Canadian Graduates Research Articles

The accreditation transition of Canadian medical schools: Possible implications for graduates applying for residency positions in the United States

The Liaison Committee on Medical Education (LCME) has accredited Canadian medical schools for over 50 years. This agency also serves as the accrediting body for medical colleges in the United States. Thus, graduates of Canadian medical programs seeking residency training in the United States are not considered international medical graduates. Due to this fact, degree holders of Canadian medical programs who wish to pursue residency training in the United States do not require Educational Commission for Foreign Medical Graduate (ECFMG) certification to attain medical licensure. By mutual agreement with the Committee on Accreditation of Canadian Medical Schools, the LCME accreditation of Canada’s 17 medical schools will end on June 30th, 2025. Beyond this date, Canadian medical graduates seeking training within the United States will be considered international medical graduates. As a result, this will require ECFMG certification to enter postgraduate training. Possible implications of this decision could mean fewer Canadian graduates attaining competitive specialties and the social stigma of being labeled an international medical graduate.

Association between Pharmacists' Country of Qualifying Education and Practising in a Hospital Setting: A Cross-Sectional Ontario Study.

It is hypothesized that international pharmacy graduates (IPGs) are underrepresented in more clinically challenging work. To examine the association between country of qualifying education for pharmacists in Ontario and the likelihood of practising in a hospital setting. This study was based on publicly available data from the Ontario College of Pharmacists website, specifically records for all Ontario pharmacists with authorization to provide patient care and for whom country of qualifying education and an accredited pharmacy as a place of practice were reported. Pharmacists who met the inclusion criteria were categorized as Canadian graduates or IPGs. The odds ratio (OR) and 95% confidence interval (CI) for reporting hospital pharmacy as a place of practice were estimated by fitting a logistic regression, with adjustment for gender and years since graduation. A total of 14 689 pharmacists were included in the study: 7403 (50.4%) Canadian graduates and 7286 (49.6%) IPGs. These pharmacists worked in a total of 5028 accredited pharmacies (243 hospital pharmacies [4.8%] and 4785 community pharmacies [95.2%]). Among Canadian graduates, 2458 (33.2%) reported at least 1 hospital pharmacy practice site, whereas the proportion was much smaller among IPGs (427, 5.9%). Canadian graduates represented 85.2% (2458/2885) of all pharmacists who reported hospital practice. The estimated crude OR for practice in a hospital pharmacy was 7.98 (95% CI 7.16-8.91), and the adjusted OR was 7.12 (95% CI 6.39-7.98). IPGs may face barriers impeding their ability to practise in a hospital setting. Providing opportunities such as structured clinical training and experiential placements may facilitate integration of IPGs in institutional settings.

Virtual OSCE examinations during COVID-19: A 360 satisfaction assessment from examiners and candidates.

We sought to determine the satisfaction rates of examiners and candidates in a Virtual Objective Structured Clinical Exam (OSCE) of graduating Canadian urology residents. An annual mock exam, aimed at simulating the licencing urology exam for Canadian graduates, was moved to an online format for the 2020 cohort. This exam consists of an Objective Structured Clinical Exam (OSCE), and a written multiple-choice exam. The Telemedicine Satisfaction Questionnaire (TSQ), a previously validated tool for clinical encounters with three sub-domains (quality of care provided, similarity to face-to-face encounter, and perception of the interaction) was modified for the purposes of evaluating the OSCE encounter. The TSQ was sent electronically to all examiners and candidates after the exam. There were 14/16 responses from examiners (87.5%) and 24/39 responses from candidates (61.5%). Overall, the format was judged to be a good experience by 13/14 (92.9%) of examiners and 21/24 (87.5%) of candidates; however, when asked specifically if the virtual OSCE was an acceptable way to determine a candidate's competency to practice urology independently, only 8/14 (57.1%) of examiners and 15/24 (62.5%) of candidates agreed. This study demonstrates an overall good satisfaction rate among both examiners and candidates when using a teleconference format for a mock OSCE.

Pharmacists' knowledge, perceptions and practices regarding frailty: A cross-sectional survey across practice settings in Canada.

