The case for additional MD residencies for Canadian IMGs in B.C.

Harry Lali

BY HARRY S. LALI

Former Minister of Transportation and Highways for BC

THE supply of doctors in British Columbia is tightly controlled by entrenched entities – namely, by the University of British Columbia and the College of Physicians and Surgeons of British Columbia (CPSBC) – resulting in doctor shortages across the province, especially in rural BC. The lack of sufficient medical training seats available for students to attain MD degrees in our universities – coupled with the lack of sufficient available spaces for doctors who have completed their MD degrees seeking medical residencies in BC – is artificially and unnecessarily creating a doctor shortage in BC.

System is unfair for Canadian IMGs

In Canada, and especially in BC, Canadian citizens or permanent residents who studied abroad (CSAs) and graduated with medical degrees internationally are known as Canadian IMGs, or Canadians who are International Medical Graduates. For these Canadian IMGs, the system of successfully obtaining scarce medical residency positions in Canada is rigged against them by the entrenched entities. The current system is unfair and not based on merit or competency. It is government’s job to create a system that is fair and rewards competency.

Currently, Canadian-trained doctors, plus new foreign visa holders from other countries, are obtaining training seats and medical residencies in our universities, while Canadian IMGs get passed over and are left waiting years, or else they end up leaving the country to go to the United States or other countries. The vast majority never come back to Canada. This is a terrible waste of a valuable resource while communities and patients across BC and Canada suffer. BC alone has nearly one million people who don’t have a family doctor.

Canadian IMGs want to fight COVID-19

BC needs trained doctors and health care professionals to assist in fighting the COVID-19 pandemic. The government is allowing retired doctors and health care workers to re-register with the province. These doctors, who are over 65 years old, retired mostly due to health reasons.

Meanwhile, there are a few dozen young, eager Canadian IMGs of BC origin who came back to BC, still live in BC, and most importantly, want to practice medicine in BC, but are being denied medical residencies in BC and in other provinces due to systemic, historic, and institutional intransigence by entrenched entities reluctant to change. In other words, as governments readily re-hire retired doctors (who, by the way, are “most at-risk” to COVID-19) they are over-looking a valued domestic resource within their own communities – a resource eager to help fight the COVID-19 pandemic locally, provincially and nationally.

Proposed by-law changes exclude Canadian IMGs

On April 1, with the blessing of the Ministry of Health, the CPSBC announced changes to their by-laws in order to allow foreign-trained doctors to register and become “associate physicians” to help fight COVID-19. Unfortunately, the registration criteria specifically excluded Canadian IMGs who haven’t done their medical residencies from even applying. Canadian IMGs meet two of the criteria: 1) Possess a Medical Degree, and 2) Passed Part 1 of the LMCC Qualifying Exam. 

However, the disqualifying criterion for Canadian IMGs included by the College of Physicians and Surgeons is the unnecessary requirement: “At least two years of postgraduate training in a medical or surgical specialty.” This particular criterion favours foreign IMGs from Ireland, England and other countries from Europe and abroad, but excludes Canadian IMGs. The foreign IMGs, once they clear the vetting process and are registered, will be eligible to work in BC hospitals as “associate physicians under the direction and supervision of attending physicians in acute care settings.”  The role of the associate physician includes working as part of a hospitalist team or in an operating room as a surgical assistant.”

My question is: How is that any different from the decades-old practice of medical residents, both domestically-trained and international medical graduates, “working under the direction and supervision of attending physicians in acute care settings” or “working as part of a hospitalist team or in an operating room as surgical assistants?” This practice already exists!

If these foreign IMGs that are going to be hired temporarily will be doing exactly the same duties “under supervision” that medical residents would also do under supervision, then why specifically exclude Canadian IMGs from participating in this program in favour of foreign IMGs? The University of BC, the College of Physicians and the Ministry of Health need to also include Canadian IMGs within their proposed by-law changes and make it a competence-based, fair-playing field.

“Lack of Funds” not an issue any more

In the past, the traditional response from UBC, the CPSBC, and also the Ministry of Health of a “lack of funds” or resources is no longer valid (even though it was suspect to begin with) as all levels of government federally and provincially are going into huge deficits to fight the COVID-19 pandemic; BC alone will have a $5-billion deficit. The amount of funds needed to open more medical residencies is a fraction of a drop in the bucket.

The time for change is NOW!

Another traditional response is that it is “too complicated” to make the changes, and that this is “not the right time” to do it.” At her daily news conference last week Dr. Bonnie Henry, the BC Provincial Health Officer, was asked by CFJC Today why foreign-trained Canadian doctors were being left out by the CPSBC and the Ministry of Health. Dr. Henry responded: “The time of crises is not necessarily the time where we want to modify the requirement that people need to have to ensure that they can practice in a safe way in this province.”

I totally disagree with Dr. Henry. The time to make the change is precisely now! If not now, during a time of crisis, then when is the right time?

While most jurisdictions across the world are playing catch-up to the COVID-19 pandemic, some like Ireland, the United Kingdom, India, New York state, Quebec, Ontario and others are proactively opening up more doctors’ positions and medical residencies in order to get ahead of the curve. The UK has dropped its domestic criteria, created a fair-playing field and made it competence-based by inviting doctors and medical graduates from across the world to participate in fighting the pandemic.  

