Friday May 16, 2008
Conspiracy Theories on Canada's Doctor Shortage
Canada faces a critical shortage of doctors. Five million Canadians can't find one. Want to know why that is? I have a conspiracy theory.
Doctors like things just the way they are. A shortage of MDs suits those already in practice. It makes doctors seem like a scarce resource (e.g. crude oil). It makes them seem heroic when they have to work hard to see as many patients as the can. And it enables provincial medical associatons to squeeze more money and concessions from the provinces.
Want to know a quick fix? Import more doctors from abroad.
This week on White Coat, Black Art, we talk about the need for international medical grads and the hoops they have to go through to work here. And, we examine the impact of Canada poaching doctors on the countries from which they come.
We want to know how the shortage of doctors affects you. Contribute to our blog (to post a reply, follow the link immediately below), or email us at whitecoatATcbc.ca.
Contribute to a Future Show:
Is your doctor ever rude to you? Does your physician need a little lesson from 'Doctor Manners?' We'd love to hear your stories. Leave us a message on our voxbox at 1-866-648-6714.
Previous Comments (28)
Dr. Brian, if I have your support and the support of the media then I am willing to make a contribution. I can guarantee and import atleast 1000 doctors within the next one year and they will all be according to the Canadian standards. We will pick and choose the best of the brightest doctors available overseas and make them sit for the neccessary exams and make them suitable/ready to take over house jobs here in Canada. You can either call me at 416 570 8976 or e-mail.Waqar Hossain, May 19, 2008 4:58 AM
To that doctor who insisted that many kinds of assessment criteria and formulas have been tried and implemented but none have been able to solve the conundrum of certifying immigrant doctors, I ask:
What have other countries been doing? What has the USA, or Great Britain, or other countries with high medical standards, and who accept these doctors much more easily than Canada been doing?
If other countries have solved that problem there must be a solution.Krystyna Hunt, May 19, 2008 11:59 AM
It was interesting to listen to the challenges of foreign doctors trying to work in Canada.
One issue that was not mentioned in any way was the impact of their societal beliefs or religious beliefs on their medical practices.
We need to go beyond medical skills - the incoming doctors should also be completely fluent in English or French and understand and accept our social norms.
Interesting comment about the financing of nurse practioners - and time the provincial governments got their act together on this.
Perhaps they should also remove the financial caps from doctors - if they want to work long hours, they should be able to and to get paid. I heard of one obstretician in Ontario who works 6 months a year in Canada, hits his maximum and then goes to another country for the rest of the year - which totally makes sense. We don't limit business people from working overtime and being paid - why should doctors be any different.
Note: This posting was edited.B. Wilkes, May 19, 2008 12:13 PM
Dear Dr. Brian Goldman:
Thank you for spotlighting this issue. I hope it leads to some changes soon.
I am an Internist from US who migrated to Canada in 2005. Although I have passed my MCC exams, including MCCQE part 2, I still remain unemployed.
As you are probably awrae that Internal Medicine specialty Residency is of 3 years in US as opposed to 4 years in Canada. RCPS approved my 3 years of training done at Cornell University but told me I needed one more year of training to sit for exam. Now, with all this qualification behind me I am still waiting to be accepted into a residency program. Carms only accepts applicants into First year of residency: so it is not available to me. Other places in Ontario have advised me that my application will wait for, if and when an opening occurs to allow a reaptriate to enter the system. Meanwhile, more than 2 years have passed. Getting into fourth year of residency proven to be impossible.
RCPS suggested I go back to US and do fourth year and come back to Canada. If I were to go back to US, why would I want to come back here again?
The Conspiracy is also known as 'Medical Mafia' in general. It is deliberate action by the Canadian physicians to unite to keep the system as it is, and appose any openings to Foreign physicians in order to keep their monoply.
In last 2 1/2 years I have had my share of exposure to appalling Medical practice here in Canada. Most doctors work with 'God's Complex' ready to axe any patient from their practice if they raise any questions. Patients perpetually are abused by their doctors for fear of being abandoned, knowing very well that they will not be able to find another physician.
Some doctors practice such poor medicine that same practice in US would lead to lawsuit or license revocation. But here it is very different.
