The Current - Getting foreign-trained doctors to work, faster

Episode Date: October 10, 2024

It takes 18 months for a foreign-trained doctor to be licensed to work in Canada, but a new plan in Nova Scotia aims to cut that time to just 12 weeks. Experts hope that getting these physicians to work faster can help the millions of Canadians who don’t have a family doctor.

In 2017, it felt like drugs were everywhere in the news, so I started a podcast called On Drugs. We covered a lot of ground over two seasons, but there are still so many more stories to tell. I'm Jeff Turner, and I'm back with Season 3 of On Drugs. And this time, it's going to get personal. I don't know who Sober Jeff is. I don't even know if I like that guy.

On Drugs is available now wherever you get your podcasts. This is a CBC Podcast. Hello, I'm Matt Galloway, and this is The Current Podcast. Akash Kumar Mishra is a doctor from Nepal, moved to PEI last year with his wife and baby. He knew it wouldn't be easy to retrain as a doctor here in Canada, but he struggled to find any job, let alone get into any kind of training program for foreign doctors. I thought that, yes, I am a qualified doctor there.

Yes, I cannot be a doctor immediately after moving to Canada. That is completely understandable. I knew that my dreams had been shattered completely. I have some potential. I've been working in the critical shattered completely. I have some potential. I've been working in the critical care department. I've been working in other sectors. So I definitely have some experience. Let me work.

Let me show my capabilities. Dr. Mishra is one of an estimated 13,000 international medical graduates waiting to be licensed in Canada at a time when more than 6 million Canadians don't have a GP. And so for some, the math is pretty simple. Get those foreign-trained doctors into Canada's medical system quickly. A newly launched program in Nova Scotia is looking to do just that. Joining me now is Dr. Gus Grant.

He is the registrar and CEO of the College of Physicians and Surgeons of Nova Scotia, and this week, they unveiled a plan to speed up licensing for internationally-trained doctors with a first-of-its-kind clinic. Dr. Grant, good morning. Good morning. Right now, how long does it take for an internationally trained doctor to have their skills assessed and get licensed to practice in Nova Scotia? Oh, it depends on where you start the clock from, Matt. But typically, the rate-limiting step for internationally trained physicians has historically been whether they pass Canadian exams. The challenge, though, is – the problem, though, is that for a mid-career physician, a high-stakes point-in-time exam such as that offered by the Royal College or the College of Family Physicians, it's the wrong tool to measure whether a physician

is competent or not. So your question is about time, but really what's been wrong with our system, if you will, is the candidates coming internationally have had to go through a pipeline to get to those examinations. And the examination really isn't the best marker for competence of a mid-career physician. And so tell me about this new clinic. I mean, the time is important in part because people are waiting for family physicians and you're looking at years before those internationally trained doctors are able to practice here. How is this new clinic going to expedite the process and provide the right tool? Sure. So the eligible candidates are eligible physicians will work in this clinic being overseen by fully licensed Canadian physicians who are trained in the science of assessment. physicians who are trained in the science of assessment.

This project is a partnership with the Medical Council of Canada who will train and accredit assessors to observe and evaluate the performance of the candidate physicians. How is that different than having to do the assessment? Than doing the testing as you were saying earlier, the wrong tool. Well, it's a high stakes point in time exam designed to be taken by a Canadian learner at the end of their training. It's not the right tool to assess whether an international mid-career physician is competent. Watching a physician practice is a better way to do it. And what we can do in short order, we believe, is that by training people, training physicians to assess these internationally trained physicians, we can compress the time for assessment, compress the time to licensure and licensure competent physicians.

