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Residencies fo IMGs now that Saudi medical trainees ordered home

Posted by imdontario on August 12, 2018 at 7:55 PM Comments comments (0)

As Saudi medical trainees ordered home, Canada prepares for potential impact on hospitals

https://www.cbc.ca/news/health/canadian-hospitals-saudi-medical-trainees-1.4778212

 

Health officials across Canada were trying to determine Wednesday the potential impact if about 800 medical residents and fellows from Saudi Arabia suddenly leave the country next month.

 

The planned recall of that group comes after Saudi Arabia suspended diplomatic relations with Canada on Sunday in response to a tweet from Global Affairs Canada that criticized the Saudis for the arrest of female social activists.

 

Trudeau rebuffs Saudi call for an apology as diplomatic spat escalates

The diplomatic row has escalated with a series of measures taken by the Saudis that include recalling students — including medical students and residents — to Saudi Arabia.

 

Saudi medical students make up the vast majority of foreign medical trainees in Canada, according to the Ottawa-based Saudi Arabian Cultural Bureau.

 

The bureau, part of the Saudi Education Ministry, which is in charge of placing Saudi medical students, has persuaded the kingdom to give trainees a "grace period" until Sept. 1 to return home, said Dr. Salvatore Spadafora, vice-dean of post-MD education at the University of Toronto's faculty of medicine.

 

What will happen to Saudi students enrolled in Canada?

In Toronto, that means 216 Saudi doctors out of the 3,600 residents and fellows in their system — the biggest in Canada.

 

"So 216 people is not insignificant, but we've got a pretty big network," Spadafora said in an interview.

 

"We're in the process now of really sitting down with our hospital partners, site by site, and program by program, and figuring out what the impact will be if Sept. 1, these folks aren't around."

 

In Montreal, 225 out of the 1,250 residents at the McGill University Health Centre (MUHC) and the Jewish General Hospital are from Saudi Arabia.

 

MUHC spokesperson Gilda Salomone said hospital authorities are monitoring events.

 

"The situation is still fluid, it's evolving," Salomone said. "We're evaluating the situation and the impact it has on our programs."

 

McGill specifically had 327 students from Saudi Arabia enrolled during the 2017-18 academic year.

 

'Definitely concerned'

 

A spokesperson for Resident Doctors of Canada, which represents about 9,000 residents across the country, warned on its website that suspended scholarships for Saudi students studying here and their forced departure from Canada could have very negative consequences.

 

Todd Coopee said the institution is keeping close tabs on the issue and the type of impact these actions will have on medical students, residents, and the system's ability to provide quality and timely care.

 

Saudi Arabia pulls its medical patients from Canadian hospitals

"While we're definitely concerned about the potential implications, we feel that at present we do not have enough verified information to comment," the communications manager said in an email.

 

"We also understand that discussions are ongoing among the various parties involved; we are hopeful that some kind of resolution can be found."

 

Saudi Arabia 'allergic to criticism', making example out of Canada, analysts say

While the Saudi government says students whose education is paid for by the kingdom can head elsewhere to continue their studies, Spadafora said there will be an impact on their academic careers.

 

"From what I have gathered ... initially it's a bit of a shock, it's a bit of a sudden announcement and I think there's a lot of people who are stressed and, quite frankly, they're sad this has happened," Spadafora said.

 

"They're worried about their future and there's a bit of uncertainty there."

 

He said health officials are pleased to have until the end of the month, adding there is "hopeful optimism there's going to be a resolution before then."

 

But Spadafora admits it's largely out of their hands.

 

"This is not a matter that's at the level of a university, or the bureau of a lowly vice-dean," he said. "This is really at the upper levels of the governments of both countries."


Canada's medical residency system is leaving some graduates in limbo

Posted by imdontario on April 4, 2018 at 11:15 PM Comments comments (0)

https://www.universityaffairs.ca/features/feature-article/canadas-medical-residency-system-leaving-graduates-limbo/

 

Robert Chu was a typical medical student in that he excelled at everything he did. He edited his high school newspaper and made it on the dean’s list in his undergraduate years. He volunteered to take notes for disabled students. After he got into medical school, he tutored hopefuls on the entry exam. “If somebody didn’t understand a concept, he was very good at explaining it to them in a manner that they could comprehend,” says his mother, Clara Chu. He was a skilled photographer and he loved to cook. Beef Wellington, macarons, homemade marshmallows. “Never anything simple,” his aunt, Cathy DeFazio, says with a laugh.

 

In his final year of medical school, it surprised everyone that he didn’t get a residency training spot, the important last stage of training to become a physician. He gained more job shadowing experience and reapplied the next year to a less competitive specialty. When he was again refused a spot, Rob Whyte, assistant dean of undergraduate medical education at McMaster University, took the rare step of personally writing him a strongly worded recommendation letter. “Unlike some other students where we are able to readily identify a concern in their file, Robert presents no such evidence and we remain collectively frustrated at his situation,” he wrote.

 

Robert, understandably, was the most frustrated of all, but he confronted the situation with the same resolve that had always worked for him. “He didn’t go halfway. It was all the way,” says Ms. DeFazio. He accessed and reviewed his reference letters – all glowing. He created flow charts of actions to take and people to contact. He wrote an impassioned letter explaining his plight and sent it to Prime Minister Justin Trudeau, then-Ontario Health Minister Eric Hoskins and others. There were a few sympathetic replies, but in the end, there was little anyone could do for him. He died by suicide in September 2016.

 

Suicide can have many factors and eludes simple explanations. No one can presume what led Robert to his death, but the stress and frustration he felt must have been enormous. What’s more, the situation he experienced and was trying desperately to expose is happening to others: a growing number of medical school graduates are not getting a residency training position required to practice medicine in Canada. In other words, more and more students are completing four or five years of intensive, not to mention costly, medical school training – only to find they can’t proceed to the next stage.

