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Provinces are only now beginning to
address Canada's 'untenable' shortage of doctors
Guy Dixon -
Wednesday, January 8, 2003
Jocelyn Dumatol-Sanchez trained as a family doctor in the Philippines and now works in an emergency room in northern Manitoba. But it took her nearly eight years to get accreditated to practise medicine in Canada.
"When I came to Canada, I was very hopeful and happy," she said, adding that Immigration officials told her she only needed to pass an assessment exam to practise medicine here.
When she arrived, however, she learned of the additional training required and the scarcity of spaces available. "It was really hard, there was a point in my life when I was depressed and angry." Now, she is simply happy to be practising again.
Roughly a quarter of Canadian physicians currently practising are trained outside Canada and the United States; Quebec has the lowest proportion of foreign-trained physicians, around 12 per cent, and Saskatchewan has the highest, approximately 56 per cent.
But with about 4.5 million Canadians reporting that they had trouble finding a family doctor last year, the shortage of doctors has reached an immediate, long-term and "untenable" shortage in communities nationwide, says the College of Family Physicians of Canada.
The country needs approximately 3,000 more family doctors, it says, warning that the shortfall could hit 6,000 by 2011.
Yet many foreign-trained doctors who could help fill the gap often face a rough path to accreditation. Foreign doctors coming to Canada must first pass the Medical Council of Canada's evaluating exam and then try to find a rare spot in provincial medical residency programs designed for international grads.
Most foreign-trained doctors bring unique skills suited to providing culturally sensitive care, such as "speaking the language of patients," said Dr. Rod Crutcher, a family physician at the University of Calgary and co-chair of a national task force looking into establishing a national accreditation standard for foreign-educated doctors.
Currently, accreditation is provincial, with each province having its own set of restrictions and with minimal co-ordination between provincial bodies.
For instance, Nova Scotia gives preference to international medical grads already working in health care and living in that province or in New Brunswick or Prince Edward Island, while Saskatchewan prefers candidates who have already passed the first part of the Medical Council of Canada's qualifying examination, which all doctors in residency programs must eventually take.
The restrictions can also vary depending on the admissions criteria of the universities administering provincial residency programs for international medical grads.
"There are challenges at every level," Dr. Crutcher said, "at licensing levels, at accreditation levels, assessment levels, human rights levels. It is a very complex tapestry."
Given the severe shortage of doctors, "there is a collective will to make progress in an area where progress at a policy level and practice level has been quite difficult," he said.
After originally settling in Duncan, B.C., with her husband and children in 1994, Dr. Dumatol-Sanchez found herself working as a mental health worker, as a clinical assistant and even for a time as a kitchen worker at Pizza Hut.
She had passed a medical assessment exam, but had to continue to apply through the Canadian Resident Matching Service (CARM) to get into one of the few residency spots available to foreign-trained doctors.
Canadian grads come first when it comes to residency placements; doctors with foreign degrees are generally placed after them, in a second round of cuts.
"Most of the time, it is very seldom that a foreign grad will get a position, even through the second round of matching," Dr. Dumatol-Sanchez said. Only 16.6 per cent of international medical grads were placed in residency programs in CARM's second round of matching in 2002.
Many provinces also have their own restrictions on foreign grads entering through the residency service. Ontario hasn't accepted any foreign grads through the first or second rounds. Instead, foreign-trained doctors there can only enter residency programs through the few spots in the province's international medical graduate program.
After repeatedly contacting programs across the country, from B.C. to Newfoundland, Dr. Dumatol-Sanchez, now 40, finally found a place in Manitoba's licensing program for international medical grads last January.
In an effort to attract doctors to practise in the north, Manitoba was in the process of starting a new clinical assessment and training program that accredits foreign-trained doctors after only a year of medical residency in that province. But they must first pass a thorough three-day assessment of their training.
"On the basis of that, it is decided whether they get into the program, which is up to one year of retraining," said Ruth Simkin, director of the program.
The program, which has been running for a year and a half and has spots for up to 10 people, funnels foreign-trained doctors to remote towns.
"The stipulation is that they practise in rural Manitoba," she said, adding that "despite the fact that Winnipeg is also underserviced, it is not designated as an underserviced area. So they have to practise in rural Manitoba." The doctors can then apply to the College of Physicians and Surgeons of Manitoba for a licence to practise.
The Ontario government has also launched a program to add roughly 600 additional doctors to the province's health system over the next five years or so, mainly by streamlining the accreditation for foreign-trained physicians.
"There are too many qualified, foreign-trained doctors already living in Ontario who have been forced to sit on the sidelines of our health care system," said Premier Ernie Eves when announcing the plan last November.
He said the program will more than double the number of foreign-trained doctors currently practising in the province.
The program, which will cost the province around $36-million, will set up a varied process for assessing the credentials of foreign-trained physicians, particularly the qualifications of foreign-trained specialists in badly needed areas and the qualifications of doctors willing to relocate to rural communities.
"It's a good idea. By fast-tracking, we don't need to spend our resources to retrain them, which is totally a waste of time and money," said Dr. Shinya Ito, a doctor in the Division of Clinical Pharmacology and Toxicology and the Department of Pediatrics at the Hospital for Sick Children in Toronto. He received his medical degree in Japan at Jichi Medical School.
"Given that there is a shortage of medical professionals, I think as a short-term solution, it is a good idea," he said.
As Dr. Dumatol-Sanchez in Thompson, Man., argued: "I might have studied a brown or black human body or cadaver," but medicine is the same regardless.
"I think a foreign medical doctor doesn't need three or four years of training to be able to know what diseases are present in Canada.
"If only they would give us a chance, we have something great to offer."
