Why Is
Canada Shutting Out Doctors?
While
millions of Canadians can’t find a doctor, thousands of foreign physicians can’t
get a licence to practise
In Iran, Dr. Shahab Khanahmadi, a graduate of the Tehran University of
Medical Sciences, had worked as a family physician for two years. He also worked
as an assistant in the university neurology department’s clinical
electrophysiology laboratory, studying diseases such as epilepsy. But in Canada,
Khanahmadi hasn’t been able to work as a doctor. The closest he’s come to a
hospital is as an unpaid assistant to a neurologist and as a volunteer in a
family practice.
The 32-year-old says, “I am so disappointed.” He is the victim of a
complicated bureaucracy that seems intent on shutting out foreign-trained
physicians.
Khanahmadi came to Vancouver in September 2001. Because his English is
flawless, he aced the language tests—written and oral—that foreign-trained
doctors must pass to practise in this country. He also passed a series of
Canadian medical exams. This year Khanahmadi applied for a residency position
under the Canadian Resident Matching Service (CaRMS). He got two interviews but
no position. Last year British Columbia had only six positions set aside in
family practice for immigrant doctors. In September 2004 Khanahmadi will try for
one of these positions, and he says that if he doesn’t make it this September,
he’ll probably move. He has already passed the three exams necessary to work in
the United States. “I’d rather stay in Canada,” he says, “but it’s so difficult
for me.”
Equally frustrated are patients, health professionals and administrators
across the country who struggle with a shortage of doctors every day. Right now,
Hamilton is short 40 physicians—and somewhere between 40,000 and 50,000 people
in the community do not have a doctor. “Young families must use after-hours
clinics and hospital emergency departments because they can’t find a physician,”
says Kim Harper, former executive director of the Academy of Medicine in
Hamilton.
In Calgary, Dana Ball has been looking for a general practitioner (GP) for
three years. The mother of three young children says, “Whenever I see a doctor
in a clinic or in emergency, I ask, ‘Do you know any doctors that are taking new
patients?’ They say, ‘There are no doctors available—there just aren’t any.’”
According to the College of Family Physicians of Canada, 41û2 million people
had trouble finding a family physician in 2002. We lack at least 3,000 family
doctors, and the situation is getting worse. The country produces fewer family
physicians now than it did a decade ago. The shortfall could grow to 6,000 by
2011 if nothing is done.
Specialists are also in critically short supply. We need cardiovascular
specialists, anesthetists, psychiatrists, radiologists, obstetricians. Hospitals
have to turn patients away because of a shortage of emergency room physicians.
In January 2000 Joshua Fleuelling, 18, suffered a serious asthma attack in
Scarborough. Because the nearest hospital could not accept any more patients,
the ambulance took him to another hospital, where he died. The coroner’s inquest
listed the acute shortage of physicians in local emergency departments as one of
the causes of his death.
Canada’s doctor shortage is partly rooted in a 1991 report commissioned by
the provincial deputy ministers of health. In that document, Morris Barer and
Greg Stoddart, two health economists, predicted that Canada was facing a
physician surplus. In response, provincial governments, scrambling to save
money, cut first-year enrollment to Canadian medical schools by about ten
percent. Dr. Andrew Cave, an associate professor in the Department of Family
Medicine at the University of Alberta in Edmonton, says, “Despite the
predictions of the gurus ten years ago, in fact, we need more doctors.”
Dr. Dale Dauphinee, executive director of the Medical Council of Canada,
coauthored a report in 1999 that calculated that Canada needs to recruit 2,500
new doctors a year. This would cover both physicians retiring or leaving the
country and population growth. Our own graduates can’t fill the void: Our
medical schools graduate only 1,570 new doctors a year—a shortfall of 930.
A major problem is the shortage of residency openings. The provincial
colleges of physicians and surgeons, which grant doctors their licences, require
that after medical school, doctors complete a residency: at least two years of
hands-on training, usually in a hospital. An American residency is treated on a
par with a Canadian one, but residencies in other countries are not. Therefore,
the majority of immigrant doctors have to complete a residency here.
“The snag is getting the training,” Cave explains. “You can pass all your
exams, but you still can’t get into a training program.”
