Politicians in every province and territory in Canada keep acknowledging the critical shortage of doctors, and keep saying how they are doing everything they can to find more and train them.
But are they? Nearly 3,600 international medical graduates are now permanent residents, according to Immigration Canada, but it is estimated that fewer than 40 per cent have been licensed to practise here.
They and their advocates don’t think enough is being done, and Rosemary Pawliuk has data to prove it.
“From where I sit, on critical analysis, each and every one of the initiatives the government has introduced is flawed,” she told me. “The question is whether the built-in flaws which retain the barriers is a result of incompetent design or deliberate design.”
Pawliuk is a lawyer and executive director of the Society of Canadians Studying Medicine Abroad.
Since she doesn’t believe health administrators are stupid, Pawliuk has concluded that these barriers are an intentional extension of decades of policies aimed at limiting health-care spending by restricting the number of doctors. They are also policies that reflect a degree of professional protectionism that informs physicians’ various licensing and regulatory bodies.
Here’s one telling example of a flawed initiative:
All medical school graduates — including international physicians and specialists who have years of working experience — need to complete a Canadian residency before they can be licensed. Placements are done through the Canadian Resident Matching Service. But the number of placements, plus the specialities for which internationally trained physicians can apply, is set by provincial governments and the Canadian medical schools.
In 2020, there were 1,822 applicants for 325 placements available to them. Two years later, there were 1,661 applicants and 331 placements.
On the other side of the ledger, graduates from Canadian and American schools had a shot at 3,072 placements in 2020. There were 3,071 applicants. Last year, only 2,985 applied for 3,075 positions.
Those 90 unfilled residency spots were not offered to internationally trained physicians.
In B.C., international graduates are restricted to residencies in family medicine, internal medicine, pediatrics, and psychiatry. But there is another condition placed on them as well.
Foreign-trained physicians must sign a “return of service” contract that requires them, after completing their residency, to work an equal period of time in the same health region where they did their training.
Failure to comply to complete the residency or remain in the region for the required period can result in penalties ranging from $525,725 for family physicians to $986,693 for psychiatrists.
In seven provinces (including B.C.), practice ready assessments are another pathway for foreign-trained family doctors to getting licensed.
In November, B.C. announced that it is tripling the number of practice ready placements.
Tripling! It sounds great until you get to the details. With 32 placements now, it will be March 2024 before that increases to 96.
Since 2015, only 188 internationally trained physicians have qualified through the B.C. program because, as Pawliuk points out, applicants must have two years of post-graduate training (i.e. a residency) in another country.
Many, if not most, countries have longer training in medical school than Canada does, and an 18-month residency rather than 24 months here.
She also notes that licensing bodies also don’t give credit for the years of experience that international graduates gained in practice prior to coming to Canada.
During the first pandemic spring, B.C. put another option in place. The College of Physicians and Surgeons agreed to license internationally trained physicians as associate physicians to work under the direction and supervision of attending physicians in acute care settings such as hospitals.
To qualify, foreign physicians must be proposed by Health Match B.C., the government-sponsored website, as a “potential” employee for one of the six health authorities willing to hire them.
Currently, Health Match B.C. lists only three positions. In two years, only one associate physician has been licensed.
For more than two decades, physicians were in short supply. Now, the problem is acute. Health Match B.C. alone lists 1,314 physician vacancies — 843 are for family doctors.
In Ontario, the government’s website lists 1,498 jobs for general practitioners alone.
Another answer is increasing funding for Canadian medical schools so that they can train more students.
Canada’s 18th medical school will open in September 2026 at Simon Fraser University’s Surrey campus. But when the announcement was made, there were no details on how many students it will accept.
Capacity at the University of B.C. will also increase by 40 undergraduate students to 328. An additional 88 residency positions will be added. Whether most or all will be reserved for Canadian and American graduates remains to be seen.
But it is going to take many more graduates and many more years just to fill longstanding gaps and the escalating number of retirements.
Up until now, the provinces’ tentative steps aimed at easing the shortage fall so far short of the mark that, as Pawliuk discovered, they may not even be enough to keep the problem from getting worse.
Data gathered from Doctors of B.C. and the B.C. College of Physicians and Surgeons show that between 2021 and 2022 the province lost 145 doctors to retirement or resignations.
Close to one of every six Canadian physicians is 60 or older, and 53 per cent report high levels of burnout.
Despite being one of the top four countries spending the most on health care, Canada only had 2.4 physicians per 1,000 population in 2019, the World Bank reported.
Canada spent $7,507 per capita in 2020, according to the Canadian Institute for Health Information. But for their money, Germany ($8,938) and the Netherlands ($7,973) are deemed by the Commonwealth Fund’s 2021 rankings to be more efficient and provide a higher quality of care.
Norway — which is ranked by the Commonwealth Fund as having the best health-care system in the world — not only has 4.97 physicians for every 1,000 people, it spends less per capita than Canada.
It also relies heavily on foreign-trained doctors, with 40 per cent of physicians having been educated elsewhere.
What makes Canada special isn’t that we have a universal health-care system.
It’s that we have an expensive, badly managed system that is failing spectacularly.
CORRECTION: This column has been updated to clarify that the number of residency placements, plus the specialities for which internationally trained physicians can apply, is set by provincial governments and the Canadian medical schools.
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