 

The residency application process is complicated, but to describe it simply, medical students apply – via the Canadian Resident Matching Service, or CaRMS – for residency positions at universities across the country in one or more specialties of their choice. The program committees select those they wish to interview, and then they rank the candidates. The medical school graduates in turn rank the programs, and an algorithm spits out a “match.” For those who don’t get matched, they can apply again over the next week for the remaining programs, often family medicine programs in small communities.

 

In 2017, 68 final-year medical students went unmatched after the second round. Another 31 went unmatched in the first iteration but chose not to apply to the remaining programs, which likely didn’t include their specialties of choice. These numbers don’t include all the prior-year graduates who had failed to match in previous years and were trying again. By comparison, in 2005, only seven students who competed in the second round remained unmatched. If the trend continues, there will be an estimated 140 graduating students who go unmatched in 2021, and 330 if you include those who are re-applying for a second time, according to the Association of Faculties of Medicine of Canada (AFMC).

 

In simple terms, more medical school graduates aren’t getting residency positions because the number of positions available has been decreasing in relation to the number of graduating medical students. “The most common reason a student doesn’t get matched is just musical chairs,” explains Anthony Sanfilippo, associate dean of undergraduate medical education in the faculty of health sciences at Queen’s University. A decade ago, there were about 114 residency positions for every 100 Canadian medical students, with internationally trained graduates filling the remaining positions. Today, there are 103 positions for every 100 Canadian medical school graduates.

 

That may seem ideal, but many Quebec-based residency positions are available only to those who can speak French, and in 2017 more than 50 of these francophone positions remained unfilled. So there are actually fewer English-language positions than there are graduates, explains Kaylynn Purdy, vice-president of education for the Canadian Federation of Medical Students (CFMS). “It comes down to the fact that no matter how good you are, someone has to go unmatched,” she says.

 

In this game of musical chairs, the stakes are high. For many, going unmatched is world-shattering. As Robert wrote in a letter sent to journalists and others, “My diligent studies of medical texts, careful practice of interview and examination skills with patients, and my student debt in excess of $100,000 on this pursuit have all been for naught.” For unmatched graduates, there’s the confusion about why they weren’t selected and the sudden uncertainty of the future. Students can apply when residency positions open up again the following year, but in the meantime, “you have resigned your fate to a year of being in limbo,” explains Aaron, a graduate who went unmatched in 2017 and asked to use a pseudonym. Feelings of social alienation often exacerbate the distress. “You go from being with this cohort of people for years and being quite close to them and they’re all celebrating and moving on with their lives and you’re not,” explains Ms. Purdy. “I’ve heard from some unmatched students that their classmates stopped talking to them because they didn’t want to make the person feel bad by talking about their residency, or the fact that they’re buying a house.” Clara Chu describes the phenomenon concisely: “Facebook,” she says, angrily.

 

The crisis is worrying everyone – medical student organizations, the residency program directors and the undergraduate program administrators. “The deans have clearly identified the unmatched Canadian medical graduate as a top priority,” says Geneviève Moineau, president and CEO of AFMC. Ravi Sidhu, the postgraduate dean at the University of British Columbia’s medical school, says “the unmatched medical student numbers are incredibly disconcerting. I can imagine how stressful it is.”

 

Who is going unmatched – and why – is difficult to grasp. Certainly, choosing a more competitive specialty can increase one’s risk of not getting a residency. In Robert’s first year of applying, he was one of 96 candidates vying for 81 radiology residencies. If family medicine had been his first choice, he would have almost certainly been matched – there were 200 more family medicine residencies than there were candidates who made the specialty their top choice. In 2017, obstetrics-gynecology was an especially competitive specialty, with 113 Canadian medical graduates vying for 77 residency spots. Paul Foster was one of the 36 ob-gyn hopefuls who didn’t match. His first reaction was self-doubt. “Maybe I screwed something up,” he thought, but then he heard of friends who suffered the same fate. “They’re superb candidates. It wasn’t the people with red flags,” he says.

 

Some argue it’s students’ own fault for choosing very competitive specialties and not wanting to go where they’re needed – especially family medicine. But it’s difficult to know from one year to the next whether a specialty will be in demand. Provincial governments set the number of specialty training spots each year, based on changing population needs. And students’ preferences can swing considerably from year to year. Many years, for example, neurology has had a one-to-one ratio of applicants to spots; last year, there were positions for only 70 percent of applicants.

 

Most of those who go unmatched are usually willing to do family medicine – more than two-thirds of graduates unmatched in the first round apply again in the second round to the remaining positions in family medicine and in small communities. But, here’s the clincher: the second round is also open to Canadians who have trained abroad. Last year, 1,811 internationally trained Canadians applied and 411 got positions. The directors of these programs often prefer a foreign-trained doctor whose first choice is family medicine, as opposed to a Canada-trained doctor who is choosing family medicine as a Plan B. As Dr. Moineau says, “family medicine can no longer be seen as a fallback.”

 

Perhaps the most egregious aspect of the matching process is that those who go unmatched are discriminated against upon reapplying. In the one application review Robert Chu was able to obtain, his failure to match the year before was mentioned in the red-flag category. A decade ago, when only a handful of students didn’t get matched, there were often clear reasons, like a professionalism issue mentioned on their medical school record, for example. Today, even though many of those going unmatched are stellar students, the stereotype remains. While almost 97 percent of final-year students are matched, only 65 percent of prior-year grads get matched, despite the fact that most have improved their resumés with an extra year of job shadowing and research. With each additional application year, the chances of matching are lower.


German doctor frustrated by rules that prevent him from practising in N.S.

Posted by imdontario on October 20, 2017 at 10:05 PM Comments comments (0)

http://www.cbc.ca/news/canada/nova-scotia/german-doctor-anesthesiologist-physicians-surgeons-certification-1.4360957

German doctor frustrated by rules that prevent him from practising in N.S.

Licensing body says qualifications not recognized

By Wendy Martin, CBC News Posted: Oct 19, 2017 7:00 AM AT Last Updated: Oct 19, 2017 7:00 AM AT

 

-------------------------------------

A German doctor says he's frustrated by Nova Scotia regulations that prevent him from moving to this province to practise.