Most immmigrants have realized that Canadian outreach for skilled workers is just a scam to lure highly qualified individauls into driving taxis or selling pizzas. Why is it that my credentials on immigration application made me believe that I was a 'skilled worker' where as I remain unemployed in my field of profession?
This is not how a great country is made. Canada will never be able to become one until it uses all the brain power it contains, including that of immigrants, to the best of its ability.
Umbrine FatimaUmbrine Fatima, May 19, 2008 2:12 PM
For many years I've said that the Ontario College of Physicians and Surgeons is a closed shop for Canadian trained doctors which consistently shuts out foreign trained doctors on the argument that they are protecting patient safety. Where was the "holier-than-thou" College when the infamous Canadian educated Dr. Smith was performing his pathology (for which he was never trained) horror show and the Scarborough General gynecologist who permanently ruined several womens' future health with botched operations that were never publicized by the College even after exposed by the media. The answer lies in the adage "where there's wealth there's greed", and this is exactly the reason that the College won't admit foreign trained doctors.....they don't want to underwrite a policy that will lead to more doctors and the consequent reduction in fees which will lower the average doctor's income and save us taxpayers some money. Mel PattersonMel Patterson, May 19, 2008 2:22 PM
Dr. Goldman came very close to expressing the core of rthe problem the way I have always put it. The doctors have a "closed shop' union which would have made Sam Gompers drool. As you said these tests to "protect" the public are simply hoops for outsiders to jump through which are designed to discourage them. The Colleges are more concerned with protecting their members from criticism than protecting the public.
Did you ever hear of a doctor being struck off before he was found guilty of malpractice in the courts?
I am relieved to read that CBC has picked up on this phenomenon. I am a Canadian finshing my medical degree in Australia this year. I have spent a lot of time and effort trying to decide the best way to come back to Canada for residency. I spoke with the people at Health Force Ontario and was essentially told it was probably best for me to complete my specialist training here in Australia and then try to come back. The reasons being that I would have a very small chance of being trained in the specialty I am interested in and in addition I would owe to province of Ontario 5 years in a northern community. The fact that I am a Canadian citizen would be of no benefit to me when applying for residency positions (which have been allocated to IMGs). Canada has a serious shortage of doctors and I can count atleast 30 Canadians in my year of medical school here in Australia. Imagine then there must be over 100 just at my university. I do not know the exact numbers of Canadians studying here but it is a significant number. The Canadian government has not made a single effort to acknowledge this unique population, which I believe could be a part of the solution for the shortage of doctors Canadians face. I know for me the prospects here in Australia are so much brighter and it is unlikely I will return to Canada. Perhaps this is how some would like it?J.A., May 19, 2008 5:23 PM
I, too, am a Canadian in 1st year med in Australia. My year has 60 Canadian students! The majority of us want to come home. Why are we even here? It seems there are hundreds of qualified people who want to be doctors living in Canada right now who cannot get the education. Lets get to the root of the problem here people....increase enrollment. There are some of us who are willing to pay (its not cheap here in Oz Land).
I completely agree that having Canadians educated abroad can be a part of the solution for the doctor shortage. The key thing now is to make sure some of us come home (may be more difficult then you think what with the subtropic climate). If this is not facilitated it will just contribute to the brain drain of our country. Of course, the other part to the solution is to let the skilled worker who have immigrated practice their skill.Med Student, May 21, 2008 6:04 AM
I have a friend who is an excellent opthalmologist. She is Turkish and trained here and in Moscow (which if you don't know is on the cutting edge of eye surgery). She has extensive experience in all aspects of eye surgery but primarily in corneal transplants. With an aging population and the increased incidence of cataracts, her skills are much in demand. and yet the process is so difficult that she will probably give up before she completes the process. Here is a good question: who owns the Canadian medical system, doctors or Canadians. We have a public health care system that is being undermined by the self interest of doctors.
The comments by the Canadians training in Australia are telling. It is time to end the charade. It is time for the government to do its job and regain control of the PUBLIC health care system (I haven't heard it referred to as the doctors' personal health care systerm yet) and start opening up more facilities, more residence programs and seriously dealing with what is an artificially constructed shortage of doctors.
