canadavisa.com

The Game is Rigged

May 22, 2007

Canada needs more doctors. This message has been trumpeted for years by politicians, hospitals, and by many ordinary Canadians, who are unable to find a family doctor and are frustrated by the long delays to see a medical specialist. For a country that prides itself on having a first-class public health care system, things could be a lot better.

A number of doctors from around the world have answered the call to come work in Canada. They gave up careers in their home countries. They accepted the fact that despite being well-educated and experienced, they would not be able to work in Canada until going through the Canadian licensing process.

Today, there is news of a group of 250 of these foreign-trained doctors who chose to settle in the province of Quebec, where thousands of inhabitants are in need of a family doctor. These doctors have passed national licensing examinations. They have passed provincial licensing examinations. They have passed language proficiency tests. But they aren't practicing today. We should be asking why.

Before medical doctors can practice in any Canadian province, they must complete a residency program, which is a paid hospital position considered the last step in medical training. This applies to doctors trained in Canada and doctors educated abroad. But there is an important difference between these two groups: nearly all Canadian medical school graduates are accepted into residency positions, but only just over a quarter of foreign-trained doctors were able to find a residency position last year. This isn't a matter of too-few residency spaces being reserved for Canadian medical students. Several dozen residency positions in Quebec are going unfilled this year. How could this be?

Foreign-trained doctors are caught in a Catch-22. In order to be accepted into residency programs, which are administered by universities and hospitals together, they must have at least one year of continuous medical practice within the previous four years. This is nearly impossible to accomplish. Upon immigrating to Canada, doctors often must take Canadian university courses and are required to sit for provincial and federal exams before they are allowed to practice medicine. This education and examination process can be lengthy. Therein lies the problem: they cannot get the residency without the experience and cannot practice in Canada without the residency. They deserve better.

Of course it is important to maintain high standards for our healthcare system. And yes, Canadian medical schools are of high quality. But there is a line between maintaining Canadian standards and creating unnecessary obstacles. In Quebec at least, that line was crossed long ago. A few weeks back, Quebec's Minister of Health, Philippe Couillard, publicly reprimanded the universities for not accommodating foreign-trained doctors in residency programs. More recently however, Couillard has back-pedalled, saying that he will not intervene on the doctors' behalf.

In contrast, the province of Ontario seems to be doing a better job on this issue. The provincial government is currently providing millions of dollars to train their foreign doctors. Last year, more medical licenses were awarded to international medical graduates than Ontario graduates. An example is being set for the rest of Canada.

The status quo in many of the Canadian provinces cannot continue in the name of "standards". To suggest that foreign doctors are not sufficiently qualified to practice even after passing provincial and national licensing is unreasonable as well as insulting to a group of professionals who left their careers behind to come to Canada. Most of all, it is unfair. It is unfair to the doctors and it is unfair to ordinary Canadians who are being robbed of this expertise in their healthcare system. We can do better.