Miller Makramalla wants to help with the province’s doctor shortage. He graduated from medical school in 2017 and has been trying to land a residency spot since then.
“Basically, when you graduate from medical school, you get a piece of paper that says: ‘Congratulations, you’ve graduated from medicine,’ but you can’t really do anything with that,” said Makramalla. “You have to go through a postgraduate process of residency.”
Students applying for residency programs do so through the Canadian Resident Matching Service (CaRMS). They upload their qualifications and resume and then apply to specific programs. Programs will invite some applicants for interviews and then both applicants and programs will rank their preferences.
“It essentially optimizes all of the decisions that are made by the applicant and the faculty programs, and then it determines the best outcomes given all those decisions,” said John Gallinger, CEO of CaRMS.
Although Makramalla lives in Nova Scotia, he is applying as an international student because he completed his medical school at St. Mathews in the Cayman Islands. So far, he has not been matched with any residency program — and he’s not alone.
In the first iteration last year, 93 per cent of first-time applicants from Canadian schools were matched, but only 46 per cent of international medical graduates got matched.
When it comes to students who had already previously applied, like Makramalla, the numbers were lower. Sixty-four per cent of Canadian students who had applied before got matched, while just 18 per cent of international students did.
“The supply and demand is kind of backwards,” said Makramalla. “There’s way more demand, and there is supply of doctors, but for some reason we can’t match those up together.” ‘
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Makramalla is going through the process again but is unsure why he has been unsuccessful before. He has completed all the tests and requirements to practice in Canada and has even done some rotations here.
“One in family medicine and one at the IWK doing my pediatrics GI,” he said. “Both of those attendings thought I did an exceptional enough job that both of them have supplied me with two recommendation letters.”
Health Minister Randy Delorey has acknowledged that students across the country have complained about the number of residency seats available.
“That’s why Nova Scotia, which is the only province in the country, to my knowledge, that has added 10 additional seats in family medicine and 15 seats to specialty program,” he said.
“That’s at a time when, even before we put those in, we were at or above the national average to the ratio of residency seats so we far exceed doing our share for making available seats for training opportunities.”
But Makramalla says at a time when the province is facing a doctor shortage, there shouldn’t be so many missed opportunities.
“It’s not just me. There are hundreds of people in my position, and unfortunately they end up going to the States or England or Australia to do their residences, and at that point, why come back?” he said.
International students sign service contracts
While many universities limit the number of residency seats for international graduates, there are some benefits for taking on more. Some provinces, including Nova Scotia, require all international grads to sign a return of service contract for their residency. That means that once they complete their residency, the province will assign them to a location where they have to practice for two years.
Makramalla points out that if he was accepted here, he could be assigned to practice in a rural area that has difficulties recruiting doctors.
“It’s up to them to decide where they want to put me, which I’m completely OK with,” he said.