Dr Shafi Bhuiyan with colleagues. He and his colleagues argue that COVID-19 has exposed gaps in the Canadian healthcare system.

By Shafi Bhuiyan and team of ITMDs
Toronto, Canada, Sep 3 2021 (IPS)

Access to quality healthcare is a basic human right, but for many, especially those in vulnerable communities, the right is not fully realized.

The Covid-19 pandemic exposed this systemic inequality and gaps in the Canadian healthcare system.

While surgical backlogs and delayed appointments may be prominent features of the healthcare crisis, the indirect impacts of Covid-19 must be considered. These include a halt in preventive programs, such as cancer screenings, declining health among Indigenous and aging people and for those with chronic illnesses, as well as worsening mental health among health care workers, to name just a few.

Canada already possesses a significant number of educated, qualified, and experienced Internationally Trained Medical Doctors (ITMDs) who can help fill gaps in the healthcare system. For example, Immigration Refugee Citizenship has reported that over 5,000 physicians came to Canada between 2015 and 2021, and this number does not include ITMDs who immigrated via a different method.

Many ITMDs possess much-needed cultural diversity, linguistic skills, and cross-cultural patient care talents. These can be utilized in the long-term care sector, for chronic disease prevention, and with Indigenous peoples and ethnic-racial groups, especially those residing in remote and rural areas across the country. Although 20% of the Canadian population lives in rural areas, only 8 percent of physicians work cfin these areas. Many ITMDs are well suited to provide quality healthcare for some of these communities.

Canada’s annual immigration intake plan is to welcome more than 400 000 immigrants per year in 2021-23, in keeping with the national plan for population growth. Based on data trends from Immigration, Refugee, Citizenship Canada (IRCC), this will likely include at least 900-1000 physicians each year. The need for diversity among physicians will continue to rise to provide culturally sensitive and quality care for all Canadians. ITMDs can provide culturally sensitive care and in-demand language skills to Canada’s increasingly diverse population.

Although the Truth and Reconciliation Commission of Canada (TRCC) Calls to Action were created in 2014, most healthcare calls have yet to be addressed. ITMDs can help address the long-standing shortcomings for this communities’ access to equitable healthcare and could contribute to rebuilding trust in the healthcare system.

The underutilization of immigrants’ education and qualifications has been reported to cost Canada $3 billion per year. Supporting the incorporation of internationally educated health professionals into the healthcare system would benefit Canada’s healthcare system and positively impact the economy.

Integration of internationally educated health professionals / ITMDs into the healthcare system requires a national strategy with a multi-stakeholder approach that focuses on scalable solutions. This strategy needs the engagement of governmental policymakers, regulatory bodies, employers, educational and training entities, service delivery agencies, and ITMDs themselves.

Once ITMDs have proven their expertise, they still require a bridging program to integrate their skills and expertise into the healthcare labor force. A recent survey of selected ITMDs who had participated in a career bridging program showed one-third had passed their licensing exams. These exams assess candidate’s clinical knowledge and skills to ensure they are comparable to Canadian medical graduates. Despite this achievement, another hurdle remains, to secure licensure. This is the residency program, which ranges from 3 to 5 years depending on the field of specialty.

The residency application process is complicated, but to describe it simply, medical students apply – via the Canadian Resident Matching Service, or CaRMS – for residency positions at universities across the country in one or more specialties of their choice. Not only are the total number of residency slots limited, but there are caps on the number of slots reserved for internationally trained versus Canadian medical graduates. The available slots for ITMDs are considerably smaller.

With the 2021 residency match results, data clearly illustrates the inequity i.e. a total of 2,852 Canadian medical graduates were matched. On the other hand, 410 internationally trained medical doctors were matched to residency positions. Over 90% of ITMD’s who have passed their qualifying exams cannot secure a residency due to their limited number and inequitable distribution of the residency slots.

An immediate solution is developing and delivering bridging programs, including in-class training and practicum placements, to support ITMDs’ employment in work commensurate with their skills, training, and experience, such as clinical assistant, research associate, and healthcare manager. Incorporating ITMDs into the healthcare system as licensed physicians can be further achieved via Practice Ready Assessments, increased residency opportunities, and increased post-graduate public health education and training.

Developing a clear roadmap will facilitate ITMDs’ integration into the Canadian healthcare system and foster diversity and equity in health research, management, and patient care.
There is a worldwide health crisis. If we cannot save a life despite having a huge pool of foreign-trained physicians ready to serve any time, we are neglecting untapped human resources to the detriment of our health.

The inclusion of ITMDs in the health system will benefit the healthcare system, patients, and the community and have a positive impact on society by reducing wait times and ensuring a better quality of life.

ITMDs are here, ready, willing, and qualified to serve Canadians as we work together to strengthen our healthcare system. There is no better time than NOW! Let’s work together to make healthcare more available and accessible to all Canadians so that no one is left behind.

• The authors are from Asia, the Middle East, Africa, and South American countries.  
• The co-authors are Drs Bhuiyan S, Orin M, Krivova A, Fathima S, Walters J, Uzonwanne G, McGuire M, Mohammad A, Alamgir AKM, Radwan E, Tasnim N, Tazrin T, Parungao J, Saad W, Shalaby Y.

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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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