 

Erik Steffen, 38, is an anesthesiologist. His wife, Julie, grew up in Wreck Cove, Cape Breton.

 

The Steffens want to move to Nova Scotia to raise their two sons, aged four and two, but Steffen says he cannot get a licence from the Nova Scotia College of Physicians and Surgeons.

 

"It's silly," said Steffen. "They make it so hard for us to come over here. I don't think the system in Germany is worse than Canada. It should be possible to transfer more easily."

 

Recruitment efforts lure 16 doctors to Cape Breton

Lots of work

 

Julie Steffen said it "makes her sad" when she hears stories about the doctor shortages in the province.

 

She said the family desperately wants to stay, and her husband would have no trouble getting a job.

 

"In fact, different doctors in Antigonish said they would take him; in Halifax, they said they would take him, but they can't hire him," she said.

 

The Nova Scotia Health Authority currently has several vacancies for anesthesiologists, in Halifax, Truro, Amherst and Bridgewater.

 

Health minister promises more flexibility for doctors setting up practices

Lacks certification

 

Steffen does not qualify for a medical licence in Nova Scotia because his qualifications are not recognized at a national level by the Royal College of Physicians and Surgeons.

 

Germany is not one of the 29 jurisdictions that qualify for Royal College certification.

 

The Steffens say some provinces will allow uncertified specialists to practise under provisional licences while working toward that certification, but in Nova Scotia, that's not the case.

 

"What I worry about most is public safety," said Dr. Gus Grant, the registrar of the College of Physicians and Surgeons of Nova Scotia.

 

Grant couldn't comment specifically on Erik Steffen or his qualifications.

 

He said the college is well aware of the pressures of underserviced communities, but that Nova Scotia rigorously follows the Royal College standards, which set the threshold for physician qualifications.

 

Business owners in Cape Breton create website to lure doctors to area

"What I am most concerned about is licensing physicians who cannot meet the standards expected of physicians."

 

Heading back

 

The Steffens, who are vacationing in Cape Breton this month, are making plans to return to Germany.

 

"My boys are going to start school soon," said Julie Steffen, "and once they do, probably we're just going to end up staying there and not coming back. It doesn't look like anything is going to change."

 

MLA Tim Houston, the Progressive Conservative finance critic, has been in touch with the Steffens, and says the situation just doesn't make sense.

 

"I just hear roadblocks that are getting in the way of common sense," he said.

 

Houston says Nova Scotia should follow the lead of other jurisdictions where international physicians can live and practise while working toward certification.

 

"Other provinces have figured it out. We should figure it out as well."

 

Grant said nationally, various jurisdictions, including the College of Physicians and Surgeons of Nova Scotia, have worked together to develop a blueprint to analyze the qualifications of international medical graduates.

 

He says, though, it will be up to individual provinces to adopt the blueprint and put it into practice.



German doctor frustrated by rules that prevent him from practising in N.S.

Posted by imdontario on October 20, 2017 at 10:05 PM Comments comments (0)

http://www.cbc.ca/news/canada/nova-scotia/german-doctor-anesthesiologist-physicians-surgeons-certification-1.4360957

German doctor frustrated by rules that prevent him from practising in N.S.

Licensing body says qualifications not recognized

By Wendy Martin, CBC News Posted: Oct 19, 2017 7:00 AM AT Last Updated: Oct 19, 2017 7:00 AM AT

 

-------------------------------------

A German doctor says he's frustrated by Nova Scotia regulations that prevent him from moving to this province to practise.

 

Erik Steffen, 38, is an anesthesiologist. His wife, Julie, grew up in Wreck Cove, Cape Breton.

 

The Steffens want to move to Nova Scotia to raise their two sons, aged four and two, but Steffen says he cannot get a licence from the Nova Scotia College of Physicians and Surgeons.

 

"It's silly," said Steffen. "They make it so hard for us to come over here. I don't think the system in Germany is worse than Canada. It should be possible to transfer more easily."

 

Recruitment efforts lure 16 doctors to Cape Breton

Lots of work

 

Julie Steffen said it "makes her sad" when she hears stories about the doctor shortages in the province.

 

She said the family desperately wants to stay, and her husband would have no trouble getting a job.

 

"In fact, different doctors in Antigonish said they would take him; in Halifax, they said they would take him, but they can't hire him," she said.

 

The Nova Scotia Health Authority currently has several vacancies for anesthesiologists, in Halifax, Truro, Amherst and Bridgewater.

 

Health minister promises more flexibility for doctors setting up practices

Lacks certification

 

Steffen does not qualify for a medical licence in Nova Scotia because his qualifications are not recognized at a national level by the Royal College of Physicians and Surgeons.

 

Germany is not one of the 29 jurisdictions that qualify for Royal College certification.

 

The Steffens say some provinces will allow uncertified specialists to practise under provisional licences while working toward that certification, but in Nova Scotia, that's not the case.

 

"What I worry about most is public safety," said Dr. Gus Grant, the registrar of the College of Physicians and Surgeons of Nova Scotia.

 

Grant couldn't comment specifically on Erik Steffen or his qualifications.

 

He said the college is well aware of the pressures of underserviced communities, but that Nova Scotia rigorously follows the Royal College standards, which set the threshold for physician qualifications.

 

Business owners in Cape Breton create website to lure doctors to area

"What I am most concerned about is licensing physicians who cannot meet the standards expected of physicians."

 

Heading back

 

The Steffens, who are vacationing in Cape Breton this month, are making plans to return to Germany.

 

"My boys are going to start school soon," said Julie Steffen, "and once they do, probably we're just going to end up staying there and not coming back. It doesn't look like anything is going to change."

 

MLA Tim Houston, the Progressive Conservative finance critic, has been in touch with the Steffens, and says the situation just doesn't make sense.

 

"I just hear roadblocks that are getting in the way of common sense," he said.

