Tuesday, December 13, 2022

Canada's doctor deficit is a product of its own provincial residency system

The Globe and Mail has posted another interesting article about Canada's ailing medical system, and this one is a real eye-opener. A shortage of doctors is a worldwide problem at the moment, and Canada seems to be having a particularly bad go of it, and yet the solution is tantalizingly simple and straightforward.

It seems like huge numbers of Canadian students are choosing to study medicine abroad because it is so hard to get into Canadian medical schools. And, while the vast majority of them say they intend to return to Canada to practise, an increasing number of them are actually ending up elsewhere because the Canadian residency system is stacked against them.

Canada has 17 medical schools, which take in 2,800 new students every year. That might sound like a lot, but those schools reject about 9 out of every 10 applicants, despite impeccable grades and qualifications, because there are just not enough study places available. So, many Canadians end up studying in Ireland, Britain, Australia, Israel, the USA, even in the Caribbean. At one major school in Ireland, about 40% of the students are Canadian, more than any other nationality.

However, when these students look to return to Canada to work out their residency (the two year postgraduate supervised training period needed to become a licensed physician), they are treated the same as international students, and have to compete against Canadian graduating students, who are given priority. Just 13% of residency training placements are given to international students, and that number continues to fall: just 439 students this year, compared to about 500 a decade ago, and 700 in the late 1980s. 

As a result, those Canadians who studied abroad are increasingly giving up on returning to Canada and choosing to work in Australia, USA and Britain, where the barriers to entry are lower. This is a brain drain that Canada can ill afford, especially given the healthcare crisis we find ourselves in now. Amazingly enough, given all the barriers militating against it, about 25% of Canada's doctors are foreign-trained, a number that rises to 62% in parts of Newfoundland and Labrador, and a mind-boggling 88% in some parts of rural Saskatchewan.

But, by the same token, there are many internationally-trained doctors who are just not able to find work here. Of the 5,135 foreign doctors who became permanent residents in  Canada between 2005 and 2020, only 37% are working in their chosen field. There are an estimated 1,200 immigrant physicians in Ontario alone who are not able to find work as physicians. Such a waste!

Ironically, between those two things - Canadians studying abroad and choosing not to return to Canada, and all the highly-trained immigrants already in Canada but having to work as taxi drivers and delivery guys because their medical qualifications are not recognized here and the process to re-qualify is just too onerous (or even impossible) - Canada would actually have enough doctors to rectify most of the deficit we are currently experiencing, but the various provincial health systems just do not allow it. Which is, as I'm sure you will admit, a ridiculous state of affairs.


Ontario is joining a few other provinces in instituting a Practice Ready Assessment program for the province, whereby foreign-trained doctors (including Canadian citizens trained overseas) can be supervised in clinical settings and fast-tracked into the workforce, rather than having to spend years in residency programs or retraining.

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