Opinion: International med school graduates are an untapped resource, as well as a complex challenge

Everyone in Canada, it seems, has met a cab driver who was a doctor in their native country. The trope is so ingrained, there was even a Canadian-Indian movie made about it in 2014: Dr. Cabbie.

With an estimated 13,000 graduates of international medical schools living in Canada, there is no doubt some truth to the cultural touchpoint. There are international medical graduates (IMGs) in Canada working as cab drivers, care aides, Amazon delivery drivers and more, instead of donning scrubs.

At a time when 6.5 million Canadians don’t have a family doctor, and physician shortages are growing worse, this is tragic. IMGs are an untapped resource with a lot of potential to help.

But let’s not pretend that hiring and integrating more foreign-trained doctors into Canada’s byzantine medical system will be easy, cheap or a panacea to our labour woes.

It’s a complex challenge that requires a host of solutions.

First of all, we have to address the myth that IMGs are currently shut out. In fact, 31 per cent of family doctors, 25 per cent of specialists and 16 per cent of surgeons in Canada are international medical graduates, according to the Canadian Institute for Health Information.

Still, there is no question that it’s much easier for someone educated in a Canadian medical school to get a job than someone who wasn’t. The pinch point is residency. (After three or four years of medical school, doctors must do training known as residency, which lasts another three to seven years, and those spots are limited.)

In Canada last year, there were 3,618 new residency spots: 2,934 went to Canadian grads, 671 to IMGs and 13 to U.S. grads. Virtually every Canadian grad gets a spot; only a fraction of IMGs do.

It’s important to note that there are two types of IMGs. The first are Canadians who study medicine abroad in places like Grenada, Ireland and Australia, usually because they weren’t accepted to Canadian schools. They argue they have a “constitutional right” to compete for residency spots on an equal footing with Canadian grads if they pass Canadian exams.

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The second type of IMGs are those educated in other countries who emigrate to Canada. If they do so before residency, they have little chance of getting a spot. (The exception is grads from countries like Saudi Arabia, who “buy” residency spots but must return home after training – a topic for another day.)

We limit the number of doctors we train because money isn’t unlimited. We already have 97,384 physicians in Canada, and spend $32.5-billion annually paying them. Rationing is a reality.

If we want more doctors, then one avenue is to open more residency spots for IMGs. A report last year from a group of independent senators recommended adding 750 spots, essentially doubling the current number.

Of the group of IMGs who have trained and worked in other countries before emigrating to Canada, some of them could start work tomorrow while others do not have the appropriate qualifications. The challenge for regulators is to figure out who’s who.

The path to practice has many hurdles: demonstrating you graduated from a legitimate medical school, having your credentials verified, passing Canadian exams, showing competency in English, having your competency tested and finding a job.

There is no doubt Canada’s bureaucracy is excessive. But it can’t be too lax either.

Begin with the fact that there are roughly 3,900 medical schools around the world. Not all medical degrees are equal. Training also differs. For example, in some countries, family doctors don’t get any training on treatment for mental-health issues, which is a mainstay of practice in Canada.

Getting a licence is easiest for doctors who practised in countries with similar systems and cultures, like the U.S., Britain, Australia and Ireland. Sometimes, doctors from other countries are forced to redo their residency training – if they can get a spot. That is costly and inefficient.

Increasingly, provinces are doing “practice-ready assessments” (PRAs) – 12-week programs that can fast-track IMGs into practice. There are only a few hundred of these spots countrywide and they require a complex dance between medical schools, medical institutions and regulators. The independent senators’ report called for 500 more PRAs. But the biggest barrier to integrating more IMGs is actually finding people to administer these assessments and oversee training, whether as part of a residency or a PRA.

If we want more doctors, then we have to invest in oversight and training beyond creating more spots in medical schools. We also have to find that proper balance between throwing open the door and not lowering our standards – nor breaking the bank.