In the face of worsening health workforce shortages, Canada must shift from a culture of personal likability to a system of objective qualifications or merits in recruiting and retaining physicians. While team cohesion and interpersonal compatibility are essential, an overemphasis on “fit” or likability excludes talented physicians, particularly immigrants and racialized minorities, who may not share the cultural background, communication style, or social behaviors preferred by decision-makers. This practice undermines equity, exacerbates staffing gaps, and weakens health care delivery. Subjective likability is rooted in unconscious bias and may undermine hiring and workplace dynamics.
Canada’s health care system increasingly depends on foreign-trained physicians, with immigrants comprising over a quarter of physicians. Despite credential recognition, clinical competence, and language fluency, many foreign-trained doctors face invisible barriers in hiring, workplace integration, and promotion. A significant barrier is the informal evaluation of likability, often equated with cultural similarity or social ease, which disadvantages those from different ethnic, linguistic, or religious backgrounds. This ethnocentrism implies that highly qualified immigrant doctors may be overlooked not because of skill deficiencies, but because the hiring team perceives them as “too assertive,” “not warm enough,” or “not fitting the culture.” These subjective judgments of likability are rarely documented but profoundly influential.
When likability becomes a gatekeeping mechanism, the result is economically and operationally unsound. Health systems across Canada are grappling with staff burnout, long wait times, and service closures. Yet, many qualified physicians living in Canada are underemployed or excluded due to informal criteria prioritizing subjective likability over technical expertise and professional integrity. A system that chooses familiarity over diversity closes the door to innovation and resilience, especially in multicultural patient settings where diverse staff are an asset. An Institute for Canadian Citizenship (ICC) official report in 2023 confirmed that growing numbers of immigrants are leaving Canada. Daniel Bernhard, ICC’s chief executive, said, “We are now seeing people coming to Canada and then saying, ‘Ah, no thanks,’ and moving on.” And the number of those people is increasing. We believe the lack of opportunities and other services is part of it.
Canada must shift from prioritizing subjective interpersonal comfort to prioritizing competence, communication, and contribution. This shift requires health care leaders and hiring committees to be trained in structured interviews, anti-bias evaluation techniques, and objective performance indicators. Peer support and mentorship programs should be explicitly inclusive, with mechanisms to ensure that marginalized physicians are integrated into team culture and decision-making. Health system leaders must challenge the assumption that cohesion depends on sameness. Indeed, diverse teams can be more innovative, adaptable, and better suited to serve Canada’s increasingly diverse population.
Canada must redefine what makes someone a “good fit” by shifting from comfort-based selection to performance-based inclusion. Only by valuing difference and dismantling subjective barriers can the health system build the diverse, resilient workforce it urgently needs. Indeed, “we don’t have to like people to work with them.”
Olumuyiwa Bamgbade is an accomplished health care leader with a strong focus on value-based health care delivery. A specialist physician with extensive training across Nigeria, the United Kingdom, the United States, and South Korea, Dr. Bamgbade brings a global perspective to clinical practice and health systems innovation.
He serves as an adjunct professor at academic institutions across Africa, Europe, and North America and has published 45 peer-reviewed scientific papers in PubMed-indexed journals. His global research collaborations span more than 20 countries, including Nigeria, Australia, Iran, Mozambique, Rwanda, Kenya, Armenia, South Africa, the U.K., China, Ethiopia, and the U.S.
Dr. Bamgbade is the director of Salem Pain Clinic in Surrey, British Columbia, Canada—a specialist and research-focused clinic. His work at the clinic centers on pain management, health equity, injury rehabilitation, neuropathy, insomnia, societal safety, substance misuse, medical sociology, public health, medicolegal science, and perioperative care.
