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Why Is Canada Shutting Out Doctors?

While millions of Canadians can’t find a doctor, thousands of foreign physicians can’t get a licence to practise

Claudia Cornwall

In Iran, Dr. Shahab Khanahmadi, a graduate of the Tehran University of Medical Sciences, had worked as a family physician for two years. He also worked as an assistant in the university neurology department’s clinical electrophysiology laboratory, studying diseases such as epilepsy. But in Canada, Khanahmadi hasn’t been able to work as a doctor. The closest he’s come to a hospital is as an unpaid assistant to a neurologist and as a volunteer in a family practice.

The 32-year-old says, “I am so disappointed.” He is the victim of a complicated bureaucracy that seems intent on shutting out foreign-trained physicians.

Khanahmadi came to Vancouver in September 2001. Because his English is flawless, he aced the language tests—written and oral—that foreign-trained doctors must pass to practise in this country. He also passed a series of Canadian medical exams. This year Khanahmadi applied for a residency position under the Canadian Resident Matching Service (CaRMS). He got two interviews but no position. Last year British Columbia had only six positions set aside in family practice for immigrant doctors. In September 2004 Khanahmadi will try for one of these positions, and he says that if he doesn’t make it this September, he’ll probably move. He has already passed the three exams necessary to work in the United States. “I’d rather stay in Canada,” he says, “but it’s so difficult for me.”

Equally frustrated are patients, health professionals and administrators across the country who struggle with a shortage of doctors every day. Right now, Hamilton is short 40 physicians—and somewhere between 40,000 and 50,000 people in the community do not have a doctor. “Young families must use after-hours clinics and hospital emergency departments because they can’t find a physician,” says Kim Harper, former executive director of the Academy of Medicine in Hamilton.

In Calgary, Dana Ball has been looking for a general practitioner (GP) for three years. The mother of three young children says, “Whenever I see a doctor in a clinic or in emergency, I ask, ‘Do you know any doctors that are taking new patients?’ They say, ‘There are no doctors available—there just aren’t any.’”

According to the College of Family Physicians of Canada, 41û2 million people had trouble finding a family physician in 2002. We lack at least 3,000 family doctors, and the situation is getting worse. The country produces fewer family physicians now than it did a decade ago. The shortfall could grow to 6,000 by 2011 if nothing is done.

Specialists are also in critically short supply. We need cardiovascular specialists, anesthetists, psychiatrists, radiologists, obstetricians. Hospitals have to turn patients away because of a shortage of emergency room physicians. In January 2000 Joshua Fleuelling, 18, suffered a serious asthma attack in Scarborough. Because the nearest hospital could not accept any more patients, the ambulance took him to another hospital, where he died. The coroner’s inquest listed the acute shortage of physicians in local emergency departments as one of the causes of his death.

Canada’s doctor shortage is partly rooted in a 1991 report commissioned by the provincial deputy ministers of health. In that document, Morris Barer and Greg Stoddart, two health economists, predicted that Canada was facing a physician surplus. In response, provincial governments, scrambling to save money, cut first-year enrollment to Canadian medical schools by about ten percent. Dr. Andrew Cave, an associate professor in the Department of Family Medicine at the University of Alberta in Edmonton, says, “Despite the predictions of the gurus ten years ago, in fact, we need more doctors.”

Dr. Dale Dauphinee, executive director of the Medical Council of Canada, coauthored a report in 1999 that calculated that Canada needs to recruit 2,500 new doctors a year. This would cover both physicians retiring or leaving the country and population growth. Our own graduates can’t fill the void: Our medical schools graduate only 1,570 new doctors a year—a shortfall of 930.

A major problem is the shortage of residency openings. The provincial colleges of physicians and surgeons, which grant doctors their licences, require that after medical school, doctors complete a residency: at least two years of hands-on training, usually in a hospital. An American residency is treated on a par with a Canadian one, but residencies in other countries are not. Therefore, the majority of immigrant doctors have to complete a residency here.

“The snag is getting the training,” Cave explains. “You can pass all your exams, but you still can’t get into a training program.”

