Ismelda Ramirez says she never expected to swap her white doctor’s coat for a McDonald’s uniform. Despite training as a family doctor in the Dominican Republic, she ended up working at the fast-food chain for eight months after she moved to Quebec in 2022.

She’s one of thousands of internationally trained physicians, or ITPs, living in Canada, the vast majority of whom are not working as doctors, according to advocacy groups.

Despite changes to the process aimed at increasing the number of internationally trained doctors working in Canada, ITPs still face significant hurdles including navigating a complex system, a lack of opportunities and requirements that force some to temporarily leave the country.