Immigrant Health Professionals have lots to offer Canadian society, but often face barriers.

By Shafi Bhuiyan and team of ITMDs
Toronto, Canada, Aug 27 2021 (IPS)

Albert Einstein said, “In the midst of every crisis lies great opportunity.” The year 2020 was a year of crisis across many sectors in Canada, especially the health care sector. There was a severe strain on the health care system through long waiting lists for family physicians, specialists, and vaccination clinics, and Intensive Care Units were working at a high level of capacity.

People’s Charter for Health describes health as a reflection of a society’s commitment to equity and justice. Health equity is not complete without equity in opportunities for medical professionals from all backgrounds to practice medicine.

Canada’s healthcare system has faced many challenges, including but not limited to long waiting times, geographical disparities, an aging population, and limited access to personal doctors and specialists. The COVID-19 pandemic further brought to light the gaps in healthcare and how opening career pathways for internationally trained medical doctors on the front lines could only be beneficial.

The Canadian demographic pattern is changing through globalization and immigration policies – hence diversity matters. There are increasing numbers of internationally trained medical doctors (ITMDs) who can work in Canada’s health care system but struggle to pursue their careers after moving to Canada due to bureaucratic and other obstacles. The ITMDs can contribute to our health care system alongside Canadian graduates. They also bring culturally sensitive care and in-demand language skills to Canada’s increasingly diverse population. 

Systemic barriers exist in Canadian healthcare for immigrants; hence, inequity in the system needs to be addressed by providing culturally respectful services. ITMDs can ensure equal opportunities to contribute to health services (i.e., indigenous community, aging population, immigrants, and migrant workers).

There is a rising demand for health care talent across the globe. Canada will face increasing competition with other countries to attract such a talented and qualified workforce. Without proper pathways for ITMDs to pursue their careers in Canada, ITMDs will eventually choose to migrate to countries that would enable them to have fair and clear pathways of integration into the healthcare system that will utilize their expertise.

Systemic barriers and inequity exist, and as a result, over 13 000 immigrant doctors are not called ‘Doctor’ in Canada. Only 26.4% of the total number of physicians in Canada are internationally trained medical graduates.

However, In Ontario, hospital care is overwhelmed with an estimated backlog of almost 257,000 surgeries. Also, Canada is the 12th lowest among OECD (Organization for Economic Cooperation and Development) countries in the number of doctors per 1000 population. This implies the need for more doctors in Canada, which can be achieved by opening more opportunities for the thousands of international medical graduates in Canada to practice medicine.

However, it can be argued that the number of doctors has increased by 1.8% from 2018, with a total of 5.2% between 2015 and 20191. Additionally, the number of international medical graduates becoming family physicians in Canada has increased from 28.7% in 2015 to 30% in 20191. Can this be interpreted as increased opportunities for internationally trained medical doctors? The answer to this question requires further exploration of opportunities and residency match processes. Internationally trained specialists with multiple years of training and expertise choose to do family medicine in Canada as the process gets extremely difficult for the specialists to do their respective courses in Canada. This is also evidenced by ITMDs being only 17% of practicing surgical specialists compared to 30% of practicing family physicians.

Furthermore, we cannot ignore that international graduates with specialty training from only certain countries are recognized to pursue Royal College Certification in their respective specialties. However, graduates with specialty training from all other countries have to undergo compulsory residency training despite years of experience in their respective fields.

A recent survey conducted in 2021 by the Internationally Trained Medical Doctors program at Ryerson University showed that 35% of the international graduates who participated in the survey have completed all necessary licensing exams but have not yet been able to secure a residency position. Likewise, 47% of immigrants with internationally obtained post-secondary health education credentials are underutilized: they are either unemployed or work in non-health occupations that require only a high school diploma. Also, the World Health Organization projects a worldwide shortfall of approximately 18 million health care workers by 2030, with certain consequences for patients, economies, and communities. This shortage may fuel global competition for skilled health workers.

Internationally educated and licensed doctors face differential access to opportunities to meet the requirements to practice medicine compared to those trained in Canada. While most immigrant doctors are required to do additional residency training here, there are very limited spaces available. In 2020, only 418 ITMDs obtained a residency position, while 2,895 medical graduates trained in Canada were matched to residency programs. At the end of the match, 56 residency positions were unfilled, 49 of which were in Family Medicine. Furthermore, of the spaces reserved for ITMDs, a majority were filled by Canadians who went abroad to study medicine. On the brighter side, however, 83% of Canadians agree that we should do more to ensure that doctors trained internationally have a fair and reasonable opportunity to practice medicine in Canada.

Hopefully, we will soon reach a stage where we, ITMDs, could look back and say that our time has finally come! Policymakers need to consider existing barriers and take steps forward in utilizing immigrants’ skills to address our society’s demands. ITMDs, let’s stay strong together–tomorrow is a new day! Diversity matters. Together, let’s act now to make our Canadian health system equity-focused and accessible to all.

