White coats, red tape

We are a doctor-hungry nation. According to Statistics Canada, more than one million Canadians did not have regular access to a doctor in 2008.

Canada has traditionally looked to foreign-trained physicians to bolster the number of doctors in its under-filled ranks. But many foreign doctors who immigrate to Canada don’t end up practicing medicine. We’ve heard the stories, and probably even met some of the people involved — surgeons working as taxi drivers, pediatricians working in coffee shops.

Part of the problem is the complicated, challenging process for international medical graduates (IMGs) to get licensed to practice in Canada, which varies by province and sometimes even by hospital.

A new pilot program that will streamline a part of this process is meant to make it easier.

Canada has a serious doctor shortage. New measures look to help foreign-trained medical gradates enter the healthcare system as efficiently as possible.

The program will introduce one national assessment for evaluating the medical knowledge and clinical skills of foreign-trained doctors. It’s set to roll out in spring 2010, and is geared toward IMGs who need to do post-graduate training, also called residency, in their quest to practice in Canada.

And while some foreign-trained doctors welcome the program, they say it won’t make a difference because there’s a bigger bottleneck further down the line that it doesn't deal with: a lack of residency spots in university hospitals .

In a situation where only one in five IMGs who apply for a residency position get one, doctors say this issue has to be addressed to make any real progress on the doctor shortage that’s ailing the nation. 

 A new national process

The National Assessment Collaboration, funded by Health Canada and led by the Medical Council of Canada, will be piloted in three of seven Canadian assessment centres in Alberta, Quebec and British Columbia. A national launch is expected in 2011, says David Thomas, media relations officer for Health Canada.

“A common assessment … will provide a more effective, efficient way to assess and train international medical graduates and to support their integration into the health workforce,” says Thomas. “This will also ensure that the assessment process is fair, transparent and consistent across Canada.”

Before IMGs can get licensed to practice in Canada, they must complete a variety of assessments and often at least one year of residency. This applies not only to those who have just finished medical school, but also to those who have had years of experience working as doctors in their home country.

The pilot program aims to simplify the assessment process IMGs must complete before they can apply for residency positions,

Joshua Thambiraj, a U.K.-trained doctor and president of the Association of International Physicians and Surgeons of Ontario, says that a pan-Canadian assessment process is a good idea, if individual provinces fall in line with it.

“A common assessment … will provide a more effective, efficient way to assess and train international medical graduates  and to support their integration into the health workforce." — David Thomas, Health Canada

“A national exam would be useful, as long as provinces don’t make IMGs sit additional exams,” he says.  

Core problems not resolved

Yet Thambiraj questions the ultimate efficacy of the program because he says it doesn’t solve the underlying problems.

“We are doing all the peripherals but we are not addressing the core issue,” he says. “The core issue is lack of residencies.”

The provinces fund residency spots, as healthcare is constitutionally a provincial responsibility. Canada’s 17 medical schools, with their affiliated teaching hospitals, then offer these spots through the Canadian Resident Matching Service.

It’s here that IMGs are at a double disadvantage: not only are there not enough residency spots for all those who apply, but Canadian medical graduates usually get first dibs.

Traditionally, IMGs have to wait until the second round of matching to be considered for a spot, says Bryan Salte, associate registrar with the College of Physicians and Surgeons of Saskatchewan.

In 2009, of the 2,313 Canadian medical graduates who applied for residency, 2,206, or 95.4 per cent, won a spot. Of the 1,387 international medical graduates who applied, only 294, or 21.2 per cent, were matched. That means roughly four out of every five foreign-trained grads were turned away and now have to wait another full year to apply.

A new pilot program could help streamline the residency application process for IMGs. But there is an overall shortage of residency spots. Canadian  graduates usually get first choice, making it even harder for IMGs.

And those who did win a spot?

“He or she is one of the lucky ones,” says Thambiraj. “There is lots and lots of waste of talent in Ontario, and in Canada.”

The reason for the lack of spots is complex, says Ian Bowmer, executive director of the Medical Council of Canada. He says that there has been “significant progress” in boosting the number of residency positions, partly thanks to increased provincial investment. But he adds that funding is not the only issue.

“IMGs are not all inexperienced doctors who have just graduated. The premise that they have to undergo training all over again is flawed." — Joshua Thambiraj, AIPSO

“Medical schools across the country have nearly doubled their enrolment,” says Bowmer. “The educational capacity of the system has to ramp up in order to not only accept the increased number of IMG residency positions but also to accept the increasing number of Canadian graduates.”

IMGs with experience

Thambiraj says there is another problem with the residency system when it comes to foreign-trained physicians.

“IMGs are not all inexperienced doctors who have just graduated,” he says. “The premise that they have to undergo training all over again is flawed. We should find ways of integrating these doctors with experience into the healthcare system.”

The difficulty with this, say some doctors, is that not all training and experience is equivalent to that of the Canadian medical system.

“While we have a responsibility to respect the professional training of immigrants coming to Canada, we also have an ethical obligation to Canadian citizens to ensure that they receive treatment from medically qualified doctors who have met the same rigorous training standards that Canadian graduates have,” says Naomi Dove, a community medicine resident physician at the University of British Columbia.

Still, Thambiraj says provinces and regulatory authorities have to make changes, otherwise many foreign-trained physicians won’t “have a chance to be a doctor in Canada.”

“That’s the reality, and they forget that these people are genuine doctors with families and intentions to serve the nation.”