Data on Canadian pharmacists' knowledge and perceptions about frailty in older adults and its assessment in pharmacy practice are scarce. A cross-sectional survey of 349 Canadian pharmacists was conducted to evaluate pharmacists' knowledge, perceptions and practices regarding frailty. Descriptive analyses summarized responses by practice setting, and a multivariable logistic regression model examined associations between respondent characteristics and the likelihood of assessing frailty. Most respondents were female (70%), aged ≤34 years (47%), Canadian graduates (83%), from Ontario/Quebec (51%) and from urban centres (58%). Although a significant proportion agreed it is important for pharmacists to know (80%) and assess (56%) patient frailty status, only 36% reported assessing frailty in practice. Respondents exclusively practising in a community pharmacy were significantly less likely to agree that it is important for a pharmacist to know or assess frailty status and to report assessing it. Factors associated with a greater likelihood of assessment included positive beliefs about the importance of knowing a patient's frailty status and having a greater proportion of older patients with cognitive or functional impairment in practice. Findings suggest that pharmacists generally agree with the importance of understanding frailty as it relates to the appropriate use of medications, but most do not assess it. Further research is needed to identify the barriers to assessing frailty, while guidance is needed on which of the available screening tools can best be integrated into a clinical pharmacy practice. There is an opportunity to improve pharmaceutical care for older adults by providing pharmacists the means and resources to assess frailty in practice.

33490 Analysis of geographic distribution of internationally educated dermatologists

Background: International medical graduates form one-quarter of the U.S. health care workforce. In contrast, the proportion of internationally educated graduates (IEGs; including Canadian graduates) in dermatology is much lower, comprising only 0.9% of graduates between 2010 and 2019. A state-by-state analysis was performed on the geographic distribution of IEG dermatologists, including representation serving medically underserved areas (MUAs) and rural communities.

The Association of Education with Entrepreneurial Propensity and Entrepreneurial Income of Recent Canadian Graduates: A Tax Data Analysis

This work examines the association of post-secondary credentials and fields of study on the earnings of recent university graduates and their propensity to become entrepreneurs. To this end, we analyze an administrative database that links post-secondary records from public educational institutions in Canada with income tax records from the Canadian Revenue Agency. The findings of this analysis showed that entrepreneurs who hold a PhD tend to earn significantly more than those who do not, and that certain fields of study tend to be associated with higher incomes. However, the results also showed that the odds of entering entrepreneurship decrease as higher credential levels are achieved. Thus, this research further demonstrates the potential relationship between education and entrepreneurial success.

Resident Exposure and Involvement in Core Procedural Competencies within Pediatric Plastic Surgery.

Introduction: The implementation of competency-based residency training in plastic surgery is underway. Key competencies in plastic surgery have been previously identified, however, within the domain of pediatrics, data suggest limited exposure throughout training for Canadian graduates. This study aims to identify the exposure and involvement of residents in core pediatric cases. Methods: We performed a retrospective, multicenter review of plastic surgery resident case logs (T-Res, POWER, New Innovations) across 10 Canadian, English-speaking training programs between 2004 and 2014. Case logs were coded according to the 8 core pediatric competencies previously identified by a modified Delphi technique. Results: A total of 3061 of 59 405 cases (5.2%) logged by 55 graduating residents were core pediatric procedures with an average of 55.6 ± 23.0 cases logged per resident. The top 3 most commonly logged procedures were cleft lip repair, cleft palate repair, and setback otoplasty. The number of cases per program varied widely with the most at 731 and least at 85 logged cases. Roles across procedures have wide variation and residents are most commonly identified as the assistant rather than surgeon or co-surgeon. Conclusion: These findings highlight variability both within and across residency programs with a paucity of exposure and involvement in pediatric plastic surgery cases. This may present a conflict between current recommendations for residency-specific procedural competencies and true clinical exposure. Further curriculum development and simulation may be of benefit.

Uptake of re-resection in T1 bladder cancer: An interrupted population-based time series analysis among different groups of surgeons.

