When patients with eye injuries come into the crowded emergency ward at Toronto East General hospital, Dr. Jorge Pena knows he could make a quick diagnosis. Once or twice, emergency-room physicians have even turned to him for advice.

But Dr. Pena, who has more than 15 years experience as an ophthalmologist, is not licensed to perform cataract surgery, treat acute glaucoma or retinal detachment.

Instead, he is stuck wheeling patients down hallways, working as an orderly for $16 an hour. He is one of more than 4,000 doctors in Ontario alone who are unable to use their medical expertise because Canada does not recognize their foreign credentials.

It is especially ironic for Dr. Pena, who trained at a world-renowned clinic in Bogota, Colombia, where Canadian medical residents have studied. "It is terrible, so frustrating for me. But this is the Canadian way," said Dr. Pena, 47. "I would feel so useful and happy if I could just be an ophthalmologist again."

Dr. Pena fled Villavicencio, a city on the western coast of Colombia, three years ago after armed groups who have been waging a civil war in Colombia for four decades threatened his life. They said they would kidnap family members if he didn't pay kickbacks.

He, his wife and two teenage children were accepted as political refugees in Toronto, where Dr. Pena, who had run a successful clinic back home, assumed he could practise medicine.

The clinic he trained at in Colombia, Instituto Barraquer de Americas, is famous for pioneering laser and cataract surgery techniques, recognized by ophthalmologists such as Harold Stein, co-owner of Toronto's Bochner Eye Institute.

"He was with a very famous clinic in Bogota run by a guy I know well. We sit on various boards and committees in the U.S. The clinic is renowned," Dr. Stein said.

However, none of this mattered to the Royal College of Physicians and Surgeons. The college did not accept Dr. Pena's credentials because Colombia is not one the 13 countries whose medical education systems have been deemed acceptable (the college has ruled the systems in 28 countries inconclusive or rejected them outright).

Dr. Pena then discovered it would take more than two years and cost about $3,000 to write the Medical Council of Canada's qualifying exams, a process which is less expensive and much faster in the United States. If he passed, he had only a 10-per-cent chance of being accepted in a residency program to retrain. (In Ontario, unlike other provinces, foreign-trained physicians cannot compete directly with Canadian medical students.)

Discouraged, Dr. Pena had to accept the reality: the family could not afford for him to requalify as an ophthalmologist -- not that he believed he should have to. He decided to retrain as a nurse in a special one-year program at Mohawk College in Hamilton for foreign-trained doctors. He, along with 160 other international medical graduates -- Chinese anesthesiologists, Iranian general practitioners and Pakistani gynecologists -- studied pill dispensing and clinical nursing techniques.

"I am glad to have retrained as nurse. But I still believe I should be able to use my high-tech skills and knowledge here," Dr. Pena said.

He knows other foreign doctors have been forced to pick fruit or clear tables for minimum wage. Not only that, Mohawk College recently closed its doors to foreign-trained doctors because the College of Nurses of Ontario now requires nurses to have bachelor of science degrees. Dr. Pena was one of the last to get in.

Joan Atkin, executive director of the Association of International Physicians and Surgeons of Ontario, said many international medical graduates are in a similar position as Dr. Pena -- except for those lucky enough to have trained in fields in which Canada has a shortage. "For mid-career specialists, their only option is to go back to the beginning and retrain in a different specialty." she said.

Provinces are aware of the difficulty foreign doctors face and have launched initiatives to assist them. The provincial government in Quebec, which has a shortage of 1,000 doctors, recently launched a program to help foreign-trained physicians pass provincial medical exams. Michelle Courchesne, provincial health minister, noted that many foreign-trained doctors were in precarious financial situations, even collecting social assistance, which she described as "a waste of important talent."

In Ontario, the government has created a separate stream for international medical graduates with 50-75 spots in specific specialties, although ophthalmology is not one. In addition, the province recently announced a program to allow international doctors in certain specialties to complete six-month qualifying rotations in hospitals, although again, ophthalmology is not one of them.

Dr. Pena recently began working as a scrub nurse at the Bochner Eye Institute. He is grateful for the job -- but finds it routine and wishes he could operate on patients, instead of hand instruments to doctors: "I am not used to being on the other side of the operating table."