You're looking at compressing it from what, 18 months to 12 weeks? We think the average length of time in the clinic will be around 12 weeks. We think positive outlier physicians, whether they're really superstars or whether they're physicians whose training doesn't really align, will be processed much more quickly. But we think a total of 12 weeks will probably be the average for assessment. When you cut the timeline like that, how do you ensure that the doctors you're licensing are qualified to practice safely to Canadian standards? Well, that's where the science of assessment comes in. And we're grateful for the partnership with the Medical

Council of Canada. And we're grateful for the physician assessors who are going to be doing the work. But that's our job. As the licensing authority, Canadians expect only competent physicians to be licensed, and that's the decision point we have to get to. We're confident that with the evolving and emerging science of workplace-based assessment, we can make safe, defensible decisions quite quickly. How many doctors do you think you'll be able to train and license through this new clinic? I think we're starting small. We're building up space, but we think we'll be able to process up to 45 in the first year and probably significantly more than that when the fully realized clinic is in operation. And how will you ensure that they stay in Nova Scotia? Well, the physicians who go through will agree to a return of service in Nova Scotia for three years. And thereafter, they will enjoy full mobility in the country with full licensure. I'm confident Nova Scotia is a great place to practice.

I think they'll want to stay. We heard from the Canadian Medical Association and the professional organization for doctors in your province, Doctors Nova Scotia, and they're supportive of speeding up licensing. They did express concern that it might not be enough to keep doctors in the province. Let me just read a bit of the statement from Dr. Gad Gobran, who's from Doctors Nova Scotia. We need to ensure that our retention efforts are equally strong and that our province is a welcoming and supportive place for international medical graduates. Continued support post-assessment will be crucial

both for the physicians and their families as they navigate not only a new health system but also cultural and community challenges. That suggests that there is some concern that doctors may come through this and then head elsewhere. I mean, Nova Scotia is a beautiful place to be, but they may want to be somewhere else.

Sure. The fully licensed doctor in Canada can practice anywhere in Canada and can practice really anywhere in the world. So the 3,500 doctors we have in Nova Scotia have chosen Nova Scotia as the best place in the world to practice for them. We're confident that physicians who've gone through our process will want to stay in Nova Scotia is the best place in the world to practice for them. We're confident that physicians who've gone through our process will want to stay in Nova Scotia. But I agree entirely with the sentiment of the quote you read that these physicians need to be supported, onboarded, and help throughout their time here so that set up for success. So they want to stay in Nova Scotia.

I have to let you go, but can I just ask finally why it took so long to get to this point? I mean, Australia does this, Britain does this in different ways. We know that people need primary care. People need doctors. We know that internationally trained doctors are here waiting to work. They're driving taxis. They're working in other jobs because they can't. Why has it taken so long to get to this point, do you think?

I'll push back gently on that, Matt. This clinic that we're proposing is the first of its kind in the world there there is no centralized uh process anywhere that we could find i guess i mean i just australia and britain both have kind of um ways to to train people uh or i guess monitor people as they're being as they're as they're practicing. As has Canada. There are eight provinces in Canada, including Nova Scotia, that have had a practice-ready assessment program. And the one in Nova Scotia has been ongoing for around seven years. The structure and approach of that program, however, didn't allow itself to be scaled up to really address the volume

of physicians we need to assess in order to meet our immediate needs. I appreciate your question, though, because I'm not in any way deaf to the fact that the country desperately and our province desperately needs more primary care physicians. I guess any good idea is always by definition too late. The best time to do something was yesterday. The second best time is today. Thanks very much. Yeah, that's fair. Dr. Grant, good to talk to you about this. Thank you. Pleasure is mine. Thank you.

Dr. Gus Grant is the Register and CEO of the College of Physicians and Surgeons of Nova Scotia. Dr. Stan Kuchar is an independent senator for Nova Scotia, also a psychiatrist, professor emeritus at Dalhousie University, and a co-author of a recent report, Maximizing Medical Talent, How Canada Can Increase the Supply of Family Doctors by 50% Quickly and Cost-Effectively. We've reached him in Halifax. Senator, good morning to you. Good morning, Mr. Galloway. Mr. Galloway, it's Matt, but thank you. I know you're under the weather as well, so I do appreciate you being with us. Okay, Matt, you can call me Stan.

