Do we need a national agency to assess IMG credentials?

NDP proposal pits Tories against Colleges

By Sam Solomon

Dr Cees Baas has 20 years' clinical experience from his native Holland. But since coming to Toronto to join his partner in 2004, the physician has worked as a data entry clerk, earning $15 an hour, acted, written a kids' book, coached the Toronto Speed Skating Club — pretty much everything but practise medicine. Like most so-called international medical graduates (IMGs), he's biding his time (and paying the bills) while waiting to take the last of his three qualifying exams to practise in Canada. "The bureaucracy is complicated and long," says Dr Baas. Other IMGs have been waiting years, and he's hoping that he doesn't end up like them, caught in an endless tangle of red tape.

It's a familiar enough story, but one that's galling to the many physicians faced with bursting patient rosters when help is so close at hand. But now a new proposal to improve credential recognition for foreign-trained professionals (including MDs), put forward by NDP MP Olivia Chow in early February, has added a new dimension to the debate.

The NDP proposal calls for the creation of a federal agency to oversee the process of assessing the credentials immigrants attained in their homelands. The Conservative government set aside $18 million in the 2006 budget for a study, still ongoing, of the feasibility of such an agency. Both the NDP and the Liberals say action, not another study, is what's really needed. "Funding earmarked for consultation towards the creation of the Canadian Agency for the Assessment and Recognition of Credentials should be used to set up this agency immediately, instead of conducting more 'talks,'" Ms Chow said in February (she declined to comment for this article).

Instead, on February 28 Monte Solberg, Minister of Human Resources and Social Development, announced another $2.8 million for a similar study called "Bridging the Gap: Integration of Skilled Immigrants into the Canadian Workplace."

The Association of International Medical Doctors of British Columbia is firmly behind the idea of a federal credentials-recognition agency. Board member Dr Carla Fast, a Brazilian now working as a nephrologist in BC, says, "I think the proposal by the NDP is very good, and addresses some of the key issues on recognition of credentials. It's unfortunate that the $18 million is being allocated to consulting, rather than implementing this proposal."

Many of the NDP proposal's recommendations — as they would apply to IMGs — echo those of the Canadian Task Force on Licensure of International Medical Graduates. The task force was an inter-provincial consultation that, in 2003, released recommendations that included standardizing the way credentials were assessed across Canada. The lack of portability of licensure — a doctor can be licensed in Newfoundland but turned down in Alberta, for instance — has long been a big problem for IMGs.

JURISDICTION FRICTION
National standardization is a touchy subject, partly because it would require the provinces to submit at least some authority in terms of assessing foreign-trained credentials to the federal government.

As it stands now, Citizenship and Immigration Canada takes applicants' professional credentials — such as a medical degree or experience working as a physician — into account during Immigration and Refugee Board decisions. The doctor may then gain entry, only to find that the provincial College has an entirely different set of guidelines.

"The immigration board may recognize someone as a physician, and we need physicians, so they grant a permit for work," explains Dr Trevor Theman, registrar of the College of Physicians and Surgeons of Alberta. But a federal permit to work does not entitle a doctor to a license from a provincial College of Physicians and Surgeons. "Everybody has to meet our postgraduate training requirements," says Dr Theman.

This gap is the source of much of the friction now emerging between the federal government and provincial regulatory organizations.

COLLEGES TO BLAME?
On March 4, Conservative MP Jason Kenney told an audience at the National Metropolis Conference in Toronto that this isn't a federal government issue. Rather, he insists, protectionist policies of professional organizations like the medical Colleges are to blame for the bottleneck. "We cannot move forward without the regulatory bodies breaking down their barriers, and it is time they begin to do so," he said. "While many of these bodies understand the need for foreign credentials recognition, many more have tried to keep the door shut on new Canadians who wish to practise in their area of expertise." Mr Kenney didn't respond to our request for an interview.

Mr Kenney's comments attracted a storm of attention. "Trying to pass off the responsibility is cold comfort to the many immigrants who came here," NDP leader Jack Layton told the Canadian Press. But he too criticized the professional regulatory agencies, saying immigrants were granted residency or citizenship by the federal government based on their expertise, "only to find when they arrive, doors slammed in their face."

The Liberal Party jumped into the fray the day after Mr Kenney spoke in Toronto. "Hiding behind jurisdiction with respect to foreign credentials is nothing but a shameless ploy to shift blame from the Conservative government's own failure on this file," said MP Ruby Dhalla in a release.

STANDING FIRM
But medicine's professional regulatory bodies appear unwilling to budge in the face of mounting pressure to hand the credentials-recognition job over to Ottawa.

Kathryn Clarke, a spokesperson for the College of Physicians and Surgeons of Ontario, says that informing potential immigrants about professional qualification issues is a federal responsibility, but she's adamant that the College is "committed to setting and maintaining registration standards that will not be compromised in response to physician human resource needs."

"This is Canada — it's not likely to happen," says Alberta's registrar Dr Theman of the likelihood of standardizing IMG credentials assessments across provincial jurisdictions. "Newfoundland and Saskatchewan have very large proportions of IMGs, and there are people who are registered in those provinces who we would not register — we have different standards. Getting agreement about a minimum standard is a real challenge," he adds. "So do we have a disconnect between the federal and provincial level? Sure. Could we have better coordination? Sure." But when asked if he'd be willing to rejig his own College's rules, he admits "I'm not sure."

As for Dr Baas, he says the NDP's new plan is a good start. "I think it is a great initiative in terms of accessibility," he says. "Accessibility is not the only issue, however. Procedures need to be much quicker. And I don't see how a front office improves that part of the problem."