White Coat Black Art26:30The MD with over 2,000 patients, but no permanent residency
Dr. Michael Antil moved from North Carolina to Toronto in July 2023, seeking a more diverse and broad-minded environment for his family and a universal health-care system in which to practice. But three years later, despite Canada’s well-documented doctor shortage and so many theoretical routes to citizenship for skilled workers like himself, he still doesn’t have permanent residency.
Antil came to Canada with over two decades’ experience in the States — and he is now adeptly managing an above-average load of over 2,000 patients at a Toronto clinic. Yet he and his wife (an ESL teacher) are still living by dint of temporary work permits, their children are facing international student fees for post-secondary education, and he had to cough up an additional 25 per cent foreign buyers’ tax on his house.
Rifling through an inches-tall stack of paperwork, the 50-year-old told White Coat, Black Art host Dr. Brian Goldman about all the hoops, hurdles and red tape he’s come up against since first applying for permanent residency in 2023.
He has been rejected three times on various technicalities even though, he says with a rueful laugh, “Ontario needs doctors.”
Over 2.5 million Ontarians are without a family doctor, according to the Ontario Medical Association. Across Canada that number sits at around 5.9 million.
“There’s this identified need but we don’t have infrastructure in place to actually make this happen,” said Wanda Morvay, who hired Antil at Toronto’s Albany Medical Clinic back in 2023. Despite millions of Canadians going without access to primary care, this years-long problem remains unsolved by both the federal and provincial governments.
“It’s staggering to me that Mike has still not got his permanent residency yet after trying three times, and there are 2,000 families who depend on his medical services,” Morvay said.
“He’s a wonderful doctor. And I think he’s exactly the kind of physician we want to have in Canada.”
A long and winding road
Antil’s immigration journey began in 2023, when, with a five-year contract at the Albany clinic in hand, he settled in Toronto with a licence from the College of Physicians and Surgeons of Ontario (CPSO) and an Ontario work permit.
Getting the former was a four-month back-and-forth process that Antil meticulously completed step by step, which he likens to building an intricate Lego set.
Getting the latter meant making a 13-hour drive from North Carolina to Buffalo, N.Y. — on the advice of an immigration lawyer after his application, filed that February, had still not been answered by June.
Things got harder after that. Antil also applied to Immigration, Refugees and Citizenship Canada’s (IRCC) express entry under the Federal Skilled Worker program — a competitive permanent residency stream that assigns applicants a points-based score, and then invites those with a high enough score to apply for the accelerated process; shorter than the usual six months.
But upon arriving, Antil didn’t meet that points threshold — though fluent in Spanish, he didn’t speak French, and his age (then 47) was considered high.
Bigger hurdles
So he applied through the Ontario Immigrant Nominee Program (OINP), which awards bonus IRCC points to people with valuable skills. But it also required more forms, including additional certification of his U.S. medical school diploma — odd, he says, since he already has a medical licence in Ontario.
A months-long comedy of errors ensued — including a two-month delay because his notary signed Antil’s photo over, not under, his seal. So Antil missed the OINP deadline and they closed his application. He got the certification two weeks later so he filed an appeal, but still hasn’t heard back.
So Antil applied, again, through IRCC but made two errors — ticking the box that said “doctoral degree” instead of “professional degree” and submitting an educational transcript for his wife that didn’t have the official IRCC approval stamp. Those errors proved fatal to his application.
A ‘rigid’ system
Antil is now working with immigration lawyer Ilene Solomon, who wasn’t surprised to learn about those rejections on what some may see as technicalities.
It’s a “rigid” system, she said, “and one mistake is fatal.”
Solomon says it’s “unfortunate” the system isn’t more flexible — that the ONIP couldn’t extend its deadline or inform him of the error in his wife’s transcript.
“It was my fault,” admits Antil. “Right away I knew what I had done wrong and I knew how easy the fix would have been. But you’re not given that option. “
Solomon says that when the express entry stream was created, the process was heavily automated to achieve that six-month processing time.
But that automation also left out some essential context for applicants like Antil. “Sometimes you can’t even find the information you’re looking for online, like these little nuanced areas,” said Solomon. “You wouldn’t even find it if you spent a whole year looking for it.”
IRCC told CBC News it acknowledges how frustrating the process can be, and that it is working to improve it through “clearer communications, improved online tools … and the introduction of new self-service options.”
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Antil was a proponent of universal health care long before he came to Canada — volunteering his evenings at a free clinic in North Carolina on top of his day job at a private medical practice because it “didn’t sit right” with him that many couldn’t afford his services.
Despite the headaches, he says he loves his work in Toronto. “Patients don’t have to prove their financial worth when they come through the door here,” he said.
“I have patients who come to their visit in their scooter with their sign asking for change still on the front of it. And I have doctors and lawyers and dentists who sit in these chairs too.”
Borrowed time and financial hits
Meanwhile, the clock is ticking. In two years he will no longer be eligible for a refund on that tax he paid on the house, and his children, who are nearing university, will face the higher tuitions for international students whether they study in Canada or the U.S.
And there’s always the possibility they’ll have to go back to the U.S. — a scenario that Ellen Gardner, one of Antil’s many patients, doesn’t want to entertain. “Oh, I’d be devastated. It would be so sad,” she said. “I think it would be a real black mark on the Canadian system.”
Ottawa is still trying to solve this. In December IRCC announced a new express entry stream for doctors with one year of Canadian work experience — they were previously categorized within a general health-care stream that also included dentists, massage therapists and vet techs.
There will also be 5,000 new spaces for provinces and territories to nominate doctors through their Provincial Nominee Programs, like the OINP.
Immigration Minister Lena Metlege Diab outlined several changes to immigration requirements for doctors Monday, including an ‘express-entry’ option that she said would be available to foreign doctors with at least one year of recent Canadian experience.
The 2025 budget vowed to invest $97 million over five years to create a fund which aims to eliminate the kinds of roadblocks Antil has experienced.
“The government will work with the provinces and territories to make credential recognition fairer, faster, and more transparent, helping qualified foreign-trained professionals contribute more quickly to Canada’s workforce, including in fields facing labour shortages such as health care and construction,” IRCC told CBC News.
Antil and Solomon, his lawyer, hope these changes will mean he’s invited again to apply, but she’s surprised that this hasn’t happened already.
IRCC says invitations to apply will be issued in “early 2026,” but did not say whether one is coming Antil’s way.
The Canadian Medical Association (CMA) is excited about IRCC’s push to make permanent residency easier for MDs — especially sorely needed primary-care doctors like Antil.
“It’s a system that we need to make more friendly,” said CMA president Dr. Margot Burnell. In that vein, she says the CMA is working with federal and provincial partners to create a concierge service for MDs looking to come to Canada, to help them better understand provincial licensing requirements, work permits and permanent residency steps — everything Antil struggled with.
The aim is to create a “one-stop shop” so applicants can “enter the system and practice to their potential more smoothly.”
Meanwhile, for Antil and his family, permanent residency can’t come soon enough. “We feel welcomed here. We call this our home,” he said. “We all put maple leaf flags on our luggage, but it doesn’t feel like home yet.”
“I really want it to feel like home.”