I'm a Canadian citizen who completed my medical degree in Germany. Coming back to B.C. is proving to be incredibly difficult. I even had to write the TOEFL exam (Exam intended for those whose second language is English). Ontario, for example, makes an exception for those IMG's who have had secondary education in english. In B.C, however, if your medical training was not in english, you have to write the TOEFL. I found this completely ridiculous since I was born and raised in Vancouver, having even completed a Bachelor Degree at UBC. This is only one of the many hoops we have to jump through.
I also don't have the option of completing my specialty training in Germany and then returning to Canada. My training would not be recognized and I would have to repeat my residency. At the moment, only specialty training programs from Commonwealth Countries are being recognized. This doesn't seem to have anything to do with the actually medical training being received. It seems very political to me.
For ex.: Canada considers British specialty training acceptable while Britain recognizes all specialists trained in any European Union country. So how is it that as a German specialist, you are considered qualified to work in Britain but not in Canada.
Why is it that Canada considers itself more elite when it comes to accepting foreign trained doctors??
Dear Brian -
This is the most fabulous radio show! Your questions from patients, the answers given by the medical staff - nurses and doctors... offer the public great medical knowledge. Improving the public's patience.
This is such an important show - the public education of the white coat/ black art.
I have not heard all the shows but most and with my tonight's first comments ,I hope this will ensure that this radio show continues - thanks to you and your staff for producing this for all of us!
Merci... Bren-da LeDrew Keyes, Barrie, Ontario.Bren-da LeDrew Keyes, May 23, 2008 8:49 PM
I would happily have a doctor who was trained in a foreign country. Even better if it meant more doctors and appointments that were not rushed and less than four and a half minutes long!Amy, May 23, 2008 9:26 PM
My son is considering attend medical school in Dublin Ireland at the RCSI. How difficult would it be for him to return to Canada to practicePhillip McGarry, May 26, 2008 9:20 AM
I am an International Medical graduate. I obtained my Medical degree from the University of the West Indies and then did the General Practice Residency in England( 3 years) as well as the membership examinations. I had a telephone interview for my first job in England and then worked there for 3 years. I am trying to obtain a licence to practice in Canada but is far more difficult than I ever imagined. I have collegues in Canada that have passed all the Medical Council of Canada examinations with high scores and yet are unable to obtain residencies. I understand that Canada wants to maintain high standards but we are well trained and need to be given a chance to prove our abilities.Gillian, May 26, 2008 12:30 PM
I am a recent graduate from the University of West Indies as well. After seeing many ads from Immigration Canada that there was a shortage of doctors, my husband and I migrated here to, not only further our education by specializing but to improve the quality of health care here in Canada. It took us approximately 1 year to complete 4 Canadian medical board exams which we passed with above average scores. Two of these exams were practical/clinical where we were assessed by Canadian doctors on our abilities to interact with patients, correctly diagnose them and effectively communicate to them using Canadian ethical practices. In order to excel at these exams we did a 6 month course which focused on communication skills, ethical issues here in Canada and the standards that are expected in Canada with regards to patient care. Both of us applied this year for residency but unfortunately were not offered positions.
We thought that once we had successfully completed these exams, we would have a good chance of acquiring a residency position. But apparently, having Canadian health care experience is the key to getting a spot. This is actually quite difficult to acquire because of all the red tape involved.
Now I am looking at the U.S.A where the chances of me getting into a residency are much higher due to the greater number of spots available there.
This is quite unfortunate because we would like to stay in Canada and be able to practice here.
There are success stories of foreign doctors who manage to find work in Canada. I know of a Chinese doctor who, after immigrating in his late twenties, is a very successful family practitioner here right now. The downside however, is that he had to redo his Bachelor's degree, reapply to a Canadian medical school, and consequently wasting many years while undergoing training of the same quality as that he had received in China.
If Canada is to address its critical shortage of doctors, it must learn to respect its high-skill immigrants first.Samuel, May 26, 2008 9:47 PM
Medical system in Canada serves well doctors, less to public. There are some honest doctors but they must follow the practice of other (less honest) colleagues, otherwise they are reprimanded by the College of Physicians who serves more doctors than public. Here are few suggestions how to improve our medical care.
