Local politicos ask Adrian Dix to recognize international medical professionals' credentials in context of COVID-19
The following open letter to Health Minister Adrian Dix has been signed by 25 locally elected politicians in B.C.
Re: Request to Recognize the Credentials of International Medical Professionals in the Context of COVID-19
Dear Minister Dix,
We, the undersigned, are local elected officials from across BC, who are concerned about the health of our communities as we come together to fight COVID-19. As local government officials, we are the closest level of government to our communities, passionate to promote health and inclusion in our communities, and yet we do not always have the authority to make changes that would make an impact on the provision of health care that is critical to our residents’ thriving in this trying time.
Currently the government is calling for retired physicians and nurses to re-register to deal with COVID-19 pandemic, and their services are so appreciated; however, we are neglecting the fact that we also have a sizable number of Internationally trained medical professionals who have come to Canada from various avenues, from skilled migrants to refugees, who have the skills to help in this crisis, but currently cannot practice because it is exceedingly difficult to have their credentials recognized. It makes little sense in this time of crisis that there are members of our community who may need medical assistance at the same time as having members of our communities who could help but are currently not allowed. International Professionals in countries around the world are starting to ask how we as a society can streamline and simplify the process to allow qualified people to practice at this time [1][2][3]. Italy and other countries are currently welcoming doctors from Cuba to help them through this crisis [4].
We believe now is the time to put the talented and experienced International Health Professionals who are currently in Canada trying to create a livelihood in the field they are trained in. There are professionals who have been able to immigrate to Canada as skilled workers because of their scores on their immigration application (general practitioners, specialists, and nurses) since Canada has a shortage of such skills. However, most are not allowed to practice even after passing all the required exams. Canada is also home to refugee health professionals who cannot practice for these reasons, as well the financial burden of paying for equivalency exams and unreasonably higher language equivalency requirements; these practitioners may also come from setting where they have worked in extreme conditions with lack of resources, which is what we are facing now. These are not new issues; however, this current health crisis is an opportunity to correct these inequities.
Now that the COVID-19 situation has placed an extra burden on the BC (and Canadian) medical system, many International doctors are ready and trained and have stepped forward to help their new communities. On the one hand, there is an increased load of patients. On the other hand, current and re-registered health workers are at increased risk of contracting the disease.
Our communities already experience a shortage of doctors and health professionals, and if some are required to self-isolate, it would put an even more significant burden on the system when we need an all hands on deck approach.
The recent proposal by the Ministry of Health and the College Physicians and Surgeons to allow international medical graduates to practice as associate physicians is a positive move, but it still presents major barriers to allowing practitioners to support their communities in this crisis. Therefore, we are asking for the following steps to be taken not only to help in this crisis but also to address our chronic shortage of physicians and nurses by allowing newcomers to this land to be able to help their neighbours:
- In the immediate term, establish the proposed associate class of physicians as soon as possible, however,
- minimize the requirements for participation from health authorities, which are already stretched in this crisis. They should be involved in meeting local needs, but detailed letters create unnecessary barriers.
- waive the $340 fee, as this is a barrier to practice
- reduce the 2 years of postgraduate training in a medical or surgical specialty to 1 year of postgraduate training in general medicine or a medical or surgical practice (in many countries, the duration of internship for general practitioners is 18 months or less. Also, in a few jurisdictions in Canada, International Medical Graduates are allowed to enter practice ready programs by having no or 1 year of postgraduate training.)
- make service during this crisis a path to provisional and full licensing. Dedicated as practitioners may be to help their adopted communities, it is not fair to ask them to put themselves in harm’s way without a path to future practice.
- do not limit the area of practice of associate physicians to acute care; we are already short of practitioners in all areas of our communities.
For the future of International Practitioners in BC:
- Re-evaluate the cost of equivalency training for refugee health professionals with an equity lens.
