Who considers alternative employment pathways among International Medical Graduates in Canada?

This study aims to examine which International Medical Graduates (IMGs) consider alternative employment pathways in Canada. IMGs are physicians whose country of practice differs from the country where they obtained their primary medical qualification. Due to the limitations and uncertainties of this career pathway, many IMGs opt for alternative career pathways (ACPs), which include non-physician roles that enable IMGs to apply their transferable knowledge, skills, and experience. This study aimed to analyze which IMGs choose alternative careers for job market integration in Canada. We carried out an anonymous, open online survey of IMGs living in Canada between November 2019 and June 2020. We recruited through IMGs-serving organizations, professional networks, social media platforms, and IMG champions. The survey collected information on sociodemographic characteristics, professional background, and consideration of ACPs. Descriptive analyses and multivariable logistic regression were used to examine factors associated with ACP consideration. Of the 1,740 survey responses received, 1,210 respondents with complete information on the primary outcome were included in the analysis. Thus, the final sample used for this analysis included 1,210 responses from IMGs who were not currently working in clinical settings as partially/fully licensed physicians and who provided responses to our key question about considering ACPs. This sample included both those considering ACPs (683 respondents, 56.45%) and those not considering ACPs (527 respondents, 43.55%), enabling comparison between these two groups of IMGs in Canada. Among participants aged ≥ 50 years, the majority were considering ACPs (75.65%). Compared to migrants who had been in Canada for <3 years, participants with longer stays in Canada (>15 years) were less likely to consider ACP, OR: 0.82, 95% CI: 0.47-1.43. An opposite trend in ACP consideration was observed between graduates within <3 years and earlier graduates (>15 years), OR: 3.41, 95% CI: 1.39-8.38. Despite persistent barriers and low residency match (13%-18%) in Canada, more than half of respondents reported considering alternative career pathways. IMGs aged 50 or older and those with longer time since graduation were more likely to consider alternative careers, whereas gender and length of stay in Canada were not significantly associated with ACP consideration. These insights from this study can guide targeted future support and career strategies to better facilitate IMGs' professional integration into the Canadian workforce, supporting their transition to fulfilling and meaningful employment.