1. Replace doctors’ salary caps by patient’s cap. Such system works very well in private insurances; a patient is advised by a letter about each service being paid to medical professional. This would introduce control of doctors’ charges, now some doctors charge for services not provided; patients would be careful and selective in using their cap (allowance). Some room could be left for special cases, as it is now an application for special treatment could be made to OHIP.
2. Modify the role of the College of Physician; particularly in deciding who is qualified to practice (It would be interesting how many licensed doctors would pass the requirements the foreign doctors are facing now?). Here is a solution. Ministry of Health decides how many more doctors we need now and receives applications from Canada and abroad. The College of Physicians selects the best candidates out of all candidates. The arguments of the College of Physicians that their foreign colleagues are not as good as doctors practicing now; doctors do not want to share the limited taxpayers fund with more doctors. In other professions (like science, engineers) when there are less barriers the new immigrants perform well, very often better than Canadians. Why the doctors from East Europe are classified by the guest of the program, as B candidates? It is known that countries like Poland and Czech Republic are facing serious problem as their doctors tempted by a better pay moved to Britain and other West Europe Countries.
3. Extend public funding to other health professionals like optometrists, ND, chiropractors, if a patient’s cap is used this would not increase medical spending but a patient would have a choice.
4. Authorize other professionals (ND, chiropractors, optometrists, licensed nurses, etc) for writing prescriptions.
5. Introduce a rule that the results of medical tests are given to patient who then give a copy or original to the doctor. In current practice it is very difficult for a patient to get such. I stop asking for the results being afraid of doctor’s negative reaction.
I would like to thank Dr. Brian Goldman for his courageous, useful, interesting and entertaining program.
If you decide to publish my comments; kindly please do not use my real name. ThanksName Witheld, May 27, 2008 7:11 PM
There's one thing missing in the whole debate about doctors shortage and that is any comparison with countries other than the US. What population/doctor ratios are there in other developed countries? Do we really fall short or is our system designed so that doctors' time is not used efficiently? Delegating some tasks to nurse practicioners would seem to be a no-brainer but apparently the system can only reimburse the doctor's time.Frank Hendriksen, June 3, 2008 5:01 PM
I won't argue the significance of foreign trained doctors (both immigrants as well as citizens) to our current crisis in healthcare.
However, I do strongly oppose the notion of Canadian citizens that go to foreign schools wanting to come back. It is not the same story as skilled labour lured from overseas. You people go abroad full-knowingly how hard will it will be to come back. Residencies for IMGs are marginally low (5-6%).
If these doctors are allowed to practice in Canada then it is unfair for those who make more sacrifices in terms of extra years in undergraduate studies, ECs, volunteer just to obtain acceptance in medical schools. How would someone who did 2 undergraduate degrees in order to achieve GPA requirements for Canadian schools can be preferred over those who go abroad because they are not willing to put up with the fierce competition back home.
The doctor shortage is another story. Instead of accepting students left and right who trained abroad, I think it is only reasonable for certain affiliated schools to be accepted in the system; but that would mean higher competition. Which, by the way, is what medicine is all about for the most parts.Aaron P, June 7, 2008 3:42 AM
If we had started to expand the medical school admissions, we would not have the "shortage" today? The government should address this issue now. We have enough talented high school and university graduates. It takes only 4 years to see the results. How many years we have been crying out loud for the shortage?
secondly, why do we have to have the kids to have a bachlor degree before applying to medical school? Britain and all of othe western europian contry don't! Their quality of medical care is as good as ours, if it is not better.Alana Yen, June 9, 2008 3:33 PM
I think Canada should bring new experienced doctors from abroad. They too go to great medical schools and have lot to offer.Especially when there is no doctor eg. in Calgary who would take new patients.I have to go to Medicare for 3 years now and see whomever is available....what a joke.Last year I was listening to the radio and there was a conversation with a woman from Medical Association of Canada.She was saying that a doctor who wanted to come and practice medicine from former Yugoslavia was not experienced enough and after all he was not really needed here because we have no war in Canada. I thought that I will laugh until I passout.
