Goverment & Medicine

All aboard the IMG express

National task force steams ahead with plans to bring more foreign-trained doctors on board, but will the provincial licensing boards stay on the platform?

By Dina O'Meara

Even the trained are shunned By Theo Sands The feds are putting up $4 million to speed immigrant doctors into practice (see accompanying article). Some provinces embrace the scheme, others can't stand the idea -- whatever camp you're in, don't hold your breath waiting for a phalanx of foreign docs to march in to lighten your workload. Three years ago Britain put about the same amount $3.66 million (£1.5 million) into a similar project, and the results haven't been quite as glowing as many there had hoped. At the time there were 910 refugee doctors on the British Medical Association lists. Of these only 110 have managed to pass all the relevant medical and English language tests. Worse still, only 49 of them have found work -- the rest complain that they've run up against serious racial or gender discrimination. It costs $14,622(£6,000) to prepare an immigrant doctor for practice compared to the $536,148 (£220,000) to train a med student in the UK.

We're here. We can be integrated into the system right away," says Dr Feroza Rojan. "And they don't need to spend the amount of money that a fresh graduate would need. Our hopes are high, but it's still frustrating and a long wait." Six years after coming to Canada, the 36-year-old doctor who's practised in Pakistan and England didn't expect to be still working as a physician's assistant.

The recently announced $4 million injection of federal funds to bring more foreign-trained physicians into Canada's work force can't come soon enough for Dr Rojan and others like her. The pledge, announced March 1 in Calgary during a meeting of a federal task force on licensing international medical graduates (IMGs), will boost assessments and training of IMGs and alleviate the country's doctor crunch.

More than 1,000 foreign-trained doctors like Dr Rojan have applied for residency in training this year alone. Another 600 IMGs are registered and waiting to be assessed. But in both cases, opportunities are limited due to lack of openings for IMGs -- and lack of funding. "Increasing [post graduate training] capacity still needs work," says Dr Dale Dauphinee, executive director of the Medical Council of Canada, and cochair of a multi-stakeholder task force on IMG licensure. "I'm still concerned that we don't have enough to cover the training -- that's still an issue that needs to be addressed and the $4 million won't do that."

INTEGRATION NATION
What the 15-month-old task force has managed to achieve is a consensus on developing a national integrated approach to assessing and training IMGs, and work toward standardizing licensure evaluations. Included in the six task force recommendations to be implemented in partnership with federal and provincial agencies and licensing boards are the creation of a centralized verification system, and a one-stop online info centre with details about applying for assessments and what resources are available. The programs will streamline evaluation processes and bring more doctors on board quicker.

"It could be a matter of months or a year; I think it's going to be variable," adds Dr Dauphinee. "But there's no reason if this is implemented quickly, and particularly with the money for assessment programs, that results couldn't be seen within months."

Ask family physicians how soon they would like to see results and most of them will say "immediately." That is, if they have time to talk. After record medical school enrolments in the 1960s and 1970s resulted in the number of doctors in Canada peaking in 1993, a 10% federal budget cut in undergrad enrolment that year, retirements and moves out of Canada have played a part in seeing the number of physicians drop by 5% since then.

"We need physicians now," says Dr Rod Crutcher, Alberta's IMG program director and task force cochair. "Pretty much all the docs that I know are going out flat, so there is an urgency to bring more capacity on."

Foreign-trained doctors represent about 23% of Canada's working physicians, and in some provinces represent up to 30%. Saskatchewan and Newfoundland license more IMGs than Canadian-trained because fewer Canadians apply there, while Ontario and British Columbia are awash with unlicensed IMGs.

"What is needed is a means whereby we can assess these people to evaluate their performances, where they can demonstrate their skills, not just their knowledge," says Dr Doug Blackman, deputy registrar of British Columbia's College of Physicians and Surgeons. "The biggest problem is the lack of opportunities for those positions."

A DISCRIMINATING PAST
British Columbia, among several other provinces, is overcoming a history of discrimination against IMGs trained outside

of Britain and South Africa that culminated in legislative changes following a successful human rights-based court case in the mid 1990s. The current doctor shortage facing Canada also helps erase the luxury of discrimination.

"I think that while historically there has been resistance in some provinces to increasing opportunities to foreign-trained doctors, it has been largely resolved in others simply out of necessity," says Dr Ed Schollenberg, registrar of New Brunswick's College of Physicians and Surgeons.

While Dr Schollenberg wants to see more IMGs working in hospitals and clinics instead of delivering pizza, and supports more streamlined evaluation processes, he's opposed to instituting a national standard licensing process. "If you had a standard license, people could practice anywhere," he says.