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One could scarcely imagine a better illustration of the expression “cutting off your nose to spite your face.”

Saudi Arabia, in a fit of pique over a tweet – a tweet! – by Foreign Affairs Minister Chrystia Freeland calling for the release of a human rights activist, has taken a series of retaliatory measures against Canada, including pulling all Saudi medical residents and post-doctoral fellows from Canadian teaching hospitals.

Those being punished most severely by this move are the 1,000 or so Saudi doctors-in-training.

Made pawns by their thin-skinned, authoritarian king, they are being uprooted abruptly and, if there is no resolution to the dispute before the Aug. 31 deadline, they will have to find training spots in other countries.

Practically that will mean at least an additional year of study and fewer doctors in Saudi Arabia. Take that Canada!

But petulantly yanking these physicians from their posts is also a blow to Canadian healthcare, and one that has exposed some of our dirty little secrets.

Many Canadians, including those who oversee and work in the health system, were surprised to learn that there were so many Saudi physicians being trained in Canadian hospitals. They make up 95 per cent of international medical trainees in this country.

This is the result of a longstanding, mutually beneficial arrangement between Canada and the desert kingdom.

The Saudi doctors (they have all graduated from medical school) are working as medical residents and training to be specialists at no cost to Canada.

In fact, they pay handsomely – the Saudi Arabian Cultural Bureau pays about $100,000 a year for each spot. In addition, the Saudi government pays the salaries of residents and trainees, so that Canadian hospitals get free labour. (Canadian residents and fellows are paid in the range of $40,000 to $50,000 a year during their training.)

Contrary to what many people believe, the Saudi residents and fellows are not “stealing” spots from Canadians trainees, nor are they taking Canadian jobs. They are being trained specifically to return to their home country.

Officially, the Saudi doctors are considered supplementary to the basic staffing requirements of Canadian hospitals.

This, of course, is a total fiction.

Over the years, the Saudi trainees have become an integral part of the workforce, especially in Canada’s teaching hospitals, where they make up 5 to 20 per cent of trainees.

There are 225 Saudi medical trainees working in Montreal hospitals, 216 in Toronto, 156 in Hamilton, 91 in London, 67 in Ottawa, 59 in Halifax, 44 in Vancouver and 23 in Calgary. Those are only partial numbers, and they tell only a small part of the story.

Because so many of the Saudis are training to be surgical specialists, the impact of their departure will be staggering in some areas. For example, at McMaster Children’s Hospital, half of the pediatric surgeons are Saudi.

We shouldn’t forget either that residents and trainees do the dirty work in hospitals – they work nights, weekends and on-call. Replacing those hours is a monumental human resources challenge.

The group of Saudi trainees is also a cash cow, bringing about $100-million a year into the coffers of hospitals, not to mention the spinoff exchanges.

On top of that, medical schools have also come to depend on the additional fees from international students – medical school tuition is roughly $25,000 a year for Canadians (with some exceptions, notably in Quebec and Newfoundland and Labrador), but $80,000 for non-Canadians.

As the full extent of the fallout becomes clear, the big unanswered question is: How will hospitals fill the gaping holes left by the sudden departure of Saudi trainees?

There are about 10,000 residents working in Canadian hospitals. Should that number be boosted by 10 per cent to make up the loss of the Saudi trainees? If so, who will pay?

And, on the off-chance provinces do find hundreds of millions of dollars to make up the shortage, who will fill these spots – medical school graduates who were unmatched to residency spots? Canadian graduates of medical schools in other countries? International medical graduates who have so much trouble finding work in Canada?

The way residency and post-doctoral fellowship spots are allocated has been under growing scrutiny in recent years.

The loss of Saudi trainees gives us another reason (and opportunity) to re-think medical training – and perhaps that will make the bitter pill Saudi Arabia has given Canada a little easier to swallow.

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