A second transurethral resection of the bladder tumor (TURBT) within 2 - 6 weeks after initial TURBT is thought to have diagnostic, therapeutic, and prognostic benefits in T1 bladder cancer (BC). However, little is known about the real-world uptake of this guideline-endorsed intervention. We aimed (1) to measure re-resection rates over time, (2) to investigate if a guideline revision (April 2008) explicitly endorsing re-resection within 2 - 6 weeks in all T1 BC patients led to an increase in re-resection rates, and (3) to investigate the uptake among different groups of surgeons. Province-wide BC pathology reports (January 2001 to December 2015; Ontario, Canada) were linked with health administrative data to (1) identify primary cases of T1 BC and to (2) ascertain whether these patients received re-resection. The resulting patients were then aggregated into quarterly time series and investigated by descriptive analysis, interventional autoregressive moving average (ARIMA) modeling, and Poisson regression analysis. A cohort of 7,373 patients was aggregated into a time series. We observed a linear increase in re-resection rates from 8.4% in 2001 to 28.3% in 2015. An actual effect of the guideline revision in April 2008 on re-resection rates could not be detected (P = 0.41). However, we observed a rather heterogeneous uptake behavior among different groups of surgeons. Specifically, female surgeons, more junior surgeons, high-volume surgeons, Canadian graduates, and surgeons without an academic affiliation were all independently more likely to re-resect their patients (all P-values < 0.05 in adjusted analysis). Re-resection rates in primary T1 BC increased between 2001 and 2015 in the province of Ontario regardless of the guideline revision in April 2008. Our study demonstrates that the uptake of this guideline-endorsed intervention varies among different groups of surgeons and therefore warrants further research to identify barriers to change that can be addressed by tailored interventions.

Does alma mater matter? An audit study of labour market outcomes of Canadian Bachelor's Degree recipients.

In many parts of the world, the rewards attached to a university degree vary significantly according to the name of the institution one attends, particularly in countries with highly stratified postsecondary systems. Because the Canadian higher education system is relatively homogenous and non-hierarchical, it has been generally accepted that Canadian graduates enter the labour market on equal footing regardless of where they matriculate. We test this assumption through an experimental audit study that compares employers' responses to fictitious matched job applications from equally qualified bachelor's degree recipients from three Ontario universities: Brock, Queen's, and Waterloo. Not all employers make a distinction between the paired applications; but when they do, Waterloo is favoured. In these cases, even though applicants had the same field of study, academic achievement and work experience, employers singled out Waterloo applicants for a response 84% more often than those from Brock. These findings indicate that institutional affiliation matters in Canada, and suggests that graduates from some institutions fare significantly better in the labour market than their equally accomplished peers from other institutions. We conclude that even in relatively non-hierarchical systems with comparatively minimal structural or resource variation, status hierarchies emerge that privilege some graduates over others.

The relationship between pharmacy licensing policies on clinical training (CT) and success rates for international pharmacists (IPs) within Canada, United Kingdom, and the United States: A comparative policy analysis

Introduction: In October 2018, the Pharmacy Examining Board of Canada released a report showing that only 41.1% of international pharmacists pass the Pharmacy Qualifying Examination, compared to 91% of Canadian graduates. When compared to the United Kingdom and United States, Canada has the lowest success rates for the integration of international pharmacists. Aim: This study aims to address two questions: What are the professional pharmacy policies governing the clinical training resources for international pharmacists within their host country? What can Canada learn from other Western countries to facilitate the integration of international pharmacists? Method: A comparative policy analysis was used to draw comparisons between Canada’s regulatory policies governing the pharmacy license to other similar models in the United Kingdom and United States. Results: Upon examining current integration systems in these countries, differences in training period requirements and competencies became apparent. Therefore, the findings suggest that Canadian stakeholders can learn from other models’ legislation, structure, and clinical outcome prospects.

Apheresis education in Canadian residency programs: A needs assessment

Indications for therapeutic and donor apheresis continue to increase and expand into new domains of therapy. The level and amount of apheresis education in residency programs remains heterogeneous, which may translate into varying degrees of clinical confidence in providing care. The purpose of this study was to assess Canadian clinicians' perceptions of their apheresis training in order to help demonstrate a need for a concrete apheresis education in residency curricula. A 22-question survey was distributed to Canadian graduates who recently completed training (2013–2017) in the following specialties: hematology, nephrology, transfusion medicine, and hematologic pathology. Questions regarding clinician perception of their training were asked using a Likert scale. Fifty-seven survey responses (32% response rate) were obtained from recent graduates from hematology (29/57, 51%), nephrology (21/57, 37%), hematologic pathology (4/57, 7%) and transfusion medicine (3/57, 5%). Although most respondents (68%) received some form of apheresis exposure during residency, only 23% reported a formal apheresis rotation. Only 40% felt that the amount of time devoted to apheresis education was sufficient, and only four respondents (7%) felt confident providing independent apheresis care at the end of training. Overall, these findings suggest that a common, dedicated apheresis curriculum in these training programs could possibly increase knowledge and competence of trainees, and provide a more solid foundation in apheresis for future practice.

