Submission to the House of Commons Standing Committee on Health by the Society for Canadians Studying Medicine Abroad October 24, 2022 In the aftermath of Covid-19, Canada is experiencing a health care crisis. 1 COVID-19 has exposed previously existing cracks in our health care foundation 2 including inadequate planning for future physician needs 3 ; […]
BC Licensing in Associate Physician and USA Certified Class—Some questions answered. Eligibility Requirements See HPA-Bylaws.pdf (cpsbc.ca) for the College eligibility requirements for registration at s. 2-25- Associate Physician Acute Care s. 2-26 Associate Physician Community Primary Care s. 2-27 USA Certified We sought clarifications. The College has advised us: a. that someone registered in this […]
NEWS RELEASE SOCIETY FOR CANADIANS STUDYING MEDICINE ABROAD (SOCASMA) (Le français suit.) The Society for Canadians Studying Medicine Abroad is applauding the recent announcements* made by the Government of Ontario and the College of Physicians and Surgeons of Ontario (CPSO) with regards to the funding of additional medical residency positions and the removal of barriers […]
MedsHousing.com, a partner of the Canadian Federation of Medical Students is a global platform founded by a team of medical community members seeking to alleviate the stress of searching for housing during medical training. The service is free for medical learners and caters exclusively to the medical community. It is an important resource dedicated to […]
Ontarians desperately need doctors. NDP Leader Andrea Horwath recently promised 300 new physicians for Northern Ontario and the Liberals promised to hire more healthcare workers. Given how long it takes to train a physician, how can we get full fledged physicians that are ready to deliver medical care now and within the next couple of […]
Les Ontariens ont désespérément besoin de médecins. La chef du NPD, Andrea Horwath, a récemment promis 300 nouveaux médecins pour le Nord de l’Ontario et les Libéraux ont promis d’embaucher plus de travailleurs de la santé. Étant donné le temps qu’il faut pour former un médecin, comment pouvons-nous avoir des médecins qui sont prêts à […]
Each year, between 50 to 100 family medicine residency positions are unfilled in Quebec. Currently, nearly 1,000,000 Quebecers do not have a family doctor. If each of these doctors would take on average 1000 patients, that means that 50,000 to 100,000 Quebecers will have access to a family doctor. The Society for Canadians Studying Medicine […]
À chaque année, entre 50 à 100 places de résidence en médecine familiale ne sont pas comblés au Québec. Présentement, près de 1 000 000 de québécois n’ont pas de médecin de famille. Si chacun de ces médecin prenait en moyenne 1000 patients, ça veut dire que 50 000 à 100 000 additionels québécois auraient […]
Aux : Ministres de la Santé, Doyens des facultés de médecine, Collège royal des médecins et chirurgiens du Canada, Médecins-chefs fédéraux et provinciaux, l’Association des facultés de médecine du Canada Cc : principaux médias canadiens à travers le Canada Sujet : Diplômés internationaux en médecine au Canada : Il est temps d’innover et d’utiliser au […]
To : Ministers of Health, Deans of Medical Schools, Royal College of Physicians and Surgeons of Canada, Federal and Provincial Chief Medical Officers, Association of Faculties of Medicine of Canada RE: International Medical Graduates in Canada : It’s time to innovate and make optimal use of this qualified but under-utilized resource! With COVID-19 still wreaking […]
Submission to the House of Commons Standing Committee on Health
by the Society for Canadians Studying Medicine Abroad
October 24, 2022
In the aftermath of Covid-19, Canada is experiencing a health care crisis. 1 COVID-19 has exposed
previously existing cracks in our health care foundation 2 including inadequate planning for future
physician needs 3 ; sustainability issues with our current models of family practice 4 and primary care;
overburdened long term care systems 5 ; and recruitment and retention issues in our nursing sector 6 . The
crisis is evidenced by 6 million Canadians being without a primary care doctor 7 , and by closures of
emergency 8 , ICU 9 , and other departments across Canada. The Canadian Medical Association reports over
4,000 excess deaths not related to COVID-19 in 2021 were due to delayed procedures and increased
wait times 10 . This statistic may be just the tip of the iceberg. The President of the Canadian Medical
Association is "concerned about collapse" and "in some places collapse has already happened." 11
To its credit, the federal government has been making efforts through its immigration policies to
address the shortages of health care workers that are a significant part of this crisis. Canada recently
pledged 1.5 million dollars to remove barriers for immigrants who want to work in healthcare. 12 In 2021,
Canada established a permanent residence pathway for health care workers 13 . Canada's immigration
targets also focus on recruiting skilled healthcare workers and removing barriers to permanent
residence for physicians. 14
Despite this federal investment in attracting immigrant physicians and other health care workers,
internationally educated physicians have been sidelined during much of the Covid-19 pandemic by
provincial regulatory authorities’ Canadian experience barriers. 15 Their skills and expertise have been lost
to Canadians.
MacFarlane, 16 in a recent peer reviewed paper, describes these barriers as they relate to internationally
trained physicians accessing residency training jobs through CaRMS which are a pre-requisite to
licensure. Due to a streaming process that likely violates federal and provincial human rights codes and
Charter rights regarding equality, liberty, and mobility, internationally educated physicians, who are
required to be Canadian citizens or permanent residents to participate in CaRMS, are prohibited from
competing for 90% of residency spaces for which they have proven themselves qualified. In 2020, over
1400 international medical graduates (IMGs) who had demonstrated competence to at least the level
expected of a graduate of a Canadian medical school (CMGs) were unmatched because of this
marginalization. Further, a 97.7% match rate for CMGs vs a 22.6% match rate for IMGs is a significant
and substantial discrepancy and represents clear evidence of marginalization and discrimination of
IMGs.