He was the one to have here ..he had a treamendous experience in trauma situations and his application was refusee by this silly woman. What a shame.
YES ,YES Canada should bring as many as needed for rural areas, northern regions where not to many people have an opportunity to see a doctor on a regular bases.
The June issue of "The Walrus" magazine has an indepth article about Doctor Poaching.Ian, June 14, 2008 8:15 PM
EDITOR: Please do not post my name. The pseudonym "Andrea" is fine. Thank you. I work in the syst.
Aaron P.'s posting is an ideal example of one of the problems with Canada's medical training and the subsequent attitudes it often nurtures in its highly competetive environment. That being; the most important thing is to "do the best" as defined by those who are going to admit you to medical school and if that means I MUST do EC or volunteer work to show what a good social citizen I am then so be it. Other programs in this country used different methods for gaining entrance but over the years were coerced into including some more 'competitive' models because instead of embracing the quality of clinicians produced despite the difference they could not understand what they were getting and expected more conventional methods! The competitiveness gets worse as one gets up the "food chain" or 'pyramid' or 'higher on the specialty mountain' and into the tertiary care centers. As this happens the ratio of problem doctors to problem patients is overwhelmingly in favor of the antisocial doctor who is not willing to consider there are actually PEOPLE who are in need of CARE in addition to Treatment by the rounding specialist and his entourage. Some of the staff who work with them would also agree there is way too much of that 'culture of entitlement' at the expense of good, comprehensive, patient care.
I think that foreign trained clinicians would be extremely welcomed in such places.
The concern about culture and practice patterns is also over-'fear'ified. Often the immigrants have been trained in commonwealth countries or those who have had the privledge of using a commonwealth oriented educational model AND the cultural impositions that came with it. I believe therefore "they" are not much different than us. Particularly when they are required to understand the same material we do in the "evidence based" journals to pass their qualifying exams, and that they have often given up things to come to this country
that we would never even consider giving up, such as two bathrooms, to start the list.
Since many of the foreign trained clinicians and other professionals (health care or otherwise), who come to this country were sold the idea of being able to practice their profession by Canada, they should be offered means by which they can actually do that. The statistics ammassed at immigration Canada can then be reported more in context.
I an told by people who have gone through the process that physicians in foreign countries applying to come to Canada as immigrants are specifically advised by Canadian immigration authorities in the embassies or high commissions to which they apply that they are going to experience great difficulties in getting their medical credentials recognised, if at all, and that much if not all of their medical training will not be recognised by Canadian licensing authorities.
I have also been told, again by people who have gone through the process, that immigration to Canada by such physicians is actively discouraged by Canadian immigration officials, again on the now well recognnised difficulties that such physicians will have in obtaining a licence to practice in any Canadian provicne or territory.
This is the reality of medical immigration to Canada. So the question immediately arises, why do such individual chose to immigrate to Canada, and why, when they encounter the reality that their medical training may never be recognised, do they persist in staying in Canada? If practising as a physician is so important to them, why do they do not return to their native country to practice, or leave to go to some other country where they may have a greater chance of having their foreign credentials recognised?
I have no idea as to whether or not there is a 'conspiracy' to keep foreign trained physicians from obtaining the right to practice medicine and related earnings in Canada. But I do believe there is a remarkable willingness of such immigrants to stay in Canada and work in non-medical jobs despite the reality that very few will ever get a licence to practice.
I suspect that the answer to this question has everything to do with the differences in standards of living and benefits of living in Canada compared to many other countries, in particular the non-western ones in what used to be known as the 'third world', not to mention the relatively low income potential of doctors in these countries compared to ordinary jobs in Canada. And where they are free to voice their complaints about how they have been duped by Canadian immigration into coming to Canada.TKW, July 7, 2008 9:21 PM
I too am a Canadian studying in Australia (one of 60 @ the University of Queensland in first year). Thank you for highlighting this issue. Hopefully we can bring it to the attention of our provincial governments, after all they are loaning many of us money to be here (which is not cheap!). I am certain it would be more cost efficient to fund spots in Canada rather than loan students money to study in Australia. It is also my hope that Canadian international medical graduates are given priority over foreign trained physicians.
