Foreign Medical Graduates In Canada - Many communities in Canada, especially rural ones, suffer from physician shortages because the distribution of family physicians is insufficient and inequitable. For example, in 2000, there were an average of 94 family physicians per 100,000 Canadians. Some communities (usually urban areas) had 140 family doctors per 100,000, while others (usually rural) had less than half that number.1 Many doctors who choose to work in rural areas do not stay beyond the minimum period of their contractual obligations. .
One way to reduce the shortage of doctors is to license more international medical graduates (IMGs). Each Canadian province uses IMGs to varying degrees to bridge the gap between the demand for primary health care and the provision of services by Canadian medical graduates. Recent data indicate that approximately one-quarter of physicians working in Canada received their primary medical education in another country.2 However, this figure does not reflect differences and the size of the IMG workforce across provinces.
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Licensing of physicians is the responsibility of health regulatory authorities in each province. Licensing forms vary by province, but there are two general classes: full and temporary. The requirements for full licensure in Canada are almost uniform, with the standard requirement being a Licentiate of the Medical Council of Canada.
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The requirement that a physician complete postgraduate medical training in Canada is a barrier to IMGs seeking full licensure. However, provisional licenses allow IMGs to practice without passing the medical board exams (and without completing the required Canadian postgraduate medical training). Thus, many IMGs begin their careers in Canada by practicing on a provisional license. The nomenclature of temporary permits varies by province, with such permits being called "public service", "limited", "certain", "conditional" or "temporary".
In remote and underserved regions of Canada, the health services provided by temporarily licensed IMGs are essential.3 Typically, temporarily licensed IMGs are hired to meet immediate physician shortages; they obtain a temporary license to practice and usually fill positions that Canadian medical graduates will not fill.
To determine rates of use of provisionally licensed IMGs in Canada, we asked licensing authorities in each of 10 provinces to report the number of provisionally licensed IMGs registered in their province in 2003 and the 5 most common locations of origin for these IMGs (see webbox available at /cgi/content/full/173/11/1315/DC1). These data were linked to the Canadian Medical Directory to provide estimates of the physician workforce share of provisionally licensed IMGs and fully licensed IMGs by province.
We found large differences in the percentage of IMGs practicing in each province. For example, fully and provisionally licensed IMGs make up more than half of the physician workforce in Newfoundland and Labrador and Saskatchewan, but only 8.0% in Quebec (Figure 1). The variation in the use of provisionally licensed IMGs is even more striking, with some provinces licensing very few (eg, Quebec, New Brunswick and Ontario) and others much more (eg, Newfoundland and Labrador and Prince Edward Island).
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Figure 1: International medical graduates (IMGs) practicing with full and provisional licenses as a percentage of the total medical workforce by province. *Does not include data from territories.
A provisional license provides a convenient path to a full license, even if it means working in a different country than the desired location of the IMG. After obtaining full licensure, IMGs are mobile and many subsequently relocate within Canada. Thus, many communities face a regular and rapid turnover of doctors.
Evidence suggests that some provinces are "entry points" for IMGs to obtain a license and full mobility in Canada. Provinces that face ongoing problems finding doctors to work in rural and remote areas offer temporary licenses to IMGs who want to relocate to Canada with an agreement to work for a certain period of time (usually) 2 years. This 2-year window coincides with the time required in clinical practice before a physician can qualify for full licensure.
Given the global shortage of health workers, there are ethical concerns about recruiting doctors from developing countries: should a wealthy country like Canada "poach" doctors from less wealthy countries who have invested heavily in their training and where are their services most sought after? although worse compensation) than in Canada? The counterargument is that people have the right to self-determination and if IMGs meet a particular need, they should be allowed to immigrate and work in their chosen profession. The compromise that has emerged is that Canadian doctors should not actively recruit IMGs until that person expresses an interest in immigrating.
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High physician turnover in rural and underserved regions is a serious problem in Canada. Continuity of care is strongly related to patient satisfaction with the physician, so the relationship with the family physician is ideally long-term. When a family doctor is only present in the community for a short period of time, it is not possible to establish a long-term relationship.
There are 2 obvious implications of our findings. The first is that some (poorer) provinces that rely heavily on provisionally licensed IMGs may serve as an initial screening mechanism for other (wealthier) provinces that wish to hire fully licensed IMGs, allowed them to avoid the granting of temporary licenses. Another consequence is that only the most qualified IMGs with temporary licenses can immigrate, while those who struggle to meet Canadian standards remain immobile.
Of particular concern is the trend of rapid turnover of newly qualified IMGs from rural and remote areas. Recruiting a new doctor, especially from abroad, is expensive. Changing doctors every 2 years requires significant financial expenses, which can be more effectively spent on the actual provision of health services. Kirti Aneja was proud of her achievements when she started working as an anesthesiologist in a rural community in the northern Indian state of Punjab in 2007.
She wanted to be a doctor since she was a little girl playing with toys, inspired by her childhood visits to leprosy hospitals. She was happily married to her school sweetheart and was expecting their first son.
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But her family decided to leave their beloved homeland and strive for a better life for their children. And her passion to use her skills turned to serving the people of her new country, Canada.
Dr. Aneja is an international registered nurse (IMG), one of a group of Canadian permanent residents or citizens who have trained outside of North America and wish to practice in Canada.
B.C. government has committed to increasing funding and working with the UBC Faculty of Medicine to expand the IMG program from 26 slots today to a proposed 58 in 2016 to help meet the need for more doctors in underserved areas of BC.
While we are committed to providing high-quality care to communities across the province, the process of bringing in qualified and passionate international graduates is rigorous.
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While the US and Canada have similar curriculum and accreditation for ical students, the systems around the world are very different. Many, for example, do not require the same level of training in a clinical setting as is required for Canadian medical education.
To ensure the uniform skills and knowledge of graduates trained outside of North America, all IMGs must pass a series of exams.
Those who do well in the exams are then selected for clinical evaluation - working in hospitals alongside experienced doctors for three months - and upon successful completion are eligible to apply to residency training programs lasting two to seven years, depending on the specialty. apply. meet the conditions for a license to exercise activity.
Dr. Aneja completed a three-year specialization in India. But here in Canada she had to start all over again.
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"I am a fighter. We came here for a better life for our family and son and I don't give up easily", says Aneja. While she was preparing for exams and taking care of her little son, Dr. Aneja worked at Wal-Mart for a living.
Dr. Aneja passed all exams and the three-month BC-IMG clinical examination for two and a half years. In July, she began her stay at St. Paul.
"I was determined to practice medicine in Canada, but it was definitely challenging," says Dr. Aneja, whose husband is still in the process of qualifying for residency training.
“In retrospect, I may have been a little naive about what it would take to get back into practice in B.C.,” says Dr. Walter, who admitted that she sometimes felt like a natural Canadian worthy of special attention.
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“But the longer I was in the program, the more I realized that all IMGs are Canadian – some have been here for 10 years and separated from their partners or children. Most of them have to support their families and children, and some of them support extended families abroad," he emphasizes.
“Many IMGs I know are not here for their careers – they had a good life in their countries as doctors. They were respected and made good money... They are here because they want a better life for their children and
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