Shafi Bhuiyan. Credit : ITMDs file photo

By Shafi Bhuiyan
TORONTO, Canada, Jun 15 2021 (IPS)

In Canada, we are fortunate to have many talented newcomers eager to contribute to the country, including thousands of doctors from Africa, Asia and the Middle East who meet Canadian standards but are blocked from becoming practicing physicians. These doctors are Canadian citizens and permanent residents with recognized training and experience.

Internationally Trained Medical Doctors (ITMDs), also known as International Medical Graduates (IMGs) are individuals who obtain their medical license outside of Canada. ITMDs face significant barriers to obtaining a medical license to practice in Canada (Wong & Lohfeld, 2008). Residencies must be completed to obtain a medical license in Canada, yet there are few residency positions available to ITMDs compared to those trained in Canada.

In 2011, over 1,800 International Medical Graduates competed for only 191 residency spots that were set aside for ITMD (Thomson & Cohl, 2011). After decades of employment experiences, still thousands of ITMDs must seek other employment opportunities. However, many are unable to find employment commensurate with their training, and some are unable to find employment at all (Environics Research Group, 2014).

If now isn’t the time for Ontario to make better use of the trained doctors who are already here, when will it ever be?

To practice medicine in Canada, ITMDs must have an approved medical degree and pass merit based qualifying exams, i.e. Medical Council of Canada Qualifying Exam 1 (MCCQE1), The National Assessment Collaboration Examination Objective Structured Clinical Examination (NAC OSCE), Medical Council of Canada Qualifying Exam 2 (MCCQE2). A large number of ITMDs have already met these requirements and are keen to serve Canadians who need access to healthcare.

During the pandemic, many of these doctors worked tirelessly to help Canadians stay healthy, even on a volunteer basis. Numerous graduates of Ryerson University’s unique ITMD Bridging Program, which helps internationally trained medical doctors transition into careers in the non-licensed health sector,have been hired to help with Ontario’s COVID-19 response.

A rapid survey of ITMD program alumni from recent cohorts (2019- 2021) was conducted by [Bhuiyan, Orin and Krivova, 2021] with the purpose of identifying their current status regarding licensure preparations to practice medicine in Canada. We targeted 100 alumni out of 277 through an online survey using SurveyMonkey, and we received 97 responses.

The rapid survey illustrated that 35% of these ITMDs have already completed the MCCQE1 and NAC OSCE. Despite being eligible to join residency programs, the wait time for residency opportunities is 4- 10 years. The remaining 65% of surveyed participants/ITMDs have not completed the medical licence qualifying exams; 44% of respondents are still considering this option, but are unsure.

Of those [35%] who have already passed the exams, many are still waiting on opportunities to complete residencies, while others are losing hope and interest in a future in clinical practice. Immigrant internationally trained doctors in Canada want and deserve equal opportunities to practise medicine.

There is an acute shortage of family doctors in Ontario’s rural and northern areas. Before the pandemic, Ontario needed thousands of new doctors within the next few years to keep up with those who are retiring and the increased needs of an aging population. The COVID-19 pandemic has exacerbated this issue and increased the need for doctors. Offering internationally trained immigrant professionals a clear path to use their medical experience and qualifications will positively impact the ITMDs as well as their surrounding communities.

ITMDs are skilled health professionals who immigrated with the potential of contributing to the Canadian healthcare system. Canadian demographic pattern is continually changing, which makes it vital to keep up with the diverse cultural needs andaddress inequity in Canadian healthcare system. Canadian long-term care facilities, ageing population, indigenous community, immigrants and migrant workers, and rural health care facilities, are now under pressure in these changing times.

Statistics show that Canada is at the lower end of OECD countries with average doctors per capita being 2.8/1,000 people where OECD countries have 3.5/1,000. It is imperative that we have more physicians in Canada.

To ensure a win-win situation in post-pandemic health care setting in Canada, let’s work together [academics, policy makers and civil society] to help support new immigrant health professionals and local community to ensure that no one will be left behind.

The author, Dr. Shafi Bhuiyan PhD is Asst. Professor, University of Toronto’s Institute for Pandemics and co-creator of the pilot MScCH Program at the DLSPH, University of Toronto; co-founder of ITMDs Post Graduate Bridge Training Program at the Chang School and Adjunct Professor at the Faculty of Community Services, Ryerson University; Board Chair, Canadian Coalition for Global Health Research

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The Sustainable Development Goals (SDGs) aim to ensure healthy lives and promote well-being for all ages. The main focus of the SDGs is to improve equity to meet the needs of women, children and disadvantaged populations in particular.

