Canadian doctors trained abroad face barriers getting back to work

Despite shortage of family doctors, regulator has no plans to relax requirements

A Canadian doctor trying to practice medicine in Victoria is sounding the alarm over what he says is a difficult and excessive process for international medical graduates seeking licensure in British Columbia

Madhur Kuckreja, an internal medicine physician who has practiced in Boston for three years, trained at St. George’s University, an international medical school in the Caribbean, before doing a residency at Georgetown in Washington, D.C.

Kuckreja, who grew up in Victoria and completed her undergraduate degree at the University of Victoria, wanted to be closer to her family and the West Coast.

Hearing about the shortage of doctors in Canada, he hoped to return and practice family medicine in his hometown.

“The doctor shortage is a big reason for that,” he said during a work break in Boston.

“My parents’ primary care doctor is about to retire in a year, my dad has heart problems [and] they won’t be able to find a doctor. So it’s really scary there.

But his application for a BC medical license was denied and he was told he needed another full year of training and passing scores on several exams, including the 1 $375 from the Medical Council of Canada.

“I think we are exhausted. We go to undergraduate, we go to medical school, we go to scholarship and then we are asked to do more training? It’s really frustrating,” he said.

“We also want to live our lives and start families and things like that.”

British Columbia rules state that additional training is required because Kuckreja was trained in internal medicine, which requires residency for three years in the United States and four years in Canada.

But Kuckreja had left medical school and was working as an outpatient primary care internist for three years when he applied.

“It’s frustrating because I see 20 to 25 patients a day,” he said. “I am their attending physician. I feel like I’m good at what I do and I could help fix the BC situation.

“I wish they would make this all a little easier, at least for US-trained doctors,” he said. “We’re not that far from Canadian-trained doctors and I feel like we could help.

Canada is home to 17 medical schools, and only one – the University of British Columbia – is in British Columbia

The schools host first-year cohorts as small as 64 at the Northern Ontario School of Medicine and as large as 288 at UBC.

Approximately 1,900 first-year medical students are admitted to Canada each year, and most residency positions are reserved for Canadian-educated students.

UBC reserves 58 residency training positions for international medical graduates, including 52 specifically for family medicine.

This is a significant increase from 2003, when UBC offered six annual admission positions to international medical graduates.

“A lot of us are passionate about being a doctor, but the training opportunities aren’t there,” Kuckreja said.

“Even if they don’t create more medical schools, they could create more residency places, so that more people can train in the Canadian system.

Each province has its own licensing process for international medical graduates.

In British Columbia, the College of Physicians and Surgeons of British Columbia regulates licensing and requires the Practice Ready Assessment BC program for international medical graduates who have not been trained in jurisdictions accepted by the college.

Before they can begin the assessment program, physicians must complete a preliminary assessment, obtain an eligibility decision, and complete Part 1 of the Medical Council of Canada Qualifying Examination. If a candidate is selected, they must obtain sponsorship through UBC medical school or a provincial health authority to be registered and licensed.

Eligibility for the assessment program is determined by medical degree, English proficiency, and citizenship or permanent residency. But meeting these criteria does not guarantee selection, according to the college of doctors. And in Kuckreja’s case, comes with an additional requirement: another year of school.

Since 2015, 175 international medical graduates have completed the Practice Ready Assessment Program, an average of 25 per year.

In an email, the college of doctors said there were no plans to change the registration process.

“The college’s role in health human resources is to ensure that all who apply to practice medicine in British Columbia meet the necessary requirements and have the appropriate qualifications, regardless of where they obtained their medical degree,” the statement read. “The college maintains strict standards and requirements for registration and licensure so that patients in British Columbia can receive the best possible care from their doctor or surgeon.”

In 2019, the College of Physicians drafted regulations for an associate physician license, which allows practitioners with some medical training to work under supervision in positions such as a surgical assistant. The new registration class does not allow physicians to work independently, but opens the door for them to work as physicians on medical teams.

The settlement has yet to be approved, and the college of physicians was unavailable for questions about the schedule.

Sultana, who asked to keep her identity anonymous to avoid repercussions on her current job, was an obstetrician practicing in Bangladesh before moving to Canada where she hoped to gain a residency position and continue practicing medicine.

She attended Jahural Islam Medical College in Dhaka, and when she arrived in British Columbia, she began applying for Canadian residency programs. Many programs give priority to provincial nominees. Since then, it has focused solely on UBC applications, requiring applicants to complete a series of standardized assessments.

Despite 10 years of effort, Sultana has never gone beyond the maintenance stage.

She now works as a licensed practical nurse – a tactical career move that allows her to meet the bylaws of the college of physicians, which determine that a registrant must have practiced in a clinic for at least 960 hours – at least 24 weeks full-time – in the past three years to be considered eligible for licensure, and Sultana would need a provisional license if accepted into UBC’s residency program.

She said the requirement is particularly taxing for immigrant doctors, many of whom arrive with their families. And the exams cost thousands of dollars.

“You only have three years to come to Canada, take the exams, get the reference letters, do the assessment, have an interview and get a licence. Then you apply for a residency match,” she said. “But we have to feed our children. You must survive. You have to pay your bills.

She notes that in the context of a shortage of doctors, more international medical graduates in residency could make a big difference.

“If you say our certificate is not comparable to the Canadian system, then OK, train us,” she said. “Let us go into residence, then we will train and live up to your expectations. We’re not saying, ‘just give me the license.’

“It’s frustrating because you’re not able to do what you’ve always wanted to do and what you’ve been doing for many years,” she said. “It’s definitely very frustrating and depressing.”

Jessica, who asked to use a pseudonym to avoid professional repercussions if she applies for another US visa, studied internal medicine at Georgetown University, like Kuckreja. She still works there today, where she practices and teaches resident doctors.

Originally from Alberta and hoping to return to the North, she must also face a one-year scholarship and several exams in order to obtain a license in Western Canada. For a working doctor, it’s an expensive and time-consuming step back from a busy career, she said.

“My work experience is not considered in Canada. They only look at my training. And despite the fact that I worked here for three years in an independent firm, for them my training is still not equivalent,” she says. “I don’t understand how my training can’t be considered equivalent when I’m teaching medicine to people at an Ivy League school.”

Among her students and colleagues, Jessica said she knows several doctors who want to come back to Canada and help ease the doctor shortage.

“Many of us are Canadian, educated in the United States and want to return home. But the process is so tedious…and difficult that it is difficult,” she said. “I think the process has been flawed from the start, honestly — from applying to medical school, to residency, to going home after residency — I think there’s room for improvement in each step of the process. And until every part of the process is addressed, unfortunately I don’t see the doctor shortage improving.

Jessica said while it’s not her first choice, she could return to practice in Ontario, which she says has looser rules for international medical graduates and considers clinical experience over training.

“I think Ontario is making progress and they’ve made changes,” she said. “If we can go back and Ontario will be the easiest way to go, then that’s the way we’ll go.

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