 

Houston says Nova Scotia should follow the lead of other jurisdictions where international physicians can live and practise while working toward certification.

 

"Other provinces have figured it out. We should figure it out as well."

 

Grant said nationally, various jurisdictions, including the College of Physicians and Surgeons of Nova Scotia, have worked together to develop a blueprint to analyze the qualifications of international medical graduates.

 

He says, though, it will be up to individual provinces to adopt the blueprint and put it into practice.



International graduate awarded $40,000 in landmark discrimination case

Posted by imdontario on July 5, 2016 at 12:40 AM Comments comments (11)

http://www.nzdoctor.co.nz/news/2016/july-2016/04/international-graduate-awarded-$40,000-in-landmark-discrimination-case.aspx

Medical Observer

Monday 04 July 2016, 9:44AM

After more than two years of legal wrangling, the verdict is in: The Australian Capital Territory did racially discriminate against an experienced Chinese-born doctor whom it overlooked for a hospital internship.

 

In a landmark ruling that could have knock-on effects for selection policies elsewhere, a territory tribunal awarded Dr Qinlin Wang $40,000 compensation and found the Australian Captial Territory (ACT) guilty of discrimination over its internship selection policy.

 

Dr Wang, aged in his 50s, will be eligible for even more money should he not be considered for future internship intakes based on his merits, ACT Civil and Administrative Tribunal senior member Allan Anforth ruled on Thursday.

 

Eight-tier ladder of preference

 

The long-running saga centred on a ministerial policy implemented in 2014, which prioritised ACT hospital internship applicants based on where they finished university.

 

ACT runs the internship programmes for the territory's hospitals.

 

Graduates of Canberra's Australian National University were given first preference on an eight-tier ladder.

 

Graduates of other Australian universities formed categories two to six, while graduates from New Zealand universities formed the seventh category and overseas-trained doctors formed the eighth and last category.

 

The policy meant there was "no real possibility" of Mr Wang - nor any international medical graduate (IMG) - securing an internship, Mr Anforth said.

 

Dr Wang, who migrated to Australia in 2001 with 16 years' experience and time as the director of neurology at a Chinese medical university, was knocked back in 2014, having completed the necessary examinations, and took his case to court.

 

He claimed the policy was directly discriminatory on the basis of race because it amounted to a refusal to consider him for an internship based on his national origin.

 

'Not discriminatory' - ACT

 

The ACT argued that the policy was not racially discriminatory because foreign-born students could graduate from Australian universities and vice versa.

 

But Mr Anforth struck that argument down, saying it focused on exceptions rather than the rule. In general, he said, graduates of foreign universities are foreign-born.

 

"The discrimination is solely based on the location of their educational history which by implication generally brings into play their national origin," he said in an 84-page written ruling.

 

Assertion over graduate quality struck down

 

Mr Anforth also struck down an assertion by the ACT that ANU graduates were of higher quality and better suited because of "subtle differences" in local practice, calling it "only an assumption".

 

He ruled there was no evidence for the claim, adding that it was "offensive to other domestic and overseas universities and even more so to well-qualified experienced overseas doctors".

 

'Motivated by desire to promote medical school'

 

Mr Anforth said the policy appeared to be largely driven by "a motivation to promote the economic and academic viability of the ANU Medical School" and a misunderstanding of discussions at a meeting of the Council of Australian Governments.

 

He said the policy was "intrinsically discriminatory on the basis of race" and robbed the people of the ACT of access to experienced overseas practitioners and the best graduates from Australia and the globe.

 

Informed that the IMG category has since been removed, Mr Anforth ruled this only made the policy more discriminatory because it means overseas trained doctors aren't considered at all.

 

Awarding Dr Wang $40,000, he said the former neurosurgeon had suffered "considerable anxiety, embarrassment and humiliation".

 

Not over yet

 

The ruling is the most substantive development in the case's long history.

 

At one point, following an interim decision in Mr Wang's favour, the ACT appealed to the Supreme Court to have Mr Anforth recuse himself for perceived bias.

 

The ACT alleged Mr Anforth had a direct personal interest in the case after he was overheard discussing discrimination in the medical profession with a witness.

 

He allegedly told the witness that a medical college in which his daughter was involved had been criticised for discriminating against women and against those tutored by overseas-trained specialists.

 

Mr Anforth dismissed the bid, saying he was required to "have an open mind to the issues, not an empty mind".

 

The ACT Supreme Court rejected the application and Dr Wang's case was re-heard after the interim decision was quashed.

 

ACT expected to appeal

 

Yet the latest decision is unlikely to be the final development. Bill Madden, a prominent medico-legal expert, says he expects the ACT to appeal the verdict.

 

The decision could have flow-on effects for intern selection policies elsewhere, he says, but it's too early to say.

 

For a start, the option is open to the ACT to amend relevant legislation to exempt medical selection policies from discrimination provisions.

 

 

Related link

The decision: Wang v Australian Captial Territory (Discrimination) [2016] ACAT 71


Ontario has NO MONEY to hire more physicians.

Posted by imdontario on December 5, 2015 at 11:05 PM Comments comments (0)
Society For Canadians Studying Medicine Abroad Meeting To Discuss More Closing Doors

In explaining its failure to endorse training for any physicians in Canada, Ontario stated it had no money to hire more physicians. If all the provinces had done what Ontario had done and endorsed 0 Statements of Need, the doors to American training would be closed.

VANCOUVER – The Society for Canadians Studying Medicine Abroad will be meeting on December 15 to address the growing barriers that face international medical graduates when they attempt to return to Canada to work as resident physicians.

In March, 2015 Health Canada announced that there were approximately 4.6 million Canadians without a family doctor. The Society for Canadians Studying Medicine Abroad (SOCASMA) has been told that we cannot train more doctors to meet our needs because of a shortage of funding and training manpower.

The cost of graduating one medical student costs the government about $400,000. The cost of salary and education costs to train a resident physician is on average about $72,000.