Dr. Abdel Bashir graduated from the Sudanese University of Gezira as a general practitioner in 1995. That same year, he came to Ontario, fleeing a brutal dictatorship. In Canada Bashir passed the English exams as well as the Medical Council of Canada’s Evaluation Exam, which all foreign doctors must write. He also passed the council’s Qualifying Exam, which Canadian medical graduates must do to get their licences. He also became a Canadian citizen. However, the final step—getting a residency—proved to be much more challenging than he’d ever imagined.

Bashir had his eye on becoming a resident in internal medicine at McMaster University in Hamilton. But to get there, he needed to pass two more exams—one written and one clinical—administered by the Ontario International Medical Graduate Program. Bashir says, “I had never failed an exam in my life.” But the first time he took the Ontario exams, his clinical scores were not high enough to be accepted into the program. He tried again a year later, with the same disappointing result.

When he wasn’t on social assistance, Bashir worked as a cabbie and a dishwasher. He tried the exams again in 2002 and 2003. His written results were always among the highest out of some 500 candidates. But the examiners weren’t satisfied with his clinical skills. They told Bashir his accent made it difficult for patients to understand him. Finally, in 2004, almost nine years and 15 exams later, Bashir got closer to practising here as a doctor. He secured a residency at McMaster. It was what he had always wanted, but he says, “I am 33. I’ve lost nine years—almost a third of my life.”
Foreign doctors can compete with Canadian medical school graduates for residency positions, but in order to do so, they have to register with CaRMS. And there is a catch: Foreign doctors will only be considered after Canadian-trained graduates have found residency positions. They can compete in the second round—for the leftovers. The competition is stiff. In 2003, 625 international graduates competed. Only 67—about ten percent—found a position.

In every province the situation regarding residency positions varies: the number of positions available, the rules about how to get them and how long a doctor has to train. Each province sets aside a few positions for foreign doctors, but in no province is the number of residencies available equal to the number of doctors seeking to fill them.

In Manitoba, the shortage of doctors has been particularly severe. But the province recently changed its regulations, creating a new program that allows a foreign graduate to receive enhanced training for up to one year to qualify as a doctor.

Mahmoud Ebadi immigrated to Canada from Iran in 1999 with his wife and two boys. He had studied medicine at the University of Tabriz and been a GP for five years. However, both Citizenship and Immigration and the Canadian embassy in Iran warned him there were no positions for immigrant physicians in Canada. They were right.

Then, in 2001, the Manitoba government announced its new program and Ebadi was accepted. After his skills were assessed, he was told he needed to complete a one-year training program. At the end of November 2003, he finally started working as a doctor for the Burntwood Regional Health Authority in Thompson, Man. “Four years is a long time to wait,” says Dr. Ebadi. “But it’s fantastic to be back in practice again.”

Admitting qualified doctors makes economic sense. If a foreign-trained doctor requires additional training to come up to Canadian standards, it is far cheaper to provide it than to educate a doctor entirely from scratch. Herb Emery, an associate professor of economics at the University of Calgary, says it costs Alberta taxpayers about $300,000 to put a student through three years of medical school. This would be saved if immigrants who already have medical degrees were accepted for residencies.

Joan Atlin, executive director of the Association of International Physicians and Surgeons of Ontario, estimates that Ontario has between 2,000 and 4,000 immigrant doctors looking for a practice. “Doctors are coming with thousands of dollars of training and experience in their pockets,” says Atlin. “They have a right to be assessed, and if found to be qualified, they should be allowed to practise their profession.”

Patrick Coady, co-ordinator of a group that assists the Association of International Medical Doctors of British Columbia, agrees. “We have people who have been the heads of emergency medicine in hospitals servicing a population of a million, anesthetists who have been practising for 20 years. After they pass all the exams, go through all the hoops, they can’t even mop a floor in a hospital let alone work as a medical professional.”

Vancouver MP Dr. Hedy Fry, a medical doctor and the parliamentary secretary to Citizenship and Immigration Minister Judy Sgro, believes that we have to look at fast-tracking. “Do we always have to have doctors come in and spend a year in residency?” she asks. “When do we start valuing foreign experience? Europe is ahead of us on this. You can be trained in Italy and work in the United Kingdom. We’re lagging.”

