In Focus Lecture: A Bitter Pill

Speakers for the lecture

Zarghoona Wakil, Senior Manager, Specialized and Innovative Programs at MOSAIC BC.

Zarghoona is an International Medical Doctor, specialized in Internal Medicine, has a Master of Public Health degree from Simon Fraser University. She has experience in healthcare and in the settlement field in BC.

Having worked with MOSAIC BC in various capacities, she currently oversees a large cluster of specialized programs that serve diverse communities and includes various programs, including MOSAIC BC health promotion programs.

Zarghoona is involved in several local and national partnerships including BC Health Coalition, Primary Care Network, PREV Net, Surrey Local Immigration Partnership, and the Resilience BC Anti-racism Network in Surrey. She is the Chair of the board of directors of Umbrella Multicultural Health Coop and is a Co-Chair of the Steering Committee at BC Health Coalition, Co-Chair of the Community Alliance of Racialized and Ethnocultural Services (CARES) for Equitable Health, member of the Local Leadership Table for Burnaby Primary Care Network and member of the BC Community Health Centers Partnership Table. Additionally, she is involved in advocacy for innovation in healthcare services to improve the quality and equity of the healthcare system.

Damilola Toki, MD, MPH, PhD Candidate, Health & Rehabilitation Sciences Graduate Program, Western University

Damilola Toki is an internationally trained physician and a PhD candidate in the Health Professional Education Program, in Health and Rehabilitation Sciences, at Western University. She brings a wealth of experience in comparative health care systems and models of inter-professional collaboration, practice, and health professional education. Her work is housed within the space that connects research with policy, practice, and education to inform solutions to problems undermining equity in health systems and access to health care.

Rosemary Pawliuk, President of The Society for Canadians Studying Medicine Abroad. (SOCASMA) 

Rosemary Pawliuk, BA, LLB, is president of the Society for Canadians Studying Medicine Abroad (SOCASMA), a national organization which supports and provides information to international medical graduates (IMGs). SOCASMA filed legal action in the BC Supreme Court to address systemic discrimination against IMGs.  Rosemary is dedicated to bringing down the barriers to licensing in Canada for IMGs. She leads a research team which studies the organizations, accreditation, credential recognition, process, law, and rules relevant to entry into the medical profession via residency training.   She volunteers her time, knowledge, and expertise supporting the complainants in the BC Human Rights Case.

Dr.  Maureen Mayhew, Clinical Professor at the School of Population and Public Health, UBC

Dr. Maureen Mayhew’s diverse, 30-year, medical career has taken her across Canada and into Africa and Asia. She trained in family medicine at McGill, in public health at Johns Hopkins University and in research methods at the University of British Columbia. She has also completed certification in professional coaching. She spent twenty years working in refugee and immigrant health and has published on those topics. Her current interests lie in using strength-based approaches to maximize potentials. She is currently writing a memoir related to her work over a decade in Afghanistan.

MODERATOR: Tess Acton, Refugee Lawyer, MKS Immigration law

Tess Acton is a lawyer who assists clients from all around the world with their Canadian immigration, refugee, and citizenship matters. She practices at MKS Immigration Law in Vancouver and Victoria. Tess is interested in litigation matters and refugee protection, as well as complex temporary and permanent residence applications, including criminal, security, and medical admissibility issues. She holds a J.D. from the University of Ottawa and an LL.M. from the University of Victoria. Her LL.M. research focused on working with interpreters in refugee law. Tess is the Vice Chair of the Excellence in Literacy Foundation. She keeps busy outside of work baking pastries, practicing yoga, and planning road trips in her 1985 Westfalia.

