The college is expanding a program called the Practice Eligibility Route, which can take years off the time it takes an internationally trained doctor to be approved to practice in their field. Michaela McKenzie / The Canadian Press
The Royal College of Physicians and Surgeons is making it easier for internationally trained specialists to work in Canadian hospitals as it responds to the country’s shortage of doctors and complaints that some of its policies discriminate against people with medical degrees abroad.
The college, a regulatory body that sets national standards for doctors who specialize in areas such as surgery, cardiology and emergency medicine, has come under pressure to streamline the way it evaluates foreign-trained doctors and determines their eligibility to write certification exams. Accrediting these doctors to work in Canada has become a critical issue as the country’s health care system has been strained by pronounced staffing problems.
Glenn Bandiera, the college’s executive director of standards and assessment, said the regulator is is working to remove barriers to the licensure of internationally educated physicians by increasing its capacity to review their applications and qualify them for examination. Once those changes are complete, he said, the college plans to provide more flexibility for foreign-trained physicians who do not meet all of the Canadian requirements to work in their disciplines. It will do this by allowing them to apply their learning to more general disciplines, he said.
The college is also expanding a program called the Practice Eligibility Route, which can take years off the time it takes an internationally trained doctor to be approved to practice in their field. The college, which certifies all specialists in Canada except family physicians, says this pathway could allow doctors to be licensed to work in just two years instead of seven.
“We want to make it as easy as possible for people who have that competency to demonstrate that competency, regardless of where they trained,” Dr. Bandiera said. “We are really aware of the current health human resource strains in the system.”
A Globe and Mail investigation has revealed that Canada is increasingly losing doctors to other developed countries because of a shortage of postgraduate specialties for internationally trained medical graduates, as well as long delays in evaluating their training.
In most provinces, medical specialists graduated from outside Canada or the US cannot be licensed until they have completed five years of practice in their fields, at least the last two of which are in Canada. The new alternative route developed by the college will reduce the five-year requirement to 12 weeks, or to two years if the applicant needs more time.
Similar practice assessment programs are already being used in seven provinces to allow internationally trained specialists in family medicine, psychiatry and internal medicine to enter the workforce more quickly – although these programs are capacity-limited and add only about 120 doctors to the country’s medical system every year. Ontario recently announced plans to develop its own assessment program, which it had previously scrapped as a cost-saving measure.
Dr. Bandiera said the college will use the same approach that puts internationally trained doctors under 12 to 16 weeks of observation in clinical settings to determine if their training meets Canadian standards, for a number of specialties that do not have evaluation programs. This will mean international doctors will spend less time working with limited or temporary licenses and will allow them to help address staff shortages more quickly, he said.
The regulator told The Globe it would take three to five years to make the Eligibility to Practice pathway available in all 64 specialist disciplines it oversees. The program is now available in about 20 disciplines and had 250 applicants last year. It is administered by the college, but expansion will require cooperation and some funding from provincial health ministries, Dr. Bandiera added.
“The mechanisms are already in place. We want to tie them together in a unified, standardized approach across Canada,” he said. “In some jurisdictions, it will be necessary to identify resources and capacity to carry out this assessment.”
Clinical assessment programs, while offering entry to more internationally trained physicians into the Canadian system, are not without their detractors. British Columbia recently announced it will triple the number of positions in its workplace assessment program to 96 by March 2024 – but only for people with two years of residency training. Many states offer only 18 months of training to their doctors, with longer periods of clinical training – experience not recognized by the BC program.
Rosemary Pawliuk, a lawyer and president of the Society of Canadians Studying Medicine Abroad, an advocacy group, said internationally trained doctors who want to practice in Canada still face significant barriers. They experience massive discrimination from a system designed to benefit Canadian medical school graduates and protect the interests of the country’s medical schools, she said.
Doctors who have to deal with these hurdles include thousands of Canadians who attended medical schools abroad, she said. They must compete for a separate and much smaller residency stream if they want to return home to practice medicine or spend years longer than local graduates proving their ability to work as specialists, she said .
Canadian regulators argue that all of these barriers are necessary for protection Canadians, Ms. Pavlyuk said. But she argues that the dangers to Canadians who cannot access timely health care due to a shortage of doctors are much more serious.
“This narrative of competence is so powerful. But people should be judged on their individual talents, not on where they graduated from,” she said. “That’s why we have to ask: Is this really about protecting the public or the profession?”
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