On a different note, I would like to point out that myself and many of my Canadian colleagues studying here possess a graduate degree (in addition to a bachelor's degree) from Canadian universities. Surprisingly, this is not a quality that Canadian medical schools focus on. I fear that many of us will return to Canada, overqualified with 3 degrees, six-figures of debt and no job.
The dogs bark, the caravan continues the journey.
Twenty years ago, when I came to this country, there was no doctors critical shortage.
I lost three years passing exams, sending CV's and resumes, knocking the doors to all but BC and Alberta medical licensing bodies to no avail.
What a no-sense loss of my years of experience ( 25 years practice in Poland), of my enthusiasm, of my devotion to help people the best way I could.
I made it somehow with Lord's help, and now at the end of my work as a physician still practicing in Canada, all I can tell is : have I known what terrible sacrifices and risk to my life and life of my family I had endured, I would had never tried, even in my imagination, come to this country again.
And this is because after all my family and I would have better living and educational chances in the post-martial law Poland then at the very beginning of my life here.
This was the martial law imposed on our people, which pushed me out of my homeland.
Now I can tell that when you compare my situation in Canada at the very beginning of stay with situation in Poland, which have pushed me out of the country, one could see clearly what terrible price I had to pay in order to become canadian doctor.
I am the one example of how difficult if not impossible was to establish practice in Canada twenty years ago.
This pertains to similar situation now, therefore I dared to quote this old adige about barking dogs and caravan at the beginning of this article.
Dr. Z. P. Sekula
My name is Li Tao and I worked as a Traditional Chinese Medicine doctor and acupuncturist at a goverment hospital in China for sixteen
I major in acupuncture therapy, moxibustion, chiropractic, cupping therapy and Chinese Herbs,to treat musculoskeletal disease like cervical spondylosis,Lumber intervetebral disc herniation,low back pain etc. Migraine,insomnia and some chronic internal diseases.
I would like to work in Cnada and try to find possible position from you.
Could you kindly consider my application ,please?I would be very glad to submit all paper as your needs.
I Jiadeng in China two hospitals professional treatment neck low back pain
Looking forward hearing from you soon.
Name: Li Tao
Date of Birth: June 1,197１
Licensed TCM Physician,
Total Years of Working in Home Country:16 years
Gratuated from Traditional Chinese Medicine of Shandong University.Majoring in acupuncture therapy, moxibustion, chiropractic, cupping therapy and Chinese Herbs.Specializing in treatment of musculoskeletal disease like cervical spondylosis,Lumber intervetebral disc herniation,low back pain etc. Migraine,insomnia and some internal diease.
Tel: 086 13863121797
And my wife is a nurse
Date of Birth: June 21, 1978
Language Spoken：Mandarin and English
Tel: 086-0631 8088947
Sep.1993-Jul.1996: Weihai Health School
Professional Certificate: Nursing Diploma
Professional License: RN of P. R. China RN of K.S.A.(2000-2003)
Professional Qualification: Senior Nurse
TOEFL Score: 520
January 2004-April: 2008:Registered Nurse in Clinic, the First People’s Hospital of Wendeng，Weihai City, Shandong Province
January 2002-January 2004: Registered Nurse in OR, the First People’s Hospital of Wendeng
December 2000-November 2001: Registered Nurse in ER, Al-Hammadi Hospital, Riyadh, K.S.A.
December 1999-November 2000: Registered Nurse in Pediatric and Female Ward, Al-Hammadi Hospital,
September 1996-October 1999: Registered Nurse in Pediatric Ward, the First People’s Hospital of Wendeng wei hai China
Thank you for your email
How can I get in Canada, working invitations and work visas, in Chinese medicine and acupuncture,
I now China Weihai in the National Hospital of Traditional Chinese Medicine Acupuncture
How does no doctor afect me ? i was hit by a car, many years ago, and need an update medical report... orthos pick and choose and avoid victims od accidents, only a very expensive lawyer will have a doctor up his sleeve willing to do paper work...in the mean time the SAAQ,controls them, and i lose at the TAC and i will continue to live in pain on a less than welfare pensionAna Maria, February 13, 2009 12:59 AM