At the start of 2020, Suvash Pokhrel was in danger of becoming a cliché. The 38-year-old had worked as an internal-medicine specialist in Nepal, but since becoming a Canadian permanent resident, in 2018, he hadn’t been able to practise medicine. Instead, the physician spent his days taking online courses, so he could stay abreast of developments in his field, and caring for his kids. The difficulty of practising medicine in Canada as a doctor trained outside the country is well known. Pokhrel was luckier than many others in his position: he was eligible for a loan to cover the thousands of dollars needed to take his two recertification exams. But that’s just one step. The relicensing process for international medical graduates (or IMGs) involves verifying one’s medical degree and previous practical experience, passing a language-proficiency test, and completing a Canadian medical residency or practicum. According to one researcher, all this can take up to a decade to complete and, accounting for factors like textbooks, commuting, and the study time that could have been spent earning income, can cost as much as $28,000. In Canada, there are thousands of IMGs who will never practise here. Worse still, some international graduates have had their immigration applications expedited precisely because, as doctors, they qualify for Canadian immigration streams designed for skilled workers — but now find their careers stalled. Often, the biggest barrier is securing the required residency because few spots are allocated to IMGs. Vahid Nilforushan, for example, an anesthesiologist who trained in Iran but now lives in Vancouver, said his application for a residency was denied several times between 2010 and 2016, and he eventually gave up trying to get relicensed. Around half of the roughly 1,000 doctors who immigrate to Canada every year eventually abandon their medical careers. Canada’s IMGs and their supporting organizations have sought reforms through human rights and legal cases against this country’s provincial medical colleges, ministries of health, and various licensing bodies. The most recent of these was filed with the British Columbia Human Rights Tribunal last summer by a group of five IMGs who allege that Canadian medical bodies impose barriers to residency that prevent them from becoming licensed despite the fact that their knowledge, judgment, and skills are equivalent to those of a Canadian medical school graduate. In another case—a lawsuit filed by the Society of Canadians Studying Medicine Abroad against, among others, the College of Practising Surgeons and Physicians of BC—IMGs argue that the residency selection process discriminates against anyone who graduated from a foreign university, including those who are Canadian. Last spring, it seemed like these inveterate difficulties faced by IMGs would finally ease. The pandemic brought with it the fear that hospitals might become short staffed, and provincial governments realized they needed more hands on deck. Both B.C. and Ontario announced they would be issuing temporary licences for IMGs to practise under the supervision of other physicians. IMGs would no longer need to have completed a Canadian residency but only to have passed their Canadian medical exams or graduated from medical school in the past two years to participate. Pokhrel looked forward to working in medicine again. “I have the skills to help, so I just want to do something,” he said. It took a pandemic to offer a glimmer of hope that professionals like him might finally be able to practise again — and fill the widening gaps in Canada’s health care system. It should have been easy for a doctor like Pokhrel to find work in Canada. Approximately 5 million people in the country do not have a regular family doctor, and hospital wait times continue to grow. A 2018 study by the Fraser Institute found that Canada has fewer physicians per capita than comparable nations: 2.7 per 1,000 people, ranking twenty-sixth in the Organisation for Economic Co-operation and Development (OECD). (The average is 3.4.) And, even though the number of doctors has been slowly increasing over the past several years, Canada is still dotted with health deserts, where access to family physicians and specialists is slim. Pokhrel expected there to be plenty of opportunities, but in order to be approved for Ontario’s thirty-day licence, there was a stipulation: applicants must have secured a position at a hospital, psychiatric facility, or Crown agency. In his enthusiasm, he rang up human resources at the Queensway Carleton Hospital and the University of Ottawa hospitals.