Introduction: The Waiting Room Paradox
For someone juggling a rare form of arthritis and a chronic kidney condition, not having a family doctor isn't an inconvenience—it's a constant, high-stakes battle. They are one of an estimated 6.5 million Canadians left to navigate a strained healthcare system alone, bouncing between walk-in clinics for prescriptions or waiting hours in overwhelmed emergency rooms for care that could have been provided elsewhere. This strain has become a national crisis.
But here is the twist at the heart of this crisis: while millions of Canadians wait for care, Canada is also home to more than 13,000 internationally trained physicians who are not working in their field. They are qualified, experienced, and already in the country, yet they are locked out of the very system that so desperately needs them.
This post will uncover the top surprising and counter-intuitive reasons behind this disconnect, exploring the systemic hurdles that prevent these qualified doctors from practicing medicine in Canada.
The Five Surprising Truths Behind Canada's Doctor Shortage
1. Canada Has a Doctor Shortage and a Doctor Surplus at the Same Time
The situation is a classic paradox. Headlines rightly focus on the critical shortage of physicians—a 2025 Health Canada report analyzing the health-care workforce estimates the country is short over 22,823 family physicians. Yet, at the same time, thousands of qualified immigrant doctors are underemployed in "survival jobs" unrelated to their profession. This phenomenon is known as ‘brain waste’—the direct result of licensing barriers that prevent highly skilled professionals from working in their field, forcing them into survival jobs. It is a staggering failure of policy and potential.
“You see the flaws in the system, you see the wait times and the shortage of doctors, and you are a doctor, and you cannot do anything about it. And we see doctors driving taxis. And that’s a confusing thing to see.”
This disconnect represents an immense loss—not just for the doctors who have invested years in their training, but for the millions of Canadian patients who are waiting for the care these professionals are ready and willing to provide.
2. A New Government "Fast-Track" to Help Doctors Has a Major Catch
In December 2025, the federal government announced a new Express Entry category designed to create a simpler, faster path to permanent residency for international doctors, with invitations to apply set to begin in early 2026. On the surface, it appears to be a positive step toward retaining much-needed medical talent.
However, the policy contains a major catch-22. To be eligible, doctors must have at least one year of Canadian work experience. This is the very paradox that traps so many: the single biggest hurdle for most internationally trained physicians is gaining that initial year of Canadian experience in the first place.
This policy is like offering a "fast-track membership conversion" to people who are already inside the gym. It benefits the select few who have already overcome the primary barrier to entry, but it does nothing to help the thousands still waiting in line outside. It streamlines paperwork for doctors who are already in the system, not the larger pool of those who are stuck.
3. It’s Not About Immigration—It’s About Licensing
A common misconception is that becoming a permanent resident is the same as becoming a doctor in Canada. It’s not. The new federal fast-track simplifies the immigration process, which is a federal responsibility. However, it does nothing to change the medical licensing process, which is controlled by the provinces. In short, the federal government can open the door to the country, but only the provincial governments can open the door to the clinic.
To get a license to practice, an internationally trained physician must run a gauntlet of provincial requirements. This includes a slow and fragmented credential assessment process, a series of costly exams, and years of supervised practice. The most significant barrier is the severe shortage of residency positions available to international graduates. In 2018, for instance, approximately 77% of international medical graduates who participated in the full match process were unable to secure a residency spot, compared to just 6% of Canadian medical graduates.
Until these complex and varied provincial licensing barriers are addressed, even the most well-intentioned federal immigration policies will have a limited impact on the overall doctor shortage.
4. Policies That Force Doctors into Rural Areas Often Backfire
To address physician shortages in underserved communities, provinces often require internationally trained doctors who secure a rare residency spot to sign a "return of service" agreement. This contract obligates them to work in a designated rural or remote community for two to four years after they are licensed.
While this seems like a logical solution, research shows it is "at best a temporary solution." These programs suffer from low retention rates, with many physicians leaving the community as soon as their mandatory service is complete. Instead of creating a stable local healthcare solution, it creates a revolving door of temporary doctors. This leaves communities and patients in a state of perpetual uncertainty, unable to build the long-term, trusting relationships that are the bedrock of effective primary care.
This outcome is not surprising when you consider the human cost. These programs have been described as infringing on professional autonomy and the right to choose where to live and work. For doctors who feel coerced into these roles, the result is often low professional and personal satisfaction, making long-term retention highly unlikely.
5. The System Appears to Favor Doctors from Certain Countries
The path to practicing medicine in Canada is not the same for all international doctors. The system contains a clear, systemic bias. Physicians who graduated from "approved jurisdictions"—such as the United States, the United Kingdom, Australia, and Ireland—often have a more streamlined process for getting licensed.
In stark contrast, physicians from non-Western regions, often referred to as the "Global South," face disproportionately high barriers. These include extremely limited caps on the number of residency positions available to them and mandatory return of service obligations that are not imposed on their Canadian-trained counterparts. This means they are not only treated differently but are often pushed into the very programs shown to backfire, creating a compounded experience of professional dissatisfaction and limiting their autonomy.
“…I think [Canada] has this idea that because you come from these kinds of countries, your knowledge is not valid.”
This systemic bias is not just a matter of perceived unfairness. It actively limits the diversity of experience and talent available to care for an increasingly diverse Canadian population, preventing highly skilled professionals from contributing their much-needed expertise.
Conclusion: Untangling the Knot
Solving Canada's doctor shortage is not simply about recruiting more talent from abroad. It is about removing the tangled knot of systemic barriers that prevents the incredible talent already living here from contributing. From paradoxical immigration rules and provincial licensing bottlenecks to coercive rural placements and biased credentialing, the system is actively sidelining thousands of physicians who could be easing the strain on our healthcare system today.
As Canada urgently seeks to heal its strained healthcare system, the most important question isn't where we will find more doctors, but whether we are finally willing to welcome the thousands who are already here, waiting to help.
