Easing Barriers for Newcomer Physicians

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It seems like every week there is a story in the news about the shortage of medical professionals in Canada. For those of you who trained as physicians in your country of origin, this looked good for your chances to immigrate, as it meant more points with which you qualify. You arrive in Canada expecting to quickly get your license to practice medicine, but discover that the process of getting your license depends on where you settle, and can take a long time; longer, perhaps, than you can afford to take with a family to look after, with no guarantee you will be able to practice your profession at the end of it.

While the image of a doctor from Poland driving a cab in Toronto may be the exception rather than the rule, it is true that many individuals who have trained and practiced as doctors in their countries of origin are not practicing their profession here. There are several reasons for this. Immigration is handled at the federal level, and it is they who decide which professions Canada needs most, such as medical practitioners like doctors and nurses. However, the medical professions in Canada, unlike in many other countries, are regulated by professional organisations within each province, rather than centrally at the federal level. Each province has its own rules and processes for licensing physicians, and there are a lot of complications in the system, including:

  • medical schools that oversee residency training programmes,
  • provincial regulatory institutions that license physicians, and
  • federal examination bodies.

“There are a lot of pieces in the puzzle that have to come together,” says Lynne Godfroy of Neighbourhood Link Support Services (on Danforth), “and if one piece is out of alignment, then opportunities [for the newcomer physician to get licensed] are lost.”

And those aren’t the only barriers. Standards of practice are different from country to country, and each province has its own standards and requirements that a newcomer physician must meet. Even if a newcomer physician has practiced in his or her country of origin, he or she must still be assessed to meet those standards and determine whether any additional training is needed.

Ontario collects more than 50 percent of newcomers to Canada, and of those, 90 percent settle in Toronto or the Greater Toronto Area (GTA). There are six medical schools in Ontario and domestic graduates tend to be given preference to fill residency positions. At the end of the 1990’s, for example, there were only 24 residency positions available to internationally trained physicians in Ontario; and if there were many graduates from local medical schools that year, those spaces were turned over to local graduates, a practice that is common across the country.

However, since 2000, much has changed. The Ontario government (which funds residency positions) has increased the number of spaces available for internationally trained medical graduates (IMGs) from 24 to 200. The College of Physicians and Surgeons of Ontario reports that in 2006, 42 percent of licenses granted went to IMGs, up from an average of 25 percent of previous years. Additionally, the College, the Ministry of Health and Long-Term Care and Ontario’s six medical schools have been working together to simplify the registration and licensing process and increase the opportunities for assessment and training for newcomer physicians.

While increasing the number of residency spaces has improved the chances for newcomer physicians to become licensed, there are many more applying for those positions than there are positions available. With only the most qualified being accepted, competition is fierce and there are many challenges. An individual must undergo assessment examinations and achieve the highest score he or she can put on their application for a residency training position. Medical schools will choose candidates from this pool of applicants to interview, and the Program Director of the school will offer the residency training positions to those they consider to be the best qualified.

HealthForceOntario Access Centre for Internationally Educated Health Professionals understands the challenges and barriers that IMGs face. The Access Centre is part of a newly formed provincial government agency and is the only organization of its kind in Canada. For newcomer physicians and other internationally trained health care professionals, the Access Centre offers information, advice and support to assist newcomers in the process for licensure and practice.

The Access Centre works with each person, based on what experience they have. For example, a person who has recently graduated from medical school in their country of origin may have different needs and require different information than someone who has been actively practicing medicine for several years. The Access Centre will help newcomers to understand how the process works, work out how long it will take them to practice medicine, and help them develop a plan to achieve their goals. If, for example, a newcomer physician has a family to support and the time to get a license will take too long, a counsellor might suggest other professions their medical education and training might be used for, such as working for a pharmaceutical or insurance company, or perhaps becoming a medical technician or researcher. The Centre also refers the newcomer to language training centres and community organizations to help with the settlement process. The next stage in the process for the newcomer physician is to take assessment examinations. In Ontario, this is handled by the Centre for the Evaluation of Health Professionals Educated Abroad (CEHPEA). CEHPEA is strictly an assessment centre. Newcomer physicians use the results of the CEHPEA assessment to compete for residency training positions.

Newcomer physicians often need additional training because medical programmes outside of Canada may not have the same content, duration, or access to technology as Canadian programmes.

Despite the improvements over the past eight years, as well as the introduction of programs like the Career Transition Program for Internationally Trained Physicians (see page 25), the process for newcomer physicians to get their licenses and to begin practicing their profession is still fairly complicated and time consuming. Decisions made in the 1990’s by the government of the day in Ontario have had a negative effect on the health care profession which is only now being dealt with, in part by easing the barriers that internationally trained physicians have had to face. One suggestion that has been made is to create an arm’s length, independent body that would work outside of the influence of both the federal and provincial governments, that would look at all the areas that affect newcomer physicians, from immigration to licensure, and make sure that the process is made as simple as possible, in all provinces.

For more information about any of the organizations mentioned above and their roles in the process, please visit their websites.

For information about IMG programmes across Canada, visit these websites

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