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Teaching hospitals across the country are scrambling to replace nearly 800 Saudi Arabian doctors-in-training after the kingdom ordered all of its sponsored students out of Canada in retaliation for Ottawa criticizing the country’s human-rights record.

Saudi Arabia is by far the largest source of international medical residents and fellows training in Canadian hospitals, the result of a decades-old visa program under which the kingdom pays approximately $100,000 a year for each trainee it sends to Canadian medical schools.

The Saudi doctors return home after completing residency placements or upgrading their skills through prestigious fellowships. While training in Canada, they treat patients at no cost to Canadian taxpayers.

Now that arrangement is in jeopardy, forcing officials at medical schools and hospitals to contemplate what happens next.

“Residents and fellows provide a great deal of direct clinical care to patients. They’re part of the on-call schedules and in all our clinics and operating rooms,” said Brian Hodges, executive vice-president for education at Toronto’s University Health Network (UHN), which is currently hosting 50 fellows and 36 residents from the Middle Eastern country.

“Should we have to replace them, it would be like if 86 people suddenly called in sick,” Dr. Hodges said.

Salvatore Spadafora, the vice-dean of post-MD education at the University of Toronto’s faculty of medicine, wrote in an e-mail Monday night that he is hopeful the Saudi trainees will be able to stay in Canada, but there is no guarantee.

The Saudi Arabian Cultural Bureau, the organization that co-ordinates the kingdom’s medical training programs with Canadian universities, has negotiated a “grace period” with the Saudi government, Dr. Spadafora wrote in the e-mail obtained by The Globe and Mail.

“Trainees will be advised to ‘work as usual for at least the next month’ while stakeholders work to resolve the situation,” he wrote. “This is encouraging news and I hope it provides some reassurance to all of you in the short term.”

In an interview, Dr. Spadafora, who oversees the training of all U of T residents and fellows, including 216 from Saudi Arabia, said his first priority is helping the Saudi trainees whose careers have been thrown into turmoil by the kingdom’s announcement.

Although Saudi Education Minister Ahmed Al-Eissa released a statement saying the state will work to make the withdrawals an “easy transfer” to other universities in countries, such as the United States and Britain, that could prove difficult for medical trainees.

“It sounds a lot easier than it actually is," Dr. Spadafora said, adding that international residents and fellows often spend years applying for spots and preparing for the move to Canada.

Hemant Shah, a hepatologist at UHN, said a Saudi fellow he worked with Tuesday was upset at the prospect of leaving his Canadian placement. "He’s worried that if he gets removed, there simply will not be another opportunity like this that he can get in his lifetime,” Dr. Shah said.

According to the Association of Faculties of Medicine of Canada, which represents the country’s 17 medical schools, there were 799 graduates of Saudi medical schools training in Canada as of Nov. 1, 2016, or nearly 18 per cent of all the foreign medical graduates training here. (There were 16,334 physicians in training in Canada that year, the vast majority of them graduates of Canadian medical schools.)

The majority of those Saudi trainees − 765 – were in Canada on visas. The second country on the list, Ireland, sent 444 graduates of its medical schools to Canada for training in 2016. But 359 of those physicians were Canadian citizens or permanent residents, meaning they were likely returning home to Canada after studying medicine in Ireland.

Other major cities that would be affected by the withdrawal of Saudi residents and fellows include Montreal, where more than 200 of McGill University’s post-MD trainees are from the kingdom, and London, Ont., where 54 of University of Western Ontario’s trainees are Saudis.

Outside of medical education, Canadian universities are expected to sustain a financial blow from the Saudi government’s moves.

A full-time Saudi student without Canadian citizenship attending a major school such as the University of British Columbia or University of Toronto would pay between $30,000 to $80,000 in tuition and living expenses, depending on their area of study and whether or not they live on campus.

The impact on specific universities is hard to measure since students don’t have to declare that they are receiving Saudi government support, UBC said.

Enrolment reports say UBC has 188 Saudi full-time students enrolled, McGill has 327 and U of T has 194 – losing all of its Saudi students could cost U of T between $5-million to $15-million, depending on the students’ faculties and whether they lived on campus.

Editor’s note: An earlier version of this article incorrectly stated that Hemant Shah was a hematologist. In fact, Shah is a hepatologist.

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