In Canada, (Quebec excepted) international medical graduates, whether Canadian born or immigrant physicians, are prohibited from competing for residency physician positions against Canadian medical school graduates. There are comparatively few positions for international medical graduates to work and train as resident physicians in Canada. As a result, many Canadians who graduated from reputable international medical schools go to the USA to obtain their practical training which enables them to return to Canada to practice medicine. This training costs Canada nothing.

In order to train in the USA, a Canadian must get an endorsement called a Statement of Need from Health Canada which states that there is a need for him/her when (s)he finishes his/her training. Despite recognizing that 4.6 million Canadians are without a family doctor, Health Canada has restricted the endorsements for family doctors to 295 in 2016.

The number of endorsements is arrived at by adding together what each province and territory advises is its estimated physician need.

Of the 295, British Columbia endorsed 280. The remainder of 15 were endorsed by the rest of Canada. Ontario refused to endorse any physicians. Doctors of Ontario states that there are over 900,000 Ontario residents without a family doctor. In explaining its failure to endorse training for any physicians in Canada, Ontario stated it had no money to hire more physicians. If all the provinces had done what Ontario had done and endorsed 0 Statements of Need, the doors to American training would be closed. Canada’s access to fully trained physicians would be significantly reduced.

Despite British Columbia endorsing 280 Statements of Needs for family physicians, B.C. can only expect to see a small fraction of these physicians. Health Canada provides Statement of Needs endorsements on a first come first serve basis regardless of the province in which the applicant intends to practice. Because most Canadians who study abroad are from Ontario, many of the 280 Statements of Needs requested by British Columbia will be issued to Ontario residents who intend to return to practice in Ontario. Further, Health Canada estimates that at most 20% of Canadians who train in the U.S. return to work in Canada.

The Society for Canadians Studying Medicine Abroad (SOCASMA), an organization that advocates for access to residency training for all Canadians with competition being based on merit, opposes the government restricting Canadians’ access to American training.

SOCASMA will host a meeting on Tuesday, December 15, 2015 at 6:45 pm. at the Arbutus Club at 2001 Nanton Avenue in Vancouver.


Only 6 percent of IMGs immigrants can practice in Canada

Posted by imdontario on June 17, 2015 at 11:05 PM Comments comments (0)

"The success rate of international medical doctors who wish to pursue a career in medicine is six per cent, according to researchers at St. Michael’s Hospital in Toronto."

http://www.asianpacificpost.com/article/6977-bridging-program-gives-hope-foreign-trained-medical-professionals.html

 

New Canadian Media

Special to The Post

 

Like many immigrants, Sadia Sohail was looking forward to starting a new life in Canada when she moved here with her young family in 2000.

“Pakistan was a troubled country. I didn’t want to raise my children in that political environment,” Sohail says. “Safety was a huge thing for us, and we felt it was important to raise our children in an atmosphere where we could be ourselves, really.”

The family settled in Mississauga, and Sohail planned to continue working as a pediatrician. “I came with an open mind. I’m such a go-getter. I thought I’d get back into medicine as soon as possible,” she says.

Instead, Sohail received a rude awakening within months of arriving. She was told her medical qualifications were the equivalent of a Bachelor of Science degree here. Sohail knew the road to practising as a doctor in Canada would be a long one, but she didn’t expect it to have as many bumps as it did.

Since she needed to provide a secondary income for her household, Sohail enrolled in an ultrasound program at a technical institute and began work as an ultrasound technician. She spent her evenings and weekends preparing to write medical board exams. Three years and $12,000 later, Sohail was elated to have passed the exams.

Now, one final step was needed to complete her equivalency process: residency.

It has proven to be the most challenging aspect. Sohail has been seeking residency since 2013 through theCanadian Resident Matching Service, which opens residency to international doctors twice a year.

“I’ve applied four times and haven’t gotten a single response for an interview. It’s disheartening. You wonder: why is this?” Sohail questions.

 

Bridging the gap

 

The answer that her mentors told her was that she was missing clinical research, and some experience in this would increase her chances of obtaining residency. To familiarize herself with research, Sohail enrolled in theInternational Trained Medical Doctors (ITMD) bridging program at The G. Raymond Chang School of Continuing Education at Ryerson University, which launched last December and began earlier this year.

Through the program, Sohail learned the fundamentals of research methodology and familiarized herself with clinical research in Canada. She also participated in a clinical placement at The Hospital for Sick Children (SickKids), which helped her begin volunteering on a research project with Toronto Public Health.

“I feel like I’m making a huge difference with the projects I’m working on,” Sohail says. “I’m doing a project now on homeless mothers and their babies, so it’s bringing me back to what I love most.”

She acknowledges this volunteer research experience isn’t a direct entry into medicine, but she says it’s bringing her closer to her goal. It’s also made her consider a possible career in clinical research. Sohail says participating in the ITMD program and volunteering in research has been empowering.

Participants from the first cohort of The Chang School’s ITMD bridging program graduated earlier this month. The 14 participants are from 10 countries and have varied backgrounds in the medical profession, as the program targeted internationally trained physicians, dental surgeons and clinical public health professionals.

 

A starting point

 

The success rate of international medical doctors who wish to pursue a career in medicine is six per cent, according to researchers at St. Michael’s Hospital in Toronto.

“This represents a lost opportunity for our province to benefit from the advanced academic and professional credentials of these highly skilled professionals,” explains Dr. Marie Bountrogianni, Dean of The G. Raymond Chang School of Continuing Education.

The program was founded to help internationally trained professionals find non-licensed health-care jobs in Ontario. Shafi Bhuiyan, an internationally trained doctor who is a distinguished visiting professor with The Chang School and Faculty of Community Services, initiated the program. According to his research, Toronto has 6,000 internationally trained doctors who are working survival jobs.

“I’m also a newcomer to this country. I don’t have anybody,” says Bhuiyan, who knows the difficulties of navigating professional systems as a newcomer. “Many immigrants come here and don’t know where to go. Some people say: drive [a taxi], or become a security guard. They’re frustrated.”

