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As government fiddles on foreign-trained doctors, B.C. citizens suffer


Opinion: A constitutional challenge by foreign-trained doctors to barriers barring them from practise is a baby step closer to being heard.

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Justice grinds slowly for foreign-trained doctors, including many who were fast-tracked into Canada precisely because of the same qualifications that provincial regulators refuse to recognize.

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It lurched a tiny step forward last week when B.C.’s Health Professions Review Board finally made a ruling.

After nearly four years, it determined that not only does it not have the regulatory authority to deal with the issues raised in the claims made by two named applicants and the Society of Canadians Studying Abroad, it also determined that it doesn’t have authority over the College of Physicians and Surgeons’ registration committee.

In an earlier ruling, the board also determined that it doesn’t have jurisdiction over the College’s board.

But Katherine Wellburn made it clear at the end of a 35-page decision that she was making no finding about whether the rules are discriminatory.

Wellburn’s ruling did, however, clear the way for the B.C. Supreme Court to proceed with a judicial review to determine whether the complex, multi-layered regulatory system is discriminatory and contrary to the Charter of Rights and Freedoms.

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The case was filed in 2018, but adjourned until the applicants had exhausted every administrative appeal to the board, which is responsible for reviewing decisions made by the B.C. College of Physicians and Surgeons and its committees.

Now, it will likely be another two years before it is heard in court because the complainants’ pleadings need to be amended to reflect this latest decision. Then, the respondents — which include the College of Physicians and Surgeons, the B.C. Health Ministry, the University of British Columbia, the Canadian Resident Matching Service — will have to respond.

The crux of the matter is that there are two categories of applicants when it comes to rare residency spots.

One is for Canadians and permanent residents who are graduates of medical schools in Canada and accredited ones in the United States and Britain.

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The other is for everyone else, including Canadians who didn’t go to the ‘right’ schools.

In order to even apply for B.C. residencies, foreign-trained graduates have to pass the same written and clinical examinations as graduates from Canadian universities.

But they must also go through the clinical assessment program at the University of British Columbia and take English fluency exams at their own expense — even Canadians who did all of their previous schooling in Canada.

Then, even if the foreign-trained graduates get residencies, they must sign a “return-of-service” agreement with the B.C. Health Ministry that on completion they will continue working for a specific period of time in a designated location or face significant financial penalties.

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There is no such requirement for graduates of Canadian universities, regardless of whether they are citizens, permanent residents or citizens of another country.

It is an agreed-upon fact that there are not enough residencies available each year for the number of graduates of Canadian medical schools, let alone for graduates from abroad.

Yet, close to five million Canadians, including 780,000 British Columbians, don’t have a family doctor. That’s being exacerbated by pandemic burnout, retirements in an aging workforce and an acute shortage of residency positions.

In the 2020-21 fiscal year, in the throes of a pandemic when 515 B.C. doctors quit practising, the province funded only 349 residency positions for graduates from Canadian schools and 30 for those who trained abroad.

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That was three fewer than the previous year. Across Canada, the number of residency positions dropped by 32.

Because of the doctor shortage, Canada’s immigration policies have long given physicians precedence over other skilled and unskilled applicants. But the message has yet to get through to the licensing and regulatory bodies.

Currently, an estimated 5,000 foreign-trained doctors are here and unable to leap the barriers to practise. It’s why there’s the court case and a similar one that’s been filed at the B.C. Human Rights Tribunal by international medical graduates who are immigrants.

Such is the preciousness of the Human Rights Tribunal that it has refused to say when a hearing might take place. In an emailed response, it said that “for privacy reasons,” it couldn’t even confirm that the case has been filed.

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Meantime, rather than addressing the barriers and the fallout from a physician shortage, policy-makers are floundering about looking for other solutions.

In 2020, the B.C. government approved the new category of “associate physician” as a pathway for those who only lack the residency experience.

The College of Physicians has yet to register a single one. It blames the health authorities for dropping the ball.

“During COVID, the health authorities (who are the employers) were focused on other priorities and many of the programs, which require accreditation by the College and where the associate physicians would be employed, were put on hold,” said an unattributed statement in response to my emailed question.

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“As we understand it now, health authorities are currently working to get the programs established in order for the College to proceed with an assessment and grant accreditation.

“Once that has occurred, we expect to see applications come in for associate physicians to be registered.”

So, another two years and counting during which foreign medical graduates’ hopes have been dashed.

Worse, for each year that these institutions — most of them taxpayer-supported — stall critical changes, patients suffer because they can’t get the timely care they need.

dbramham@postmedia.com

Twitter: @bramham_daphne


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