Predictors of Success in the NCLEX-RN for Canadian Graduates.

The National Council Licensure Examination for Registered Nurses (NCLEX-RN) has been the nursing licensure exam in most Canadian jurisdictions since 2015. Nursing faculty across the country have invested considerable effort into understanding the NCLEX-RN, so they could help to prepare students to be successful in the exam. A retrospective study was conducted at one Canadian university to identify predictors of success on the NCLEX-RN. Findings revealed that the strongest predictors of success were a grade point average of >3.5 and a course grade in the community development course. The strong predictive value of the community development course was unexpected, and this suggests that content specifically related to acute care may not play as heavy a role in the NCLEX-RN outcome as previously expected. It is possible that students' higher levels of cognitive abilities, such as application, analysis and synthesis of nursing knowledge, play a larger role in the exam outcome than content-specific knowledge.

The prevalence, sources, and persistence of overqualification among Canadian graduates

ABSTRACTPrevious research has documented substantial overqualification and an association with social disadvantage and fields of study. Overqualification persistence has been less studied. Persistence is more important than prevalence because skill and job matches are likely to involve lags. Our data set allows us to estimate the prevalence, the correlates, and the persistence of overqualification among Canadian postsecondary graduates using two different measures. We find: i) substantial overqualification and overqualification persistence; ii) the socially disadvantaged and those with less vocational diplomas were more likely to be overqualified but not more likely to move to a match; iii) mobility and academic performance seem to influence catch-up; iv) choice of overqualification measure has large effects on results.

Pediatric Neurology Workforce in Canada: A 5-Year Update

In 2013, a task force was developed to discuss the future of the Canadian pediatric neurology workforce. The consensus was that there was no indication to reduce the number of training positions, but that the issue required continued surveillance. The current study provides a 5-year update on Canadian pediatric neurology workforce data. Names, practice types, number of weekly outpatient clinics, and dates of certification of all physicians currently practicing pediatric neurology in Canada were obtained. International data were used to compute comparisons between countries. National data sets were used to provide information about the number of residency positions available and the number of Canadian graduates per year. Models for future projections were developed based on published projected population data and trends from the past decade. The number of pediatric neurologists practicing in Canada has increased 165% since 1994. During this period, wait times have not significantly shortened. There are regional discrepancies in access to child neurologists. The Canadian pediatric neurology workforce available to see outpatient consultations is proportionally less than that of USA. After accounting for retirements and emigrations, the number of child neurologists being added to the workforce each year is 4.9. This will result in an expected 10-year increase in Canadian pediatric neurologists from 151 to 200. Despite an increase in the number of Canadian child neurologists over the last two decades, we do not predict that there will be problems with underemployment over the next decade.

The Canadian pediatric surgery workforce: A 5-year prospective study

BackgroundIn 2014, a survey study of the Canadian pediatric surgery workforce predicted a need for 2 new pediatric surgeons/yr. in Canada. We sought to assess these predictions and evaluate the status of the workforce. MethodsWith IRB approval, a web-based survey was sent to pediatric surgery division chiefs in Canada each year (2013–2017). The survey data included: number of practicing pediatric surgeons, full time equivalent (FTE) positions, and fellowship graduates. ResultsThere was a 100% response rate (18 divisions). From 2013 to 2017, the number of practicing pediatric surgeons and FTE positions increased (73 to 78, and 64.6 to 67.5, respectively). Eleven positions were vacated (4 retirement, 7 new practice), and 18 were filled. Eight were filled by new Canadian graduates, 7 by Canadians previously working in Canada or abroad, and 3 by European surgeons. Thirty-eight fellows completed training in Canada, including 24 non-Canadians who all left Canada. Nine Canadians who started practicing immediately after fellowship took positions in Canada (5) and the US (4). ConclusionsPredictions made in 2014 were largely accurate. There has been modest growth in the Canadian pediatric surgery workforce over the last 5 years. A significant mismatch continues to exist between Canadian pediatric surgery graduates and attending staff positions. Type of studySurvey. Level of evidenceV

Strategies and Practices for Overcoming Obstacles to the Effective Commercialization of Student Innovation on University Campuses