If Canada is to be successful in addressing the current health crisis and addressing the impact and
aftermath of COVID-19, it is critical we use all the human resources at our disposal. Canada cannot
continue to waste the medical skills, talents, and health care human resources we have recruited at
considerable expense. Organizations such as the Canadian Medical Association, the Canadian Nurses
Association, the College of Family Physicians of Canada and the Ontario Medical Association have
recognized the critical role internationally trained physicians have to play in addressing the current
health care crisis and have advocated for improved access to the profession for IMGs. 17, 18
It is important that the federal government take a leadership role with the provinces in addressing and
removing barriers faced by internationally educated physicians and health professions in accessing the
medical profession. To this end, the Society for Canadians Studying Medicine Abroad recommends the
following:
1) The federal government should immediately open dialogue with their provincial health counterparts
with the aim of addressing and removing barriers to practice faced by internationally trained healthcare
providers.
2) The federal government should immediately open dialogue with other stakeholders with the aim of
identifying and removing barriers to practice faced by internationally trained health care providers. Such
stakeholders should include the Canadian Medical Association, various provincial medical associations,
and IMG stakeholders such as the Society for Canadians Studying Medicine Abroad, Canadian on Paper
Society for Immigrants for Physician Equality, and International Trained Physicians of Ontario.
3) The federal government should consider tying funding for COVID-19 recovery and efforts to address
healthcare shortages contributing to the current crisis to provincial commitments and progress in
removing barriers faced by internationally trained health care providers.
4) Removal of barriers should include:
a. Opening all residency positions to competition by all Canadian citizens and permanent residents
who have graduated from Canadian medical schools or passed the Medical Council of Canada
exams which establish that they have the critical medical knowledge, decision-making ability
and clinical skills expected of a graduate of a Canadian medical school and as such are qualified
to work as resident physicians. A system designed to select for the best candidate as
determined by selection committees comprised of practicing, not academic physicians, will have
the added benefit of adding efficiency, reducing costs, and improving quality of care.
b. Increasing the number of residency positions.
c. Implementing Practice Ready Assessments (PRA) in all provinces for graduates of international
medical schools, including specialists, as an alternative to residency training.
d. Ending the requirement that graduates of international medical schools sign a return of service
contract as a condition of working as resident physicians. If it is considered necessary to have a
commitment for physicians to work in a particular location, such positions should be open to all
candidates. This burden should not be imposed on IMGs alone.
e. Removing exclusive responsibility and unfettered discretion for the system of selection of
residents from Faculties of Medicine and putting in place oversight to overcome the bias
embedded in the system.
f. Implementing and/or increasing existing oversight and accountability including enforcement
powers (by institutions such as provincial Colleges of Physicians and Surgeons and Fairness
Commissioners) of all aspects of the entry to the medical profession to ensure admission to the
profession is: (i) fair and free of discrimination, i.e., inclusive and consistent with the principles
of a free and democratic society; (ii) impartial; (iii) objective; (iv) flexible and (v) transparent.
g. Requiring representation of graduates of international medicals schools on all committees and
other forums which make decisions which affect graduates of international medical schools’
access to the medical profession.
Thank you for accepting and considering this submission. Should you desire further information
regarding these issues and recommendations, we would be pleased to respond to questions or to
appear in person before the Committee.
1. Canada’s health care crisis: What we need now | CMA
2. COVID-19 exposing cracks in our universal healthcare – Healthy Debate
3. Canada's doctor shortage will only worsen in the coming decade | Fraser Institute
4. Open letter from the CFPC to our Members | The College of Family Physicians of Canada
5. Long-term care reform in Canada will require a massive, multi-year effort (irpp.org)
6. Canada headed for nursing shortage ‘beyond anything we’ve ever experienced’: experts |Globalnews.ca
7. Family doctors scarce across Canada amid health-care crisis: report | CTV News
8. Emergency Rooms Across Canada Close Amid Nursing Shortage – The New York Times(nytimes.com)
9. 'Significant staff shortage' forces ICU closure at Bowmanville Hospital | CBC News
10. Excess deaths, increased mental health disorders and substance use: new CMA report highlightspandemic’s broader impact | CMA
11. 'This is a crisis': Head of medical association warns that the health-care system faces 'collapse' |CBC News
12. Canada to support internationally educated health professionals | Canada Immigration News(cicnews.com)
13. New pathway to permanent residency for over 90,000 essential temporary workers andinternational graduates – Canada.ca
14. Canada removing barriers to permanent residence for physicians | Canada Immigration News(cicnews.com)
15. Despite health-care ‘crisis,’ internationally-trained doctors, nurses face barriers to work -National | Globalnews.ca
16. View of When a Canadian is not a Canadian: marginalization of IMGs in the CaRMS match(ucalgary.ca)
17. Physicians, nurses offer solutions to immediately address health human resource crisis | CMA
18. OMA proposes three immediate solutions for Ontario’s health-care system
Submitted by:
Rosemary Pawliuk
President, Society for Canadians Studying Medicine Abroad
22879 29B Avenue
Langley, BC
V2Z 3B1
604-541-4747
www.socasma.com
socasma@outlook.com
BC Licensing in Associate Physician and USA Certified Class—Some questions answered.
Eligibility Requirements
See HPA-Bylaws.pdf (cpsbc.ca) for the College eligibility requirements for registration at
s. 2-25- Associate Physician Acute Care
s. 2-26 Associate Physician Community Primary Care
s. 2-27 USA Certified
We sought clarifications. The College has advised us:
a. that someone registered in this class has the same scope of practice as a RCPSC certified physician but cannot hold themselves out to be RCPSC certified.
b. That physicians licensed in this class must bill under the Family Medicine fee schedule, not the specialist fee schedule.