Bhuiyan says licensing for international doctors is an expensive and lengthy process, with no guarantee of obtaining a residency. Because the medical system is not absorbing these professionals, the ITMD bridging program’s goal is to lead these professionals to non-licensed careers, which are in demand, such as project managers, research managers and analysts in the health-care industry.

“If we can involve [internationally trained doctors] in a non-licensed area of the medical field, they will be happy,” Bhuiyan says. “A bridging program is not the solution. It’s a starting point.”

At The Chang School, a recruitment committee scored applications out of 100 based on the applicant’s letter of intent, health and research experience, academic degrees and qualifications and English communication scores.

“Our plan was to start with 10 people and nearly 180 people applied for the program. We found 36 very strong people who scored well and were interviewed, and from that we offered 14 students to join the program and all of them accepted,” Bhuiyan says.

The 11-week program, which took place daily in the evenings, included a four-week volunteer clinical placement. Topics covered in the curriculum include: health research, project management, data management in health care, professional communication and workplace culture.

By the completion of the program, three graduates received job offers and six received an extension to their volunteer clinical placements.

Bountrogianni says the next cohort of the ITMD bridging program will begin in fall 2015 and that there has been a 50 per cent increase in applications for the program’s 15 spots.

 

Knocking down doors

 

The 15-year journey in pursuing a medical career in Canada has taken a toll on Sohail and her family – and it isn’t over yet.

When Sohail moved to Canada with her young family, she was pregnant and had a two-year-old toddler. Now, her children are teenagers.

“My children – all they’ve seen growing up is their mother studying,” she says. “My routine has been very hectic and because I work, my evenings are dedicated to studying. My family is extremely supportive, but it seems like there has to be an end to this.”

Despite being open to relocating and applying for residency positions across the country, Sohail is yet to hear a response, but she maintains her optimism.

“I still don’t know if I’ll be able to get residency in Canada, but I will keep trying. I will knock on 100 doors and I hope that finally one will open.”

 

This is part one of a series of profiles of graduates of the Internationally Trained Medical Doctors program. This article first appeared on ww.newcanadianmedia.ca. See www.newcanadianmedia.ca/item/27796-bridging-program-gives-hope-to-foreign-trained-medical-professionals


A Sad place - Past, Present and Future

Posted by imdontario on March 21, 2015 at 12:25 AM Comments comments (0)

http://www.cfp.ca/content/61/3/205.full.pdf+html

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The latest data available from the Canadian Resident Matching Service indicate that only 6% of immigrant IMG applicants were successful in obtaining one of these sought-after training positions.....

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Historically, international medical graduates (IMGs) have played an important role in maintaining Canada’s medical work force. Approximately 25% of Ontario doctors are IMGs.1 In some provinces, such as Saskatchewan and Manitoba, the numbers are higher.1

However, the contribution of foreign-trained doctors to the net increase in practising doctors from 2000 to 2007 was a modest 8% in Canada, compared with 55% in the United States and 92% in Ireland (Figure 1).1,2 In 2012, Canada had 2.44 physicians per 1000 people, well below the Organisation for Economic Co-operation and Development (OECD) average of 3.4.2 In 2007, Canada had 6.2 medical graduates per 100 000 people, well below the OECD average of 9.9 (Figure 2).1

In the past, IMGs typically immigrated to Canada under the Federal Skilled Worker Program. Recently, the federal government has closed this door by removing physicians from the list of eligible professions.3 While this will shift the future medical landscape in Ontario by virtually eliminating newcomer physicians from the immigration mix, there still exists a substantial backlog of immigrant IMGs in Canada who have not been able to achieve licensure. In most cases, IMGs must complete a postgraduate training program to be licensed in Ontario. Some provinces, such as Saskatchewan, Manitoba, Nova Scotia, and Newfoundland and Labrador, allow some IMGs to start practising with limited licensure without going through a postgraduate program. The shortage of training positions has meant that many IMGs have been unable to retrain.

Ontario more than doubled training positions for IMGs from 90 positions in 2003 to 200 positions in 2004.4 George Smitherman, the Minister of Health and Long-Term Care at the time, announced: This is a win-win for this province .... Foreign- trained doctors will be able to practice in their new home, as they want and are trained to do. And Ontario patients will have better access to doctors in their own communities.5 The situation now is dramatically different.

While these 200 positions still exist, the latest data available from the Canadian Resident Matching Service indicate that only 6% of immigrant IMG applicants were successful in obtaining one of these sought-after training positions compared with 23% in 2008.6 There are now new players in the game. More than 4000 Canadian citizens are studying undergraduate medicine abroad.7 These Canadians studying abroad (CSAs) are studying in various medical institutions. These are mostly Caribbean-based schools without affiliated clerkship or residency positions or opportunity to practise in the country where the school is situated. Even European and Australian medical schools do not provide CSAs with opportunities for postgraduate training. It appears that the mandate of most of these schools is to profit from largely North American trainees. They do not absorb these students into their own hospitals; instead, they send them mostly to the United States or the students’ countries of origin for clerkship and residency. More than 90% of CSAs intend to return to Canada to pursue postgraduate medical training and more than 87% intend to practise medicine in Canada.7

The current policies have these CSAs competing in the same pool as the immigrant IMGs, and the CSAs are gaining ground. In 2011, CSAs represented approximately 25% of the IMG applicants and obtained more than 50% of the first-year IMG residency positions in Ontario.6 Selection process The IMG selection process is expensive and onerous. Based on an unpublished literature search we com- pleted, the process of selecting residents includes file review; completing short structured interviews; completing standardized tests such as the United States Medical Licensing Examination and objective structured clinical examinations; and providing let- ters of recommendation and personal statements. Nevertheless, there is little or no evidence that any of these selection modalities, alone or in combina- tion, are able to identify the best candidates. Despite this onerous selection process, IMG candidates have a substantial and consistently higher failure rate on the College of Family Physicians of Canada Certification Examination in Family Medicine than residents from Canadian medical schools.8 Commentary International medical graduates Past, present, and future