- Allow those International Professionals who have passed the exams run by the given professional college or council (MCCQE1 and either NAC OSCE or MCCQE2) and have one year of independent clinical practice outside of Canada to practice conditionally. *
- Remove unnecessary restrictions of ‘Practice Ready’ Programs and put them in line with other provinces (such as Manitoba and Saskatchewan).**
- Increase in residency positions for International Professionals or allowing them to compete in the same stream with Canadian medical graduates. Of note, in the USA, all candidates regardless of their training origin, compete in the same stream.***
Now is the time to let a group of highly skilled Newcomers to Canada be part of the solution, and help us fight. As Dr John Blatherwick, former Medical Health Officer of Vancouver Coastal Health said [5]: “Now is the time for us to consider foreign-trained graduates that we have in our community. We have an army of physicians, who can help bravely… This is a good time to sit down and say, Okay! We haven’t tackled this problem. We wasted all those people’s talents, and now we could use them.”
Sincerely,
Dr. Amy Lubik, Councillor, City of Port Moody
Jennifer Blatherwick, School Trustee
Leah Main, Councillor, Village of Silverton, Director, Regional District of Central Kootenay, Director and BC Caucus Chair, Federation of Canadian Municipalities
Brittny Anderson M.Sc., Councillor, City of Nelson
John Manuel, Councillor, Town of Golden
Sharmarke Dubow, Councillor, City of Victoria
Christine Boyle, Councillor, City of Vancouver
Sarah Potts, Councillor, City of Victoria
Megan Curren, Councillor, District of North Vancouver
Nadine Nakagawa, Councillor, City of New Westminster
Polly J Krier, Councillor, Village of Anmore
Jean Swanson, Councillor, Vancouver
Jessica McIlroy, Councillor, City of North Vancouver
Ryan Painter, School Trustee, Greater Victoria Board of Education
Rik Logtenberg, Councillor, City of Nelson
Jeremy Loveday, Councillor, City of victoria
Kelly Greene, Councillor, City of Richmond
Michael Wolfe, Councillor, City of Richmond
Sara Duncan, Councillor, Town of Sidney
Gurveen Dhaliwal, School Trustee, New Westminster Board of Education
CaroleAnn Leishman, Councillor, City of Powell River
Anthony Manning, Councillor, City of White Rock
Tony St-Pierre, M.Sc. Rural Planning & Development, Councillor, District of Sooke
Jennifer Reddy, School Trustee, City of Vancouver
Ben Geselbracht, City of Nanaimo Councillor
[4]https://www.democracynow.org/2020/3/24/cuba_medical_diplomacy_italy_coronavirus
* Of note, passing the MCCQE1 and MCCQE2 leads to the acquisition of the Licentiate of the Medical Council of Canada (LMCC). Unfortunately, obtaining the LMCC has no value by itself in Canada. Interestingly, obtaining the LMCC allows IMGs to apply for conditional license to practice in Australia, which has high standards in medical care. This is a long-running program in Australia and has been proven to be effective and safe.
** There are a few programs across Canada that provide a pathway for physicians to practice conditionally as a general practitioner in rural areas of Canada without doing a residency (practice ready programs) and providing an option for physicians to get fully licensed after a few years. Although this pathway has been running for a few years in BC, its criteria is very restrictive comparing to the two other provinces (Manitoba and Saskatchewan) that have similar programs. BC requires physicians to have two years of internship (postgraduate training in general practice) regardless of the years of experience of physicians. In most countries, including Iran, the duration of internship is 1.5 years. This requirement prevents many highly qualified and experienced IMGs from applying and serving in rural areas of BC. In Manitoba, there is no requirement for the internship and in Saskatchewan one-year internship suffices. Of note, the latter may be replaced by experience in the areas relevant to internship. These programs have been running for many years in those provinces and have proven their efficacy and safety in providing medical care to rural areas.
*** It is worth mentioning that one of the main reasons for the occurrence of medical errors is a high workload of physicians. Therefore, recruitment of IMGs can improve the quality of care from different aspects, make medical services accessible to all Canadians and prevent a lot of harm to IMGs and their families.
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