Nova Scotia

Loss of foreign doctor program cut at least 40 physicians from N.S. workforce

Doctors Nova Scotia says the loss of a foreign doctor assessment program in the province created a significant gap in the number of working physicians, especially in rural communities.

Assessments of foreign-trained doctors to return at Dalhousie University under new national guidelines

The previous assessment program for foreign-trained doctors helped fill 40 to 45 vacancies, says Doctors Nova Scotia. (Carsten Koall/Getty Images)

Doctors Nova Scotia says it's relieved that a new program to assess the skills of foreign-trained physicians could start up in a matter of months.

The organization says when the previous assessment program was scrapped two years ago, it created a significant gap in the number of working physicians, especially in rural communities.

The program filled 40 to 45 vacancies while it was operating, said Kevin Chapman, director of partnerships and finance at Doctors Nova Scotia.

The Clinical Assessment for Practice Program (CAPP) was cancelled by the College of Physicians and Surgeons of Nova Scotia in 2015. CAPP allowed international medical graduates to practise in underserviced areas under supervision using a provisional licence.

"The absence of the CAPP program has been a significant issue, particularly in Springhill, Yarmouth," said Chapman.

About 100 doctors participated in the program during its 10-year lifespan.

Expensive program with low retention

Dr. Gus Grant, registrar and CEO of the College of Physicians and Surgeons of Nova Scotia, said the program was expensive, used a significant amount of resources and had a low retention rate. The college opted to cut it while a national program with consistent standards was being developed.

Dr. Gus Grant with the College of Physicians and Surgeons says despite public pressure to make swift changes, it's essential that public safety is protected. (Dave Laughlin/CBC)

"We're not deaf to the needs of the underserviced regions," he said. "This is a highly emotional issue. But … we have to service the public's confidence in the profession."

Chapman agrees that the retention rate was low, but said the program did fulfil a need.

"It's not a solution, but it's another tool in the box that we have to take advantage of," he said.

'Perfect storm'

Chapman said Nova Scotia is experiencing the "perfect storm" of physician shortages due to retirements, tax issues, physician burnout and the loss of CAPP.

Doctors Nova Scotia, citing Statistics Canada research, estimates 100,000 Nova Scotians do not have a family doctor.

Despite public outcry over the doctor shortage, Grant said the college must ensure public safety. He points out there are hundreds of thousands of medical schools around the world, each with different standards.

"One thing's for sure: there's very low mistake tolerance. We can't license the wrong physicians. That's a terrible risk to the public."

New program almost ready

The province announced money to start the new model of practice-ready assessments in the last budget. The program will be led by Dalhousie University, which is expecting a report by January that will determine how it's rolled out.

Then, it will be up to the provincial government to give the program the go-ahead. The Health Department said it expects to launch it as soon as possible.

CAPP did see some challenges with qualifications. In one case, a physician who was placed in Sydney, N.S., had his licence revoked because he falsified some of his credentials on his resume.

Kevin Chapman with Doctors Nova Scotia says re-establishing foreign-trained doctor assessments will help ease the physician shortage. (Dave Laughlin/CBC)

While he exaggerated, there were two cases where physicians were punished for downplaying their credentials — one in Parrsboro and one in Glace Bay.

The doctor in Glace Bay was an emergency medical specialist who left that off his resume because he was so desperate to work in Canada. The doctor in Parrsboro was disciplined for not saying he was a pediatrician. Both reapplied after their suspensions and were able to work again.

No assessments for specialists

Specialists will continue to be left out under the new model. The province is opening the program to 10 family physicians in the first year. 

Grant said in the past, specialist assessments were problematic, as few doctors were successful in gaining credentials and of those who were, fewer than 20 per cent stayed in Nova Scotia.

"So you're asking for a large, complex expensive process to identify physicians who in all likelihood, or at least past experience, won't stay here."

Grant points out that there are 72 different medical specialties, so assessing foreign-trained physicians in every field would be unrealistic. But testing those in fields with the greatest need, such as psychiatry, could be an option, Grant said.

Still, Doctors Nova Scotia would like to see specialist assessments back on the radar.

"There is a big gap in that right now, for sure — one we as a health system need to address and come to grips pretty quickly," Chapman said.

As of Nov. 1, the Nova Scotia Health Authority's job board listed postings for 72 full-time family physicians and 36 full-time specialists. Those vacancies do not include part-time positions and locums.


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