The Medical Council of Canada’s Dr. Dale Dauphinee is more blunt: “We are shooting ourselves in the foot.”


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11 comments

    When was this article written? In Calgary new patients cannot find a Canadian doctor. Pretty well all of them are from Saudi Arabia, India, Pakistan, or Kenya and almost all have less than one year of experience. (That also often includes specialists).. Is this because they get more money from training foreign students than they get from Canadians, or is it that Canadians find the medical system so deplorable that none are applying? There has to be a reason there are no Canadian doctors in Canada. Where do people have to go to find Canadian doctors when they can't find them in Canada? India? Pakistan? Saudi Arabia? What especially annoys me someone in Canada who is from one of these nationalities decides to zap up the only Canadian doctor available. Why don't they choose their own country doctors and leaver our Canadian doctors for Canadians? I'm extremely bitter that Canadian doctors are not being trained in Canada.

    Submitted by Susan on Wed. 2012-08-01 9:08pm

    We need Doctors, qualify them and let them go to work no matter where they come from after all everybody in Canada came from somewhere else at so time. If you want to curb any professionals try the Lawyers they seem to breed like mice. Who needs that many. They are a huge drain, sucking off fees for the least little trivial thing. They have the opposite effect to a Doctor. They leave you broke, stressed and helpless. Have a Good Day

    Submitted by matt Sheridan on Thu. 2012-08-16 9:08am

    The issue is often geography. Canada needs doctors, however Canadians need doctors in areas where foreign trained doctors may have trouble practicing. Should a doctor want to practice in Vancouver, there are only a limited number of positions in Vancouver. However, if he/she were willing to move to a different area of the Province or the country, their chances of matching are greatly increased. Canada needs foreign doctors, but the country doesn't need them in Vancouver. Be willing to move. You are essentially employed by the Provincial government when you are a doctor in the public health care system. If the Province licenses you to practice, then there is a trade off of a willingness to go where you are needed.

    Submitted by Allan on Thu. 2012-08-16 8:08am

    Why don't they go back to their own countries and practice medicine?

    Submitted by Al on Thu. 2012-08-16 12:08am

    At one point the article mentions Sept 2004 as in the future. No mention of any dates later than 2004. So probably written in 2004 or maybe 2005. My doctor is from South Africa and she is very good. But she has been limiting her practice to 4 half days a week. However, I believe that that education and working opportunities are strictly managed to keep the number small. Maybe using the excuse that standards must be maintained for public protection. I suspect it is for other reason such as money or ego. This is the same way with Laywers. I have a niece that has a 4 year nursing degree and is a registered RN. But she cannot find a full time permanent job. In her case it is a problem because the Nurses Union strictly limits full time positions.

    Submitted by Dave Hart on Thu. 2012-08-16 11:08am

    Canada will remain a state with a shortfall of physicians in which patients get rushed, careless, and overpriced service because the medical brotherhood, while paying lip-service to wanting to expedite foreign trained professionals, are smart enough to understand supply and demand. They are now hot commodities, commanding anywhere from a quarter million to 2 million a year for full-time work, guaranteed, with no risk of not having enough patients, even if they are really bad and careless and uncaring.

    In Canada, physicians are like toilets; some gold plated with marble enclosures, and some are like prison toilets without a rim and decades of fecal matter with maggots... There are only 10 toilets, but 20 people have bowel movements, and they have nowhere else to poop. But they have to poop, so they make do and count their blessings if they find a can to sit on, no matter how inferior it is. The toilets meanwhile, are kings, because everyone wants them, and they can be as bad as they want to be and people will still queue up to use them. The second they let in ambitious, talented doctors who are eager to offer pleasant service and spend half and hour per patient to give them excellent care, they will need to start to compete.

    And the better the service, the fewer the patients they see, meaning their salary will drop to more terrestrial levels compared with the rest of society. They will need to be good and compete, just like every other job in our society. But they would be fools to encourage that. These are aristocrats pre-French Revolution. And the government is too dumb to regulate them or put up a good fight, and they feel no pressure, because the public has forgotten what good healthcare really is like, and they are just happy to see a doctor at all.

