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Getting into Canadian medical schools requires a stellar GPA, high exam scores, extracurriculars, lots of money, and the rest is up to admissions boards. Photo by: Bermix Studio.

Why is it so hard to get into Canadian medical schools?

Strain on the healthcare system creates medical school bottleneck

By Tia Sacks , in City , on April 29, 2024

Spring marks another cycle of the Canadian medical-school application process for over 13,000 aspiring doctors. Of this applicant pool, only about 3,000 will be accepted, underscoring the extraordinarily narrow funnel for those aspiring to become doctors. On average, only 7.5 per cent of applicants will be accepted to Canadian schools, versus 36 per cent of applicants who apply to American schools.  

As the Canadian doctor shortage continues, the main question I hear in conversations with applicants, parents, and friends is: Why? Why are these odds so unfavourable? Why is getting into a Canadian medical school so hard?

There is clearly an issue where we have too few doctors and lots of willing, would-be physicians not getting accepted into one of the 17 Canadian medical schools. Some will find other pathways; others will continue to apply in each cycle. 

In answering these questions, we must look at the system as well as the application process itself. 

There are so few spots in the first place 

In short, training doctors in Canada is extremely expensive. Although each student pays tuition, provinces end up making a larger contribution to their education costs and the school itself than the students do.

“It takes six to 10 years from the start of medical school to practicing as a doctor in Canada,” says Dr. Harry Azinger, the president of the Resident Doctors of B.C., and the government invests large sums of money to get each student to that point. “That can be a hard thing to plan for.”

Each province must determine how many applicants schools can admit based on their educational and financial capacity, as well as the needs of the future physician workforce.

After a student has been admitted, they will spend their first two years in lectures and small-group sessions. The student must subsequently fulfill two years of what is called clerkship – akin to a rotating internship within various physician specialities, to give them clinical exposure. 

In the second-half of medical school, students learn under physicians in clerkships. Photo: Freepik

The issue here is there are only so many working physicians with the time and resources to take in students while the healthcare system continues to be strained and doctors are overtaxed.

“It takes time to teach, and that’s time they are not seeing patients, doing paperwork, etc.” said Azinger.

However, one part of the process that doesn’t have the same bottleneck is the medical residency stage. During this two- to six-year period, graduates learn their speciality and work as independent physicians while receiving a salary. They are matched into positions based on a mutual selection process, where graduates rank their top programs and the programs do the same with the students.

Although residencies require federal funding and a proportionate number of open spots within the healthcare system, Azinger explains there is now “a healthy amount of residency spots compared to medical students, so students not matching is much less frequent.”

But, in order for Canadian medical schools to take in more students, provinces must ensure that educators, clerkship and residency programs are equipped to handle the influx, which is a difficult thing to measure.

Varying application requirements

With an already limited number of school options in Canada, school-specific application requirements make the prospect of admission even more challenging.

“Even within my own province, I felt like I had no chance,” said Bayley Levy, a clinical research assistant at Sick Kids Hospital. She grew up in Toronto wanting to be a doctor, did well in school and earned a master’s of science in community health. In Ontario, there are six medical schools, but because of the varying application requirements, she is only eligible to apply to three. She’s currently awaiting answers from her second round of applying.

Western University in London and the University of Ottawa do not take applicants who took a reduced course load (fewer than five credits per term each year) during their undergrad. In Levy’s case, she took a reduced course load over the span of five years because of her ADHD symptoms, and there were no pathways for her to apply with disability consideration.

McMaster University in Hamilton and the University of Toronto allow these students to apply and look more at overall GPA. Ottawa also has prerequisite courses that students must complete to be considered.

University of Toronto is one of two schools which allows students to apply with a reduced course load and personal essays. Photo: Joydeep Pal

“Do you take a course you know you won’t do well in to apply to one school, or do you get rid of that school, know you can’t apply there, and take something else to better your chances at other schools? You’re constantly having to make this kind of cost-benefit analysis,” explains Levy.

In terms of the exam that each student is required to take as part of their application, the MCAT exam, each of the four sections in the test is looked at differently by each school. One point in one section could make or break your ability to apply to one. The sections are biological and biochemical foundations of living systems, chemical and physical foundations of biological systems, psychological, social, and biological foundations of behaviour, and critical analysis and reasoning skills. It takes between seven and eight hours to complete.

The University of British Columbia requires a minimum score of 124 on each section of the MCAT, whereas McMaster University only looks at the critical analyses and reasoning section which must be at least a 123. 

Applying out of province was out of the question for Levy, as the chances of admission as an-out-of-province candidate are more rare. For instance, UBC medical school only offers 10 per cent of their seats to out-of-province applicants. Applying to a larger number of schools is highly costly, on top of all other application expenses.

Applying is expensive

Applying to one medical school can cost anywhere from $75 to $345. That is excluding other province-specific fees and the costs for taking the MCAT and a second required exam, called the CASPer exam.

To apply to three Ontario medical schools, Levy paid about $1,000 in fees. And this is not a one-stop shop. Those who don’t get in during their first application cycle have to pay this price all over again each time they apply.

The MCAT itself costs about $500 total to complete and often requires preparatory courses and tutoring for many applicants. The CASper exam, which assesses personal and professional characteristics, is approximately 90 to 110 minutes and is another additional $50.