We synthesize knowledge about the policy and practices and infrastructure available for technology transfer of student inventions. Our joint consideration of intellectual property protection and business and legal support services has tried to overcome some of the traditional functional and knowledge silos. Looking forward, we recommend that independent and comprehensive measures be developed to assess the performance of each university with respect to its student commercialization policies and practices. Do comprehensive and student-centered IP policies make a difference in creating certainty for student innovators and confidence in the institutional infrastructure to support commercialization? Previous researchers have studied the connection between patents and on campus commercialization. Future research must differentiate student commercialization from faculty commercialization. Additionally, other indicators related specifically to student centered innovation in Canada must move beyond patents to include other forms of intellectual property, such as copyright and industrial designs. Further, given that universities are measured by learning outcomes, we recommend that universities include learning outcomes connected to experiential entrepreneurial opportunities. If a purpose is also to create an entrepreneurial culture, and students who are better able to identify and seize venture opportunities, then we must also consider indicators over time that reflect the true impact of developing a student-centered entrepreneurial culture. The university learning culture supported by strong student centered policies and practices will develop a more enduring entrepreneurial spirit in Canadian graduates. Finally, more work needs to be done in relation to measuring the effectiveness of various models for providing independent legal advice to student innovators with the view to ensuring that students are given timely, meaningful and cost-effective access to legal support so that their rights and interests are properly addressed.

Realization of entry-to-practice milestones by Canadians who studied medicine abroad and other international medical graduates: a retrospective cohort study.

International medical graduates must realize a series of milestones to obtain full licensure. We examined the realization of milestones by Canadian and non-Canadian graduates of Western or Caribbean medical schools, and Canadian and non-Canadian graduates from other medical schools. Using the National IMG Database (data available for 2005-2011), we created 2 cohorts: 1) international medical graduates who had passed the Medical Council of Canada Qualifying Examination Part I between 2005 and 2010 and 2) those who had first entered a family medicine postgraduate program between 2005 and 2009, or had first entered a specialty postgraduate program in 2005 or 2006. We examined 3 entry-to-practice milestones; obtaining a postgraduate position, passing the Medical Council of Canada Qualifying Examination Part II and obtaining a specialty designation. Of the 6925 eligible graduates in cohort 1, 2144 (31.0%) had obtained a postgraduate position. Of the 1214 eligible graduates in cohort 2, 1126 (92.8%) had passed the Qualifying Examination Part II, and 889 (73.2%) had obtained a specialty designation. In multivariate analyses, Canadian graduates of Western or Caribbean medical schools (odds ratio [OR] 4.69, 95% confidence interval [CI] 3.82-5.71) and Canadian graduates of other medical schools (OR 1.49, 95% CI 1.31-1.70) were more likely to obtain a postgraduate position than non-Canadian graduates of other (not Western or Caribbean) medical schools. There was no difference among the groups in passing the Qualifying Examination Part II or obtaining a specialty designation. Canadians who studied abroad were more likely than other international medical graduates to obtain a postgraduate position; there were no differences among the groups in realizing milestones once in a postgraduate program. These findings support policies that do not distinguish postgraduate applicants by citizenship or permanent residency status before medical school.

Using Automatic Item Generation to Improve the Quality of MCQ Distractors

ABSTRACTConstruct: Automatic item generation (AIG) is an alternative method for producing large numbers of test items that integrate cognitive modeling with computer technology to systematically generate multiple-choice questions (MCQs). The purpose of our study is to describe and validate a method of generating plausible but incorrect distractors. Initial applications of AIG demonstrated its effectiveness in producing test items. However, expert review of the initial items identified a key limitation where the generation of implausible incorrect options, or distractors, might limit the applicability of items in real testing situations. Background: Medical educators require development of test items in large quantities to facilitate the continual assessment of student knowledge. Traditional item development processes are time-consuming and resource intensive. Studies have validated the quality of generated items through content expert review. However, no study has yet documented how generated items perform in a test administration. Moreover, no study has yet to validate AIG through student responses to generated test items. Approach: To validate our refined AIG method in generating plausible distractors, we collected psychometric evidence from a field test of the generated test items. A three-step process was used to generate test items in the area of jaundice. At least 455 Canadian and international medical graduates responded to each of the 13 generated items embedded in a high-stake exam administration. Item difficulty, discrimination, and index of discrimination estimates were calculated for the correct option as well as each distractor. Results: Item analysis results for the correct options suggest that the generated items measured candidate performances across a range of ability levels while providing a consistent level of discrimination for each item. Results for the distractors reveal that the generated items differentiated the low- from the high-performing candidates. Conclusions: Previous research on AIG highlighted how this item development method can be used to produce high-quality stems and correct options for MCQ exams. The purpose of the current study was to describe, illustrate, and evaluate a method for modeling plausible but incorrect options. Evidence provided in this study demonstrates that AIG can produce psychometrically sound test items. More important, by adapting the distractors to match the unique features presented in the stem and correct option, the generation of MCQs using automated procedure has the potential to produce plausible distractors and yield large numbers of high-quality items for medical education.