Look at that. It's only fair if I call you Matt, you can call me Stan. All right, we'll do that, Stan. What do you make of Nova Scotia's plan? I mean, again, this seems to meet a need in some ways. What do you make of it? It's a new direction, and if properly executed, I think it can be an improvement on a pathway to licensure for internationally trained physicians. A pathway that we've already had in this province, as Dr. Grant has said, for almost a decade, and pathways that have been in other parts of Canada, again, for almost a decade or longer. parts of Canada, again, for almost a decade or longer. But these pathways, which have already existed, the practice-ready assessment pathway, have been inadequate. They've been insufficient in numbers. They do not meet the demand either for physicians who are waiting to be assessed, and their outputs have been horribly low, while Canadians have been waiting for years and years and years for more primary care physicians. So these programs have been around. There has been

no national program. Each province or territory has done its own thing. Some of them have done better than others. In some places, these programs have been run by dedicated clinicians off the sides of their desks. And what we have needed for some time now is a national program. And should this improved iteration on the old PRA assessment program that Dr. Grant is running prove to actually be a good model, this may be a prototype for the rest of Canada. What do you think the resistance has been to get to this point? Again, we know the need. Is it about bureaucracy? Is it about perhaps not believing that doctors who are trained elsewhere can meet Canadian standards? What's going on here? Gee, you know, I wish I knew the answer to that, Matt. I think

it's complex. The decisions for improving health, human resources in all of health care has been a huge problem across this country. Some of it goes back to the old Bayer and Stard report, which limited the number of medical school slots. So we have been way, way behind the curve in graduating the physicians that we need. And the provinces and territories, frankly, have not stepped up to meet the demand that they knew was there and they knew was going to get worse. And also the federal government has not pushed and used its spending power in federal transfer payments to actually encourage provinces and territories to move more quickly to address this.

Many provinces have created these practice-ready assessment programs, as you've mentioned. In your report, you write that since 2018, only 1,000 internationally trained doctors have graduated from these assessment programs to enter family practice. Why is that number so low? enter family practice? Why is that number so low? Again, we have had a huge demand for these programs. Many physicians who have passed through all the hoops and jumping over all the barriers to get all their exams, get their language proficiency, get their additional training, all the assessments that they've needed. Sometimes it's taken years, as Dr. Grant has stated, only to find that there are no locations, no spots for them.

So we have this huge group of eligible physicians, but the bottleneck has been in enough practice-ready assessment slots. enough practice-ready assessment slots. Now, these have typically taken three months as compared to a two-year residency program, so that technically, when done correctly, these practice-ready assessments can be an extremely cost-effective way of improving the flow of highly experienced and well-trained physicians who are practicing to Canadian standards of care to enter the workforce. It's just that parts of this country have been asleep at the switch for decades. We just have a few seconds left.

The last word would go to those patients, the 6 million plus Canadians who are waiting for a family physician. What do you think the message is to them? If they are waiting for a physician now, What do you think the message is to them? If they are waiting for a physician now, how do you think this could help them? Well, certainly this will be able to move qualified physicians more quickly through a competency-based assessment,

which is what we really need to have, and that if the door is wide enough, we are going to have lots and lots of physicians be able to come through that door and go relatively quickly into licensure, practicing at the level that all physicians in Canada must meet. The threshold will not change.

It will be the Canadian threshold and we will have more doctors. Stan, I hope you're right and we'll follow this along. I'm glad to have you here. Thank you very much. Thank you for having me. Dr. Stan Kuchar is an independent senator for Nova Scotia, co-author of the recent report, Maximizing Medical Talent, How Canada Can Increase the Supply of Family Doctors by 50% quickly and cost effectively. If you are a patient who is waiting for a family doctor or one of those doctors waiting to practice,

we'd love to hear from you. Email us, thecurrentatcbc.ca. For more CBC Podcasts, go to cbc.ca slash podcasts.