Alan A. Monavvari MD MHSc CCFP CHE Colette Peters PhD Perle Feldman MD MHPE CCFP FCFP This article has been peer reviewed. Can Fam Physician 2015;61:205-8 La traduction en français de cet article se trouve à www.cfp.ca dans la table des matières du numéro de mars 2015 à la page 214. Vol 61: march • mars 2015 | Canadian Family Physician • Le Médecin de famille canadien 205

A recent independent review of the IMG selection process in Ontario suggests, Comprehensive research to support an evidence- based approach should lead to a reexamination of many current techniques [of IMG selection]—or at least reconsideration of the weight to be attached to them.6


Many program directors use recency of graduation and medical practice as the main predictors of success during residency. Overall, 78.8% of immigrant IMG applicants versus 2.3% of CSA applicants graduated in 2004 or earlier.6 This is a distinct disad- vantage for the IMGs, who might not have been able to practise for some time while they settled in Canada and wrote the necessary examinations.

It can also be argued that the current process, with its emphasis on examina- tion scores, favours examination and memory skills per- haps more easily accessed by younger and more recent graduates. Finally, the only evaluation of interpersonal skills is in a North American–style job interview. Without training in cross-cultural interviewing skills, interview- ers are more likely to choose the CSAs, who more closely resemble them culturally.9,10

Perhaps some weight should be given to the diversity and experience that IMGs bring to the Canadian health care system. Perhaps we should show some compassion toward our colleagues who are often here escaping war and persecution. If the CanMEDS roles (medical expert, communicator, collaborator, manager, health advocate, scholar, and professional) are the criteria we currently use to define a good physician,11 then the selection process should reflect these criteria. Currently the process is heavily weighted to the medical expert role. Access to medical education The increasing number of CSAs in Ontario residency positions has implications for residency programs and the size of the physician work force.

At first glance, out- sourcing undergraduate medical education might appear cost efficient, but it relinquishes control of medical edu- cation to enterprises that are not accredited to Canadian standards and have no stake in the Canadian health care system. If we continue to rely on immigrant IMGs, with their different education and cultural backgrounds, per- haps selection criteria based on CanMEDS roles could improve their success rate. This will be a challenge for those who train immigrant IMGs, as they might require more resources for selection and integration. We can also increase the capacity of our own medical schools to the current OECD standard but this requires more financial and human resource investment. Why not create an accredited Canadian for-profit medical school?

Perhaps the main question is not primarily financial but more about our Canadian values: Who should have access to medical education? Not all Canadians have the substantial financial resources CSAs require to fund their own undergraduate medical education abroad. Does this disadvantage Canadians who cannot afford the, on average, $175000 to $200000 in tuition for one of the offshore medical schools?7 At the moment, we have immigrant IMGs with the legitimate desire to practise medicine who cannot access postgraduate training positions and CSAs who cannot access undergraduate medical education in Canada. They return to Canada to compete for training positions originally intended for immigrant IMGs, and offshore medical schools profit from this dynamic.

We also have a third group of Canadian medical graduates who believe the current reserved IMG residency positions are opportunities taken away from them. Both CSAs and immigrant IMGs might not have been fully informed as to their true chances of gaining a training position and licensure in Canada. The previous federal immigration policy encouraged applications from physicians from other countries, which led immigrant IMGs to expect to practise their profession when they arrived. The disconnect between the federal immigration policies that enticed physicians and the provincial licensing policies they faced once they arrived has been addressed by removing physicians from the list of desirable professions; yet, the backlog from previous policy still exists.

Canadians studying abroad have also been lured by advertising from foreign medical schools, which do not alert potential students to the shortage of Canadian residency positions. This situation has created unanticipated consequences for both CSAs and immigrant IMGs, and possibly for the size of the physician work force in the near future. We believe that action is needed, and that we need to consider whether it is time to invest in educating our own country’s future physicians. Questions about the future As a country of immigrants, do we have obligations to physicians who have already immigrated to Canada in terms of access to training?

We invite the readers to reflect on these issues. Does Canada want to improve its physician-to- population ratio and increase the number of medical student positions to the OECD average? If so, how do we best achieve this? Should we create new Canadian medical schools or enlarge existing ones? Could this provide a more equitable chance for Canadian candidates to become doctors, and also to ensure high- quality training?

If we want to increase the medical work force without increasing our training capacity, do we want to rely on immigrant IMGs?

If so, do we value the diversity and experience that immigrant IMGs bring to our health care system? If we do, should we maintain the residency positions originally created for immigrant IMGs? If we should, how do we make sure we are not depleting developing countries of their physician resources and how do we make sure every qualified immigrant physician has a fair chance to practise medicine? Vol 61: march • mars 2015 | Canadian Family Physician • Le Médecin de famille canadien 207

 If the answer to increasing the physician work force is to use CSAs, how can we provide an equitable chance for all to practise in their native country? Should we provide them opportunities to reintegrate sooner at the clerkship level or provide more postgraduate positions?

If the answer is to have both immigrant IMGs and CSAs, we should have a residency selection process that reflects the values of fairness and transparency while ensuring high-quality care for the population. We then need to establish an effective, evidence-based selection process that reflects all the CanMEDS roles. It might require rigorous research to identify the predictors of success. Conclusion The system we have now seems cumbersome and unfair. We must seek a solution to improve it for stu- dents, immigrant IMGs, the medical system, and—most important—patients.


Dr Monavvari is Chief of Family Medicine at Markham Stouffville Hospital in Ontario. Dr Peters is Research Associate at Queen’s University in Kingston, Ont. Dr Feldman was Residency Program Site Director at North York General Hospital in Toronto, Ont, at the time of writing.Accessed 2015 Jan 21.


Foreign medical grad finds Ontario system tough to crack

Posted by imdontario on February 28, 2015 at 5:55 PM Comments comments (0)
Foreign medical grad finds Ontario system tough to crack


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Anupam Apu is good enough to be an immigrant but not a doctor.

