When Dr. Shafi Bhuiyan moved to Canada from Bangladesh in 2010 with decades of experience as a medical practitioner, he never knew the barriers waiting for him in Canada to continue serving as a health professional.
Internationally trained doctors have a difficult time getting licensed to practise in Canada – in spite of their skills in training and waiting lists full of patients here.
“My wife and I decided not to practise, which is OK. We are happy. But there are thousands of very good doctors here and they are not getting any scope,” said Bhuiyan, an award-winning faculty member at the University of Toronto and Toronto Metropolitan University. He is an internationally recognized academic leader in global health research and training.
Thousands of qualified internationally trained medical doctors like Bhuiyan have been unable to work in Canada, and the public is taking note. A Walrus story published June, 2021 presents a similar account of Suvash Pokhrel, an internal-medicine specialist from Nepal. The story continued in 2022 as CBC wrote in December about Ayman Jabril, who had trained and worked as a physician in Yemen and Saudi Arabia before immigrating to Canada.
The Royal College of Physicians and Surgeons of Canada recently announced a plan to “streamline the process for internationally trained specialists” to relieve the shortage of medical practitioners.
Let’s take a closer look at the reason for the shortage — not of doctors, but of licence to practise.
How to apply and obtain a medical license in Ontario
To become a practising physician in Canada, medical graduates must qualify as the Licentiate of the Medical Council of Canada (LMCC) granted by the Medical Council of Canada (MCC). However, the LMCC is not enough. Rather, physicians must also meet a set of nationally standardized requirements before applying for full license to practise in Canada.
The provincial and territorial medical regulatory authorities issue licenses to doctors upon meeting the established criteria. If you are applying in Ontario, the provincial government controls the number of residency spots — which is highly restricted and prioritizes graduates from Canadian medical schools, rather than for international medical graduates (IMG). Byuiyan said the system is more difficult for doctors who migrated to Canada with training and years of experience; they are known within the system as internationally trained physicians (ITP).
“Canadian citizens who go abroad for medical education and then come back are treated as IMG,” Bhuiyan said. “But actual immigrant doctors who moved here like me or my wife, we have no clue where to go or what to do, and that is a shame on the system.”
Urgent plea to resolve health human resource crisis
On Oct. 31, 2022, the Canadian Doctors for Medicare drafted an open letter addressed to Ontario’s premier, health minister and long-term care minister. It’s an urgent plea to fix Ontario health care. Click here to view it.
The Canadian Medical Association (CMA) also highlighted the issue in its August, 2022, publication Canada’s health crisis: what we need to know.
Dr. Alykhan Abdulla, a family physician, published an open letter in the Ottawa Citizen apologizing to patients for the broken health care system.
“I am sorry that I can’t take more patients. I am sorry you are in pain, or worried, or have many unanswered questions, or unmet expectation.”Dr. Alykhan Abdulla, family physician.
A woman from Vancouver Island in a desperate move placed a newspaper ad pleading for a doctor to renew prescriptions for her 82-year-old husband which read “WANTED: BC Licensed Medical Doctor for Prescription Renewal.”
These are only a few examples of many such stories floating in the news with ample and clear evidence on the acute shortage of doctors and its impact.
Barriers to entry for internationally trained doctors
“We don’t have a health human resource plan to incorporate the immigrant health professionals,” said Bhuiyan. “You apply for various exams, pay hefty amounts and then wait, but nobody calls and three years later they say you have lost the recency of practice and (are) disqualified.”
Bhuiyan said it is the system’s failure for being unable to provide opportunity to experienced ITPs who need the scope to serve their fellow Canadians. “You talk about the culturally respectful service, and you are not recruiting these culturally appropriate people who are ready to serve.”
“Even after earning extra certifications, internationally trained doctors still aren’t allowed to apply to 90% of the total residency positions available in Canada.”Institute of Canadian Citizenship (ICC)
According to the Institute of Canadian Citizenship (ICC) internationally trained medical doctors have to go through “extra processes, sessions and certifications,” which renders it “almost impossible” for international doctors to practise in Canada.
“Licencing process is tedious, very complex,” said Bhuiyan. “The roles and responsibilities are not clear between the Royal College of Physicians and Surgeons of Canada, the CMA, the College of Physicians and Surgeons of Ontario.”
Finding a solution to Canada’s health crisis
“I was part of the equal opportunity campaign (#equalchance – Institute of Canadian Citizenship (ICC)) last year and we did conduct a survey which found that Canadians have no problem going to the immigrant physicians,” said Bhuiyan. #Equalchance is a campaign run by the ICC that strives to give equal opportunity to all doctors and “take action against the unfair barriers faced by internationally trained medical doctor in Canada.”
According to the Canadian public policy think-tank the Fraser Institute, “even if government imposed restrictions on the number of doctors being trained in Canada are immediately removed, it won’t have an impact for much of the next decade given the time it takes to train a new doctor.”
“The only short-term solution is to recruit more foreign-trained doctors.”Fraser Institute.
The Royal College of Physicians and Surgeons of Canada in January announced changes to streamline the certification process for ITPs.
“We’re trying to create the opportunity for anybody, regardless of where they were trained, to be able to demonstrate their knowledge and ability to do the work in practise, observed by experts,” said Dr. Glen Bandiera, executive director of Standards and Assessment at the Royal College in a Jan. 23 statement.
The college announced it was simplifying the process for ITPs. Candidates will be allowed to take a written exam before moving to Canada, which will speed up the process for international doctors by eliminating the steps in the road to licensure. Candidates can now “apply after two years of practice in their home jurisdiction,” rather than the previous requirement of five years.
“I think five years from now, internationally trained physicians would be getting into the system within one or two years, regardless of their medical specialty, as opposed to five to seven years,” said Bandiera.
But Bhuiyan, the doctor from Bangladesh, said the proposed solution might be a failure because the ITPs were not included in the discussion, decision and solution.
Recognizing the education and experience of ITPs and expediting their pathway to practise is an immediate way out of the shortage, he said. He said the government must focus on allocating and increasing funding toward more residency spots in medical schools which has been a huge bottleneck.
“People are suffering now, and you are waiting for three years later,” said Bhuiyan. “Give me the responsibility. I will fix it in 72 hours.”