Ontario’s recently enacted Bill 33, known as the Supporting Children and Students Act, is facing significant criticism from leading medical education experts who argue it threatens crucial holistic admission pathways to medical schools. This legislation, passed in November, mandates that publicly assisted universities assess applicants based on "merit" and publicly disclose their assessment criteria and processes. However, critics contend that the bill’s vague definition of merit and its potential to undermine equity-focused admissions could jeopardize the training of future doctors equipped to serve diverse and underserved populations, including Indigenous, rural, and low-income urban communities.
This contentious issue has been brought to the forefront by an editorial published in the esteemed Canadian Medical Association Journal (CMAJ). The editorial, penned by two prominent figures in medical education – Dr. Lisa Richardson, Vice-Dean of Strategy and Governance at the University of Toronto’s Temerty Faculty of Medicine, and Dr. Marcia Anderson, Vice-Dean of Indigenous Health, Social Justice and Anti-Racism at the University of Manitoba – expresses profound concern that the new law fails to adequately consider the unique needs and historical disadvantages faced by Indigenous peoples and racial minorities.
Drawing upon their extensive combined experience of two decades as field researchers and influential leaders in Indigenous health, Drs. Richardson and Anderson state their intention to "set the record straight" regarding the implications of Bill 33. They argue that a medical workforce that mirrors the cultural diversity of Ontario is essential for effectively serving the public health interests of its population.
The Ambiguity of "Merit" and its Impact on Equity
A central tenet of the criticism leveled against Bill 33 is its failure to define the term "merit." The legislation implicitly suggests that current admission criteria are neither rigorous nor transparent, a premise that medical education leaders strongly dispute. Drs. Richardson and Anderson assert that a diverse medical workforce, comprising physicians from various backgrounds and cultural experiences, is not only reflective of Ontario’s demographic landscape but is also crucial for addressing the multifaceted health needs of its population.
Despite Ontario grappling with a severe shortage of physicians, the province’s medical schools admit a limited number of students annually – approximately 1,100. The editorial highlights that even within this limited cohort, students admitted through holistic criteria are already considered highly meritorious candidates. The authors cite a body of academic research that consistently demonstrates the positive outcomes associated with equity-forward admissions policies. This evidence, they argue, calls into question the foundational justification for Bill 33.
"We agree merit should be the central determinant of admissions to medical schools," the authors state in their editorial. "However, only by expanding traditional definitions, which focus on biomedical and scientific academic domains, to include comprehensive measures of merit through evidence-based approaches can medical schools create the diversity required to respond to the health needs of Canada’s population." This perspective underscores a call for a broader, more inclusive understanding of merit that extends beyond purely academic metrics.
Medical Faculties Advocate for a Seat at the Table
As details surrounding the government’s implementation strategy for Bill 33 remain largely undisclosed, medical faculties across Ontario are vocally advocating for their inclusion in the process of defining "merit." This call for collaboration stems from a deep-seated concern that decisions impacting medical education admissions will be made without the input of those with direct expertise and experience.
Connie LeBlanc, President and CEO of the Association of Faculties of Medicine of Canada (AFMC), an organization representing Canada’s 19 medical schools, emphasizes the critical need for diverse perspectives in shaping admission criteria. "If we don’t include people from minority communities in how we define merit, we’re making a mistake," Dr. LeBlanc stated. The AFMC has intensified its support for Diversity, Equity, and Inclusion (DEI) initiatives, particularly in the wake of recent U.S. Supreme Court rulings that have challenged race-based equity measures. This has led the AFMC to re-evaluate its accreditation standards, notably discontinuing the use of U.S. standards for accrediting Canadian medical schools last year.
Each Canadian medical school currently sets its own admission criteria, a process developed over years of consultation with experts. These steps are designed to reflect the most current understanding of the qualities and competencies required for successful entry into medical school and subsequent practice. Dr. Richardson elaborates, "It’s a very rigorous process in which merit is assessed in a highly relevant and practical manner, in order to train excellent doctors to serve the needs of our society."
The Demographic Imperative: Addressing Indigenous Physician Shortages
The urgency of maintaining and enhancing holistic admission pathways is underscored by demographic realities. Statistics Canada data indicates that Ontario has approximately 335 Indigenous physicians, representing about one-third of the total Indigenous physician workforce nationwide (1,175). While this number signifies a crucial presence, it also highlights the ongoing need to increase representation to better serve Indigenous communities.
Some Ontario universities have already implemented specific measures to foster Indigenous representation. For instance, Queen’s University and the University of Ottawa reserve a certain number of admission spots for Indigenous students. While the University of Toronto does not have reserved spots, it provides mechanisms for Indigenous applicants to submit supplementary documentation, which aids in demonstrating their qualifications against the institution’s "extremely robust" selection criteria. These criteria, Dr. Richardson notes, are transparently outlined on the faculty’s website.
Supporting Evidence for Holistic Admissions
The efficacy of holistic admissions processes is further supported by recent research. An online survey conducted in 2025 at McMaster University, involving 647 medical students, explored their perspectives on equity-based admissions. Of the 95 students who participated, a significant majority expressed support for holistic admissions criteria as a means to counteract systemic barriers faced by Black and Indigenous students. However, the survey also revealed that less than half of the respondents were familiar with equitable admissions measures. A key finding indicated that medical students are concerned that current admissions processes may disproportionately favour applicants from higher socioeconomic backgrounds, further reinforcing the need for equitable approaches.
The Ontario Confederation of University Faculty Associations (OCUFA), which was invited to provide its views on Bill 33 to the Ministry of Colleges and Universities, Research Excellence and Security, also maintains that existing admission criteria are already merit-based. OCUFA President Rob Kristofferson voiced concerns that the current Conservative government might be seeking to standardize admissions across provincial faculties, potentially overstepping its purview and encroaching on areas where it lacks expertise. This concern is echoed by a 2021 study by the non-partisan NGO Evidence for Democracy, which found a pattern of the Premier Doug Ford government failing to provide scientific evidence to support its policy decisions.
Reaffirming Inclusiveness and Rigour in Medical Admissions
Drs. Richardson and Anderson are keen to clarify their position, emphasizing that their advocacy is not for preferential treatment but for a more comprehensive assessment of the merits of Indigenous candidates. "We’re not saying that Indigenous applicants should receive preferential treatment," stated Dr. Anderson. "But, rather, that there should be a more comprehensive assessment of the merits of Indigenous candidates." This nuanced stance underscores the goal of ensuring that all relevant qualifications and experiences are duly considered.
Dr. LeBlanc of the AFMC further reinforces the national perspective, describing holistic admissions as effective tools for addressing widespread systemic discrimination. She acknowledges that medical school is an "intense and a long haul" and that admitting students who may lack the inherent potential to succeed would be detrimental to students, universities, and the healthcare system alike. "There is no credible evidence that faculties of medicine which achieve diversity through equitable admissions processes have lower graduation rates," she concluded, providing a crucial counterpoint to potential concerns about academic outcomes.
The debate surrounding Bill 33 highlights a critical juncture in Ontario’s approach to medical education. Critics argue that by potentially dismantling holistic admissions, the province risks diminishing its capacity to train a diverse and culturally competent physician workforce, thereby impacting its ability to meet the evolving health needs of all its residents. The call for transparency and collaboration in defining "merit" remains a central demand from the medical education community, seeking to ensure that future admissions policies uphold both excellence and equity.
