My letter to the AFMC

(Letter was delivered electronically via email to the AFMC on December 29, 2023, with minor grammatical and formatting errors corrected below)

Dear AFMC senior leadership and board of directors,

I am writing to you today to express my deep concern for possible bias, discrimination, and racism manifesting itself as interference in the fairness of the Canadian residency program selection and matching process.

Over a week ago, CBC News reported on the censorship acts and attempts occurring in Canadian workplaces and schools for people expressing concern for the health and human rights of Palestinians during the conflict in Israel and Palestine. There were many instances and cases of concern reported in this article, but I will focus on the screenshot of a post from a closed physician group that had “compiled a list of 271 medical students who signed an open letter calling for a ceasefire and an end to targeting health-care facilities and workers in Gaza”, with the “stated intention to share this list with program directors ahead of residency interviews”.

As you know, the practice of medicine of caring for patients and communities, is inherently political through acknowledging and addressing the root causes of disease and suffering.

It was in the first few days and weeks of medical school that I learned about Dr. Rudolf Virchow, a German physician who is known as ‘the father of modern pathology’ and as the founder of social medicine. He is often quoted, that “medicine is a social science, and politics is nothing else but medicine on a large scale”. He goes on to say “medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution. The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction”.

It is for these exact sentiments outlined by Dr. Virchow in the 19^th century, that I chose to study and practice public health and preventive medicine – a field of practice that considers the root causes of the social determinants of health, including that of colonization. We know this all too well in the Canadian context with reports from the Truth and Reconciliation Commission of Canada and its Calls to Action. Health advocacy for Palestinians fits within this scope of drawing attention to the root causes of poor health outcomes as a consequence of war, conflict, and occupation. Medical students are now being systematically targeted for their solidarity. This is so incredibly wrong, and must not stand. These deliberate attempts to punish and discriminate against medical students who have chosen to take a position on advocating for health and human rights for Palestinians must not be punished – they must be supported and protected. Political health advocacy and solidarity do not affect clinical competency. To assume and question such a thing says more about the person making such an accusation out of a place of bias and racism.

Your organization’s statement against discrimination states that as an institution you collectively “stand against racial discrimination as well as all other forms of discrimination” and that you are “committed to working with health partners to ensure that our environments are diverse, inclusive, culturally safe and foster equity”, and that you will “implement institutional change and lead in addressing systemic racism through education and curricular innovation, research and advocacy for equity, diversity and inclusiveness”. However, these are the exact times that matter for action, commitment, and change. So please act and exercise your leadership with the urgency that is required to reassure, protect, and support medical learners from discrimination.

I am aware that your organization has shared a statement, that the “AFMC takes the integrity of the national resident match very seriously” and has provided information to “reinforce this commitment to our students, residents, and faculty”. As someone that has participated in the residency match process as an interviewee, file reviewer, and interviewer, this information with multiple reminders for postgraduate deans and program directors is in large part not new. The reminder that “no external lists, data, or letters may be shared, disseminated, or utilized at any stage in the resident selection process”, appears to be in response to the concerns brought forward by the CBC News report. However, I am troubled and worried that this statement and information alone are insufficient.

The organization, Canadians for Justice and Peace in the Middle East (CJPME), has provided a list of demands, that I think are reasonable. Please see the following:

1. Conducting an investigation into allegations of physicians and CaRMS selection committee members attempting to introduce bias into the CaRMS process,
2. Ensuring that faculty involved with the Facebook group posts are identified and excluded from the CaRMS interview process and selection decisions,
3. Statements from CaRMS, Faculties of Medicine, and program directors across the country to reassure applicants and the public that the residency matching process is fair and free from organized political targeting.

Furthermore, the group Health Workers Alliance for Palestine (HAP), has also provided a list of demands, that I too agree with. Please see the following:

1. An independent investigation into the allegations of physicians and physician groups attempting to introduce bias into the CaRMS process.
2. Ensure all faculty involved with the Facebook group posts reported by the CBC are identified and any actions against residency program applicants are mitigated.
3. Faculty involved with the Facebook group should be recused from the residency match process.
4. Public statements from CaRMS, Faculties of Medicine, and program directors across the country asserting that the residency matching process is fair and free from organized political targeting.
5. Ensure applications for learners targeted by these efforts are reassessed by impartial faculty and residents.
6. Outlining a clear appeals process for trainees who feel their match results may have been affected by these actions.

I strongly believe that anything short of these commitments is a failure of your leadership and organization to protect and support prospective candidates by ensuring that undue political influence may not compromise the integrity of the residency match process. I have already heard from medical learners who have expressed concern that their residency program interview invitations have been affected and compromised because of their solidarity for Palestine, and with the CBC News report feel even more strongly that this is the case.

I look forward to hearing from you at your earliest convenience, on this time sensitive matter.

Sincerely,

Yipeng Ge, MPH MD CCFP (he/him)
PGY4 Public Health and Preventive Medicine Resident Physician