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B.C.’s doctor business diagnosis

Doctor Crisis: Foreign-trained MDs ready to help ease doctor shortage, but political will lacking says observer
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"We have this large group of professionals – many of whom have already taken their Canadian qualifying exams but aren’t able to practice," says Daniel Bernhard.

B.C.’s much publicized doctor and health worker labour shortage could be largely artificial. The reason, said Institute for Canadian Citizenship (ICC) CEO Daniel Bernhard, is that there is a large group of doctors, trained and eager to serve throughout Canada, that has so far received little opportunity to practice and serve: doctors who are trained abroad.

While the ICC does not have statistics for B.C., Bernhard said there are more than 13,000 internationally trained medical graduates living in Ontario waiting to serve, and the situation in B.C., another populous province with large international communities and the propensity to attract professionals from abroad, is similar. 

“Wait times for basic surgeries are over a year long,” Bernhard said. “Millions of people don’t have a family doctor. Specialists are few and far between ... And yet we have this large group of professionals – many of whom have already taken their Canadian qualifying exams but aren’t able to practice because of, frankly, stupid obstacles that governments throw in their way."

“So the story here is not how come there are no doctors. The story should be, how come we are not letting all of these doctors work?” 

The accreditation and certification of foreign-trained doctors had already been a hotly debated issue prior to 2020, but the COVID-19 pandemic exacerbated the situation. It led to ICC launching its #EqualChance awareness campaign in May 2021 that called for the universalization of standards for a doctor to practise across Canada. 

Currently, the field is regulated provincially, and the requirement in B.C. is for international medical graduates (IMGs) to register through one of the registration classes offered by the College of Physicians and Surgeons of British Columbia (CPSBC) – each with specific language, knowledge testing and certification requirements. Even CPSBC officials, however, recognized the acute need for doctors in the province (and the potential solution offered by foreign-trained candidates who are already living in B.C.). 

In April 2020, the organization proposed – and later received approval – for a new registration class: the associate physician (AP). The AP class would put foreign-trained doctors quickly into practise in the province, albeit under the supervision of other physicians. The theory is that the easier pathway would allow more foreign-trained doctors to serve in the medical fields in which they are trained while living in B.C., fulfilling an area where the labour shortage is severe. 

However, as of June 2022, no IMG has registered as an AP practitioner in B.C., and the key reason, many observers say, is that the process for APs (along with other registration classes available to foreign-trained doctors) requires residency or training positions at local health authorities to reach completion. That is the missing link. 

When a candidate can take exams and reach different stages of certification, few – if any – residency spaces are currently open to IMGs to gain the necessary hours to become full-time practitioners. 

In a statement, the CPSBC said the pandemic has delayed the process at local health authorities to provide programs to accept AP class candidates and other IMGs, and there’s little the CPSBC can do to expedite the process. “During COVID, the health authorities [who are the employers] were focused on other priorities and many of the programs, which require accreditation by the College and where the APs would be employed, were put on hold,” the statement said. “... The programs [proposed by health authorities] have to be accredited first before the [health authority] (HA) can employ an AP. 

“At this point, until we hear from the HAs and get a better sense of how many programs are needing to be accredited, there isn’t much more for the College to add. The College establishes the class of registration, but the HAs need to implement the program and recruit potential applicants in their respective health-care facilities.” 

Both Vancouver Coastal Health and Fraser Health declined to comment, deferring to the provincial government for a response. 

In its written response, B.C.’s Ministry of Health said it is working with CPSBC, Health Match BC and health authorities to “develop all the policies that need to be in place for a new class of registration for health professionals called ‘Associate Physicians.’” 

“The Ministry of Health continues to explore and implement a wide range of measures to help address staffing shortages within the health-care system,” the ministry said. “The initial recruitment for associate physicians is estimated to begin in the summer of 2022.” 

In a separate response, ministry officials noted other efforts to get IMGs to practise sooner in B.C., including the $2.3 million allocated to Practice Ready Assessment BC to provide foreign-trained doctors with an alternative pathway to family-physician certification. 

Since 2015, as many as 175 IMGs have been placed into B.C.’s medical sector through that program. 

B.C. also funds a number of residency positions at the University of British Columbia that are reserved for IMGs, the ministry said. Currently, there are 58 such positions – including 52 dedicated to family medicine. But Bernhard said those numbers are hardly enough – especially when there are thousands of trained physicians waiting to help. And while regulatory organizations like the CPSBC can hinder the process through paperwork requirements, Bernhard said the bigger challenge is whether the provincial governments are committed to adding residency opportunities for IMGs, and that is much more uncertain. 

“The residencies are controlled by the government based on how many physicians they are prepared to pay,” Bernhard said. “In many provinces, internationally trained physicians are prevented from applying to over 90 per cent of those residencies.... It would be possible with political will for government to mobilize thousands of doctors on very short notice – if they chose to do so. They are here, they are qualified and they want to contribute to the public well-being of their new chosen country.” 

And that brings the discussion back to a possible solution. 

“The key lies with voters,” Bernhard said. “Voters upset about this need to call their elected officials. This is not us bringing people from some faraway land. They live here; they are citizens or permanent residents. Why on Earth are you keeping them out of hospitals and clinics? Why are you keeping these people from helping the rest of us to live happy, healthy lives? 

“Until voters take the problem and put it at the feet of their elected officials, I think we are going to be treading water for some time.”