Six years after bringing his family to Canada, Jayanth Manilall, a South African dentist trained at the University of the Witswatersand, is working 12-hour shifts behind the wheel of a taxi.
Manilall, 46, wants to practice dentistry in Canada. He estimates he has spent $40,000 on textbooks, exam fees and travelling to exam locations in order to qualify.
Despite these repeated efforts, Manilall still can’t practice in Canada, even though he worked as a dentist for 16 years in his home country and in the United Kingdom.
When he’s not driving cab, he continues to study, and looks after the house while his wife works.
"I didn’t know it would be this difficult," Manilall said. "When I left, I knew I was very capable and I could work and be of service to the community."
Most countries’ credentials not recognized by Canada
Canada only recognizes the credentials of dentists from the United States, and recent graduates from Australia and New Zealand.
Dentists from all other countries must qualify through a procedure administered by the National Dental Examining Board. Until 2010, the process was lengthy and costly, requiring a series of exams costing thousands of dollars each.
Foreign-trained dentists who passed their NDEB exams then had to apply for one of a few-dozen spots in two-year programs at Canadian dental schools, a process that would ultimately cost well in excess of $100,000.
In 2010, the NDEB introduced an alternate process that eliminated the requirement of the two-year program at a dental school. Still, fewer than 20 per cent of applicants are ultimately successful.
Majority of foreign-trained dentists will never practice in Canada
Manilall said he realized something was wrong when he showed up for the first exam.
"People were telling me they hadn’t seen me before," he said.
"A guy told me ‘everyone else here I’ve seen the last five or six times.’ Then I figured out lots and lots of people are just writing the exams over and over."
The National Dental Examining Board declined Go Public’s request for an interview about the low success rate and the support and feedback applicants receive.
Dr. Jack Gerrow, NDEB executive director and registrar, said the process is "clearly and transparently documented" on its website.
Edmonton institute aids foreign-trained professionals
Manilall eventually heard about the Bredin Institute in Edmonton.
Funded by the federal and provincial governments, the institute helps foreign-trained professionals navigate the Canadian licensure system.
Executive director Debbie MacDonald says professionals trained in other countries are often lost when they arrive in Canada.
"Very much in the health professions feedback is not available," she said.
"So they get advice from one another on where they think they went wrong, which often puts them in the wrong direction. They start studying the wrong things again …and fall short again."
Manilall says the pressure to get 80% to 90% on exams, covering academic material he last studied 20 years ago, was intense.
By the time he reached his clinical skills exam he hadn’t practiced for six years and his confidence had been shattered.
"It's been a nightmare in the sense you are something, but you feel as though it's been taken away," he said.
"You feel humiliated. You question who you are. You go through bouts of depression. But you always feel that you can make it, and you strive and you strive."
The Bredin Institute’s Debbie MacDonald says it’s a story she’s heard hundreds of times.
"For them it’s very depressing, very discouraging," she said.
MacDonald says there should be more support for those trying to qualify in Canada, and better screening overseas, so potential immigrants will know the challenges they face when they arrive.
Alberta Dental College satisfied with approval process
"When it comes to getting registered in Canada we absolutely…bias on the side of public protection," said Dr Randall Crutze, spokesman for the Alberta Dental Association and College.
Crutze says applicants fail or drop out of the process for a number of reasons, including being completely unqualified.
"I think that 100% of those people who are successful are going to do very well in private practice in Canada."
Meanwhile, Jayanth Manilall has one last chance to pass his clinical skills exam.
Before he takes it, he wants to get back the confidence he says he’s lost during the past six years.
He’s returning to South Africa to work as a dentist for three months.
"So I can pay for the exam fees, and also send some money for the family. It’s going to give me two things, some finance and getting back my skills and confidence."
If that doesn’t work, he says he’ll close his family’s chapter on Canada, and move to a country that will accept his credentials.