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Professional Journeys of International Medical Graduates in Quebec: Recognition, Uphill Battles, or Career Change


In Quebec and Canada, immigration policies are designed to attract “the best and the brightest.” Once migration occurs, however, the “brain waste” is challenging. This research focuses on the professional trajectories of international medical graduates (IMG) who migrate to Quebec. The main goal is to understand why certain individuals of a similar occupational group can easily access the doctoral profession while others cannot. Following a qualitative approach, and stemming from IMGs’ perspectives, this article explores the interplay of economic, social, and symbolic resources in a context of highly fragmented institutional resources and protectionism. We are critical of the individual-centered approaches that ignore social norms and constraints. If migrants are free to choose their paths and manner of integration, the “human capital” approach is limited in explaining the heterogeneous pathways within the same professional group. The current structure for professional recognition places unusual constraints on IMGs, whereby some encounter more obstacles than others. The “battle” for professional recognition takes shape in a highly competitive context, one which—although presented as a neutral process—is underlain with ideological, relational, and subjective currents.

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  1. The IMGs in our study are all immigrants who hold degrees from outside Canada and the USA. They were recruited from overseas by institutions in Quebec or immigrated without a confirmed job beforehand.

  2. i.e., “social recognition of the group, of the place it occupies and the value of this place within a given milieu” (Fortin and Renaud 2004: 35).

  3. Having an official letter of employment along with the sponsorship of an institution does not exempt individuals from difficulties (Blain et al. 2012). In our typology, the administrative definition of “recruited” on a restrictive permit does not exactly match ours. We have considered that a process of more than 3 years is an “uphill battle” as the respondent experienced greater difficulties to access medical practices.

  4. A process of 10 years is not unusual if the IMG was unable to pay for the college exam (high cost) or if the admission process in residency program was not successful the first time (Bardai 2010).

  5. Put in place in 2011, and offered by the Centre d’évaluation des diplômés internationaux en santé ( “In 2012, nine of the twelve candidates who successfully finished the upgrade training had obtained a residency position, but in 2013 only half of the candidates were selected” (CDPDJ 2013: 1).

  6. Approved by the ethics committees for research at the CHU Ste-Justine and the University of Montreal.

  7. Since the issue is the accessibility of institutional services, “formal private resources” are not addressed, even if they were sometimes consulted (for ex. private teachers [French language or medicine], preparatory training for exams through the American Kaplan Institute).

  8. Interviews were conducted by MJ Blain in different contexts, chosen by the respondent (in their homes, workplaces, coffee shop, or in Blain’s university office).

  9. For three participants, their birth country was different from the country of graduation. We focused on the latter, because the process of recognition in Quebec is based on the place of study.

  10. Four women and seven men, from Western Europe (1), Eastern Europe (2), Latin America (4), Antilles (1), and Africa (3).

  11. Before the application of France-Quebec’s arrangement of mutual recognition signed in 2009—the tendency may have intensified since then.

  12. For a critical look about the residency positions left vacant, see: CDPDJ (2010).

  13. Three other specialists initially admissible to a restrictive permit changed their careers (two female graduates from France and Ukraine and one male from Russia). Their situations are explained mainly by the information they received at the beginning about the complexity of the process. Discouraged, they waited too long and lost admissibility to the restrictive permit.

  14. For all types of pathways, with the exception of the restrictive permit, there are fewer exams and the cost of the evaluation period is covered by the government (in successful cases). We should add that once in residency, IMGs are salaried like any resident.

  15. In our study, no men (and only two women) with a degree from France chose a new career.

  16. Fahim (Russia) who already had a new career before his migration, and Nafissa (Algeria), without experience in Quebec, who was working as a nurse in France and is considering technical college.

  17. Questions related to gender issues were not an initial focus of our research. Nevertheless, many women spontaneously shared the difficulties and challenges that arose in their personal life during the interviews. Our findings suggest that this dimension should be explored further.

  18. Working group to facilitate integration for international medical graduates from outside Canada and the United States, also called “Comité Echavé,” created in 2006 by the Council of Ministers; it included 13 institutional representatives (health, education, employment, and immigration).

  19. With the exception of the Career transition program offered by the organization CREMCV (identified by the Comité Echavé in 2009, too recent for our participants) (


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Thanks to the Social Sciences and Humanities Research Council of Canada, to the CHU Sainte-Justine Foundation & Foundation of stars, to the Department of Anthropology at the University of Montreal for their support, as well as to all the participants. Our gratitude to Vincent Duclos for his attentive reading of the first draft and to the reviewers of JIMI whose constructive comments helped to substantially improve the manuscript.

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Correspondence to Marie-Jeanne Blain.

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Blain, MJ., Fortin, S. & Alvarez, F. Professional Journeys of International Medical Graduates in Quebec: Recognition, Uphill Battles, or Career Change. Int. Migration & Integration 18, 223–247 (2017).

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  • International medical graduates
  • Highly qualified migrants
  • Occupational integration
  • Recognition
  • Quebec-Canada
  • Employment resources