Our additional questions were directed to CPSBC’s lawyer who responded as follows. Response are in italic:
Bylaws 2-25 and 2-26 Associate Physicians
Bylaws 2-25 (Associate Physician – acute care) and 2-26 (Associate Physician- community primary care)
At this time, we do not have any further information related to section 2-26. As our website states:
“The Ministry of Health is working with the College and health system partners to develop a structure that enables associate physicians to work in community primary care settings. As this is a new classification, considerable planning is required to ensure appropriate and safe integration of associate physicians into community primary care settings. This includes establishing an employment and compensation model as well as a regulatory framework with supporting policies on clinical supervision. It is vital that policies and processes are in place to protect both the health and safety of patients, and ensure associate physicians are supported in their work to deliver quality medical care to British Columbians.
Interested applicants are encouraged to engage with Health Match (HMBC), the free health professional recruitment service funded by the Government of BC. HMBC supports physicians in navigating the pathway to practise medicine in the province. HMBC also guides physicians through the licensing and registration process and matches physicians’ skills and interests to opportunities throughout BC.
Questions:
1. Could you please send me a precedent sponsorship letter that would be satisfactory to the CPSBC? We will send a template under separate cover.
2. The bylaw provides that the letter must identify the applicant’s sponsor. Is it correct that the physicians seeking to hire, train, and supervise the prospective associate physician should contact the regional Health Authority for sponsorship and approval? This has not yet been determined as 2-26 is still under development with the Ministry.
3. Can you confirm that “sponsorship” is being used in the broad sense where the Health Authority is not paying for the associate physician but sponsoring in the sense of registering and approving the supervising physician and prospective applicant? See template letter.
4. Are there other requirements of sponsorship by the Health Authority? If there are, please specify what they are. It is an employment relationship. See template letter.
5. Does the CPSBC have a list of contact people at each Regional Health Authority for the supervising physicians to contact or do they just contact their local Health office? The College does not have a list of contact people.
6. Out of curiosity, why does the CPSBC require a Health Authority sponsor instead of just a qualified licensed physician sponsor? We are unable to respond as 2-26 is still under development with the Ministry.
Bylaw 2-27 USA Certified
Questions
7. Are we correct that CSAs can now come home and be licensed under 2-27 while they are going through the lengthy certification process, even if they have more than three years of ACGME accredited postgraduate training? Yes. Generally, the College is seeing applications from physicians who have the three years of training.
8. Are we correct that once these physicians licensed under 2-27 have worked their way through the RCPSC certification process, they can apply for full licensure and upon licensure in the full specialty class will no longer be restricted to the family practice fee billing schedule which the CPSBC advises 2-27 registrants are restricted to? Correct – if found to be eligible for the full or provisional – specialty class.
9. As evidenced by the Health Match BC vacancy list, there is substantial need for specialists in other fields. Where there is a difference in length of training, does the CPSBC anticipate expanding this classification beyond pediatrics, internal medicine, and emergency? No.
10. If so, when? See answer above.
11. Of particular interest are psychiatry, anesthesiology, and obstetrics and gynecology where the PGT training is one year shorter. Are these specialties under consideration for a class similar to 2-27? No
Billing
Many of the items in the fee schedule are the same regardless of whether they are billed under the Family Medicine Fee schedule or whether billed under the fee schedule for the specialist. We sought clarification from Health Insurance BC about billing. We were advised:
“Restrictions on certain Specialist fee codes
While fee items within the Payment Schedule may only appear under certain sections (such as under Family Medicine, or Pediatrics, etc.) that does not necessarily mean that the fee items are restricted to those practitioners that are registered with the CPSBC (and thus with MSP) as that particular specialty.
Most procedures listed within the Payment Schedule are not restricted by specialty, regardless of which section the fee may be listed in. The primary exception to this is diagnostic procedures, which are more likely to be restricted to the section specialty in which they are listed. As an example, Electrocardiogram and interpretation codes 00527 (for office) and 00528 (for home) are restricted to Pediatrics. So there will be services that a pediatrician can bill for, that a Family Medicine specialist cannot.
In addition, the specialist consultation and visit codes that appear within a particular section of the Payment Schedule will be restricted to practitioners of that specialty. So 00510 (Pediatric consultation), or 50507 (Pediatric telehealth subsequent office visit) would be restricted to a practitioner that is registered with MSP as a Pediatrician. The same logic applies to all other sections with the exception of Family Medicine. Fee codes such as 00110, or 00100 are billable by any specialist.
Exemption of specialty restrictions
There may be circumstances where a practitioner wishes to bill for specialty restricted fees. To be able to do so, the practitioner would first need to obtain the approval of the section of medicine that is responsible for the fee item in question. To start this process, the practitioner needs to contact the responsible section through the Doctors of BC. They will be able to provide further guidance on how to apply for an exemption to a specialty restriction.
Rate difference between conceptually similar Specialty fee codes
There will be circumstances where the rate of compensation between different specialties for the same conceptual service differs (ex: 12100 GP office visit age 0-1 @ $34.90 vs 00507 Pediatric subsequent office visit @ $91.04 vs 00307 General Internal Medicine subsequent office visit @ $53.73). The rate at which a fee item is set is done external to MSP and would be handled by the Medical Services Commission at the recommendation of the Doctors of BC and/or the Government of British Columbia. Section C. 2. “Setting and Modification of Fees” (page 1-8) in the MSC Payment Schedule has more information about this.
Ministry of Health – Medical Services Commission Payment Schedule – 01 May 2022.pdf
Associate Physician Classification Payment Schedule and Billing
MSP does not have any information at this time as to whether or not any fee codes, or a broader Payment Schedule, is being developed for associate physicians. Such development would be handled by the Medical Service Commission with the Doctors of BC and the Government of British Columbia.
So long as the associate physician is registered with MSP, they would submit claims for services to MSP using eligible fee codes. This may be done through the Teleplan system, or if eligible, via form HLTH 1915 (details of which may be found here: HLTH 1915 Pay Practitioner Claim (gov.bc.ca))
I hope this has provided the information you were looking for. If there are other questions, please do not hesitate to contact us.
