In this article, Navid shares his experience of how he became a resident physician through the International Medical Graduate program at UBC.
Getting into medical residency is very difficult, even for local Canadians. As an international applicant, did you face any additional challenges going through the process?
For most applicants I know, language is the biggest challenge. My English was pretty good before I came here to Canada, so it wasn’t an issue for me, but I see language barriers make even basic tasks a major problem for many applicants. If you know English, good; you can move on to other challenges, to the next steps. But there are so many people who are stuck on the first step because of language difficulties.
For myself, the most challenging thing was proving my qualifications. Even though I practiced as a physician in Iran for several years before coming to Canada, I had to go through so many qualification exams and assessment programs. Because of that, money became another major challenge. All these exams are very, very expensive, and of course you are not qualified to work as a doctor here so you don’t have a doctor’s income to overcome all these financial obstacles. You have to find some job or else you won’t have enough income, but you are also very busy with your exams so it is really hard to balance your time. And if you manage to pass your qualifications, you have to pay many fees to apply for medical residency programs. Even if you are lucky enough to get an interview, you have to travel around the country for those interviews, and that will cost you a fortune as well.
Another challenge for me was having to work in a general, unskilled job outside of my career to keep myself financially afloat. It ended up being a good experience for me because I found very nice friends through that job and it improved my communication skills by helping me become more familiar with Canadian culture. So it was very helpful in that sense, but sometimes you get frustrated when it feels like your skills as a doctor are wasted in a job that anyone can do.
Another challenge for many people, especially those who come here alone, is that they don’t have any friends or family members who can support them here. Because I am an independent person, and of course my wife was here with me and was very supportive, this was not an issue for me. But for many others, suddenly losing all the support they were receiving back home can be a big challenge.
One last thing I remember from that time was all the negative advice I heard from others who didn’t make it. They kept telling me that this is impossible. It doesn’t seem like a big deal but actually it was, because I believe at the end of the day the only thing that kept me motivated was hope. I hoped that after all these challenges, all the hard work that I put in, and all the sacrifices that I made, I hoped that I would eventually make it. This last year was actually the most challenging year of my life, but it was the most rewarding one too.
What are your thoughts on medical education and healthcare in Iran versus in Canada?
The medical system and medical education in Iran and North America are relatively similar because the medical system in Iran was copied over from the US by the previous generation of Iranian doctors who trained in the States. Both Canada and Iran follow evidence-based medicine and use up-to-date studies for choosing methods of treatment and diagnostic techniques, so in that regard I believe the two countries are very close. But one thing that I found very different in the education is that the ethical aspects of medicine are emphasized a lot in Canada. Here in Canada, we spend a lot of time on bedside manners, communication, skills with the patient; so in a nutshell: patient-centered medicine. We also receive specific training on how to interact with multidisciplinary teams, which includes nursing, rehabilitation, occupational health, and palliative health. In Iran, medicine is still more traditional, more paternalistic. Iran is moving away from that model but it’s still behind Canada in that case.
One other interesting difference is that here we receive special training on how to care for vulnerable populations such as youths, First Nations, homeless people, people with addictions, people with different sexual orientations, and other people who may face challenges in receiving good healthcare. It can be very hard and frustrating working with these patients. You can do your very best to give care to them, but at the end of the day instead of thanking you, they might start cursing at you instead and go back to doing high-risk behaviours. So you really need to have special skills working with them. Without specific training and direct experience working with them, I believe we would fail these patients. You can also categorize of this training as patient-centered medicine because you learn how to really pay attention to what these different populations need.
You mentioned that you were working in an unskilled job while you were applying for medical residency. Can you tell us more about that experience?
This is something I really want to share with other international applicants. Many people come here and they struggle with financial problems. I was working in a very general, unskilled job that paid just above minimum wage while I was studying. I did a lot of overtime too. Some applicants come here with good financial status, and so they think they should sit at home and just study, study, study, and focus only on their exams. That’s not the best way to do it. Even if you’re fortunate enough to not need to work, you should still go out and be active, because it’s not just about the money; you also need to know how to build relations and build your confidence in this country.
In the beginning, to be honest, you don’t know if you can integrate. Can you communicate and work with other people? How do they like you? Do they accept you? Once I went out there and started working, I realized that there are people in this society who like me and accept me and trust me and believe in me. And now that I’ve started working with patients, I feel more comfortable and confident about treating them because I improved my communication skills, so even today I really feel the benefits of being active. Medicine is all about communication and making relationships with your patients, especially for family medicine. So that’s why I believe that working, volunteering or doing research, even if it’s only for a few hours every week, is very good. It will make you more confident about communicating with others, which is a skill you can’t learn from reading textbooks at home all day. And if people have problems with English, being active will help with that too because learning English is not just about going to class.
Some people say that it’s too hard to study and work at the same time, so I always try to share my experience to new applicants to give them hope and show them that, no, it is possible. I did it, so others can do it too. And if you’re lucky enough that you don’t need to work, don’t waste your time. Don’t take your sweet time and think that you should do your exams in five years. You’ll never make it like that. You need to challenge yourself to achieve your goals. It’s not easy but it’s possible.
Any advice for international applicants who are trying to get Canadian medical residency?
First of all, before you start applying or even before coming to Canada, seek and obtain as much information as you can. Some people just come here and get surprised in the middle of the application process. They go, “Oh! I should do that too?” Some other people come here and they apply and then they realize, “Oh, this is not what I wanted. I actually wanted this or that.” You should be coming here with wide open eyes and not have any doubts when you apply for residency. If you have any doubts, you’re not going to be sure about things; you’re not going to work as hard as you can with 100% power. You should be motivated and hopeful and determined the whole way through. So I believe first of all, information, information, and information. This is the most important thing.
In addition to having information, people should also have a good plan. They should start planning way ahead before coming to Canada. They should have an approximate idea of when they’ll take their exams, when they want to apply to residency, and so on. I know some people who came here without a plan and they say, “Okay, I’ll the first exam”, but then they take their sweet time and it honestly took them three years just to finish that first step. You need to make a good timeline that helps you move quickly and challenge yourself.
The third thing I want to say is, hard work and motivation are essential, but at the end of the day you need luck because the system is not always fair. Whether you make it in or not can be decided by something you have no control over, like how nice your supervising physician is when they write your recommendation letter. And there are very, very limited spots for foreign graduates in Canada so you should be realistic about your chances. So my recommendation is that you should have a Plan B. For example, if you don’t make it in, maybe you’re okay with working in a related field in medicine or doing a PhD in neuroscience or some other research. For me, my Plan B was to practice in the US. Some people may apply for Australia instead. Of course, you want Plan A to succeed, but it’s not bad to have a Plan B because then you can say to yourself, “Okay, if this doesn’t work out, I still have my Plan B.” Then you can keep going without being stressed about failing.
And lastly, and this is something I’ve already mentioned, stay positive. This is a very challenging process and the only thing that will keep you going is hope and motivation. You should be realistic about how hard this is and that your chance of success is not that high, but if you’re determined to do it, now you need to stay motivated and hopeful. If you lose hope at any point, you’re not going to make it. And challenge yourself, because the more you challenge yourself, the more you realize your capabilities. Like I said, it’s a tough process but you will be very joyful if you make it, because then you’ll understand that, “Oh, I have these skills and capabilities. If I can do this, now I can do anything.”
Navid was a practicing physician in Iran prior to coming to Canada. His portfolio includes treating patients in a cancer ward, a military base, a rural clinic, and a community hospital, as well as conducting original medical research.