How Competitive Is the Canadian Diagnostic Radiology Residency Match? Application and Matching Trends From 1991-2014

PurposeThe study sought to evaluate application trends in Canadian diagnostic radiology residency programs and to assess the relative competitiveness of radiology as a specialty. MethodsThe Canadian Residency Matching Service Reports from 1991–2014 for Canadian graduates were used to extract the total residency positions and radiology residency positions, number of applicants to all specialties and to radiology, number of first-choice radiology applicants, number of unmatched radiology positions, and number of positions and applicants to each specialty. Ratios were calculated: radiology positions to applicants and first-choice applicants, first-choice radiology applicants to applicants for all specialties, and training positions to applicants in each specialty. Data trends and correlation coefficients were analysed. ResultsThe number of radiology residency positions offered increased, with strong positive correlation (r = 0.91, P < .001), while the number of applicants increased with only a moderate positive correlation (r = 0.49, P = .03). Radiology was the most competitive in 1997, with a ratio of 0.32 positions/applicant. There was an increase of positions/applicant over time (decreasing competitiveness; r = 0.76, P < .001) but no change in positions/first-choice applicant (r = 0.11, P = .65). The highest percentage of applicants who ranked radiology as their first choice was in 2003 at 6.5% with a decrease in this percentage over time (r = −0.36, P = .13). Radiology is moderately competitive for positions/overall applicants and very competitive for positions/first-choice applicants compared to other specialties. ConclusionsThe number of radiology residency positions has increased while the number of applicants has not grown commensurately. The match was most competitive in 1997, and decreased in subsequent years. Possible reasons include job market, reimbursement, and work environment.

Primary care physician characteristics associated with cancer screening: a retrospective cohort study in Ontario, Canada.

Primary care physicians can serve as both facilitators and barriers to cancer screening, particularly for under-screened groups such as immigrant patients. The objective of this study was to inform physician-targeted interventions by identifying primary care physician characteristics associated with cancer screening for their eligible patients, for their eligible immigrant patients, and for foreign-trained physicians, for their eligible immigrant patients from the same world region. A population-based retrospective cohort study was performed, looking back 3 years from 31 December 2010. The study was performed in urban primary care practices in Ontario, Canada's largest province. A total of 6303 physicians serving 1,156,627 women eligible for breast cancer screening, 2,730,380 women eligible for cervical screening, and 2,260,569 patients eligible for colorectal screening participated. Appropriate breast screening was defined as at least one mammogram in the previous 2 years, appropriate cervical screening was defined as at least one Pap test in the previous 3 years, and appropriate colorectal screening as at least one fecal occult blood test in the previous 2 years or at least one colonoscopy or barium enema in the previous 10 years. Just fewer than 40% of physicians were female, and 26.1% were foreign trained. In multivariable analyses, physicians who attended medical schools in the Caribbean/Latin America, the Middle East/North Africa, South Asia, and Western Europe were less likely to screen their patients than Canadian graduates. South Asian-trained physicians were significantly less likely to screen South Asian women for cervical cancer than other foreign-trained physicians who were seeing region-congruent patients (adjusted odds ratio: 0.56 [95% confidence interval 0.32–0.98] versus physicians from the USA, Australia and New Zealand). South Asian patients were the most vulnerable to under-screening, and decreasing patient income quintile was consistently associated with lower likelihood of screening, although less so for immigrant patients. This study highlights certain physician characteristics that are associated with cancer screening for eligible patients, including immigrant patients, and that should be considered when designing physician-targeted interventions. We have also highlighted an ethnic community, South Asians, which requires particular attention, both among its patients and its primary care providers. Future research should further explore the reasons for these findings.