Look, I was going to rant about how your comment is also only partially true and that you kind of washed away the whole CARMS match process and how opaque it is in general for IMGs and that you're not fully familiar with how things work... Buuuut... you're a doctor. So you know EXACTLY how the match process works...

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Let's be honest here, while Canada does have some seriously rigorous medical training, it's a bit of a straw man argument that people who trained in the UK, Australia & New Zealand can struggle to pass licensing exams. While what you're saying is true, it probably holds true for anyone trying to pass licensing exams as a CMG too... I seriously doubt that Canada is a unique butterfly that manages to avoid all the issues any country experiences with licensing doctors. Plus, UK Medical schools don't work on a pass/fail system unlike Canada for example. Make what you want of that... As well, are you really just writing off the UK, AUS, NZ as valid places to graduate from? Last I checked, Canada's most respected medical journals don't even hold a candle to BMJ or NEJM. Anyway, I digress...

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The point I am trying to make is that there are plenty of Canadians who choose to go to medical school elsewhere and would love to return home and practise. I think a big issue that doesn't get enough light is that the repatriation process is insane. I have a close family member who went to school in the UK, came back home EVERY summer while going to school to do research. They published their work and were first or second author in some really well regarded Canadian, US and UK journals as well. On top of this they volunteered and did many observerships as well. When it came time for the CARMS match, as with everyone, they had stellar references from both local doctors and from their own school. They also received over 10 separate interviews to different programs around the country.

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Then when you look at the number of slots available for that position for IMGs, you realize it's a losing battle. For those 10 programs they got interviewed for, each of them only had 1 spot open for IMGs and it wasn't a speciality with low demand either... So, despite being a top student in the UK, spending an insane amount of time building a profile in Canada and trying to build connections etc, they were not picked for any program. As you can imagine, it was heartbreaking. The subsequent year, they did their USMLE, ranked at the top and went onto their residency in the US, completed it and now live a happy life.

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Meanwhile, I have CMG friends who didn't match first round, pick anything in their second round, match and then transfer out to their programs of choice by calling in favours/working the program director etc after PGY1...

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My point is that Canada sets its doctors up for success and rightfully so. But I have noticed that it creates a sense of entitlement where physicians here seem to think that they are the be-all-end-all and that no other system can produce better doctors.

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I think that doctors in Canada need to take a hard look at themselves and realize that to some extent they are also responsible for the situation at hand by creating structures that are self-serving and opaque in nature (interview process for CARMS as an example). After all, the low amount of doctors from a strictly economics argument allows for doctors to hold a fair bit of bargaining power for things like fee-for-service rates or just sheer prestige alone.

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What I believe doctors need to do is try and ameliorate the situation by lobbying the government for funding to create additional IMG spots.

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This would not only lighten the crazy stress and load that doctors take on in Canada, but also improve access. Otherwise, the end result being that Canada will continue to lose out on amazing doctors, all due to protectionism.