Does Canada have a doctor shortage? Or, do we need fast-track licensing of Canadian doctors trained abroad?

• Does Canada have a shortage of doctors, or do we have barriers in getting internationally trained (Canadian) physicians licensed into our heath system?
• India and Pakistan are the top 2 countries when it comes to foreign trained working in the US and UK. Then what are there barriers to licensing these internationally trained Canadian physicians?
• Does our pool of physician resources reflect the diversity of international skills, or representative of our population, similar to other countries like USA, UK, Ireland and others?

May 19, 2023 | Opinion Article | MainstreamCanadian.ca – Canada is respected across the globe for its healthcare research and network of hospitals. However, when we compare ourselves to some of the other G7, or EU countries, the data shows we need to do some strategic rethinking how we enable healthcare diversity.

The Canada Health Act (CHA or the Act) is Canada’s federal legislation for publicly funded health care insurance. The Act sets out the primary objective of Canadian health care policy, which is “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.”

On March 9, 2023, the Honourable Federal Minister of Health, Jean-Yves Duclos, wrote a letter to provinces and territories on the importance of upholding the Canada Health Act and voiced concerns in regards to the recent increase in reports of patient charges for medically necessary services, which must be examined and addressed.

The honourable Federal Minister of Health also emphasized that as “our health care system evolves, it must do so while respecting the Canada Health Act, in order to protect and preserve public coverage for all medically necessary health services.”

Does Canada have enough Doctors/Physicians to enable barrier free access to all Canadians for care and speedy diagnosis?

Global data and statistics reveal that when it comes Canada, we had around 2.35 doctors per 1,000 people with a minimum of 2.01 doctors per 1,000 people in 2000, and as per the latest data on OECD.ORG, as of 2021, the value now is 2.80 doctors per 1,000 people. For comparison, the world average in 2021 based on 12 countries is 3.93 doctors per 1,000 people.  

Israel, New Zealand, Ireland, Australia and United Kingdom are the top 5 countries where the percentage of foreign trained physicians range between 58% to 28% as per international data.

Foreign-trained physicians historically account for about 25 per cent of all doctors, according to data from the Canadian Institute for Health Information, which indicates Canada is behind Israel, Australia or UK when it comes to benefitting from the diverse skills of internationally trained physicians.

significance of diversity in healthcare

In Canada, the top five countries from which international medical graduates (IMGs) were immigrating to Canada were from South Africa, Pakistan, United Kingdom, Nigeria and US. Physicians from other countries like Philippines, Poland, Romania, India and China also emigrate to Canada as per data available on OECD.ORG.

Diversity in healthcare plays a crucial role in ensuring the provision of equitable, high-quality, and patient-centered care. Here are some key reasons why diversity is important in the healthcare field:

1. Improving Access to Care: Diversity in healthcare can help address barriers to access faced by underserved populations. Healthcare providers who understand the specific needs and challenges of marginalized communities are more likely to work in underserved areas, increasing access to care for those who need it the most.
2. Enhancing Cultural Competence: A diverse healthcare workforce can better understand and respond to the unique cultural, linguistic, and social needs of patients from diverse backgrounds Healthcare providers who share similar backgrounds and experiences with their patients can foster trust, improve communication, and provide culturally sensitive care.
3. Addressing Health Disparities: Health disparities disproportionately affect marginalized and underrepresented communities. By having a diverse healthcare workforce, including providers from different racial, ethnic, and socioeconomic backgrounds, there is a better chance of identifying and addressing the root causes of these disparities, leading to improved health outcomes for all patients.
4. Enhancing Innovation and Problem-Solving: Diversity brings a variety of perspectives, experiences, and ideas to the table. In healthcare, this can lead to more innovative solutions, improved patient care, and better health outcomes. Different backgrounds and viewpoints can stimulate creative problem-solving and drive advancements in research, policy, and practice.
5. Promoting Inclusive Research: Inclusive research that encompasses diverse populations helps generate more comprehensive and applicable knowledge in healthcare. Diversity in research participants ensures that findings can be generalized and applied to various patient populations, leading to more effective and tailored treatments and interventions.
6. Strengthening Healthcare Systems: Diverse healthcare teams promote collaboration, teamwork, and learning from one another’s experiences. This enhances the overall performance and effectiveness of healthcare systems, leading to improved patient safety, quality of care, and patient satisfaction.
7. Reflecting Patient Demographics: Patients come from diverse backgrounds, and it is essential for the healthcare workforce to reflect this diversity. Having a diverse healthcare workforce allows patients to see providers who share their cultural, racial, or ethnic background, which can increase patient comfort, trust, and engagement in healthcare.

