by: Olivia Hnatyshyn
Taxi drivers. House cleaners. Waiters. Cashiers.
These are just a few of the low-wage jobs filled by thousands of highly skilled doctors who have come to Canada, in hopes of pursuing their medical careers.
Approximately 2,000 foreign-trained doctors immigrate to Canada every year, according to Immigration and Citizenship Canada. Due to the competitive licensing process, only five to six per cent of these immigrants will be able to practice.
“There are people who are bringing all kinds of exceptional experience, and knowledge, and skills, that they could be delivering to us when they arrive here,” explains Kelly McGahey, who is responsible for stakeholder relations for Hire Immigrants Ottawa, a local initiative that connects skilled immigrants with employers.
The problem has persisted for decades, despite a severe shortage of doctors in many parts of Canada, where there are 2.41 physicians for every 1,000 patients, according to the Canadian Institute for Health Information.
“I think it’s extremely unfortunate both for us and the individuals with those skills when they are unable to utilize them… We suffer from it and they suffer from it as well.”
Facing a lengthy and expensive process to have their credentials recognized, thousands of these doctors take on “survival jobs” for which they are absurdly overqualified. For example, a 2012 Citizenship and Immigration Canada report found that 200 immigrants with medical degrees were driving taxis in Canada in 2006.
Dr. Cara Uy is all too familiar with Canada’s licensing challenges. After completing medical school in the Philippines, she was accepted into a residency position in Manila. After one year of training she decided to move to Canada to be closer to her mother, who had immigrated in 2010.
Four years after her arrival in Canada, she remains a doctor in name alone. She passed the Canadian medical exams in 2017 and applied for a residency in a Canadian hospital – the last required step to become fully qualified. But, like many other foreign-trained applicants, she was not selected. She plans to apply again but for now, she works as a scribe at the Queensway-Carleton Hospital, taking notes for physicians during patient visits.
The licensing process in Canada varies provincially and is not regulated by governments but by professional organizations. In Ontario, the College of Physicians and Surgeons of Ontario (CPSO) is the licensing body.
According to Uy, regulatory bodies use a list of universities from all over the world that match Canadian education standards. In Ontario, after an applicant’s medical degree has been recognized as equivalent to Canadian standards, the person has to take two examinations, proving written and oral sufficiency of medical knowledge. According to the Canadian Resident Matching Service (CaRMS), a national non-profit organization that provides matching services for residency training across the country, examinations can cost around $1,000 to $3,000 each. Once candidates have passed the tests, they need to apply to be matched to a residency to practice in a Canadian setting for a minimum of three years. All previous experience outside of Canada, including residency and former medical careers, remains unaccredited.
Limited provincial healthcare funding means there are not enough residencies in Canada. Last year, 3,346 residency spots were available across the country for 5,634 applicants, according to CaRMS. The majority of these spots are limited to Canadian medical graduates: of the 3,346 available residencies in 2019, only 326 were allocated to foreign-trained doctors, according to CaRMS.
The medical licensing process is competitive for a reason. The healthcare system is not willing to take chances and risk liability, or the well-being of their patients.
According to Dr. Yiming Wang, an IMG from China and a resident physician at the Hospital for Sick Children in Toronto, medical practices vary from country to country, with different medical equipment and technology.
Dr. Wang explains that culture also plays a role to some degree in medicine. For example, the Canadian medical system puts a strong emphasis on mental health, with physicians being trained to recognize and address signs of mental illness such as depression. But in many other countries, mental health issues are highly stigmatized and doctors have little to no training in diagnosing and treating them. For example, according to a 2006 World Health Organization report, less than one per cent of the training for medical doctors in Afghanistan is devoted to mental health diagnosis.
Practices relating to the reproductive rights of women also vary widely. For example, in many countries, such as the Philippines, Egypt and the Dominican Republic, abortions are illegal.
What is unique to medicine, unlike other scientific fields, is that it is not just about logistical knowledge, but also highly social, requiring ‘bedside manner’ that will potentially differ between cultures. Therefore, all doctors who practice in Canada require residency in the country, according to Dr. Wang.
However, critics argue that federal immigration policies and recruitment practices misrepresent the barriers of accreditation for IMGs.
Under the federal ranking system for immigration applicants, doctors are given more points as members of a highly skilled profession (especially one in high demand), which greatly expedites their immigration process to Canada.
This policy is often misconstrued to mean that those professionals will be able to practice in Canada- In fact, the vast majority of immigrant doctors are unaware of how difficult the process will be to obtain a licence in Canada, a 2014 study by researchers at St. Michael’s Hospital in Toronto found.
The government’s recruitment tactics, claiming that Canada needs more doctors, are misleading, according to Michelle James, coordinator for career transitions for international health professionals at the Catholic Centre for Immigrants in Ottawa.
“It’s all fine and dandy to say, ‘Canada needs doctors’, but I feel like they need to rephrase that and say what they mean; ‘Canada needs Canadian doctors,’ you know? Because some of the challenges, and the process itself, are not very welcoming,” says James.
“There is a disconnect between the government and regulatory bodies. The government does not hire doctors. They can say, ‘Canada needs doctors,’ but it’s really the regulatory bodies who are certifying and educating people,” explains James.
To make matters worse, most IMGs come from developing countries, according to researchers at St. Michael's hospital. This process is often criticized by pundits for draining other countries of their own skilled workers, a concept known as brain drain.
Canadian regulatory bodies have called on recruiters to take these issues into consideration:
“To be ethical, active recruitment efforts must employ strategies that are cognizant of physician resource needs in source jurisdictions and adequately protect those jurisdictions and the recruited physicians,” states CPSO.
Unlike many other IMGs, Uy says that she knew of the difficulties of the licensing process, from having family in Canada. “I did consider possibly not becoming a doctor anymore,” explains Uy, deciding to give up the path she was on in the Philippines to come to Canada.
With legitimate doctor shortages in the labour market, critics are asking why foreign experience is being dismissed in the accreditation process, and how Canada can tap into the skills of IMGs more effectively, in order to minimize 'brain waste'.
“If there is a taxi driver out there who is a physician, I want to ask why there is no opportunity to utilize his or her medical knowledge, and prepare them to become a doctor in Canada?” Dr. Wang asks.
As a member of the Association of International Physicians and Surgeons of Ontario, Dr. Wang holds a free weekly seminar in Toronto for IMGs, helping them to find opportunities in health care. Dr. Wang explains that IMGs are highly skilled and should be able to find work in scientific research, or as professors, nurses, occupational therapists, and project managers across a variety of fields.
McGahey explains that immigrants who were professionals in their home countries face a variety of barriers besides licensing hurdles.
“It may be technical glitches in resume screening, that screens out particular keywords that aren’t used in the same way with other countries. There is bias, both conscious and unconscious with many employers. It can be everything from bias towards (foreign-sounding) last names, all the way to a preference for Canadian work experience,” explains McGahey.
Uy is now applying to a physician’s assistant program in Toronto, which would allow her to utilize her medical skills in Canada, if she is unable to obtain her medical licence during her next attempt. “At least if it doesn’t work out, then I have a career in health care,” explain Uy. “I’m not giving up.”
With the COVID-19 pandemic plaguing the country, and world, Canada has been more dependent on healthcare workers than ever before. The threat of a second wave, and the possible shortage of doctors that could ensue, begs the question; Will this be the opening into the Canadian medical system that IMGs have been waiting for?