PETER MANSBRIDGE: For many foreign trained doctors, Canada
may seem like a great place to be. A public health care system, affordable
schools, and a shortage of trained doctors. But the reality is much different
and much more frustrating. In fact, many foreign trained doctors are resigned to
a life where practicing medicine is merely a dream rather than a reality. Here's
The National's Dan Bjarnason with doctors in waiting.
DAN BJARNASON (Reporter): Dr. David Ruani begins each day
with one of the tools of his trade, what he jokingly refers to as his
stethoscope. Actually he's Dr. Ruani only back in his native Pakistan. Here at
work in this apartment block in Kingston, Ontario he's plain old David Ruani,
janitor. Here, his years of medical training over there count for nothing.
DR. DAVID RUANI: We were entered into a medical school by
competition which took us five years to graduate from there. I turned to a
United Christian hospital and did a one year surgical internship. I was selected
as the best surgical intern. I was working with American consultants over there.
I got surgical internship award for that year. After that worked for six months
in medicine, six months in surgery. So I decided to join federal post-graduate
institute and started again fresh. I got a six month contract. Then again it was
renewed for a six month period. I was in charge of the private wards over there.
That hospital is a place where the Prime Minister or the President, if they fall
sick, they check into that hospital and I was supposed to be in charge of the
hospital.
BJARNASON: Ruani is actually moving up in the world. When
he came to Canada five years ago to make a better life for his family, he
started out delivering flyers door to door. But he's unable to get his license
to practice medicine. Foreign trained doctors must take special exams to even be
eligible for internships and hospital residencies. And of the hundreds of
hopefuls in Ontario who take those exams each year, only the top applicants are
selected. Two years ago it was 36. Last year there were 50. So far, Ruani hasn't
been among the chosen but he isn't giving up.
RUANI: When I opted for this job, I knew that this was
going to be a stop gap arrangement. But what I did not realize is that I might
also have to suffer from an intellectual environmentally deprived set up. And
what I've been able to do is besides be environmentally deprived set up, what I
have done is proved myself that I have the potential to be picked up and to be
considered.
BJARNASON: One estimate puts the number of unlicensed
foreign trade doctors as high as 4,000 just in Ontario alone. And their medical
training is slipping further and further into the past. An advocacy group
lobbying on behalf of foreign trained physicians says the licensing ground
rules, especially in Ontario, are too onerous and fail to take into account
medical experience overseas.
JOAN ATLIN (Association of International Physicians &
Surgeons of Ontario): There are myriad of levels and a myriad of different
organizations and what we really have in Canada is a sort of ad hoc system that
really, to a newcomer looks like a maze where there are a whole number of
different doors, most of them very narrow, that they can go through.
BJARNASON: Says Joan Atlin, even for foreign trained
doctors who pass all the exams, it can still take as long as five additional
years of retraining to become qualified, retraining that sometimes isn't
necessary.
ATLIN: Some time around the 80's, there were predictions
that there was going to be a physician surplus in Canada. Predictions that have
proved to be badly incorrect. And restrictions started to be put in place then
in terms of how foreign trained physicians would come into the system and what
they were required to do and how many of them, I mean a quota essentially in
Ontario was placed. There was 24 positions starting in the mid 1980's.
BJARNASON: Calista Phillips is one of the chosen ones.
After three years of effort and raising a family in the meantime, she finally
gets to begin her retraining and start her residency in a hospital in Hamilton,
Ontario this summer.
CALLISTA PHILLIPS: I did know I'd have to give exams and in
every country, you have to qualify and I could quite understand that because
there are so many schools, medical schools, they don't know what the standard
is. But I did not really realize that it would be this tough to come to do it.
BJARNASON: Born and trained in India and with both her
parents physicians, Dr. Phillips practiced medicine in India itself and also in
the Middle East. She finally got a foot in the medical door here but will still
have to redo almost all of her training. So you add up all of your years of
getting accredited in Canada and all those years you spent studying in India,
what does that add up to?
PHILLIPS: Add all up? Well, it would add up to, five and
three, eight, nine... 18 years, 18 years nearly. Yeah, that's right. Even 18
years of my life, if I get back to practicing medicine, that's what I want to
do. I don't mind. I've got many more years hopefully to live. And I live by the
motto, I mean my mom used to tell me like that troubles like the hills ahead
straighten out when you advance upon them. And that's how my troubles have. I
have been through a lot financially and in other ways, not being able to
practice medicine and feeling bad. But people have helped me a lot in Canada.
This is a great system that you're getting but it's like a gate keeping system
only 36 or only 50 when there are thousands like, you know, equally qualified.
DR. GERRY TANNENBAUM: Mary?
BJARNASON: Canada is short of doctors. Ontario alone needs
more than 1,500 physicians. Yet Ontario remains one of the toughest provinces
for foreign trained doctors to crack. Dr. Gerry Tannenbaum is the head of the
Ontario international medical graduate program, in effect, the gate keeper in
the system that determines how many foreign doctors get to take those exams that
may lead to hospital residencies.
TANNENBAUM: I think that we need to assure ourselves that
we choose among the physicians that are available the kind of physician that
would be equivalent to or better than because some of them are better than the
Canadian physicians that we're bringing into Ontario.
BJARNASON: In your personal opinion, in an ideal world,
should that 50 number be highter?
TANNENBAUM: I'd like to see it higher. But I against
emphasize the importance, your mother and my mother and our relatives have to be
looked at with regard to having physicians who we would feel would be
appropriate for ourselves or for them. And we will never sacrifice quality for
quantity.
ATLIN: Our organization has never questioned and our
members don't question having to meet Canadian standards. That's not the issue.
The unfairness is that for instance, even having passed the same licensing exams
that a Canadian graduate has passed, they're not allowed to apply and compete at
the same level with people who've graduated in Canada.
BJARNASON: Dr. Tennenbaum says the current system is
rigorous but fair.
TANNENBAUM: What we're trying to do is we're trying to
evaluate these physicians that you're describing to choose from among them,
those that are best qualified who can provide the best health care for the
people of Ontario. We have a very rigorous system of evaluation including the
Medical Council of Canada evaluating exam, communication tests and exams that we
provide multiple choice exams, all of these assessments very well validated.
BJARNASON: Still despite his cautions, Dr. Tennenbaum
encourages foreign trained doctors to come to Canada.
TANNENBAUM: We don't have enough doctors. We need more
physicians and if I were advising someone who was looking to move, I would
suggest to them that their opportunities in Canada are very good. And that they
would be welcomed.
RUANI: I do get discouraged at times. What I was prepared
to do is basically take the exams, go through the system, be evaluated. If they
were not satisfied with a certain standard, I was even willing to be examined
again and again. But what is frustrating to me is after establishing a certain
level, those credentials do not seem to get me anywhere.
BJARNASON: David Ruani has accepted a job as a clinical
assistant at the University of Alberta. That province allows foreign trained
doctors to be retrained and retested more quickly than in Ontario. In Alberta,
he'll try again to become a doctor.
RUANI: One chance. That's all it takes. I basically felt
that there's one job out there which is waiting for me. I have the papers. I
have the credentials. I have been standing by the medical counselor and all I
need is one chance to get inside and I will.
BJARNASON: In a country short of doctors, says David Ruani,
janitor, there should be some rooms somehow for David Ruani, doctor. For The
National, I'm Dan Bjarnason in Kingston.
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