Shafi Bhuiyan PhD

Globally, the Maternal and Child Health MCH Handbook International Committee’s implementation research established that the MCH handbook is an innovative home-based record that integrates information about maternal and child health into one booklet, including pregnancy, labour, immunization, breastfeeding, nutrition, child growth and development, and diseases. As such, it has proven to be an effective tool in promoting and protecting the health of mothers and children. MCH handbooks are often the only health care guides that facilitate equitable access to primary health care. The handbook will thus help to break the stigma of seeking health care for women and empower women to make informed decisions about their own health and pregnancy.

The handbook was first introduced in Japan in 1948, along with other public health interventions. The handbook has helped Japan become the country with the second-lowest infant mortality rate in the world. Nevertheless, Japan is still identifying new perspectives and potential to use the MCH handbook for early detection of diseases in children (autism, neurodevelopmental disorders) and the evaluation of risks for obesity, cardiovascular, endocrine diseases, and mental illness.

The MCH handbook has been adopted in over 42 developed and developing countries worldwide, and has proven its efficacy in enhancing maternal and child healthcare. Mothers with MCH handbooks have been observed as being more knowledgeable of proper antenatal care, good nutritional choices during pregnancy, and possess increased awareness of the importance of immunization. Also, content of the MCH handbook is flexible and easy to edit according to the country’s culture and socio economic status.

The MCH handbook helps service providers and users to understand what comprehensive MCH services entail. With its two-way interface, the handbook also provides mothers with an opportunity to collaborate with healthcare providers. It enables mothers to document their health concerns, symptoms, and timelines to monitor their health progress over time. Simultaneously, it allows healthcare providers to keep records of health services accessed by mothers. This reciprocal exchange of information between the healthcare provider and mothers increases both the provider’s capacity to monitor health status and the patient’s capacity to understand when to seek medical care.

The handbook is recognized for its simplicity, cost-effectiveness, ease of implementation and the aggregation of multiple health knowledge tools and health records. Its simplistic user interface has also demonstrated a huge impact on economic and research value.

Even before the emergence of COVID-19, high-quality and timely maternal healthcare services were unavailable, inaccessible, or unaffordable for millions of women. Now with public health restrictions, there is an excessive burden on the healthcare system. This limits the access to care and negatively impacts women’s and children’s health. As a result, many expecting mothers are likely to end up receiving less than adequate care throughout their pregnancy.

Disruption of essential services might lead to disproportionately greater perinatal losses in areas with high maternal and neonatal mortality, reductions in breastfeeding prevalence and an increase in the number of unvaccinated and under-vaccinated children. All these factors exacerbate the existing inequities in accessing healthcare services. However, the MCH handbook could promote a continuum of care for maternal and child health and bridge the existing gap even during the pandemic. Utilizing the handbook [digital or paper books] also ensures invisible mothers and children become visible. It helps strengthen the healthcare system by allowing women to become active participants in their healthcare.

Globally, the MCH handbook has been used in many countries for over two decades. There are now efforts to develop a digital MCH handbook application, thereby ensuring safe delivery and MCH services locally and globally. The MCH handbook digital application is expected to help reduce delays in decision-making at the family level, as well as delays in arranging quality services at the facility level.

The United Nations Sustainable Development Goals (SDGs) emphasize improving health equity so that ‘No One is Left Behind’. Pilot implementation research from multiple countries has demonstrated that the MCH Handbook is a useful tool for extending the knowledge for better access to quality primary health care, that is affordable and equitable. It could also support the integration of reproductive health into national strategies and promote effective maternal and child health programs. Thus, the MCH handbook provides a platform to improve universal access to health-care services, strengthen human health security and reduce the “unmet need” for the most unprivileged population.

Dr. Shafi Bhuiyan is an award-winning professor and an internationally recognized–academic/professional leader in global health. He is a co-creator of Pilot Masters of Sciences program at U of T, and a co-founder & academic director of the Internationally Trained Medical Doctors Bridging Program at Ryerson University. Dr. Bhuiyan currently serves as the Chair, Board of Directors, Canadian Coalition for Global Health Research and a visiting Professor, Bangladesh University of Health Sciences.

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