Get involved with the campaign

  • Alliance for Doctors Denied by Degree
    • Encourage your organization to become a member of the Alliance
    • Become an intermediary with other organizations who might be interested in the work and the possibility of joining the alliance
    • Become a volunteer to assist with website design, podcasts, and social media etc.
    • Collaborate and/or provide support in potential funding applications to sustain the Alliance work.
  • Human Rights Case
    • Set up opportunities to build awareness in the settlement and other sectors about the human rights case and the discrimination that IMGs face (in newsletters, on your organization’s website, webinars, community dialogues etc.)
    • Explore the possibility of your organization being an intervenor in the Human Rights Case. If public interest organizations seek to intervene in support of the human rights claimants, this assists in public awareness and adds importance and credibility to the case. 
    • Provide direct or indirect help with fundraising. 
        • For example: have an option on your organization’s website to donate to the Human Rights case by setting up a link to Canadian of Paper Society for Immigrant Physicians Equality 
    • Assist with researching and collecting evidence for the areas that advance our objectives such as discrimination against IMGs, harms they have faced, brain drain; Speak up about the discrimination facing IMGs

Information for download and further reading


In Canada, the government distinguishes between medical graduates using the terms “CMGs” &  “IMGs”.  

CMGs or Canadian medical graduates refer to graduates of Canadian or American medical schools.

IMGs or International medical graduates refer to individuals that are not graduates of American or Canadian medical schools. They also consist of Canadian medical students who chose to study abroad (CSAs) and immigrant physicians. 

Thousands of internationally trained professionals are unable to qualify as physicians in Canada and enter their profession. Even though Canada has experienced a physician shortage for over a decade, these trained immigrants and refugees continue to experience difficulty with the licensure system. The problem is systemic discrimination where immigrant physicians are denied the right to apply for 90% of the jobs in Canada.

  1. A majority of refugees and immigrants lack the opportunity to utilise their education and valuable professional experience in the Canadian workforce despite being chosen through the Canadian immigration points system. 
  2. Removing and recognising systemic barriers is key to reducing the strain on the Canadian healthcare system which is currently overwhelmed with high wait-times for specialists, over-use of emergency departments and difficulties in securing a family physician. 
  3. Most importantly, there is a need to increase inclusion in the path to licensure so that internationally trained physicians have access to a more fair, equitable and transparent system.
  • IMGs have limited access to sub-specialisations compared to CMGs
    • Currently, in British Columbia, IMGs who are Canadian citizens and permanent residents can access residency training only in general disciplines: with only 52 positions available in Family Medicine; and 6 positions in 3 base specialties. 
    • In comparison, the CMGs in BC have access to 122 positions in Family medicine; and 172 positions in 29 base specialties!
  • IMGs have limited access to the residency positions compared to CMGs 
    • IMGs have a small ratio of positions per applicant. For instance, In March 2020 there were 1822 IMG applicants, of which 1400/1822 applicants were unable to access a residency position. 
    • In comparison, there were 3072 CMG applicants, of which only 25/3072 applicants were unable to access a residency position. 
  • Most importantly, IMGs are not free to train and work wherever they choose after certification 
    • IMGs are offered conditional access to practise when they sign a “return of service” contract mandated by the Ministry of Health to work a fixed period of years.
    • This interferes with cultural, religious and social ties and is an incursion of freedom, rights and mobility of IMGs.
  • According to research,  immigrant female professionals often suffer from compromised careers.
  • They face barriers such as credential devaluing as well as non-recognition which force female doctors to work in the lowest tier of the healthcare system ( for instance, a personal support worker)
  • They often have to face the demands of home/family work as well, making it an even greater challenge for them to take the time to acclimatise to Canadian culture or hone their English skills. 
  • Many female IMGs have to take on unpaid observerships as part of the licensure but as female participants they were also constrained by a lack of financial resources making it very difficult to afford day-care for their children. (Observerships are programs designed to help international medical graduates prepare for residency)
  • According to Statistics Canada, 60% of new immigrants did not work in the same occupational field as they had before arriving in Canada.
  • From 1989-1993 to 2003-2007, the percentage of women who completed residencies increased from 41% to 52% for CMGs and from 28% to 42% (791/1,879) for IMGs