BY HARRY S. LALI

Former Minister of Transportation and Highways for BC

THE supply of doctors in British Columbia is tightly controlled by entrenched entities – namely, by the University of British Columbia and the College of Physicians and Surgeons of British Columbia (CPSBC) – resulting in doctor shortages across the province, especially in rural BC. The lack of sufficient medical training seats available for students to attain MD degrees in our universities – coupled with the lack of sufficient available spaces for doctors who have completed their MD degrees seeking medical residencies in BC – is artificially and unnecessarily creating a doctor shortage in BC.

System is unfair for Canadian IMGs

In Canada, and especially in BC, Canadian citizens or permanent residents who studied abroad (CSAs) and graduated with medical degrees internationally are known as Canadian IMGs, or Canadians who are International Medical Graduates. For these Canadian IMGs, the system of successfully obtaining scarce medical residency positions in Canada is rigged against them by the entrenched entities. The current system is unfair and not based on merit or competency. It is government’s job to create a system that is fair and rewards competency.

Currently, Canadian-trained doctors, plus new foreign visa holders from other countries, are obtaining training seats and medical residencies in our universities, while Canadian IMGs get passed over and are left waiting years, or else they end up leaving the country to go to the United States or other countries. The vast majority never come back to Canada. This is a terrible waste of a valuable resource while communities and patients across BC and Canada suffer. BC alone has nearly one million people who don’t have a family doctor.

Canadian IMGs want to fight COVID-19

BC needs trained doctors and health care professionals to assist in fighting the COVID-19 pandemic. The government is allowing retired doctors and health care workers to re-register with the province. These doctors, who are over 65 years old, retired mostly due to health reasons.

Meanwhile, there are a few dozen young, eager Canadian IMGs of BC origin who came back to BC, still live in BC, and most importantly, want to practice medicine in BC, but are being denied medical residencies in BC and in other provinces due to systemic, historic, and institutional intransigence by entrenched entities reluctant to change. In other words, as governments readily re-hire retired doctors (who, by the way, are “most at-risk” to COVID-19) they are over-looking a valued domestic resource within their own communities – a resource eager to help fight the COVID-19 pandemic locally, provincially and nationally.

Proposed by-law changes exclude Canadian IMGs

On April 1, with the blessing of the Ministry of Health, the CPSBC announced changes to their by-laws in order to allow foreign-trained doctors to register and become “associate physicians” to help fight COVID-19. Unfortunately, the registration criteria specifically excluded Canadian IMGs who haven’t done their medical residencies from even applying. Canadian IMGs meet two of the criteria: 1) Possess a Medical Degree, and 2) Passed Part 1 of the LMCC Qualifying Exam. 

However, the disqualifying criterion for Canadian IMGs included by the College of Physicians and Surgeons is the unnecessary requirement: “At least two years of postgraduate training in a medical or surgical specialty.” This particular criterion favours foreign IMGs from Ireland, England and other countries from Europe and abroad, but excludes Canadian IMGs. The foreign IMGs, once they clear the vetting process and are registered, will be eligible to work in BC hospitals as “associate physicians under the direction and supervision of attending physicians in acute care settings.”  The role of the associate physician includes “working as part of a hospitalist team or in an operating room as a surgical assistant.”

My question is: How is that any different from the decades-old practice of medical residents, both domestically-trained and international medical graduates, “working under the direction and supervision of attending physicians in acute care settings” or “working as part of a hospitalist team or in an operating room as surgical assistants?” This practice already exists!

If these foreign IMGs that are going to be hired temporarily will be doing exactly the same duties “under supervision” that medical residents would also do under supervision, then why specifically exclude Canadian IMGs from participating in this program in favour of foreign IMGs? The University of BC, the College of Physicians and the Ministry of Health need to also include Canadian IMGs within their proposed by-law changes and make it a competence-based, fair-playing field.

“Lack of Funds” not an issue any more

In the past, the traditional response from UBC, the CPSBC, and also the Ministry of Health of a “lack of funds” or resources is no longer valid (even though it was suspect to begin with) as all levels of government federally and provincially are going into huge deficits to fight the COVID-19 pandemic; BC alone will have a $5-billion deficit. The amount of funds needed to open more medical residencies is a fraction of a drop in the bucket.

The time for change is NOW!

Another traditional response is that it is “too complicated” to make the changes, and that this is “not the right time” to do it.” At her daily news conference last week Dr. Bonnie Henry, the BC Provincial Health Officer, was asked by CFJC Today why foreign-trained Canadian doctors were being left out by the CPSBC and the Ministry of Health. Dr. Henry responded: “The time of crises is not necessarily the time where we want to modify the requirement that people need to have to ensure that they can practice in a safe way in this province.”

I totally disagree with Dr. Henry. The time to make the change is precisely now! If not now, during a time of crisis, then when is the right time?

While most jurisdictions across the world are playing catch-up to the COVID-19 pandemic, some like Ireland, the United Kingdom, India, New York state, Quebec, Ontario and others are proactively opening up more doctors’ positions and medical residencies in order to get ahead of the curve. The UK has dropped its domestic criteria, created a fair-playing field and made it competence-based by inviting doctors and medical graduates from across the world to participate in fighting the pandemic.  

British Columbia should also be proactive and do the same here in this province. British Columbia needs more doctors now to fight the pandemic, not when it is over!

NOTE: If you are a Canadian IMG, I’d like to hear from you. Write to me at: <harry.lali.1991@gmail.com>