Canada is facing a serious shortage of general practitioners, but Canadian-born general practitioners working abroad are fighting to get the paperwork they need to practice here.
Dr. Stephanie DeMarchi, a GP born in Hamilton, Ontario, who has worked in Australia for the past 10 years, is one of those doctors.
She was educated at the University of Queensland and spent her residency and years as a general practitioner in rural Australia. She now wants to come home to Canada to take over from her mother, a GP in Hamilton who is about to retire.
But a jumble of red tape has made the process tedious. She has been battling the Canadian health care bureaucracy for nearly 16 months to get the license she needs to practice.
In April 2022, DeMarchi opened a Physicians Apply account for the first time under a program of the Medical Council of Canada (MCC), the body that evaluates medical graduates and physicians.
In October, she took an eight-hour MCC exam to test her medical knowledge. She said the test netted her several thousand dollars.
She then moved to Canada with her Australian husband and two young children. She said she assumed the process would be completed shortly as she is already a practicing physician.
But the MCC didn’t come up with the number DeMarchi needed for her other licensing applications until May 25. At this point, she still doesn’t have everything she needs to work in Canada.
DeMarchi said she had to move back to Australia on her own to keep her Australian license current while the MCC verified documents such as her medical degree, postgraduate certificate and resume.
Those documents must be approved by the MCC before it can issue a “licenciate,” something anyone wanting to practice medicine in Canada must have in order to apply for a license.
She said she was confined to Gundagai, a small town in rural New South Wales about 390 kilometers from Sydney, where she lives in a caravan park and works in a local practice while her family is far away in southern Ontario.
“It all feels so deliberate, like they just don’t want me,” DeMarchi told Breaking:.
“The process just has to change. Not only does it affect lives, but it has the real potential to destroy lives.
“I don’t know why Canada wouldn’t want these skilled workers in times of crisis. I don’t know why they haven’t created a much more polished, efficient system.”
It is not clear who exactly is responsible for the MCC and the perceived failures and shortcomings.
The MCC is a national body that operates throughout the country. In a statement, Health Canada said it has “no authority whatsoever” over the “independent organization” that assesses physician competence.
But Ottawa does provide the MCC with cash.
In June, it pushed up $28.8 million for the “Modernizing Mandatory Physician Activities Enabling Safe Patient Care” framework — a long name for an initiative designed to make the medical reference review process less cumbersome.
DeMarchi said she just wants the MCC to answer her calls and emails and quickly review documents issued by a fellow Commonwealth country with a top-notch healthcare system.
In a media statement, a spokesperson for the MCC said it was “receiving a higher-than-normal number of applications.”
“We are actively working to clear the current backlog by, among other things, hiring extra staff in this part of the organization,” said the spokesperson.
But the MCC process isn’t the only hurdle DeMarchi and others face as they seek the license they need to practice medicine in Canada.
Like other healthcare-related records, physician recruitment in Canada is a legal quagmire.
There is a parallel process aspiring physicians must go through with provincial boards of physicians and surgeons, the agencies responsible for licensing physicians.
In theory, the MCC should be the agency in charge of collecting and verifying foreign credentials and then passing that information on to the provincial colleges of doctors and surgeons. But DeMarchi said she’s run into trouble with the College of Physicians and Surgeons of Ontario (CPSO). They want her to reproduce some documents she has already sent to the MCC.
That may sound like an easy fix, but DeMarchi has to pay a hefty fee and wait for the Australian regulator to make new copies of documents she has already provided to another Canadian healthcare gatekeeper.
“That was a nightmare. It’s absolutely ridiculous,” DeMarchi said.
“They keep telling me, ‘Look, ma’am, these things take time.’ They’re not saying, ‘This is a Canadian who’s studied and trained and ready to go, let’s speed this up.’ No.”
DeMarchi said the CPSO recently rejected one of her reference letters because the agent reviewing it wasn’t sure whether the date was formatted on a month-day-year or day-month-year basis. CPSO wants the month first.
DeMarchi said there should be one person handling interagency paperwork issues so in-demand doctors don’t have to wade through the labyrinthine system themselves.
“These regulators don’t talk to each other. And we doctors, we get the message. Canada is essentially saying, ‘We don’t want doctors, we don’t need you,'” she said.
But Canada does need doctors.
After years of restraint spending by federal and provincial governments and a generation of protectionist policies restricting access to medical residency programs, Canada’s healthcare system is short of nearly 17,000 physicians, according to recent data compiled by the Royal Bank of Canada.
The problem is only expected to get worse.
Over the next five years, as the baby boomers retire en masse and the population grows by some 500,000 people a year, Canada will be short of an estimated 43,900 doctors, the bank reported – including more than 30,000 general practitioners.
Rosemary Pawliuk is president of the Society for Canadians Studying Medicine Abroad and an expert on Canada’s physician licensing system.
She said bureaucratic delays, such as those DeMarchi experienced, are dangerous – because they mean some sick people don’t have easy access to a qualified GP.
“It’s not just this doctor who’s being hurt. She’s not the only one. Many, many more of us — the public — are getting hurt,” Pawliuk told Breaking:.
“We have 6,000,000 Canadians without a GP. They are the quarterback of our system. The GP alleviates your suffering or refers you to someone who can. The bureaucracy is completely blind to the fact that people are dying, literally dying.” and suffer because they can’t get a doctor to treat them.”
Pawliuk said there is little accountability for the actions of agencies like the MCC – the federal government, the provinces and the colleges don’t have much say in how it works. The web of competing organizations, each with some sort of role in the regulatory process, is an unnecessary headache, she said.
“Each of these entities has its own little kingdom to develop. You just get lost in the bureaucracy,” she said.
It shouldn’t take more than a year for a qualified doctor trained in a country like Australia to be licensed to practice, she said.
“That’s outrageous, absolutely outrageous. I don’t know what the problem is or what’s going on.”