MSP Billing Support can be reached at:
Phone 1-866-456-6950 press option 1, then option 1 again
Fax 250-405-3593
Doctors of BC can be reached at:
Phone 1-800-665-2262
https://www.doctorsofbc.ca/
Billing Support
Health Insurance BC”
NEWS RELEASE
SOCIETY FOR CANADIANS STUDYING
MEDICINE ABROAD (SOCASMA)
(Le français suit.)
The Society for Canadians Studying Medicine Abroad is applauding the recent announcements* made by the Government of Ontario and the College of Physicians and Surgeons of Ontario (CPSO) with regards to the funding of additional medical residency positions and the removal of barriers for internationally educated physicians.
“These are first, but important steps aimed at improving the provision of medical care for all Ontarians. We applaud Ontario’s leadership and urge other provinces to follow suit and consider going even further in providing Canadians the health care they deserve. Our health care system will recover when an adequately sized workforce is qualified and treated equitably, whether trained in Canada or abroad” says Rosemary Pawliuk, Executive Director, SOCASMA.
To build upon the partial progress made as a result of these recent announcements, SOCASMA urges the Government of Ontario, as well as other provincial and territorial governments to also:
Establish a residency recruitment system that permits all Canadians and permanent residents to compete equally for all residency positions on the same level playing field and that is free from systemic discrimination, whether they are graduates of Canadian Medical Programs or Internationally Recognized Medical Programs.
Support the development Practice Ready Assessment for physicians trained in non-approved jurisdictions.
For the College of Family Physicians of Canada to expand the list of approved jurisdictions. For example, to better serve the needs of the francophone community of Ontario, and in line with the French Language Act of Ontario, for the CPSO to consider adding France, Belgium and Switzerland as part of those countries that will be able to obtain Registration from the College of Physicians and Surgeons of Ontario without supervision, assessments and further examination. (U.S., U.K., Ireland and Australia are newly eligible.)
For all provinces to implement transition programs and alternate medical profession pathways for unmatched medical graduates.
Rosemary Pawliuk
Executive Director
SOCASMA
E-mail: socasma@outlook.com
Tel: 604-541-4747
Alternate contact and francophone media:
Carole Lafrenière
E-mail: socasma.working@gmail.com
Tel: (613) 807-0776
* Reference:
CPSO Removes Barriers for Internationally Educated Physicians https://www.cpso.on.ca/News/News-Articles/CPSO-Removes-Barriers-for-Internationally-Educated
Province Helping More Ontario Students Become Doctors at Home in Ontario
https://news.ontario.ca/en/release/1002882/province-helping-more-ontario-students-become-doctors-at-home-in-ontario
——————————————————————————————————————
COMMUNIQUÉ DE PRESSE
SOCIÉTÉ POUR LES CANADIENS QUI ÉTUDIENT
LA MÉDECINE À L’ÉTRANGER (SOCASMA)
La Société pour les Canadiens étudiant en médecine à l’étranger applaudit les récentes annonces* faites par le gouvernement de l’Ontario et l’Ordre des médecins et chirurgiens de l’Ontario (OMCO) concernant le financement de postes de résidence en médecine supplémentaires et la suppression des obstacles pour les médecins formés à l’étranger .
« Il s’agit de premières étapes, mais importantes, visant à améliorer la prestation de soins médicaux à tous les Ontariens. Nous applaudissons le leadership de l’Ontario et exhortons les autres provinces à emboîter le pas et à envisager d’aller encore plus loin pour fournir aux Canadiens les soins de santé qu’ils méritent. Notre système de santé se rétablira lorsqu’une main-d’œuvre de taille adéquate sera qualifiée et traitée équitablement, qu’elle soit formée au Canada ou à l’étranger », a déclaré Rosemary Pawliuk, directrice générale, SOCASMA.
Pour tirer parti des progrès partiels réalisés à la suite de ces récentes annonces, la SOCASMA exhorte le gouvernement de l’Ontario, ainsi que les autres gouvernements provinciaux et territoriaux à également :
– Établir un système de recrutement en résidence qui permet à tous les Canadiens et résidents permanents de concourir de manière égale pour tous les postes de résidence sur un pied d’égalité et qui est exempt de discrimination systémique, qu’ils soient diplômés de programmes médicaux canadiens ou de programmes médicaux reconnus à l’échelle internationale.
– Appuyer le développement d’évaluation de la préparation à la pratique pour les médecins qui ont été formés dans des juridictions non approuvées.
– Pour que le Collège des médecins de famille du Canada élargisse la liste des juridictions approuvées. Par exemple, pour mieux répondre aux besoins de la communauté francophone de l’Ontario, et conformément à la Loi sur les services en français de l’Ontario, que l’OMCO envisage d’ajouter la France, la Belgique et la Suisse parmi les pays qui pourront obtenir l’inscription auprès de l’Ordre des médecins et chirurgiens de l’Ontario sans supervision, évaluation et examen supplémentaire. (Les États-Unis, le Royaume-Uni, l’Irlande et l’Australie sont nouvellement éligibles.)
Que toutes les provinces mettent en œuvre des programmes de transition et des cheminements alternatifs vers la profession médicale pour les diplômés en médecine non jumelés.
Rosemary Pawliuk
Directeur exécutif
SOCASMA
Courriel : socasma@outlook.com
Tél : 604-541-4747
Contact alternatif et médias francophones :
Carole Lafrenière
Courriel : socasma.working@gmail.com
Tél : (613) 807-0776
* Référence:
CPSO Removes Barriers for Internationally Educated Physicians
https://www.cpso.on.ca/News/News-Articles/CPSO-Removes-Barriers-for-Internationally-Educated
La province aide un plus grand nombre de ses élèves à accéder à la médecine en Ontario
https://news.ontario.ca/fr/release/1002882/la-province-aide-un-plus-grand-nombre-de-ses-eleves-a-acceder-a-la-medecine-en-ontario
MedsHousing.com, a partner of the Canadian Federation of Medical Students is a global platform founded by a team of medical community members seeking to alleviate the stress of searching for housing during medical training. The service is free for medical learners and caters exclusively to the medical community. It is an important resource dedicated to helping the medical trainees find reliable housing across Canada and abroad during their undergraduate and postgraduate training.
