Medical schools must adapt in wake of spat with Saudi Arabia
It’s time to fund the training of more Canadian doctors, says Dr. John Stewart.
The Saudi Arabian government’s pending threat of withdrawing Saudi medical residents (doctors undergoing specialty training after obtaining their MD) and fellows (those undertaking further training in a sub-specialty) is causing great consternation in Canadian university hospitals. There are between 750 and 1,000 Saudi trainees distributed among almost every medical faculty in Canada. Having known, taught and worked with many Saudi doctors, I have great personal sympathy for them if this abrupt withdrawal takes place.
However, the truths behind this training arrangement are very disquieting. The current spat between Canada and Saudi Arabia provides the opportunity for an overdue reappraisal by our medical schools and health-care planners.
These trainees are funded by their governments, hospitals and (at least in the past) oil companies. In addition, the Canadian faculties of medicine and their parent universities receive a generous stipend. This is irresistible for cash-strapped institutions, but detrimental to training doctors for Canada’s needs. The shortage of Canadian doctors is well-established. Every Saudi trainee takes the place of a Canadian who would live and work here.
Why doesn’t Saudi Arabia train its own specialists? I have been involved in medical schools that were established with overseas help, in both the Caribbean and Kenya. The specific early goal was to provide doctors for these countries/regions. The next goal was to send some of their graduates to train as specialists in centres of excellence abroad. On return, they established local programs to further train their own cadre of specialists. Both goals were achieved.
By contrast, the University of Toronto has trained more than 1,000 Saudi specialists in 40 years, and adding those in other Canadian faculties, that number is probably four times larger. In four decades, it would appear that the Saudis have not developed their own specialty and sub-specialty programs. While I cannot comment further on that, my cynical conclusion is that the continued influx of Saudi trainees to Canadian medical schools is due to two dishonourable reasons here: money, and free extra pairs of hands to help in the day-to-day running of university teaching hospitals.
The impact of training Saudi Arabian doctors on both the training of Canadian doctors and on our medical manpower needs are vital issues. Canada is short many doctors, notably family physicians, and particularly in rural areas. In spite of this, it is an alarming fact that this year 115 new graduates from Canadian medical schools did not match to a Canadian residency program.
Meanwhile there is a treasure trove of other well qualified doctors available for residency training in Canada: Canadian International Medical Graduates (CIMGs). These are mainly students who satisfied the requirements to get into the limited number of Canadian medical school posts, but didn’t make the cut, and so to pursue their career goals have gone to overseas medical schools. In 2010, it was estimated that there were no fewer than 3,570 Canadian citizens studying medicine abroad. Many are in very well-established medical schools in Ireland, Australia and Europe, which offer significant numbers of positions for international students. The important fact is that 90 per cent of CIMGs want to return to Canada for further training and to work here, but only a few are accepted. Just imagine the farreaching benefits to our medical manpower shortages if more of these “eager-beavers” were allowed into those 750-to-1,000 training positions currently held by certain other international medical graduates.
The down side to such a rearrangement is that this cadre of Canadian residents would require funding — funding that will go away if the Saudi residents go, since it currently comes from their government, not ours. Given that Canada is a fairly affluent country in need of more doctors, I suggest that replacing that funding would be a wise investment here. Dr. John Stewart is Emeritus Professor at McGill University. He was a lecturer in the Department of Medicine, University of Nairobi; a clinical associate professor, University of British Columbia; and professor, Departments of Medicine and Neurology and Neurosurgery, McGill University.