IF CANADA HAS LESS DOCTORS PER CAPITA, WHY DO INTERNATIONAL MEDICAL GRADUATES (IMG) THEN FACE CHALLENGES?

If we focus specifically on the unique challenges International Medical Graduates (IMGs) face for entry into the Canadian health system, we need to review strategic determinants of innovation and diversity in care delivery. The challenges faced by IMGs encompass a range of factors, including language proficiency requirements, licensing examinations, professional networks, and the need for clinical experience (which in many cases, IMGs bring from their native countries).

The Process and Licensing Examinations:

Besides the need for meeting language proficiency requirements, IMGs must undertake a series of licensing examinations to practice medicine in Canada. The Medical Council of Canada Evaluating Examination (MCCEE), the Medical Council of Canada Qualifying Examination (MCCQE), and the National Assessment Collaboration (NAC) Examination are some of the mandatory tests that evaluate medical knowledge and clinical skills. These examinations are rigorous and demand thorough preparation.

Challenges and Barriers:

IMGs spend years to adequately prepare for these exams and access study materials, review medical textbooks, and enrol in preparatory courses specifically tailored to these exams. However, while they are able to pass these exams, they still are not able to secure a spot to begin clinical practice.

According to a CBC News report, the number of international applicants to residency positions has fallen steadily from 2,219 in 2013 to 1,661 in 2022 — a drop of 25 per cent in just a decade. Some foreign-trained doctors are giving up on Canada because the process is so difficult.

The general perception amongst the IMGs is that while in the US, UK or Ireland, the system of examinations and licensing helps IMGs get into the system, the process in Canada is very challenging in comparison.

One key aspect of Canada Health Act requires reasonable access to health care services without undue delay or geographic barriers. It aims to ensure that Canadians can obtain necessary medical care in a timely manner, regardless of where they live

And here we have situations in Canada, where we have to wait for up to 5-6 hours in Emergency due to shortage of staff, challenged capacity and lack of hospital beds and/or delays in getting diagnostic exams completed. One wonders then, why can’t these experienced IMGs, who in majority of the cases are either Canadian Permanent Residents or Canadian citizens, still struggling to enter into our health care system?

How are the USA, New Zealand, Ireland, UK or Australia willing to accept foreign medical credentials and integrate IMGs into their healthcare system?

Isn’t the basic premise of all these medical schools and universities is to teach and train upcoming physicians how to deliver care based on evidenced-based medical literature, which tends to follow same principles and guidelines across the globe?

The top 5 countries from where IMGs come to Canada, have wide network of healthcare facilities, public health network and system of medical schools and universities recognized by WHO and other competent licensing bodies in other countries.

Two key questions that need to be considered are:

• Why can’t Canada follow the same guidelines and remove the entry barriers to Canada’s own IMGs who are Canadian citizens or permanent residency holders.
• Why do IMGs have to think about working as Physician Assistants, Sonographers, or manage the cash register at dollar store, or even drive Taxis?

enabling a diverse health intelligence strategy – path forward

In Canada, we have a unique opportunity due to the diverse nature of our population. In 2021, more than 8.3 million people, or almost 1/4 of the population, were or have ever been a landed immigrant or permanent resident in Canada.

The Federal Government and the Provinces need to devise a strategy, and put timelines in place that identifies this doctor shortage challenge as a key mission, and put forward an implementation plan. What Canada needs isn’t just more seats in medical schools, Canada already has doctors (IMGs), all they need is a similar system for entry in our healthcare system, like what USA, UK, Australia, Ireland and others are doing.

As of June 2022, approximately 4,300 permanent residents were admitted under the health care streams of the time-limited Temporary Residence to Permanent Residence Pathway. The temporary resident to permanent resident pathway closed on November 5, 2021

So the discussion goes back to the primary question, does Canada have a doctor or physician shortage? The available data says a thousand words, doctors (IMGs) are available, and it is now time we seriously consider a framework that enables the licensing of IMGs in the same manner how other countries have done successfully. We need to invest in delivering fast and diverse care options to our population.

The world can learn from us how we implement diversely integrated, intelligently accessible and innovative care, let’s show the world we can do it!

This opinion piece is provided by Dr. A.M Ahmed, a global speaker and thought leader on value-based care, and care innovation leveraging Artificial Intelligence. The writer is a physician with double masters in business administration, management information systems, and attended Harvard’s International Physician Leadership Program. Dr. Ahmed provides guidance and roadmap development to care providers across the globe. Dr. Ahmed is a resident of Ontario, Canada and works for a global healthcare technology solution provider in a senior leadership role. Read his other article on Precision Health Intelligence and what it means for Canada.

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