ArticleBMJ open2026
Comparing civil legal actions among international and Canadian or American medical graduates in Canada: a retrospective cohort study.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
9 authors.
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Abstract
objectiveOur aim was to compare the incidence and outcomes of civil legal cases in Canada involving international medical graduate (IMG) physicians to physicians who graduated from medical schools in Canada or the US.
designWe conducted a retrospective cohort study with multilevel, multivariate modelling of civil legal cases against physicians licensed to practise in Canada.
settingWe used the Canadian Medical Protective Association's national repository of medicolegal case data.
participantsWe extracted data on physicians' demographic characteristics, geographical characteristics and undergraduate medical education. OUTCOMES: Outcomes included physician medicolegal case rates (the number of civil legal actions a physician is involved in per year) and case outcomes (when a case proceeds and is either dismissed, settled or proceeds to trial). Our multilevel models examined associations between physician factors and the rate of civil legal actions and the distribution of civil legal outcomes.
resultsThe case rate model included 433 038 physician-year observations from 98 960 physicians (2015-2019), with 7657 civil legal cases (mean case rate per physician-year 0.0221; 98% had no cases). Case rates did not differ significantly between IMGs and Canadian/US graduates (p=0.0516). The case outcome model included 8046 cases (2016-2023). Unadjusted, cases favoured the plaintiff slightly more often for IMGs (39.1% vs 36.6%, χ² (2, N=8046)=14.03, p<0.001, Cramér's V=0.04), but IMG status was not associated with case outcomes after adjustment (OR 1.135, 95% CI 0.977 to 1.319).
conclusionOur study suggests that where physicians receive their medical degree has no effect on their level of medicolegal risk in civil legal actions in Canada.
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