Practicing medicine in Canada when trained abroad: an – incomprehensible – obstacle course

Foreign-trained doctors are sidelined in Canada as six million Canadians don’t have a family doctor.

These health care professionals, who completed their education outside of Canada or the United States, constitute a diverse group of practitioners trained in various specialties. Several have been lured to Canada for the promise of a better life.

Most even took advantage of “express entry” under the skilled worker program by virtue of their high-level training.

Yet they face multiple hurdles throughout the licensing process.

In October 2021, a community-based research team from Simon Fraser University examined the Canadian exclusion policies against them.

The project grew out of British Columbia’s response to the health crisis, including the campaign Trained To Save Lives on social media, which focused on the role of internationally educated health professionals.

Our interviews with 11 foreign-trained British Columbia doctors highlight, in our view, the barriers they face across Canada.

Read more: National licensure for healthcare professionals in Canada: is it possible?

Eight steps

The Canadian process is complex because each province has its own licensing system. In British Columbia, the requirements are as follows:

1. Foreign-trained physicians must graduate from an accredited school listed in the World Directory of Medical Schools.

2. They must provide a language proficiency certificate if the language of their degree is not English and if they have not practiced in English.

3. They must succeed Medical Council of Canada Qualifying Examination Part 1And the Objective Structured Clinical Examination of the National Assessment Collaboration (NEC).

4. They must register for a clinical evaluation program.

5. They must complete a residency or pass the practise-evaluation program of the CNE.

6. If they do a residency, they have to enter into a contract to provide years of service.

7. They must obtain the provincial license (here, from the College of Physicians and Surgeons of British Columbia).

8. Finally, general practitioners must pass the certification examinations of the provincial College of Physicians and Surgeons and specialists, the same with the Royal College of Physicians and Surgeons of Canada.

The obstacle course

Our interviews allowed us to identify several obstacles. One of the main ones is the CNE Objective Structured Clinical Examination (not required for Canadian and American college graduates). This exam, which is very expensive, is rarely offered every year.

The wait is sometimes very long. In addition, immigration consultants are often misinformed about career prospects. Many were told that their education “was worthless” in Canada.

Foreign-trained doctors pointed to the lack of clarity in licensing information. Although they expected an arduous process, nothing prepared them for the difficulties encountered.

Despite the claims of the federal immigration department regarding skilled workersa large number must be satisfied precarious and poorly paid jobs regardless of their training or experience.

Few places in residence

The other important obstacle, against which the foreign-trained doctors lobbyis the limited number of residency positions open for them.

The residence is a postgraduate training required for obtaining a license to practice. The Canadian Resident Matching Service (CaRMS) divides applicants into two categories : Canadian medical graduates and others.

However, only 10% of residencies are open to doctors trained abroad. Most concern specialties in need of candidates, such as family medicine.

Another systemic barrier relates to the contracts that must be signed by those who obtain a residency position: they must agree to practice for two to five years in a underserved community (except in Alberta and Quebec).

This obligation does not exist for graduates of Canadian medical schools.

All of these barriers have a negative impact on the mental health and well-being of foreign-trained physicians.

Upcoming changes

Some provinces have launched initiatives to correct these problems. A pilot project of the College of Physicians and Surgeons of Alberta will seek to waive certain requirements for those coming from designated territoriessuch as the United States.

In British Columbia, the capacity assessment program will expand from 32 to 96 spaces. The province will thereby offer them an alternative to residency and a better access to licensure.

These significant advances do not address all systemic barriers. So much so that our health system, manhandledabsolutely cannot benefit from the expertise of these qualified doctors.

The federal government recently launched a call for proposals to remedy this. A significant effort will be needed to integrate foreign-trained physicians into the health system.

We propose to

1. Provide transparent and clear information on the requirements needed before immigration.

2. Provide better mental health support upon arrival and during the licensing process.

3. Increase the number of residency positions and expand the list of medical specialties for foreign-trained physicians.