    But I ask you this, would you rather have a talented specialist with 20 years experience from China whose English is marginal see you right away with a smile and explain everything you need to know and treat your health like it counts, or would you rather stand in queue and wait 2 weeks in pain at possible detriment to your health to see a doctor who tells you in 2 minutes to go home and take and aspirin, only to go back 2 weeks later because your condition hasn't improved, and then wait 2 months to see a specialist, by which time your condition (pray it's not a cancer that has spread in the meanwhile) deteriorates and you needlessly suffer, while the doctors involved got paid 3 times to do something one guy could have handled with a smile?

    As a regular citizen of course I want the latter, because I'm old enough to remember when doctors made house calls and cared about your health, but younger people don't know, and doctors, well, they're smart enough to know it's best to just complain they are overworked and are suffering in spite of their huge paycheque so that the regular people don't hate them, and suggest that they actually want fair competition from qualified doctors, but then behind the scenes, contribute to making the process for qualification so difficult that foreign trained doctor immigrants end up moving around boxes in the hospital warehouse.

    Submitted by Craig on Thu. 2012-08-16 4:08pm

    I think we need to think this through very carefully. I want a doctor, but I want a doctor who can speak and understand English well and without a heavy accent so I can understand him/her well. I want a doctor who understands the culture in which I live, and who believes in the equality of men and women. I want a doctor who successfully wrote the exams here in Canada, and who has completed the required residency in a Canadian hospital. I do not believe that it is unreasonable to have a doctor from another country re-qualify to practice medicine here in Canada. Better we be short of doctors than to have plenty of unqualified doctors whether it be from education, experience, language, or cultural attitudes.

    Submitted by Opera Alexander on Sun. 2012-12-30 8:12pm

    There are too many terrible doctors. A good doctor is an extremely rare gem. Doctors, at least in Ontario, have become the worst of the worst. I can't tell you how many doctors have told my family, friends and neighbours that they can only announce one reason for their visit. Other reasons would have to be left for separate visits. This is a damn crime. What are we paying into health care for when the quality of service is disgusting to the point where people are held up too long before another visit and either become sicker or die? Doctors should be held accountable for such a greedy practice. I now refuse to visit any doctors and must resort to self diagnosis and research via the search engines. This country's health care is in ruins, and the doctors further anger me. I wish them the worst.

    Submitted by Al on Mon. 2013-01-28 12:01pm

    doctors from Saudi Arabia, India, Pakistan or Kenia, are Canadians btw, unless you refer to their skin color. the government of  Canada grants the permanent resident status and Canadian citizenship ito forein trained doctors, inviting them from various countries through the skilled migrant immigration program. and they have to go through the hell of bureaucracy and multiple exams before they can even come close to a patient. If you have issues with skin color or accent , you should probably lobby the Canadian government to revise the immigration policy. Will granting status to illegal and uneducated immigrants as the US does be a better idea? The doctors , who you are referring to, spend 5 to 10 years washing floors while revalidating their MD in Canada and after such a challenge are willing to work the north part of the country, unlike the Canadian graduates (White Canadians ) who get lucrative jobs in Toronto. Furthermore, Canadian doctors leave Canadians for American patients, because they are paid more across the boarder. This might be a reason why you do not see "Canadian" doctors in Calgary.

    Submitted by Anonymous on Tue. 2013-01-08 12:01am

    many Canadian medical student can not get a job  

    Submitted by Anonymous on Fri. 2012-09-28 10:09pm

    the medical schools here in Canada are limited by the number of students they can train. I've wasted 3 years trying to get in every year I could qualify to enter med school and I'm not the only one rejected. There are many many other people (thousands) out there trying to get a spot just to get into a med school and dare I say, some more qualified overall than me and still do not get in. I put my whole heart and soul in it and it's just sad when I pass everything with flying colours but only did "average" on interviews that caused my rejection every time. It's very expensive to train doctors and so I can understand there are limits. It's not as straightforward as I thought and it feels rather very political. As I understand it, the med doctors here work a lot more than elsewhere for roughly the same pay so many of them move away. Canada's only going to suffer from here.

    Submitted by Anonymous on Sat. 2012-08-11 7:08pm

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