Why is Canada shunning trained doctors during a health crisis?

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Internationally trained physicians are being pushed aside in Canada, while six million Canadians do not have a family doctor.

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Internationally trained physicians are medical professionals who completed their education outside of Canada or the United States. They are a diverse group of professionals trained in various specialties.

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Many move to Canada in search of a better quality of life, training opportunities, and political and economic security. Historically, most migrated through the Skilled Worker Express Entry Program, which favors their extensive educational background. However, they face several hurdles throughout the licensing process.

In October 2021, a community research team at Simon Fraser University, supported by an advisory committee, conducted research on Canada’s medical licensing policies.

The project grew out of Trained To Save Lives, a social media campaign about the role of internationally trained health workers in BC’s response to COVID.

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We conducted interviews with 11 internationally trained physicians in BC Although this study was conducted in BC, the results highlight licensure barriers for internationally trained physicians across Canada.

eight steps

The path to licensing in Canada is complex, especially as each province has its own licensing system. At BC, requirements include:

• Internationally trained physicians must have a medical degree from an accredited school in the World Directory of Medical Schools.

• They must provide certification of language proficiency if the language of their medical degree obtained is not English and the provision of care is not performed in English.

• They must pass the Medical Council of Canada Qualifying Examination Part 1 and the Objective Structural Clinical Examination of the National Evaluation Collaboration.

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• Must apply for a Clinical Assessment Program.

• They must then complete a Residency or Practice Ready Assessment.

• When applying for residency, they are required to sign a Return of Service agreement.

• Must obtain a provincial license. In BC, these are awarded by the College of Physicians and Surgeons of BC

• Finally, they must pass a certification process involving national certification exams administered by the College of Physicians and Surgeons for family doctors or the Royal College of Physicians and Surgeons of Canada for specialists.

licensing barriers

From our interviews, we identified several barriers. The National Assessment Collaboration Objective Structural Clinical Examination, required for international medical graduates applying for Canadian postgraduate training, was identified as a major obstacle.

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While Canadian and US medical school graduates are not required to take this exam, internationally trained physicians must pay significant fees to take the assessment, which has few annual offerings.

Several faced long waiting times and had problems with settlement workers regarding their career prospects. They were told that their education “meant nothing” in Canada.

Internationally trained physicians highlighted the lack of transparency, including unclear information about licensing. Although they expected relicensing to be arduous, they were not prepared for the difficulties they would face.

Their experiences contradicted the federal immigration department’s demand for skilled workers. Instead, many have been pushed into precarious, low-paying jobs that don’t match their education or experience.

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Few vacancies

One of the most profound barriers that internationally trained physicians have been lobbying against is the limited number of residency slots available to them.

Residency is postgraduate training required for licensure. The Canadian Resident Matching Service, the organization responsible for matching candidates with residency programs, separates positions into two streams: Canadian medical graduates and international medical graduates.

When applying, international medical graduates can apply for only 10% of the places and are restricted to a handful of underserved specialties, such as family medicine.

Another systemic barrier is the previously mentioned Return of Service agreements. Under these contracts, internationally trained physicians who secure residency positions must work in an underserved community for two to five years (excluding Alberta and Québec).

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Collectively, these barriers negatively impact the mental health and well-being of internationally trained physicians.

changes ahead

Some provinces have introduced initiatives to allow internationally trained physicians to practice.

The BC Practice Ready Assessment program will increase from 32 to 96 seats to provide internationally trained family physicians with postgraduate training an “alternative path to licensure”.

While these are important steps, they do not address all systemic barriers to licensing. They don’t allow these qualified doctors to use their expertise to support an overburdened healthcare system.

The federal government recently launched a call for proposals aimed at addressing Canada’s labor shortage by allowing internationally educated professionals to work in the Canadian healthcare system.

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Significant engagement with internationally trained physicians is also required to integrate them into the health workforce. We propose to provide transparent and clear information about licensing requirements prior to migration; prioritize mental health supports upon arrival and during the licensing process; increase the number of residency vacancies and medical specialties for physicians with international training.

Simran Purewal is Research Associate, Health Sciences, Simon Fraser University; Evelyn Encalada Grez is Assistant Professor, Labor Studies, Simon Fraser University; Paola Ardiles is Senior Lecturer in Health Sciences at Simon Fraser University.

This article originally appeared on theconversation.coman independent source of news and opinion from the academic and research community.