“I was a doctor back home.”
“I’m writing my exams to get my licence here.”
“It’s been three years since I practised last.”
“Seven years.”
“Ten.”
We’ve heard it countless times over the last few years — from close family friends to people we meet through our work or even on a taxi ride home — and every time we’re disappointed this is the experience of so many internationally trained physicians in our country.
The foreign credentialing issue has been a concern since well before the COVID-19 health crisis. It’s disheartening that even with a pandemic in full swing, Canada is still not leveraging one of its most valuable assets: the skills and experience of thousands of doctors.
Ontario alone has 13,000 physicians and 6,000 nurses who were trained outside of Canada. Many of them immigrated here with hopes of contributing their medical expertise to the health-care system. Unfortunately, their dreams have been hampered by systemic barriers such as exorbitant testing fees, challenges obtaining insurance and, in the case of physicians, a dismally low number of available residency spots.
Part of the rationale for such barriers is the critical importance of Canadian experience and the need for medical professionals to meet Canadian standards. Requirements for residency experience within Canada are coupled with a limited number of spots, which essentially forces many physicians to start over despite having potentially decades of experience under their belt. Even Canadian-trained medical students can struggle to find placements, but for internationally trained physicians it is even more difficult. In 2019, the Canadian Residency Matching Service reported that out of 1,758 international medical graduates, 1,360 were not matched with residency placements. And even if internationally trained physicians receive a spot, they are often underemployed and unsupported, leading to financial and emotional hardship.
As foreign experts languish in the system, the need for physicians continues to be great. Many institutions have noted Canada falls behind the majority of OECD nations when it comes to physicians per capita. According to the World Bank, Canada has only 2.6 doctors for every 1,000 residents. Italy, which until recently was the epicentre of the pandemic, has about 50 per cent more per capita.
Crisis and opportunity
The COVID-19 crisis has spurred some promising initiatives to leverage this untapped talent pool to address an immense need. Italy, the United Kingdom and some American states have eased the requirements for internationally educated physicians and novice medical graduates to contribute to national COVID-19 efforts. For example, in New Jersey, authorities have granted temporary licences to doctors residing in state with good standing in foreign countries. In New York, internationally trained medical graduates are now allowed to treat patients after one year of residency, compared to the regular requirement of three years.
Some medical licensing bodies in Canada are taking similar steps. For example, in Ontario, international medical graduates who have passed their exams in Canada can apply for a 30-day medical licence. The College of Physicians and Surgeons of British Columbia has fast-tracked a new bylaw to amend the province’s Health Professions Act so international medical graduates can apply for a supervised associate physician licence allowing them to work under the supervision of attending physicians.
These efforts to lower barriers to entry show promise as a way to address the immediate health crisis. But the pandemic also presents a crucial opportunity to leverage this globally educated talent pool over the long term. The Canadian population is aging and more health care is being delivered outside of hospitals, so we will continue to need more health professionals in the community. Many Canadians also find it challenging to find a physician who understands their mother tongue and cultural context; internationally trained medical professionals can help plug those health equity gaps.
We need federal leadership during this crisis to ensure there is coordination across all jurisdictions to achieve clarity for internationally trained physicians. Canada should consider several options to achieve this:
· Adopt the solution proposed by the Ontario Council of Agencies Serving Immigrants, Toronto Region Immigrant Employment Council and World Education Services to recruit, train and deploy internationally trained physicians to support our health-care systems during this time of emergency.
· Automatically grant physicians who have been provided a temporary licence during the pandemic the ability to practise to their full capacity afterwards.
· Increase the number of residency spaces for internationally trained physicians.
· Once this pandemic passes, a federal-provincial-territorial working group should be established to examine the issue more deeply and build pan-Canadian consensus. One of the first tasks assigned to this entity should be to create a simplified accreditation process across the country.
Over the past number of years, we’ve seen various orders of government, academic institutions and self-governed medical professions work together to make some progress, such as investing in bridging programs and placements for internationally trained physicians. This is a helpful start but more needs to be done. COVID-19 provides an opportunity to accelerate the many good program and policy ideas that have already been discussed or introduced in ways that are too limited. Now is the time to make real and lasting progress to help our health-care system, internationally trained medical professionals and Canadians in need of health care.
Georgette Morris is a doctoral student at Carleton University, contributes her time to Jaku Konbit and holds a Masters in Public Policy, Administration and Law. Shireen Salti is the Interim Executive Director of the Canadian Arab Institute and holds a Masters in Public Policy, Administration and Law. Anjum Sultana is the Founder of Millennial Womxn in Policy, the Director of Public Policy & Strategic Communications at YWCA Canada and holds a Masters in Public Health from the Dalla Lana School of Public Health from the University of Toronto.
