This Toronto doctor has more than 2,000 patients, but still no permanent residence

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Dr. Michael Antill moved to Toronto from North Carolina 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 several theoretical pathways to citizenship for skilled workers like them, they still don’t have permanent residency.

Antill came to Canada with more than two decades of experience in the US – and now he is efficiently managing a higher-than-average patient load of more than 2,000 patients at the Toronto clinic. Yet he and his wife (an ESL teacher) are still living off a temporary work permit, their children face international student fees for post-secondary education, and they have to pay an additional 25 percent foreign buyers tax on their home.

The 50-year-old man said while sifting through an inch-long stack of papers. white coat, black art Host Dr. Brian Goldman talks about all the hurdles, obstacles, and red tape he has faced since first applying for permanent residence in 2023.

He has been rejected three times for various technical reasons, yet, he says with a raucous laugh, “Ontario needs doctors.”

According to the Ontario Medical Association, more than 2.5 million Ontarians are without a family doctor. Across Canada the number is about 5.9 million.

“It’s a recognized need, but we don’t really have the infrastructure to do it,” said Wanda Morwe, who hired Antil at Toronto’s Albany Medical Clinic in 2023. Despite millions of Canadians living without access to primary care, this years-long problem remains unresolved by both the federal and provincial governments.

Morwe said, “It’s shocking to me that even after trying three times, Mike still hasn’t gotten his permanent residency, and there are 2,000 families who depend on his medical services.”

“He’s a wonderful doctor. And I think he’s exactly the kind of physician we want in Canada.”

a long and winding road

Antil’s immigration journey began in 2023, when, with a five-year contract at the Albany Clinic, he settled in Toronto with a license 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 completed carefully step by step, which he compares to building a complex Lego set.

Achieving the latter meant driving 13 hours from North Carolina to Buffalo, NY — on the advice of an immigration attorney after her application, filed in February, was still not responded to by June.

After that the situation became more difficult. Antil also applied for Immigration, Refugees and Citizenship Canada (IRCC) Express Entry under the federal Skilled Worker Program – a competitive permanent residence stream that assigns points-based scores to applicants, and then invites those with high enough scores to apply for the accelerated process; Normally less than six months.

But upon arriving, Antil did not meet that score threshold – although fluent in Spanish, he did not speak French, and his age (then 47) was considered excessive.

major obstacles

So he applied through the Ontario Immigrant Nominee Program (OINP), which offers bonus IRCC points to people with valuable skills. But it also required more forms, including additional attestation of his American medical school diploma — strange, he says, because he already had a medical license in Ontario.

The string of errors lasted a month – including a two-month delay because their notary had signed Antil’s photograph, not under his seal. So Antil missed the OINP deadline and closed his application. He got the certification after two weeks so he filed an appeal, but no hearing has been held yet.

So Antil applied through IRCC again, but made two errors – ticking the box containing “doctoral degree” instead of “professional degree” and submitting an educational transcript for his wife that did not have an official IRCC approval stamp. Those errors proved fatal to his application.

A ‘Rigid’ System

Antill is now working with immigration attorney Illene Solomon, who wasn’t surprised to learn about the rejections that some might view as technicalities.

It is a “rigorous” system, he said, “and one mistake is fatal.”

Solomon says it’s “unfortunate” that the system isn’t more flexible — that ONIP couldn’t extend his deadline or notify him about the error in his wife’s transcript.

“It was my mistake,” Antil admits. “I knew immediately what I did wrong and I knew how easy it would have been to fix it. But you’re not given that option.”

Solomon says that when the Express Entry stream was created, the process was heavily automated to achieve a six-month processing time.

But that automation also left out some essential context for applicants Antille. “Sometimes you can’t even find the information you’re looking for online, like these little granular areas,” Solomon said. “Even if you spend a whole year looking for it, you won’t find it.”

IRCC told CBC News it recognizes how frustrating the process can be, and it is working to improve it through “clear communication, better online tools … and the introduction of new self-service options.”

Antill was a supporter of universal health care long before coming to Canada – volunteering his evenings at a free clinic in North Carolina in addition to his day job at a private medical practice because it was “not right” to him that many people could not afford his services.

Despite the headaches, he says he likes his job in Toronto. “When patients come through the door here, they don’t have to prove their financial eligibility,” he said.

“I have patients who come in on their scooters with signs in front of them asking for change. And I also have doctors, lawyers and dentists who sit on these chairs.”

Borrowed time and the financial blow

Meanwhile, the clock is ticking. In two years he will no longer be eligible for a refund on taxes paid at home, and his children, who are closer to university, will face higher tuition than international students, whether they study in Canada or the US.

And there’s always the possibility they’ll have to return to the U.S. — a scenario that Ellen Gardner, one of Antill’s many patients, doesn’t have in mind.I don’t want to entertain. “Oh, I would be devastated. It would be so sad,” she said. “I think it will be a real black spot on the Canadian system.”

Ottawa is still trying to sort it out. In December IRCC announced a new Express Entry stream for doctors with one year of Canadian work experience – they were previously classified in the general health care stream which also included dentists, massage therapists and veterinarians.

There will also be 5,000 new spots for provinces and territories to nominate doctors through provincial nominate programs like OINP.

The 2025 budget pledged to invest $97 million over five years to create a fund that aims to eliminate barriers experienced by the Antilles.

“The government will work with provinces and territories to make credential recognition fair, Faster, and more transparently, helps qualified foreign-trained professionals contribute more quickly to the Canadian workforce, including in sectors facing labor shortages such as health care and construction,” IRCC told CBC News.

Antill and Solomon, his lawyers, arePay These changes would mean that he would be invited to reapply, but he is surprised that this has not happened already.

The IRCC says invitations to apply will be issued in “early 2026”, but did not say if any are on the way to Antilles.

The Canadian Medical Association (CMA) is excited by IRCC’s effort to make permanent residency easier for MDs – especially something primary care doctors like Antille desperately need.

“This is a system we need to adapt to more,” said CMA President Dr. Margot Burnell. Along those lines, 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 – all of which Antill had to contend with.

It aims to create a “one-stop shop” so that applicants can “enter the system and practice their potential more smoothly.”

Meanwhile, for Antil and his family, permanent residency may not come so soon. “We feel welcome here. We call this our home,” he said. “We all put maple leaf flags on our stuff, but it doesn’t feel like home yet.”

“I really want it to feel like home.”