Red tape deters needed MDs
Delays frustrate Canadian-born medical students
Many turn to U.S. in order to get residency posts
ELAINE CAREY
MEDICAL REPORTER
They're young, bright, ambitious and eager to return home to practise medicine in Ontario. But the 200 Ontarians who graduate from foreign medical schools every year are finding it easier to go to the United States, where they're eagerly welcomed, than to return to their hometowns, where they're badly needed. "I was set on returning to Canada to do a residency in family medicine," said Vancouver's Sara Junaid, 29, who graduated this spring from University College Dublin's medical school with a $250,000 debt. But Junaid, who earned her undergraduate degree at the University of Western Ontario, was unable to find a residency spot. She even applied to do a two-month course in family medicine at several Canadian universities, hoping to get her foot in the door, but was turned down. So she snapped up a residency position in psychiatry at the prestigious Mayo Clinic in Minnesota, where she was accepted in the first round of applicants."Now I'm thinking I might just stay in the States and work in an under-serviced area after residency. At the moment, I'm fed up with hoop-jumping and Canadian red tape," she said.Despite a serious shortage of family physicians in every province, only Newfoundland and Alberta welcome all foreign-trained Canadian medical graduates. In Ontario, Canadian-born students who have trained abroad are not even considered for the first round of residency appointments. Most of them have studied in the Commonwealth countries of Ireland, England and Australia, but when they return to Ontario, they are considered foreign medical graduates. It means they can't apply for the first round of coveted residency spots at university teaching hospitals, or even the second round to fill any specialist spots that are still vacant.Instead, they are placed in an assessment program with hundreds of foreign-trained doctors from around the world, where a committee decides if their qualifications are good enough to apply for a residency.It adds at least a year and a good deal of paperwork to the long, arduous business of becoming a doctor and, at the end, there's no guarantee they'll find a residency spot at all."I'm a Canadian citizen and I'm basically being treated like someone who's starting an immigration application from square one," said Toronto's Alex Singer, 24, who has just finished his second year at University College Dublin."What's most frustrating is I don't feel that I should have to beg the government to let me come back," he says. According to the Ontario Medical Association, Ontario is short 1,585 physicians, a number that has risen 60 per cent in the past two years. The shortage is expected to almost double by 2010 to between 2,400 and 3,400 physicians, which will affect access to medical care for 1.4 million to 2 million residents.If an international graduate could step right into an Ontario residency, "you're going to have a doctor ready to go in two years," said Dr. Barry Adams, president of the Ontario College of Physicians and Surgeons."If they're considered foreign-trained, it means at least another year of medical school first and that means at least three years," he said.It can also mean they're lost to Canada for good.
`We are losing a lot of Ontario graduates permanently.'Barry Adams, Ontario College of Physicians and Surgeons
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While the province's policy is to provide residency spots for all Ontario medical graduates, the international graduates are left to vie for one of 75 residency placements and 50 six-month clerkships that will lead to a residency. If they don't get in the first time, their only choice is to apply again next year.Most choose instead to go to the U.S., where they are welcomed in the first round of residency applications and there are more than enough spots. "Unfortunately, quite often what happens is a person stays where they do their training, so we are losing a lot of Ontario graduates permanently," Adams said. Those lost doctors could include Rob Fewster of Kitchener, who graduated from Queen's University with an 85 per cent average and "didn't even get a sniff" from a Canadian medical school. "If I was able to come back to Ontario and go into family practice, I would," said Fewster, 25, who's at University College Dublin. "I'm almost certain I will go to the States, not because I want to, but because I have to," said Fewster, who is carrying two loans to finance his medical dream. The College of Physicians and Surgeons believes that Ontario students should be allowed to compete with Canadian graduates for the first round of residency placements, Adams said. The College is calling for an assessment process for all foreign-trained medical graduates and enough residency positions to accommodate those who are successful, instead of just 75. "The feeling of the majority of the college is we are losing people who could move into the system without any international assessment. But they're not our rules to change."The ministry of health sets the number of residency spots, as well as the number of undergraduate medical spaces at Ontario universities.The current system of evaluating graduates is based on where you get your medical education, a ministry spokesperson said. "We don't differentiate between medical schools," said Bradley Sinclair, executive director of IMG Ontario, the assessment, training and placement centre for internationally trained doctors.American graduates are subject to a different process, Sinclair said. The schools they attend are evaluated by an international team that guarantees they meet Canadian standards. If the school qualifies, they don't have to go through an assessment process. Ontario used to recognize students who graduated from Commonwealth universities as equivalent to those in North America, Adams said.But in the early '90s the New Democratic Party government reduced the number of medical school and residency spots. Three of the more than 200 Canadian students in medicine at five Irish universities surveyed their fellow students recently and found 83 per cent of them want to return to Canada eventually to practise medicine. "There are a lot of us who would love to come back, and feel really frustrated about the way things are," said student Neil Dilworth of Toronto.
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