Over 21 months into the COVID-19 pandemic, Canada’s public health systems are stretched thin while thousands of foreign-trained doctors living in Canada remain sidelined due to credentialing and licensing policies.
Experts say the barriers in place include not recognizing international experience and asking foreign doctors to start as if they were freshly graduated medical students. It’s limiting them from working in Canada as physicians and contributing to the effort to combat COVID.
“This is the time to make a change,” said Shafi Bhuiyan, an assistant professor at the University of Toronto, who was a practicing doctor in Bangladesh, but had to work through the Canadian accreditation process.
Dr. Saida Azam spent nearly four years working as a physician in India and Oman but she has been unable to work during the pandemic. Her years of training, experience dealing with thousands of patients, and desire to help, has not been enough to get her working in the Canadian healthcare system.
“I want to get involved as much as possible. It has been very difficult for me to be on the sidelines, because this is the time for me to give my fullest experience to the population where I am living,” Azam said.
Currently there are more than 13,000 internationally trained doctors in Canada who are not working as doctors, according to the Internationally Trained Physicians’ Access Coalition. Of those doctors, 47 per cent are not in the healthcare field at all.
Meanwhile, Canada ranks 26th worldwide in physician-to-patient ratio, at 2.8 doctors per 1,000 people, according to Organisation for Economic Co-operation and Development (OECD). That’s about half the number in Norway (5.3) and other developed countries. The Canadian Medical Association estimates five million Canadians don’t have a primary care physician.
In Ontario and B.C., foreign doctors looking to practice must get a certificate of registration with a governing medical college, verify their degree to ensure they were educated by an institution in the World Directory of Medical Schools, secure a license from the Medical Council of Canada, and undertake one year of postgraduate training or active medical practice, as well as obtain Canadian citizenship or permanent residency.
The College of Physicians and Surgeons of Ontario states on its website it is “committed to finding new ways to evaluate individuals wishing to practise medicine in Ontario” regardless of the source country of their medical degree.
Azam, 30, has been in Canada since 2018. To become a practicing doctor, Azam needs to take a mandatory written and practical exam, each costing between $1,500 to $2,500. Additionally, she plans to write another another optional exam given to try and boost her chances when she applies for residency.
So far, Azam has not yet written any of the exams. Instead she’s been focused on taking advanced English classes to prepare for the exams.
After the exams, Azam has to apply to a residency program, which will last between three and five years.
Medical school graduates who attended school in North America, or have practical experience in the U.S., are statistically favoured for residency programs. Less than a third of recent international medical graduates applying for residency were accepted, according to Canadian Resident Matching Service (CaRMS). Meanwhile, 95 per cent of Canadian-trained medical graduates who applied were matched for residencies.
“The unwritten rule is that we should have recent practice within the last three years of applying and preferably practice is in North America with reference letters from doctors in North America,” Azam said.
CaRMS decides where to match Canadian and foreign medical graduates to a residency program. A spokesperson for CaRMS told Global News the matching process is objective and doesn’t discriminate based on where someone studied.
“CaRMS’ role in the residency match process is to provide a fair, objective, reliable, and transparent application and matching service for entry into postgraduate medical training throughout Canada — for all participants,” wrote a CaRMS spokesperson in an email to Global News.
To Bhuiyan, the current method of relicensing, and making foreign doctors go through the same process as if they were new medical graduates is discriminatory, and it discredits international healthcare.
“The experience of foreign doctors coming into Canada is extremely underutilized. It perpetuates bias,” he said.
Dr. Hassan Moustafa was a supervising doctor in one of the largest refugee camps in Kurdistan, where he oversaw medical operations for 60,000 people. The Syrian-born doctor spent over a decade working as a surgeon in Iraq and Syria with the United Nations and Doctors Without Borders, but now he can only get work with a medical equipment manufacturer in Canada.
Moustafa has tried to get regulated and even fast-tracked in Canada so he can continue practicing, but he’d have to go through the typical five years in residency to be a surgeon in Canada. At 45 years old, the clock is ticking, and while he wants to ultimately work as a surgeon, Moustafa is willing to take a less skilled job to simply get into the system.
“Respect my experience. I’ve done a lot of work. I have a lot of experience. So let me enter this system as a surgeon’s assistant,” he said.
There are two evident needs for change in policy around foreign doctors, Bhuiyan said: Canada’s aging population and continuing doctor shortages.
Canada is not graduating enough doctors to match the needs in the country, said Bhuiyan, especially in family medicine where there is a nationwide shortage. Investing in foreign doctors is a simple solution and can happen immediately, he said.
“We have all the resources. We need to make a plan,” he said.
Katharine Smart, President of the Canadian Medical Association agreed that staff shortages in healthcare settings across the country are glaring and have been ongoing for decades.
“We have longstanding staff shortages, particularly in primary care,” she said.
According to Smart, nearly a quarter of all physicians working in Canada right now were trained overseas, but challenges remain regarding how to credential doctors coming into the country. Each province and territory has a medical regulatory authority responsible for setting licensing criteria.
“The training and the experience of people is very variable, depending what part of the world they’re from. We definitely do have systems in place that allow people to access our system, but it’s complicated,” Smart said, adding the concern warrants exploration.
“It’s not something that’s likely going to be solved overnight.”
—with files from Jamie Mauracher