The Medical Practitioner’s Road Map
(A brief scenario of what to Expect & what To Do -to succeed in Canada)
Only one-quarter of immigrants educated outside Canada are working in medical, law and teaching occupations for which they’re trained, according to a report from Statistics Canada. And with Doctors the problem seems to be an everlasting one.
Foreign-trained doctors who immigrate to Canada face a rigorous licensing process in which they must prove themselves worthy of a residency seat in the Canadian medical system. But many -often despite 7-10+ yrs. of experience, hit a serious roadblock when it comes to qualifying & becoming a medical practitioner in Canada.
What the Bosses say?
“I am told there are at least a thousand doctors from different jurisdictions that are in Canada that aren’t practicing,” said Dosanjh. “We need to re-skill them, retrain them and bring them on stream so they can do what they do best instead of driving cabs”.
-Ujjal Dosanjh, Federal Health Minister, Sep. 27 2004
“Alberta doesn’t have a doctor shortage, but a shortage of practicing doctors. We have a huge talent pool that will stale date if we don’t get immigrant physicians into medical practice”.
-Dr. David Watt, University of Calgary language education researcher
“We have people who have been the heads of emergency medicine in hospitals servicing a population of a million, anesthetists who have been practicing 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”.
-Dr. Patrick Coady, Association of International Medical Doctors of British Columbia
The Procedure to become ‘Practicing Doctors’ in Canada:
In simple terms, an expatriate doctor must get Retrained, pass some Exams, complete a 1 yr. Internship then apply for a 2 yr. Residency Position. The total Timeframe in theory should take 4-5 yrs., before being ‘permitted’ to practice medicine. But is it? Here are the Steps involved:
Step-1. Language Tests (Written & Oral):
All foreign-trained doctors firstly, must pass the language tests [2 types -written as well as oral] to practice in this country.
Step-2. Canadian Medical Course & Exam:
Secondly, doctors must take Canadian university courses and are required to sit for a series of exams. These are two  exams -one written and one clinical -administered by the Ontario International Medical Graduate Program [similar in other provinces].These are the Qualifying Exams before they are allowed to practice medicine.
Step-3. Medical Practice of 1 year:
In order to be accepted into Residency Programs, they must have at least one  year of continuous medical practice within the previous four years. This is usually a hands-on training under a qualified medical practitioner.
Step-4. The Residency Program of 2 years:
The last step is to apply for a two  year residency position under the Canadian Resident Matching Service (CaRMS). Which are administered by universities and hospitals together.
Step-5. Medical Council of Canada’s Evaluation Exam:
As a final step, there is the Medical Council of Canada’s Evaluation Exam, which all foreign doctors must write to obtain his Medical License. And thereon, s/he can practice medicine in Canada.
So, where is the Problem?
The foregoing 5 steps seem to be fairly Ok. Though time consuming, but is achievable, Right? Wrong… there is a problem.
Problem-1. Govt. Policy -say Apathy:
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.
Thus, however smart & experienced an overseas qualified a doctor be, the openings in those provincial medical schools / colleges are not enough. There is stiff compitition, assessment tests & accessibility of a fair passage. Thus, getting pass those is a vehemoth task for an expatriate doctor.
Problem-2. Scarcity of Residency Openings:
A major problem is the shortage of residency openings. An American residency is treated on a par with a Canadian one, but doctors from other countries are not. Therefore, the majority of immigrant doctors have to complete a residency here. “The snag is getting the residency, you can pass all your exams, but you still can’t get into a training program.”
Foreign doctors can compete with Canadian medical school graduates for residency positions. But 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.
Problem-3. Qualifying for the Residency Programs:
Foreign-trained doctors are caught in a Catch-22. In order to be accepted into residency programs, they must have at least one year of continuous medical practice. This is nearly impossible to accomplish. ‘Coz, upon immigrating to Canada, doctors also must take Canadian university courses and are required to sit for provincial and federal exams before they are allowed to practice medicine. Therein lies the problem: they cannot get the residency without the experience and cannot practice in Canada without passing the qualifying exams A complex situation, albeit.
Problem-4. Time, Effort & Money:
This education, examination, training & residency process can be lengthy. And costs quite a lot. Most of us have digged into all our savings & ‘landed’ here. How many of us can afford long standing retraining costs, besides devoting some serious time over our family responsibilities? And if all goes well it would yet take 4-5 years to complete. But, if we run into red-flags, the timeframe can be anything. How many of us would have that perseverance?
(a) In Iran, Dr. Shahab Khanahmad had worked as a family physician for two years. He also worked as an assistant in the Teheran University Neurology Dept’s clinical Electrophysiology Lab, 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.”
Dr. Khanahmadi came to Vancouver in September 2001. He studied in UBC, passed all Canadian medical exams and in 2004 applied for a residency position under the CaRMS. He got two interviews but no position. That year British Columbia had only six positions set aside in family practice for immigrant doctors. After 2 more year’s attempts, in 2007 he finally got his residential opening.
(b) Dr. Bashir started studying medicine ab-initio in Canada. After 3 yrs. of medical school & clearing the qualifying exams he needed to pass the clinical exam. 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 [though he had passed the Language Exams].
Finally, in 2004, almost 9 years and 15 exams later, Bashir got closer to practicing 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.”
Solution to the Problem:
“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 3 years of medical school. This would be saved if immigrants who already have medical degrees were accepted for residencies’.
Currently, there is news of 250 foreign-trained doctors who chose to settle in 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?
Dr. Albert Schumacher, president of the medical association, said retraining international doctors isn’t quite that easy. There are about 1,000 individuals who are qualified to do residency training, but they’ve had little or no experience working with actual patients. He says, “Getting immigrant doctors into the system would be a good idea but it’s the fast-track that becomes difficult.”
“Not only did they cut back our medical school numbers but they also cut back resident medical training spots and those spots went up in vapor too,” he adds. The only quick solution would be for the federal government to pay for extra residency spots in Canada’s medical schools, he said.
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. How could this be???
They are the victims of a complicated bureaucracy that seems intent on shutting out foreign-trained physicians. But, that’s not going to remain true. There is a silverline visible beyond the dark clouds.
The AIPSO proposal is under study [link below]. And Govt. is seriously thinking of implementing it in its entirety. And their are success stories too, which should be a moral booster to many ‘landed’ doctors -read the stories of Dr. Saldhana & Dr. Nirvair Kaur [link below].
1) The AIPSO Proposal…
2) The Doctors’ Dilemma…
3) Conspiracy Theories…
4) Our own David Cohen’s Article…
5) Minister Ujjal Dosanjh asserts…
6) Why is Canada Shutting Out Doctors…
7) Dr. Colin Saldanha…
9) Dr. Nirvair Kaur Levitt…
I hope by writing the foregoing piece it helped my doctor friends.
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