MedsHousing.com is a website dedicated to posting short and long-term housing that is:
● Offered exclusively to the medical community
● Suitable for international placements, such as clinical rotations and electives
● Close to hospitals, clinics, medical school & satellite campuses
● Furnished and unfurnished
● Ideal for rural placements
Web site: https://www.medshousing.com/
Video : https://youtu.be/ypDUG9UtTDE
Ontarians desperately need doctors. NDP Leader Andrea Horwath recently promised 300 new physicians for Northern Ontario and the Liberals promised to hire more healthcare workers. Given how long it takes to train a physician, how can we get full fledged physicians that are ready to deliver medical care now and within the next couple of years, not the next decade? The only feasible answer is internationally trained physicians.
Every year anywhere between 1,000 and 2,000 Canadians and permanent residents who have trained abroad in medicine and have successfully passed the Medical Council of Canada exams which test whether they meet the Canadian standard necessary to enter medical residency training and then become licensed to practice in Canada. Yet, Canada only took 439 for residency training in 2022! Canada can’t afford to leave these highly educated individuals not contributing fully to Ontario’s healthcare system, especially as we experience the ravages of a pandemic. The 1.3 million Ontarians waiting for a family physician deserve better!
The Ontario Conservatives promised funding more residency positions as part of the solution, and passed the Ontario Pandemic and Emergency Preparedness Act in April. . Schedule 6 of the Act prohibits health Colleges from requiring Canadian experience. This change can open the doors for Canadian and permanent resident physicians trained internationally to practice in Ontario. Because of these Canadian experience requirements, even internationally trained physicians (ITPs) with years of experience cannot practice medicine in Canada until they complete a Canadian medical residency.
We need to make sure our next government follows through with implementing Bill 106 and that it is not diluted through protectionist exemptions in regulations. We also need to tell election candidates that we need to make more residency training positions available for those Canadian medical students studying abroad. Two years of residency training for internationally educated Canadian citizens or permanent residents will give us a full fledged family physicians, compared to the seven years of medical education and training that will be required when new Ontario medical school positions are opened. Please talk to Ontario election candidates and make sure they understand that increased and improved access to residency, a level playing field for all qualified graduates, and streamlined routes to licensure for international medical graduates that are trained abroad, are part of the solution to providing quality healthcare for all Ontarians.
Rosemary Pawliuk, Executive Director, Society for Canadians Studying Medicine Abroad
Les Ontariens ont désespérément besoin de médecins. La chef du NPD, Andrea Horwath, a récemment promis 300 nouveaux médecins pour le Nord de l’Ontario et les Libéraux ont promis d’embaucher plus de travailleurs de la santé. Étant donné le temps qu’il faut pour former un médecin, comment pouvons-nous avoir des médecins qui sont prêts à prodiguer des soins médicaux maintenant et non dans dix ans? Les médecins formés à l’étranger sont la seule solution à court terme.
Chaque année, entre 1 000 et 2 000 Canadiens et résidents permanents ont suivi une formation en médecine à l’étranger et ont réussi les examens du Conseil médical du Canada. La réussite de ces examens confirme que ces diplômés rencontrent la norme canadienne nécessaire pour entreprendre une formation en résidence médicale et obtenir ensuite un permis d’exercice au Canada. Pourtant, le Canada n’en a pris que 439 pour la formation en résidence en 2022! Le Canada ne peut pas se permettre de laisser ces personnes hautement scolarisées de côté. Ces diplômés doivent contribuer pleinement au système de santé de l’Ontario, d’autant plus que nous subissons encore les ravages de la pandémie. Les 1,3 million d’Ontariens qui attendent un médecin de famille méritent mieux!
Le Parti Conservateurs de l’Ontario a promis de financer davantage de postes en résidence et en avril 2022 le Gouvernement de l’Ontario a adopté la Loi sur la protection civile en cas de pandémie et d’urgence de l’Ontario. L’annexe 6 de la Loi interdit aux collèges de la santé d’exiger une expérience canadienne. Ce changement peut ouvrir les portes aux médecins canadiens et aux résidents permanents formés à l’étranger pour qu’ils puissent exercer en Ontario. A l’heure actuelle, les exigences en matière d’expérience canadienne font en sorte que même les médecins formés à l’étranger ayant des années d’expérience ne peuvent exercer la médecine au Canada tant qu’ils n’ont pas terminé leur résidence médicale au Canada.
Nous devons nous assurer que notre prochain gouvernement donne suite à la mise en œuvre de la loi 106 et qu’elle ne soit pas diluée par des exemptions protectionnistes dans les règlements. Nous devons également dire aux candidats aux élections que nous devons offrir davantage de postes de formation en résidence aux étudiants en médecine canadiens qui étudient à l’étranger. Deux années de formation en résidence pour les citoyens canadiens ou les résidents permanents formés à l’étranger nous donneront des médecins de famille à part entière, comparativement aux sept années d’études et de formation en médecine qui seront nécessaires lorsque de nouveaux postes dans les facultés de médecine de l’Ontario seront ouverts. Parlez aux candidats aux élections de l’Ontario et assurez-vous qu’ils comprennent qu’il faut un accès accru et amélioré aux résidences en médecine, des règles du jeu équitables pour tous les diplômés qualifiés et une approche simplifiée d’obtention du permis d’exercice pour les diplômés internationaux en médecine formés à l’étranger. Il s’agit d’éléments fondamentaux pour fournir des soins de santé de qualité pour tous les Ontariens.
