Oxford-trained doctor shut out of B.C.

A British doctor with a medical degree from Oxford University says he is leaving Canada — frustrated and disillusioned — after red tape kept him from applying for a residency position in B.C.

Paperwork delay means doctor can't help relieve pediatrician shortage

Dr. Ashish Marwaha has been conducting research at the University of British Columbia into childhood diabetes while trying to get a medical residency position in B.C. ((CBC))
A British doctor with a medical degree from Oxford University says he is leaving Canada — frustrated and disillusioned — after red tape kept him from applying for a residency position in B.C. 

"There is no way I would advise any doctor in England to set foot in this country and to try to do what I did," said Dr. Ashish Marwaha.

After months of preparation, Marwaha missed this year's residency application deadlines because his immigration paperwork was delayed in the mail.

"It was actually in the mail — on its way," he said of the proof of his permanent resident status. "And I could not apply for a job without this piece of paper."

Marwaha came to B.C. in August 2008 to do diabetes research at the Child and Family Research Institute in Vancouver. He wanted to stay and work as a pediatrician, a specialty in which there is a shortage in B.C. 

He said he passed all the exams to qualify for a residency — the next step in the training he needs to practise — and he has excellent recommendations from Canadian doctors.

'Valuable commodity'

"I'm a valuable commodity in England," he said, "But I gave myself two years to stay in Canada and try to get through all the bureaucracy and apply for a job. I thought that would be plenty of time, but I was thwarted at the last hurdle."

After living in Canada for a year, as required, Marwaha applied for permanent resident status, which he also needed to qualify for the post-graduate training positions open to foreign-trained doctors.

Because he has a Canadian spouse, his application was approved by Citizenship and Immigration Canada in the spousal category.

The approval took six months, however. And the letter confirming the approval, dated Feb. 25, didn't arrive until April — too late for this year's application deadlines.

"Canada is, hands down, the hardest place in the world … to get a job as a medical resident," Marwaha said.

His permanent resident card also got lost, he said. It was mailed in June but still hasn't arrived.

Immigration Minister Jason Kenney was not available to talk about the delays, but a spokesperson for his department suggested nothing was wrong. "We have looked into the case and are satisfied it was processed within our normal time frames (of six to twelve months)."

Leaving Canada reluctantly

Dr. Ashish Marwaha tells Go Public reporter Kathy Tomlinson that he will warn physician colleagues to steer clear of Canada. ((CBC))
Marwaha said he is heading back to the U.K., reluctantly, for a residency at Oxford but first wanted to speak out about the obstacles he and other foreign-trained doctors face in B.C.

"I've not heard a single positive story of an international medical graduate from another country like England coming to Canada and being successful," he said. 

Among the frustrations: medical school graduates must live in Canada and obtain permanent resident status to apply for positions in B.C. And unlike Marwaha, most can't qualify for status until they have a job, he said. 

"What they are saying to you is, 'You can be a doctor here. Just give up your job in your home country. Come here. Live for a year — with no job — then maybe you can apply.'"

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Those who get over that obstacle face another: most residency positions aren't open to foreign-trained doctors.

In B.C., only 18 positions, or six per cent of all spots, are reserved for them. Canadian graduates get first crack at the rest. Foreign-trained candidates can apply in a second application round, if there are any positions left.

Marwaha thinks the best candidates should get the jobs — no matter where they went to school. This is the way it works in the U.S., he said.

"We cannot directly compete with the students who graduated in Canada — and that just seems absurd to me," he said. "It's discrimination … and being discriminated against is not a nice feeling."

More positions needed: College

Heidi Oetter of the College of Physicians and Surgeons of B.C. says the province needs more residency positions to help meet the demand for new doctors. ((CBC))
The registrar of the College of Physicians and Surgeons of B.C. said Canadian-trained doctors get priority for residency spots because they've invested in their education here.

Dr. Heidi Oetter also acknowledged there are few, if any, positions left over for foreign-trained doctors beyond the 18 set aside for them.

"Governments can only afford to fund so many positions," she said. "And generally the number of positions in Canada roughly matches the number of people who graduate from medical school."

She estimated B.C. needs 10 to 20 more residency places to help meet the need for 300 new doctors a year. Each position costs the province hundreds of thousands of dollars a year, she said.

Oetter defended the requirement that applicants prove they have lived in the province at least 12 months. "This helps to ensure that successful candidates are committed to staying and practising in British Columbia once they've completed the program."

'People are going to have to die'

Marwaha predicts the strained health-care system will worsen if much more isn't done to fill the shortages within certain specialties.

"The system will have to come to a breaking point," he said. "And you know what? People are going to have to die because of lapses in the systems."

When public health care in the U.K. reached a crisis point, the government made radical changes, said Marwaha, who doubts he'll return to B.C. after his residency at Oxford.

"What Canada needs to do is learn from the rest of the world."