimed at increasing the number of internationally trained doctors working in Canada, ITPs still face significant hurdles including navigating a complex system, a lack of opportunities and requirements that force some to temporarily leave the country.  

The Canadian Medical Association (CMA) says more than 6.5 million Canadians do not have access to a family doctor, a number that is only growing. 

"We saw a lot of burnout during COVID, lots of physicians either decreasing their hours or leaving the profession completely," said CMA president Dr. Joss Reimer, adding many doctors are also nearing the age of retirement.

"So there's higher demand for physician care and fewer of us being able to provide the care," she said.

It's unclear exactly how many ITPs are living in Canada, but advocacy groups in Ontario, Quebec and Alberta tell CBC News there are more than 5,000 internationally trained physicians in those provinces. The groups say the vast majority are not working as doctors.

The first complication they face is navigating a difficult process, Reimer says. 

"As the president of the Canadian Medical Association, I find it challenging to understand what the different options are and how they work," she said. 

All 13 provinces and territories in Canada have separate licensing requirements. Those requirements can also vary depending on where the international doctor trained. 

Depending on the province and path they choose, ITPs could take up to four initial exams, all while trying to build a life in Canada, get a job and pay bills. 

The tests can be expensive, with one costing $3,255.