British Columbia is expanding a program to provide qualified internationally educated doctors with a pathway to licensure and creating a new associate physician class for those who do not meet requirements, in a push to get more such professionals working across the province.
The actions are part of B.C.’s health human resources strategy, a five-year plan announced in late September aimed at retaining, recruiting and training health care workers while redesigning the overall health care system. About a million British Columbians, or one in five, are without a family doctor, which has fed into pressures in emergency departments and secondary care systems such as specialist access.
Premier David Eby and Health Minister Adrian Dix made the announcement at Richmond Hospital on Sunday, flanked by representatives from Doctors of BC and the College of Physicians and Surgeons of BC.
“While many are challenged to find a family doctor, we actually have family doctors that are trained outside of Canada, who aren’t able to practise family medicine in B.C.,” Mr. Eby said – recalling recently being hosted in Chilliwack by a doctor and his dentist wife, both of whom were working for the local school board instead of their trained professions because they lacked the pathways to practise. “We need to fix this.”
Internationally educated physicians who want to obtain a medical licence in Canada must first successfully complete a medical degree from a recognized school and demonstrate proficiency in English or French. If their credentials are verified, they take the computer-based Medical Council of Canada Qualifying Examination.
They subsequently pursue one of two tracks. Those who already have formal medical training can apply for the three-month Practice-Ready Assessment programs, which are offered in seven provinces, each province with its own rules. Physicians who completed training in the U.S., Australia, Ireland or Britain do not need to apply for the PRA and are advised to register with Health Match BC, a recruitment service for health professionals funded by the provincial government.
The PRA programs, aimed at offering doctors an alternative pathway to licensure while bolstering health care coverage in underserved communities, involve a number of exams and 12 weeks of supervised clinical field assessments. B.C. requires eight weeks in family medicine and four weeks rotating through specialties including emergency medicine, obstetrics/gynecology and pediatrics, typically followed by a commitment to work three years in a rural community identified by local health authorities.
B.C.’s PRA program will triple from 32 to 96 seats by March, 2024, and place qualified family doctors in urban and suburban communities as part of primary care networks, government officials said Sunday.
Doctors who have not completed a formal training program must take a National Assessment Collaboration examination – offered only twice a year, in Canada – and apply for a residency position through the Canadian Resident Matching Service, or CaRMS. After being matched, and upon completion of the residency, they apply to become a licentiate of the Medical Council of Canada.
Data from CaRMS show that of 300 international medical graduates who applied to programs in B.C. in the 2022 match, 58 were matched in the province and 114 outside of it. Of 292 international medical graduates who applied in the year prior, 59 were matched to programs in B.C. and 93 outside. CaRMS notes that it is common for people to apply to multiple provinces.
B.C. is also creating a new associate physician class of restricted registration for international medical graduates who are not eligible for full or provisional licensure, which would allow them to care for patients in primary care settings under the direction and supervision of an attending physician. Currently, associate physicians can work in limited college-accredited programs in health authorities.
The College will also make bylaw changes to allow doctors trained in the U.S. for three years to practise medicine in community settings by January, 2023.
Sarah Ddamba, who worked as a family doctor in Northern Ireland before moving with her family to Canada in 2019, said Sunday’s announcement was positive, but her primary concerns are the bureaucracy and lengthy timelines of the overall licensure process.
When Dr. Ddamba contacted Health Match BC to inquire about resuming her work in the province, she was provided with an overview for an application process that she described as long and confusing – including up to a six-month wait to verify credentials, exams that cost thousands of dollars and are only offered at certain times of the year, and up to an eight-week wait for test scores.
A candidate in her position could expect the process to take a minimum of one year, according to a timeline she was provided – a daunting commitment for someone with a family still figuring out its place in B.C.
“Certainly, it is very discouraging for me after such lengthy training in a very similar system, to have no prospect of work here for over 12 months into the future,” said Dr. Ddamba, who now lives in Prince George.
“It’s very hard to know what to do, because I do want to try this out – but do I want to spend the whole year wrestling with bureaucracy, or should I do something else? … I was looking into other work, if I can do some teaching, or admin work at the university, but I’m a doctor. That’s what I love and what I want to do.”
Mr. Dix acknowledged the frustration Sunday and said change is coming. B.C. can expect a streamlining of the process similar to that for internationally educated nurses, for which the government triple-tracked the assessment process and invested $9-million in bursaries to help with fees.
“We’ve already seen that success … and we believe these changes will have the same positive effect for doctors.”