Dr. Abdel Bashir graduated from the Sudanese University of Gezira as a
general practitioner in 1995. That same year, he came to Ontario, fleeing a
brutal dictatorship. In Canada Bashir passed the English exams as well as the
Medical Council of Canada’s Evaluation Exam, which all foreign doctors must
write. He also passed the council’s Qualifying Exam, which Canadian medical
graduates must do to get their licences. He also became a Canadian citizen.
However, the final step—getting a residency—proved to be much more challenging
than he’d ever imagined.
Bashir had his eye on becoming a resident in internal medicine at McMaster
University in Hamilton. But to get there, he needed to pass two more exams—one
written and one clinical—administered by the Ontario International Medical
Graduate Program. Bashir says, “I had never failed an exam in my life.” But the
first time he took the Ontario exams, his clinical scores were not high enough
to be accepted into the program. He tried again a year later, with the same
disappointing result.
When he wasn’t on social assistance, Bashir worked as a cabbie and a
dishwasher. He tried the exams again in 2002 and 2003. His written results were
always among the highest out of some 500 candidates. But the examiners weren’t
satisfied with his clinical skills. They told Bashir his accent made it
difficult for patients to understand him. Finally, in 2004, almost nine years
and 15 exams later, Bashir got closer to practising here as a doctor. He secured
a residency at McMaster. It was what he had always wanted, but he says, “I am
33. I’ve lost nine years—almost a third of my life.”
Foreign doctors can compete with Canadian medical school graduates for residency
positions, but in order to do so, they have to register with CaRMS. And there is
a catch: Foreign doctors will only be considered after Canadian-trained
graduates have found residency positions. They can compete in the second
round—for the leftovers. The competition is stiff. In 2003, 625 international
graduates competed. Only 67—about ten percent—found a position.
In every province the situation regarding residency positions varies: the
number of positions available, the rules about how to get them and how long a
doctor has to train. Each province sets aside a few positions for foreign
doctors, but in no province is the number of residencies available equal to the
number of doctors seeking to fill them.
In Manitoba, the shortage of doctors has been particularly severe. But the
province recently changed its regulations, creating a new program that allows a
foreign graduate to receive enhanced training for up to one year to qualify as a
doctor.
Mahmoud Ebadi immigrated to Canada from Iran in 1999 with his wife and two
boys. He had studied medicine at the University of Tabriz and been a GP for five
years. However, both Citizenship and Immigration and the Canadian embassy in
Iran warned him there were no positions for immigrant physicians in Canada. They
were right.
Then, in 2001, the Manitoba government announced its new program and Ebadi
was accepted. After his skills were assessed, he was told he needed to complete
a one-year training program. At the end of November 2003, he finally started
working as a doctor for the Burntwood Regional Health Authority in Thompson,
Man. “Four years is a long time to wait,” says Dr. Ebadi. “But it’s fantastic to
be back in practice again.”
Admitting qualified doctors makes economic sense. If a foreign-trained doctor
requires additional training to come up to Canadian standards, it is far cheaper
to provide it than to educate a doctor entirely from scratch. Herb Emery, an
associate professor of economics at the University of Calgary, says it costs
Alberta taxpayers about $300,000 to put a student through three years of medical
school. This would be saved if immigrants who already have medical degrees were
accepted for residencies.
Joan Atlin, executive director of the Association of International Physicians
and Surgeons of Ontario, estimates that Ontario has between 2,000 and 4,000
immigrant doctors looking for a practice. “Doctors are coming with thousands of
dollars of training and experience in their pockets,” says Atlin. “They have a
right to be assessed, and if found to be qualified, they should be allowed to
practise their profession.”
Patrick Coady, co-ordinator of a group that assists the Association of
International Medical Doctors of British Columbia, agrees. “We have people who
have been the heads of emergency medicine in hospitals servicing a population of
a million, anesthetists who have been practising for 20 years. After they pass
all the exams, go through all the hoops, they can’t even mop a floor in a
hospital let alone work as a medical professional.”
Vancouver MP Dr. Hedy Fry, a medical doctor and the parliamentary secretary
to Citizenship and Immigration Minister Judy Sgro, believes that we have to look
at fast-tracking. “Do we always have to have doctors come in and spend a year in
residency?” she asks. “When do we start valuing foreign experience? Europe is
ahead of us on this. You can be trained in Italy and work in the United Kingdom.
We’re lagging.”
The Medical Council of Canada’s Dr. Dale Dauphinee is more blunt: “We are
shooting ourselves in the foot.”
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