Over 6.5 million Canadians lack access to a family doctor, a concerning statistic that highlights a critical shortage in the nation's healthcare system. Despite this pressing demand, thousands of internationally trained physicians (ITPs) residing in Canada face significant hurdles in practicing medicine. These barriers range from complex licensing requirements to the necessity of passing costly exams and securing limited residency positions.
Faiza Amer, an ITP, epitomizes this challenge. Moving to British Columbia in 2022 with over 15 years of medical experience from Pakistan and the United Arab Emirates, Amer sought to contribute to easing Canada's doctor shortage. However, like many ITPs, she found herself caught in a web of regulatory complexities.
In Canada, ITPs may need to take up to four initial exams to qualify for medical practice. Unfortunately, experience gained from non-medical jobs or even medical assistant roles doesn't count as recent medical experience. This requirement further complicates their integration into the healthcare system.
"I just think it should be more transparent [with] what is it that we need to do." – Ramirez
In 2022, only 671 ITPs successfully landed a residency spot, a stark contrast to the 2,936 Canadian medical school graduates who secured similar positions. Residency is essential for doctors to gain hands-on training in hospitals and clinics, yet the pathway for ITPs remains fraught with obstacles.
All 13 provinces and territories in Canada enforce separate licensing requirements for ITPs. They must demonstrate recent medical practice within a specific timeframe to qualify for a Practice Ready Assessment (PRA). This 12-week clinical assessment evaluates ITPs under the supervision of a licensed physician. The tests for the PRA can be prohibitively expensive, with fees reaching up to $3,255.
Moreover, some provinces mandate that ITPs work in rural or northern communities for up to three years before they are eligible for a full license. This requirement can be daunting for many foreign-trained doctors.
"We don't want any shortcuts, we don't want any gifts, we want to work hard," – Ramirez
The federal government is considering funding 750 spots annually for ITPs. However, despite these efforts, many ITPs find themselves working in non-medical jobs or as medical assistants rather than practicing as doctors. Oghenefego Akpomi is one such example. A former family doctor from Nigeria, Akpomi moved to Canada in 2016 and now works as a clinical assistant in Ontario.
"It is a big challenge because there are lots of things going back home, it's not safe," – Oghenefego Akpomi
"You can't leave the kids here on your own, so it's a challenge." – Oghenefego Akpomi
Ismelda Ramirez represents another story of perseverance. Despite passing her qualifying exams, she continues her search for a residency position where she can receive necessary hands-on training.
"Before coming here, I was so energetic, I was so much more hopeful I can do anything now for me, for my future, for my kids, or to alleviate some pressure [on the] Canadian health system. But right now, I don't see any hope," – Ismelda Ramirez
This situation has been exacerbated by the COVID-19 pandemic, which saw many physicians reducing their hours or leaving the profession altogether due to burnout.
"We saw a lot of burnout during COVID, lots of physicians either decreasing their hours or leaving the profession completely," – Dr. Joss Reimer
"So there's higher demand for physician care and fewer of us being able to provide the care," – Dr. Joss Reimer
As Stephanie Price notes, there is an increasing recognition of the risk posed by the shortage of doctors in Canada. There's a growing emphasis on competence rather than equivalence when evaluating potential candidates.
"There's more of a recognition of the risk of there not being enough physicians and so we're looking for competence, not equivalence. That actually doesn't change the bar, we're still looking for a competent physician, but it broadens the number of people who [can] apply." – Stephanie Price
Nevertheless, many foreign-trained doctors experience socio-professional isolation due to these barriers.
"They are experiencing socio-professional isolation, which takes a toll. It's unfortunate given the demand that exists." – Marie Ange Jeudy