• The authors are from Asia, the Middle East, Africa, and South American countries.
• The co-authors are Drs Bhuiyan S, Azam S, Krivova A, Orin M, Mukoko P, Radwan E, Adelekan O, Abdulhameed M, Mehrotra M, Anuradha D, Gaby V, Tasnim N, Abolurin A, Dare A, Telchi J, Mariano K, Bukhari S.

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Dr Shafi Bhuiyan is pictured here with a team of ITMDs. Foreign-trained doctors are underutilized in Canada despite shortages of trained personnel.

By Shafi Bhuiyan and team of ITMDs
Toronto, Canada, Aug 20 2021 (IPS)

Canada is ranked number one out of 78 countries globally, with the highest marks in social purpose indicators, emphasizing human rights, social justice, and racial equity commitment, according to a recent U.S. News & World Report survey.

The country follows the Equity, Diversity, and Inclusion (EDI) principles, incorporating them into research and workplace environments, and it acknowledges challenges vulnerable populations face. Adopting these principles in every aspect of people’s lives makes Canada one of the most attractive places for numerous immigrants worldwide, with more than 13 000 internationally trained medical doctors (ITMDs) calling Canada home.

Canada’s health care is based on social equity fundamentals, having universal health coverage for essential medical services free of charge. Nevertheless, in 2019, about 4.6 million Canadians claimed that they do not have regular medical practitioners to seek advice or help.

In 2020, the highest record of 10.5 weeks waiting time from a family physician referral to specialist consultation was documented, with additional 12.1 weeks interval before treatment was initiated.

The COVID-19 pandemic aggravated these issues resulting in about 16 million healthcare services backlogs in Ontario alone. These will need up to almost two years to be resolved.

At the same time, Canada possesses significantly underutilized skilled healthcare professional resources trained abroad. According to the survey conducted among recent ITMDs graduates, 35% have passed the required licensing exams, including Medical Council of Canada Qualifying Examination Part I (MCCQE1), the National Assessment Collaboration Objective Structured Clinical Examination (NAC OSCE). This means they are eligible to enter the residency.

Very few will secure a residency position. The residency quotes retrieved from the Canadian Resident Matching Service (CaRMS) website showed that only 325 out of 3,365 (less than 10 %) spots were available for international medical graduates (IMGs) for the first iteration of the 2021 matching process.

Out of 1,358 IMGs participants, 948 (almost 70%) were unmatched this year partly due to a lack of transparency and understanding of the process rules.

Not to mention the cost associated with licensing examination, the CaRMS application process is a significant financial burden and even a barrier in many cases for the newcomers. According to Statistics Canada report, 47% of foreign-educated health professionals are either unemployed or employed in non-health-related positions that required only a high school diploma.

Nevertheless, internationally trained medical doctors play a significant role in fighting the COVID-19 pandemic, supporting the vaccination clinics, working as contact tracing managers and mental health advisors.

Another issue that needs an urgent solution is physician wellbeing. A recent study in Vancouver showed that the burnout rate reaches 68% among doctors, with 63% feeling emotionally exhausted and 39% depersonalized. Moreover, 21% of them had resigned or have thoughts about leaving their career.

On top of that, the aging population required complex care, along with a growing diverse population of Canada, underserved racialized, and newcomers’ communities need a considerate strategy to encompass community-based, culturally sensitive approaches to health care.

The ITMDs is a culturally diverse group with rich experience in different fields of medicine and research. Thus, foreign-educated health care professionals are fit perfectly to engage underprivileged communities, promote health and disease prevention, and manage multiple health priorities. Hence, the integration of internationally trained health care professionals could be a turning point to solve the current and prospective issues.

Moreover, 80% of Canadians stated that they feel comfortable being cared for by doctors who obtained mainly their training outside Canada, with 83% claimed that it should be more action to ensure fairness and opportunities for IMGs to practice medicine.

The question is: Why are internationally trained medical doctors still sidelined? The action is for the government to bring Equity, Diversity, and Inclusion (EDI) principles into the Canadian health care system.

Thus, a clear roadmap to integrate internationally trained healthcare professionals is necessary to address all existing challenges and strengthen Canada’s health care system. A move considered to be highly beneficial for all stakeholders (patients, physicians, ITMDs, government).

Collaboration is vital to move forward and make the ‘no one left behind ‘strategy a reality.

• The authors are from Asia, the Middle East, Africa, and South American countries.   
• The co-authors are: Drs Bhuiyan S, Krivova A, Orin M, Azam S., Shalaby Y, Tasnim N, Badran H, Al-Chetachi W, Radwan E, Tazrin T, Biswas M, Min K. S, Mehrotra M, Anuradha, Quintanilla E, Begum N, Adhikary I, Fatima N

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