British Columbia should also be proactive and do the same here in this province. British Columbia needs more doctors now to fight the pandemic, not when it is over!

NOTE: If you are a Canadian IMG, I’d like to hear from you. Write to me at: <[email protected]>

6 COMMENTS

  1. Bringing the issue of IMG,I was just wondering if Canada could implement the same system as Australia or United Kingdom. In Australia and United Kingdom if you pass their medical council test ,I mean the standardized test then you can work in hospital as a junior medical officer. What I’m asking is if we pass MCCQE one and NAC OSCE ,which is Canadian standardized medical test then please let us continue to work as a junior medical officer in the hospitals. And these junior medical officers can always be supervised and they can also maintain the title as a doctor and can help many places where there is area of need for doctors to work. Gradually after working for a few years then they can be enrolled into residency program if they qualify. Even if they don’t qualify and they don’t get to do the residency for specialty like emergency, internal medicine surgery, then they could still work as a medical officer for the rest of the life. And that makes sense for all the IMGs that came as a doctor to Canada. Prior to coming to Canada all of us IMG’s worked as a medical officer ,as doctors in our own country we were able to manage all kind of illness and ailments that affected our patients back home. So please think on this way and raise your voice on our behalf so you can help us.
    I’m not asking to grant license for unqualified people but if we write the exam and pass the exam then at least give us a position to enter a hospital system and this way we can help the people of Canada, we can go to remote places and work as a medical officer, and then there will not be any scarcity of any doctors in Canada. For example , CNO and a lot of nursing Association of Canada has allowed international educated nurses to integrate with Canadian healthcare system this way they can write the test pass the exam and be integrated and start working as an RN. They can get orientation in the hospital and they’re set to go. If you see in BC, Ontario , a lot of hospitals have international educated nurses working all over.
    My question is if a nurse can get an additional training of two years to become a nurse practitioner and start working and seeing the patients. So please consider giving IMG just an opportunity to work at least as a junior medical officer if they are able to clear the exam after proper orientation and supervision. They can even give training for six months and even charge money for that if there’s wanted but in the long run it’ll help Canada and Canada economy and all the people in Canada can benefit with IMGs .Thank you.

  2. The situation for IMGs is even worse in a subspecialty like the NICU for many IMGs who got their fellowship training in Canada and wrote the Royal College exam for neonatology, then the Royal College declined granting them a license although they have the same training as the Canadian graduates and they passed the same Royal college exam!!!
    These well trained and experienced IMGs are feeling so frustrated, disrespected and deeply discriminated and many of them has abandoned their dream to help their own Canadian fellow citizens and they went overseas to other countries like UK where they felt more respected and appreciated …
    I wish if some wise person could listen…

  3. In addition to the rarity of medical residency positions for the IMGs, and the high cost of the licensing exams, there are some important obstacles that face the Canadian IMGs and make them unable to practjve medicine in Canada and probably leave yo other countries wher they can become doctors again. Thes obstacles include :
    I would like to add few important points about unnecessary obstacles.
    1-Firstly, a heridetary legend called “Recency of practice.” The licensing exams take long time to prepare to and to take, so IMGs very easily become away of practice according to the current roles. Secondly, IMGs take a lot of exams which test their medical knowledge and experience; moreover, they train under supervision during the medical residency, so “away of practice” is an unnecessary obstacle that has no real meaning .

    2- Language requirements : very high scores are required. A lot of people speaks, write, and communicate very perfectly in English and/or French, but they fail to achieve these very high scores because IELTS and TFI tests depend mainly on the speed and time management rather than testing the language proficiency. I suggest either to make provincial language exams to assess the real language proficiency needed and suitable for work OR decrease the required scores.
    N. B. The language level is already being tested in all the interviews for the residency, so non fluent persons can never be chosen, anyway.

    3- British Colombia and some other provinces hold extra exams with nearly the same contents of the licensing exams held by the Medical Counsel of Canada. These additional extra exams present extra loads and consume a lot of time, money and unnecessary efforts.
    It is time now to correct our ways of making the great use of our IMGs and add a great power to our medical arsenal. It is time know to provide sufficient medical services to the remote areas and to all the Canadian. It is time now tk decrease the too long waiting time in emergency rooms, exposing the esiting patients to worsen their medical conditions or attracting infections from the other surrounding patient, or simply depleting their time and power. It is time now to fight covid 19 and support the exhausted medical staff. Finally, it is time now to get ready for the second wave of covid 19, before it is too late, and And when regret does not work.

  4. I do agree with Bemen’s points, as the entrance exams like NAC osce and MCCQE2 assess the candidates for language proficiency as well, then why college ask for additional language assessment exam like IELTS, for example if someone clears all usmle exams then there is no need for them to provide additional language assessment.
    Secondly , if at all , College asks for the language proficiency in form of IELTS, then please make it mandatory before NAC OSCE and MCCQE2 ,because both these exams are assessing candidate on language as well, and so many IMG’s after successfully clearing these two exams , struggle for many months and may be years to achieve requires ielts score. In some western countries like UK ,Ireland and Australia it is absolute requirement to achieve ielts required score before IMG can appear for their respective qualifying exams.
    Thirdly, I completely agree with Asheta, about many trained and experienced IMG’s even after successfully clearing all exams , do not get any respectable opportunities, left frustrated and leave the country as well, which is ultimately loss of valuable and intelligent resources of the country.

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