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Friday, January 28, 2022

Opinion: Canada’s discriminatory barriers to foreign doctors persist

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Doctors trained abroad, who were quickly relocated to Canada, were forced to go to court to try to remove discriminatory barriers to practice.

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After nearly three years, there was some faint hope last July that Canadian medical students who studied abroad might finally get their day in court to argue that the discrimination they face in becoming medical practitioners in Canada is unconstitutional.

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Canadians who have studied abroad are among a broader group of physicians trained abroad that includes physicians and surgeons designated in Canada as permanent residents to help alleviate the long-term shortage.

More than two years ago, five of these other International Medical Graduates (IMGs) filed a separate complaint with the Human Rights Tribunal of British Columbia arguing that Canadian medical graduates had been privileged to receive licensure. Among the forms of unequal treatment they refer to is “contract servitude.” Among them are an anesthesiologist, an oncologist, and an emergency medicine specialist. No date has been set for their hearing yet.

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Discrimination begins with the exclusion of foreign-trained physicians from competing for all hospital resident positions covering more than 200 specialties. Alternatively, each year, approximately 1,000 IMGs can apply for 58 positions in family medicine, internal medicine, psychiatry, and pediatrics.

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Then, the qualifications they need to apply are more stressful than those of Canadian medical school graduates.

What’s different, however, is what IMGs call “contractual slavery.” All internationally trained physicians—regardless of whether they are Canadian students trained abroad or IMGs with permanent residency—must sign a Re-Service Agreement in order to obtain a desirable residency position.

However, all Canadian medical school graduates, even foreign nationals, are exempt from this provision.

Return of service means that after residency expires, physicians must practice for up to three years in a community designated by the provincial health ministry but cannot establish independent practices. Breach of the terms of the agreement can result in penalties (called “compensations”) ranging from $480,375 for family medicine to $897,581 for psychiatry.

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The ministry recently won an arbitration against IMG. The arbitrator concluded that she had other options including going to another province or country or going to medical school in Canada.

In their report to the Human Rights Court, the IMGs argue – with support from the Canadian Society on Paper for Immigrant Physician Equality, or COPSIPE – that because graduates of Canadian schools do not have to compete with IMGs who may be better trained, qualified and more experienced, this ensures “separation.” Virtually everyone will get residencies and will be fully licensed.

Similar arguments were found in a September 2018 lawsuit brought by Canadian students who studied abroad with the support of the Association of Canadians Studying Abroad, or SOCSMA.

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BC Supreme Court judge kept the case until the BC Health Professionals Review Board determines who sets the rules and who should be held accountable – BC Department of Health, College of Physicians and Surgeons, University of British Columbia, Canadian Residents Matching Service, or Association of Medical Colleges of Canada Or one of its many councils and committees.

This decision was expected to take three to five months. But in testament to how tangled the web is, deadlines came and went as Judge David Silverside asked for more and more documents.

Finally, the deadline for applications is set for March 2021 with the decision set for July. But, tragically, Silversides was diagnosed with pancreatic cancer and was never able to write a resolution. He died in late November.

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In September 2021, SOCSMA rejected the board’s proposal to start the process over and insisted that the new judge make a decision based on existing files.

The board’s director, Susan Brennan, said a new judge has been appointed and is in the process of writing a decision. It will be posted on the board’s website but has not given an indication of when that might happen.

But SOCSMA president Rosemary Pauliock said if there is no decision by March, the students will return to the British Columbia Supreme Court to demand a ruling.

This would seem an esoteric discussion of interest primarily to constitutional scholars who analyze equality with the exception of several crucial facts.

Even before the pandemic, Canada ranked 26th out of 28 countries in terms of the number of doctors per capita. Canada has 2.9 per 1,000 people, which is significantly lower than countries like Austria (5.3) and Norway (5.2), according to the Fraser Institute.

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In British Columbia, there are more than 1,100 doctor positions vacant, and it is estimated that between 700,000 to 900,000 British Columbians are without family doctors, and even before waiting times for pandemic surgery often exceed recommended standards.

In response to the physician shortage, British Columbia expanded the practice of nurse practitioners and proposed increased funding to train more of them.

I asked the College of Physicians and Surgeons of British Columbia in Spring 2020 to expedite the evaluation, processing and registration of a new “Physician Assistant Class” that would allow for IMGs that can assist fully licensed physicians in various clinical settings. Not a single assistant physician has yet been registered.

Then in early 2021 in the rush to vaccinate people as quickly as possible, the department excluded IMGs from vaccinations. Instead, it has set up short courses for nursing students and healthcare workers from various professions including dental hygienists, pharmacy technicians, midwives and emergency medical assistants.

It was only after Vahid Nelforoshan, a human rights plaintiff, wrote to Drs Bonnie Henry and Adrian Dix on behalf of COPSIPE that IMGs were included.

Even back then, they faced even more stressful rules.

They must have passed Part 1 of the Canadian Medical Council Qualifying Examination, which is a standardized national examination that Canadian medical students take at the end of their program.

Thousands of IMGs have passed the test also required to apply for residency positions. But to date, no qualified IMG has been designated as an immunogen.

dbramham@postmedia.com

Twitter: bramham_daphne

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