 

He is one of more than 6,000 international medical graduates in Ontario dealing with the daily frustration of knowing their chances of becoming practising doctors are slim to none.

 

The 36-year Bangladesh native thought that when he ticked the box for general physician as a preferred career on his immigration application, he would have a chance to continue in his field.

 

But both Apu and his wife, Homayra Ferdous, also a medical graduate from Bangladesh, soon found the deck was stacked against them because of the limited number of international medical graduates certified annually for medical residency positions in Ontario.

 

Before leaving for Canada almost four years ago, Apu said he was in the early stages of training in neurosurgery.

 

“It is discouraging actually,” he said in an interview, outlining the roadblocks in a system that “definitely” looks down on medical graduates from his country, even though he says his medical degree is recognized in England.

 

Apu’s story resonates for “a lot of folks out there,” said Ontario fairness commissioner Jean Augustine.

 

She has been urging the Liberal government to consider a “practice ready assessment” system similar to the ones in Alberta and Newfoundland, where foreign-trained doctors get a provisional licence and work under supervision to determine their level of competence.

 

“We have made that recommendation to government . . . but I don’t think anybody is listening,” Augustine said.

 

Apu is frustrated as well. “If a person could be assessed in a workplace, then it would be much easier for that person to get into the system.”

 

Augustine’s dismay with the current system of certifying foreign-trained doctors follows an announcement earlier in the week in which the College of Physicians and Surgeons of Ontario reported the highest number yet of international medical graduates being certified for full practice or residency.

 

But Augustine noted the college failed to mention the majority of the 200 provincially funded residency positions are going to Canadian students who trained abroad and returned to launch their careers, which she said was never the program’s intent.

 

Even so, Health Minister Eric Hoskins said: “We are working hard to train more Ontarians to be doctors and to attract doctors from across the country and around the world . . . The number of international medical graduate residency spots in Ontario has more than doubled, from 90 to 200.”

 

Apu, who graduated with a bachelor of medicine and surgery, said he and his wife made inquiries soon after arriving but quickly learned it would cost $4,000 or more to take four exams before being able to apply to the international medical graduate program. And even then there were no guarantees.

 

“They virtually told me not to pursue as a general surgeon because there were almost (no positions). So spending all that money and then with no guarantee I would get it didn’t sound nice to me,” Apu said. In the meantime he and his wife have decided to take exams to get into a U.S. residency program.

 

“It is a very level playing field (in the U.S.),” said Apu, who works as an assistant to a family physician in a practice where he says just about all the other doctors completed their residencies in other provinces.

 

Despite Ontario’s seemingly impervious system, Apu said he still feels there is a place for him and will write the eligibility exams if he can find the money.

 

“I do want to keep my channels open everywhere,” he said.

 

Foreign-trained doctors coming to Canada often end up with a “sense of betrayal,” said Tanya Chute Molina, a program adviser in the fairness commissioner’s office.

 

“The system for skilled immigration sends the message that doctors or other professionals are wanted and needed, and that there will be jobs available, so (applicants) don’t anticipate the challenges with licensing.”

 

Toronto Star


Prospects not entirely rosy for foreign-trained MDs

Posted by imdontario on August 28, 2014 at 9:00 AM Comments comments (0)

Prospects not entirely rosy for foreign-trained MDs, says fairness commissioner

Ontario Fairness Commissioner Jean Augustine says things are anything but rosy for foreign-trained doctors trying to break into Ontario.

According to 2011 StatsCan figures, she said there are 6,540 IMGs living in Ontario, many of whom are left without a hope of ever practicing medicine in the province.

By: Richard J. Brennan Provincial Politics, Published on Wed Aug 27 2014

Ontario’s Fairness Commissioner Jean Augustine says things are anything but rosy for foreign-trained doctors trying to break into Ontario.

Augustine on Wednesday took particular exceptions to an overly “rosy and glowing portrait” in a report earlier this week by the College of Physicians and Surgeons of Ontario bragging that a record number of international medical graduates (IMG) were either being accepted into residency programs or being certified to open up their own practices.

Augustine said a further look at the numbers show that a small percentage of foreign-trained doctors are being accepted into 200 government-funded IMG residency positions. Instead, many are being given to Canadians who have trained offshore and want to return to Ontario, which, she says, belies the original intent of the program.

According to 2011 StatsCan figures, she said there are 6,540 IMGs living in Ontario, many of whom are left without a hope of ever practicing medicine in the province.

“I would make the argument that many of them would like to have continued to work as doctors,” she told the Star, adding that she will be taking up her concerns with the health ministry about access to residency programs.

The College of Physicians and Surgeons of Ontario in its 2013 report stated that more foreign-trained doctors than ever before were certified to practice medicine in the province, eclipsing the Ontario graduates for the 10th year running.

Augustine said the issue now is how the province can make it possible for “qualified applicants” to make their way into the medical system.”

One of those is 45-year-old Syed Jaffery, who trained in India and the United Kingdom and practiced medicine in the Middle East.

Jaffery said, at his age, writing all kinds of exams and four years of residency for family medicine with no guarantee at the end of it is not worth it.

“For me there is a brick wall . . . because they don’t need specialists here,” said Jaffery, who is trained in general surgery.

“They said that homegrown surgeons are waiting to get in and that the infrastructure does not support foreign-trained surgeons to get into the system. And that they won’t be needing my services here,” said Jaffery, who has lived in Canada for more than two years.

A Fairness Commission report from 2013 reported that in recent years a disproportionate number of the residency positions designated for IMGs were granted to Canadians who study medicine abroad (CSAs).

The report stated that in 2012, 59 per cent of all residency positions matched to international medical graduates went to CSAs, and only 34 per cent went to immigrant physicians from countries other than the United States. Of the 1,265 immigrant physicians applying for residency, only 83 were successful.

The CSAs, the report stated, have natural advantages because of language and familiarity with the Canadian health-care system, and noted that “the imbalance between applications and number of positions available results in high exclusion rates.”



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