Carole Lafrenière
Société pour les Canadiens qui étudient la médecine à l’étranger
Each year, between 50 to 100 family medicine residency positions are unfilled in Quebec. Currently, nearly 1,000,000 Quebecers do not have a family doctor. If each of these doctors would take on average 1000 patients, that means that 50,000 to 100,000 Quebecers will have access to a family doctor.
The Society for Canadians Studying Medicine Abroad is planning to write to the Government of Quebec, the College des Médecins du Québec, and Quebec’s Faculties of Medicine, asking them to cease the practice of requiring the equivalence of International Medical Graduates’s (IMG) medical degree BEFORE applying for residency in Quebec.
In fact, if you want to apply for a residency position in Québec as an IMG, you must send a copy of your diploma and get your equivalence before being able to apply to the CaRMS which results in a one-year delay after med school graduation. Sadly, this discourages most Canadian IMGs to apply to Quebec for residency. Instead, we would ask Quebec to follow the same practice as other Canadian provinces and the United States where this equivalence occurs after one has matched and before the start of the contract (July 1st).
This would mean that residency applicants would apply for the Match and assuming that one gets matched into residency in Quebec, that applicant would secure a conditional contract under the condition that they obtain their medical degree and that this degree is certified by provincial authority. Result: IMGs won’t have to wait one year before starting their residency and will be able to match to Quebec following their graduation from medical school. In addition, this will help with the urgent need of doctors in Quebec and to occupy the many unfilled-residency positions.
Writing a letter to Quebec on behalf of a number of people would carry more weight. Even if you don’t intend on applying to Québec for residency, I urge you to sign this letter to help out those who want to be able to go back home to practice. Please share this with your fellow colleagues or any faculty you know in Canada.
Thank you.
Here’s the letter that we are planning to send to Quebec:
https://docs.google.com/document/d/1VSs2fk56huRCXq3ITCqySOz7Qic-qQhj0BfcBEVvGoU/edit?usp=sharing
Please indicate your interest in co-signing this letter on the following form (see at the bottom end of the message) + your e-mail address for follow up:
https://docs.google.com/forms/d/e/1FAIpQLSdyRqX1rBn46hiPCLifkQMeuuf-BnUts6ald6-YNS4V0EUhJA/viewform?fbclid=IwAR2OgrC0mg3QlXinI6hQl_yCBsxb4mcOWG7f4_psVGfQaa32V55sEWlvg2U
Here’s a link to our Facebook post:
https://www.facebook.com/socasma/posts/2115317475304642
For any questions or to remove your name from this letter please contact socasma.working@gmail.com
À chaque année, entre 50 à 100 places de résidence en médecine familiale ne sont pas comblés au Québec. Présentement, près de 1 000 000 de québécois n’ont pas de médecin de famille. Si chacun de ces médecin prenait en moyenne 1000 patients, ça veut dire que 50 000 à 100 000 additionels québécois auraient accès à un médecin de famille.
La Société des Canadiens qui étudient la médecine à l’étranger prévoit écrire au gouvernement du Québec, au Collège des médecins du Québec et aux facultés de médecine du Québec pour leur demander de cesser la pratique d’exiger l’équivalence des diplômes des ‘Diplômés en médecine hors Canada et États-Unis’ (DHCEU) AVANT de présenter une demande de résidence au Québec.
En effet, si vous souhaitez postuler à un poste de résidence au Québec en tant que DHCEU, vous devez envoyer une copie de votre diplôme et en obtenir son équivalence AVANT de pouvoir postuler au CaRMS ce qui entraîne un délai d’un an après l’obtention du diplôme en médecine. Malheuseuement, cela démotive la plus part des DHCEU Québecois à postuler au Québec. On veut plutôt demander au Québec de suivre la même pratique que les autres provinces canadiennes et les États-Unis où cette équivalence se produit après le jumelage et avant le début du contrat (1er juillet).
Cela signifierait que les candidats à la résidence postuleraient pour le jumelage et suite à un jumelage à un poste de résidence au Québec, ce candidat obtiendrait un contrat conditionnel; à condition qu’il obtienne son diplôme en médecine et que ce diplôme soit certifié par l’autorité provinciale. Résultat: les DHCEU n’auront plus à attendre un an avant de commencer leur résidence et ainsi pourront être jumelés dans un poste en résidence au Québec suite à leur graduation. Adopter cette pratique pourrait aider à réduire le manque urgent de médecins au Québec et à combler tous les postes de résidence au Québec.
Écrire cette lettre au Québec, au nom de nombreuses personnes, aurait plus de poids. Même si vous n’avez pas l’intention de postuler au Québec en résidence, je vous invite à signer cette lettre pour venir en aide à ceux qui veulent retourner et pratiquer chez eux, au Québec. Veuillez partager ceci avec vos collègues ou tout autre membre des facultés de médecine que vous connaissez au Canada.
Merci.
Lien vers la lettre que l’on prévoit faire parvenir à Québec:
https://docs.google.com/document/d/1VSs2fk56huRCXq3ITCqySOz7Qic-qQhj0BfcBEVvGoU/edit?usp=sharing
Remplir le formulaire qui suit si vous désirez être co-signataire de cette lettre:
Poste Facebook:
https://www.facebook.com/socasma/posts/2115317475304642
Pour toute question ou pour retirer votre nom de la lettre, veuillez contacter socasma.working@gmail.com
Aux : Ministres de la Santé, Doyens des facultés de médecine, Collège royal des médecins et chirurgiens du Canada, Médecins-chefs fédéraux et provinciaux, l’Association des facultés de médecine du Canada
Cc : principaux médias canadiens à travers le Canada
Sujet : Diplômés internationaux en médecine au Canada : Il est temps d’innover et d’utiliser au mieux cette ressource qualifiée mais sous-utilisée !