“I took an MCAT course and used a tutor when studying for the MCAT. This was particularly helpful as it was very difficult to know where to start with the prep. However, I am very aware that this is not something accessible to all applicants and is a significant barrier in the process,” says Abbey Tafler, a first-year medical student at the University of Toronto.

These courses and tutors can cost thousands of dollars depending on the length of study. Preparatory books that cover every section cost roughly $300. Students with more time to study and more resources have an advantage over those who must work to pay their costs of living.

Personal Character Requirements 

Most Canadian medical schools require applicants to demonstrate that they have participated in  extracurricular activities like volunteering, research, or leadership positions. 

Ontario schools require an autobiographical sketch which is a snapshot of an applicant’s extracurricular activities which demonstrate “an ability to determine needs in your community and a willingness to play a part in filling those needs,” according to the Ontario Universities’ Application Centre. This is the portion where applicants can provide admissions boards with further insight into who they are. 

The only catch is that they can only do so in 150 characters or less. “

You adequately can’t explain explain what you did,” said Levy. “U of T is the only school that takes essays, but no other school gives you a chance to explain yourself.” 

Canadian medical-school applicants are expected to demonstrate they know how to respond to the needs of others through their extracurriculars. Here, volunteers are donating food during the coronavirus pandemic. Photo: Joel Muniz.

While Dalhousie University in Halifax used to require essays, they now only have applicants complete five short answer questions where they can use 1,700 characters which is approximately two paragraphs to explain their non-academic attributes. 

Students applying everywhere else in the country must seek and fulfill these roles over the course of their life, but are only able to write about them in one to three sentences.  

The University of British Columbia only allows 350 characters in these descriptions, while asking applicants to explain experiences that “showcase intentional, genuine concern for others, demonstrated by long-standing volunteer commitments or employment in a caring industry.” The school says they are looking for students who exhibit “motivation, social concern and responsibility, creativity, scientific and intellectual curiosity, attitude toward continuing learning, maturity, integrity, and realistic self-appraisal, among other qualities,” within this section. 

“I think it can be hard without amazing statistics to make yourself stand out,” said Tafler about these requirements. Applicants must prove that they have the life experience and the character attributes to take on the role of a physician within these character count limits. Canada differs from The States, whereas, American medical schools require a personal statement in the form of a one-page essay where applicants can explain why they want to go to medical school. 

Alternate pathways

For many Canadians, applying overseas is an alternative particularly in Ireland. Irish medical schools admit large numbers of Canadian applicants.

“Half of the program is Canadian,” said Shayna Mooljee, a first-year medical student at the University of Limerick, which has 170 students in the program. “They made it very easy for us (Canadians) to apply here.”

The University of Limerick held its interviews for overseas applicants in Toronto and Vancouver, and applicants from the United States travelled to one of these Canadian cities. Moolijee believes the decision to have them in Canada is deliberate, as they want to accommodate and target Canadian applicants.

The application is set up to be user-friendly, as the Atlantic Bridge portal for Irish universities allows people to apply to multiple medical schools within the country at the same time. “It’s one application that you write, and then Atlantic Bridge sends off your application to the specific schools that you choose. It was the easiest application to write over Canada and The States” said Mooljee.

However, going this route poses a significant risk for students. When it comes to getting a residency spot upon graduation, only the leftover spots unfilled by Canadian graduates are offered to international medical graduates. Those from a Canadian school in any province get to apply for residency spots first.

“There are a few exceptions that have extra dedicated international medical graduate residency seats, including family medicine and pediatrics,” says Azinger. International graduates seeking a specialized residency spot are less likely to succeed. 

“I’m not the only one that’s gonna have that problem coming back to Canada,” said Mooljee. “It’s nice that you can feel like you’re in the same boat as so many people and that you’re not alone.”

What now?

In the last couple years, Canadian provinces have taken pivotal steps to support the medical school system across the country.

Most recently, funding from the B.C. government for a new medical school at Simon Fraser University in Surrey has been confirmed with plans to open its doors in 2026. B.C. also rolled out plans last year to increase UBC medical school class sizes and created 88 new residency seats at the UBC faculty of medicine.

A new medical school at Simon Fraser University is scheulded o open its doors in 2026. Photo: Ujjwal Arora

Last year, the Ontario government invested $33 million to add 100 undergraduate medical school seats and another 154 postgraduate medical training seats that are prioritized for Ontario residents, bringing the total number up to 1,637. This plan builds on an expansion in 2022, where $100.8 million was invested to accelerate and grow medical training seats by 160 undergraduate and 295 postgraduate medical students. The province has also announced the development of a new medical school at Toronto Metropolitan University.

Additionally in Nova Scotia, the provincial government announced their investment of $58.9 million towards the development of a new medical school at Cape Breton University. In P.E.I, the construction of a new medical school is underway at the University of Prince Edward Island. 

In efforts to create a more equitable process, Queen’s University recently introduced a lottery for applicants who meet a certain GPA and MCAT score threshold to get chosen for an interview. They believe this addition will help level the playing field for those applying from lower socio-economic backgrounds by setting aside eight per cent of their spots for those admitted by the lottery. While this may give students who did not perform as well academically a chance to be considered for admission, it does not address the issue of the application expenses, or the limited number of admitted students.  

With this influx in funding, more medical schools being built, and new admissions pathways, there may be a glimmer of hope for future Canadian medical-school applicants, as long as clerkship and residency programs also follow suit in these expansions.

But until then, aspiring doctors in Canada must grapple with the challenges of the system itself before they face the challenges of working as a doctor.