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Some Saudi Arabian medical graduates training at Canadian hospitals are withdrawing from their clinical duties ahead of an Aug. 31 deadline, leaving hospitals scrambling to fill the gaps.

The early departures are the latest development in a chaotic situation that’s having a “destabilizing effect” on parts of Canada’s health-care system, said Richard McLean, vice-president of medical affairs and quality at Hamilton Health Sciences Centre.

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“In the short term, I don’t think there’s an easily identifiable solution,” Dr. McLean said in an interview.

It’s unclear how many Saudi medical trainees are asking to be relieved of their duties, but Dr. McLean said he expects many more will be “stepping away from the workplace” in the coming weeks as they make arrangements to leave the country.

Salvatore Spadafora, vice-dean of postgraduate medical education and continuous professional development at the University of Toronto, said the school is trying to be understanding as the Saudi trainees focus on things such as cancelling rental agreements and booking flights.

“A lot of it is just down to logistics and it’s not that anyone is urgently telling them to vacate now,” he said.

More than 1,000 Saudi medical graduates working at Canadian teaching hospitals must leave the country by Aug. 31 as the result of a diplomatic row between Canada and the Middle East kingdom.

Canada has had a longstanding program in place to allow Saudi Arabian medical graduates to train at Canadian teaching hospitals. The Saudis pay about $100,000 for each medical trainee. The doctors-in-training receive valuable experience and help provide care for patients in Canada at no cost to taxpayers.

On Aug. 5, Saudi Arabia suspended diplomatic relations with Canada and expelled the Canadian ambassador after Foreign Affairs Minister Chrystia Freeland publicly called on the kingdom to release jailed human rights advocates. Saudi Arabia, which suspended direct flights to Canada as of Aug. 13, said it will no longer purchase Canadian wheat or barley; it also ended scholarship programs for thousands of Saudi students studying in Canada.

Paul-Émile Cloutier, president and chief executive of Health CareCAN, an association representing Canadian hospitals and health-care institutions, said negotiations between the two countries are ongoing and there’s still hope the Saudi trainees can stay.

“It’s still very unknown if this is going to go through or not go through,” he said.

On Monday, Prime Minister Justin Trudeau said Canada will “continue to engage diplomatically” with Saudi Arabia, but will not sacrifice Canada’s position on human rights.

Dr. Spadafora said there were 216 residents and fellows from Saudi Arabia working at Toronto hospitals before the kingdom suspended the training program. They made up about 6 per cent of the total number of residents and fellows in the city, spread out across many programs at several hospitals, Dr. Spadafora said. Officials are looking at those programs to determine what impact the departures will have and how to address any gaps.

Dr. McLean said there were 156 Saudi Arabian doctors-in-training at McMaster University working at Hamilton hospitals before the recall happened. While they make up about 15 per cent of the city’s resident work force, he said some areas, notably McMaster Children’s Hospital, will be profoundly affected by their departure. In some parts of the hospital, including the neonatal intensive care unit and on pediatric patient wards, the Saudi trainees make up one-third to one-half of the resident work force, creating a difficult challenge for the hospital going forward, he said.

“We’re still trying to understand what the gaps in coverage are, but they are significant,” Dr. McLean said. “There’s a lot of uncovered nights.”

There’s also a financial cost, as the Saudi government provides funding to Canadian medical schools where its students are enrolled. And hospitals will now have to make up for the loss of the Saudi residents and fellows, which will undoubtedly come with a cost, Dr. McLean said.

Other hospitals say they are working on contingency plans. In a statement, Paul Woods, president and chief executive of London Health Sciences Centre, said that while he remains “hopeful a resolution will be achieved," officials are figuring out how to make up for the loss of 91 Saudi residents and fellows. McGill University Health Centre also issued a statement saying 225 Saudi residents and fellows could be affected by the diplomatic dispute and that officials are developing plans to minimize the impact on patient care.

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