Alors que la COVID 19 continue de faire des ravages, il n’y a jamais eu de meilleur moment pour remettre en question le statu quo qui menace le système de santé du Canada. Plus que jamais, il est temps d’innover pour s’assurer que les diplômés internationaux en médecine (DIM) qui sont au Canada sont pleinement employés – en tant que médecins résidents en exercice, médecins autorisés ou dans le cadre d’une autre profession de la santé. Le Canada doit mettre les rouages en marche pour que notre système de santé profite pleinement des connaissances et de la formation médicales des DIM.
Le fait qu’il y ait près de 5 millions de Canadiens qui n’ont pas de médecin de famille fait partie de ces faiblesses, tout comme la pénurie de spécialistes, surtout en milieu rural. Cette pénurie s’étend à presque tous les types de travailleurs de la santé, y compris les infirmières, les adjoints au médecin, les technologues de la santé, les ambulanciers paramédicaux et autres. Pourtant, malgré ce triste état des choses, presque aucun progrès n’a été réalisé pour intégrer pleinement les diplômés internationaux en médecine au Canada afin qu’ils puissent pleinement contribuer à notre système de santé.
Même s’ils ont peut-être reçu leur formation médicale dans un autre pays, certains de ces diplômés internationaux en médecine sont des Canadiens nés, élevés et éduqués au Canada. D’autres étaient des médecins pleinement certifiés dans leur pays d’origine, avant d’immigrer au Canada. Bon nombre de ces derniers ont été attirés dans ce pays dans le cadre du Programme des travailleurs qualifiés, où leurs demandes d’immigration ont été accélérées en raison de la pénurie de médecins à laquelle nous sommes confrontés dans ce pays. La plupart sont surpris que même après avoir obtenu leur diplôme d’écoles de médecine réputées et réussi les examens qui prouvent qu’ils possèdent les connaissances médicales, la capacité de prise de décision et les compétences cliniques attendues d’un diplômé d’une école canadienne, ils sont séparés et interdits de concourir pour 90 % des emplois de premier échelon en médecine, et ce, même s’ils se sont révélés qualifiés pour ces postes de formation en résidence. Ils ne peuvent donc pas devenir médecins agréés au Canada. Trop d’entre eux se retrouvent dans des emplois qui n’utilisent pas pleinement leurs connaissances et leur expertise. Non seulement ils n’ont pas accès à la formation en résidence requise pour exercer la médecine, mais il n’existe aucun programme de transition leur permettant d’aspirer à une telle formation. Quel gâchis! Quelle honte, surtout pour un pays qui se targue d’être une société ouverte et inclusive fondée sur l’immigration et le fair-play, un pays qui devrait s’efforcer de soutenir nos meilleurs et nos plus brillants!
Avec un leadership solide, nous pouvons agir pour aider le système de santé du Canada à répondre à la pandémie de COVID-19 et à ses variantes, et à bâtir une infrastructure de soins de santé plus résiliente pour l’avenir. Il y a plus de 2 000 diplômés internationaux en médecine au Canada qui ont réussi les examens du Conseil médical du Canada qui servent à reconnaître que ces candidats satisfont à la norme canadienne. La grande majorité de ces diplômés n’ont pas obtenu de poste de résidence en 2021. Ils sont disponibles immédiatement pour accéder à des emplois de formation postdoctorale en tant que médecins résidents. Nous avons également de nombreux Canadiens qui ont étudié à l’étranger et qui travaillent comme médecins pleinement autorisés dans d’autres pays. Ces médecins pourraient exercer au Canada maintenant. Nous devons éliminer les obstacles à leur enregistrement. Voici comment nous pouvons immédiatement attirer plus de médecins qualifiés dans le système de santé canadien :
– Augmenter les postes de résidence médicale et les voies d’inscription.
o Financer de nouveaux postes de résidence PGY-1 pour ces citoyens canadiens et résidents permanents à partir de fonds fédéraux et provinciaux, y compris des fonds d’urgence, pour (1) remplacer les stagiaires en visa PGY-1 prévus et (2) augmenter le nombre de résidents PGY-1 postes actuellement financés par les provinces.
o Demander au Service canadien de jumelage des résidents et à l’Association des facultés de médecine du Canada de rétablir la pratique selon laquelle la date du jumelage pour la formation en résidence est antérieure à la date du jumelage aux États-Unis. (Cela permettrait à plus de Canadiens de choisir de pratiquer au Canada plutôt qu’aux États-Unis.)
o Interdire l’entrée au Canada de nouveaux stagiaires étrangers titulaires d’un visa, à compter d’aujourd’hui. (Changer cette pratique signifierait que les infrastructures payées par les contribuables seraient utilisées pour former des Canadiens et non des étrangers qui sont obligés de retourner pratiquer dans leur pays.)
o Éliminer les obstacles et augmenter les voies d’inscription des médecins immigrants.
o Travailler avec les collèges provinciaux de médecins et de chirurgiens pour accorder des licences provisoires temporaires aux médecins immigrants qui ont réussi les examens du Conseil médical du Canada et qui sont pleinement qualifiés dans leur pays d’origine.
– Ramenez chez nous des médecins canadiens pleinement qualifiés.
o Travailler avec les collèges provinciaux de médecins et de chirurgiens pour ramener les médecins canadiens exerçant actuellement dans des juridictions reconnues, notamment le Royaume-Uni, l’Irlande, l’Australie, la Nouvelle-Zélande et les États-Unis, en supprimant les obstacles à l’inscription, en particulier en médecine familiale, en médecine interne et en médecine d’urgence.
– Mettre en œuvre des programmes de transition abordables pour les DIM.
o Programmes de transition pour les candidats souhaitant devenir médecins. (Le seul programme est avec l’Université Queen’s, mais il est maintenant suspendu. https://www.queensu.ca/sgs/graduate-calendar/programs-study/medical-sciences)
o Programmes de transition vers une carrière d’adjoint au médecin. (Seules quelques provinces reconnaissent ce type de carrière. Il n’y a pas de programme de transition pour quelqu’un qui a déjà un diplôme de médecine. Le programme complet est d’une durée de 2 ans.)
– Mettre en place des programmes d’incitatifs financiers pour les candidats nécessitant une formation en transition de programme.
La pandémie de COVID 19 a montré la fragilité de notre système de santé. Il est temps, plus que jamais, d’innover et d’utiliser de façon optimale les connaissances et l’expertise en soins de santé qui sont à notre disposition au Canada.
Cordialement,
Rosemary Pawliuk
Présidente de la Société des Canadiens qui étudient la médecine à l’étranger
Tél : (604) 541-4747
Courriel : socasma@outlook.com
www.socasma.com
Carole Lafrenière
SOCASMA – Équipe de l’Ontario et porte-parole francophone
Tel: (613) 807-0776
Courriel: socasma.working@gmail.com
To : Ministers of Health, Deans of Medical Schools, Royal College of Physicians and Surgeons of Canada, Federal and Provincial Chief Medical Officers, Association of Faculties of Medicine of Canada
RE: International Medical Graduates in Canada : It’s time to innovate and make optimal use of this qualified but under-utilized resource!
With COVID-19 still wreaking havoc, there has never been a better time to question the status quo that threatens Canada’s health care system. More than ever, now is the time to innovate to ensure that International Medical Graduates (IMG) who are in Canada, are fully employed – as practicing medical residents, licensed physicians or as part of another health care profession. Canada needs to set the wheels in motion so that our health system reaps the full benefit of IMGs’ medical knowledge and training.
The fact that there are close to 5 million Canadians that do not have a family doctor is part of these weaknesses and so is the shortage of specialists, especially in rural areas. This shortage extends to almost every type of healthcare worker, including nurses, physician assistants, health technologists, paramedic, and others. Yet, despite this sad state of affairs, almost no progress has been made to fully integrate International Medical Graduates in Canada so that they can fully contribute to our health care system.
While they may have received their medical education in another country, some of these International Medical Graduates are Canadians born, bred and educated in Canada. Others were fully certified physicians in their country of origin, before immigrating to Canada. Many of the latter were enticed to this country under the Skilled Worker Program where their immigration applications were expedited because of the doctor shortage we face in this country. Most are surprised that even after graduating from reputable medical schools and passing the examinations that prove that they have the medical knowledge, decision-making ability, and clinical skills expected of a graduate of a Canadian school, that they are segregated and forbidden from competing for 90% of the entry level jobs in medicine despite proving themselves qualified for these residency training positions. Thus they cannot become licensed physicians in Canada. Too many of them end up in jobs that do not make any, let alone, full use of their knowledge and expertise. Not only do they not access residency training required to practice medicine, there are no transition programs for them to aspire to such training. What a waste! What a disgrace, especially for a country that prides itself of being an open and inclusive society that was built on immigration and fair play, a country that should strive to support our best and brightest!
With strong leadership we can act to help Canada’s healthcare system respond to the COVID-19 pandemic and its aftershock, and build a more resilient health care infrastructure for the future. There are over 2,000 International Medical Graduates in Canada who have passed the Medical Council of Canada examinations which serves to recognize that these candidates meet the Canadian standard. The vast majority of these graduates did not secure residency positions in 2021. They are available immediately to move into post-graduate training jobs as medical residents. We also have many Canadians who studied abroad who are working as fully licensed physicians in other countries, who could practice in Canada now. We need to remove barriers to their registration. Here is how we can immediately bring more qualified doctors into the Canadian health care system:
– Increase Medical Residency positions and Registration Pathways.
o Fund new PGY-1 residency positions for these Canadian citizens and permanent residents from federal and provincial funds, including emergency funds, to (1) replace scheduled PGY-1 visa-trainees, and (2) increase the number of PGY-1 residency positions currently funded by the provinces.
o Instruct the Canadian Residency Matching Service and the Association of Faculties of Medicine of Canada to re-establish the practice whereby the Match date for residency training is prior to the Match date in the United States. (This would allow more Canadians to choose to practice in Canada instead of the United States.)
o Do not allow any new foreign visa trainees into Canada , effective immediately. (Changing this practice would mean that infrastructure paid for by taxpayers would be used to train Canadians and not foreigners who are obliged to go back and practice in their country.)
o Remove barriers and increase pathways for registration of Immigrant Physicians.
o Work with provincial colleges of physicians and surgeons to grant temporary provisional licenses to immigrant physicians who have passed the Medical Council of Canada examinations and are fully qualified in their country of origin.
Bring home fully qualified Canadian doctors.
o Work with provincial colleges of physicians and surgeons to bring back Canadian physicians currently practicing in recognised jurisdictions, including the UK, Ireland, Australia New Zealand, and the United States, by removing registration barriers, especially in Family Medicine, Internal Medicine, and Emergency Medicine which are stretched and under-resourced because of the COVID pandemic.
Implement affordable transition programs for IMGs.
o Transition programs for candidates wishing to become physicians. (The only program is with Queen’s University, but it is now on hold. https://www.queensu.ca/sgs/graduate-calendar/programs-study/medical-sciences)
o Transition programs for a career as a Physician Assistant. (Only a few provinces recognize this type of career. There is no transition program for someone who already has an M.D. degree. The full program is of a duration of 2 years.)
Implement financial incentive programs for candidates requiring program transition training.
The COVID-19 pandemic has shown the fragility of our health system. It is time, more than ever, to innovate and make optimal use of health care knowledge and expertise that is at our disposal in Canada.
Sincerely yours,
Rosemary Pawliuk
President of Society for Canadians Studying Medicine Abroad
Tel: (604) 541-4747
E-Mail: socasma@outlook.com
www.socasma.com
Carole Lafrenière
SOCASMA – Ontario team (French speaking spokesperson)
Tel: (613) 807-0776
E-Mail: socasma.working@gmail.com