Saudi recall of 16,000 medical students will hurt everyone involved

Canadian health care system scrambling for solutions

The Kingdom of Saudi Arabia announced a decision to remove all its medical trainees from Canadian hospitals this month. The spat began with Canada taking to Twitter to express its concerns regarding Saudi Arabian detention of women’s rights activists, and a call for the release of its activists.

Escalating diplomatic tensions drastically distorted the relationship between the two governments. Saudi leadership took strong action in retaliation for what it perceived as undue interference: cutting ambassador ties, freezing trade and investments, suspending air transportation, terminating grain imports and transferring medical care for Saudi patients away from Canada.

Among its major sanctions was suspension of scholarships for approximately 16,000 Canada-based Saudi students, including almost 800 medical residents and fellows.

Saudi medical trainees comprise 18 per cent of international medical graduates in Canada and 5 per cent of all Canadian postgraduate medical trainees. Five per cent of the trainee workforce may appear minor. However, balanced with the intricate involvement of these residents and fellows in teaching hospitals and institutions across the country, the precarious nature of the positions of almost 1,000 physicians leaves the Canadian healthcare system scrambling for solutions.

Much of the ensuing dialogue has been around the weight of the degree of uncertainty surrounding Saudi-funded trainees on Canadian institutions and fellow trainees. Indeed, in a system where residents and fellows are so integral to the fabric of seamlessly co-ordinated care, acute instability in trainee positions places unanticipated demands on colleagues and hospital administrators.

It is important not to overlook the direct impact this will have on patient care. The absence of hundreds of residents at the end of August may spell calamitous circumstances for care provision where hospitals already struggle to match patient volumes and available physician coverage.

Yet, largely slipping under the radar is the collateral damage of these sanctions to Saudi trainees and their families. Hundreds of individuals who have dedicated years in training to furnishing careers as physicians are being uprooted after finding their feet and making Canada their home away from home.

Disruption of their educational trajectories with unclear directions leaves them at the mercy of the political forces that graciously supported their education in the first place. The kingdom’s sanctions will acutely fracture the stabilities of entire family units, many of whom have accompanied their medical counterparts and have built parallel lives in Canada.

Perhaps of as much significance as the damage itself is the limited support Saudi trainees have received through these testing times. Despite many being disconnected from their support networks abroad, little has been arranged from either Canadian or Saudi Arabian sides to prepare or support these trainees in navigating options and dealing with uncertainty.

Captured as “scared,” “disappointed” and “confused” in media excerpts, trainees have been instructed not to comment publicly until further notice — effectively silencing their perspectives.

In a heated diplomatic political confrontation, this compromise of optimal patient care and medical education is unjustifiable. Patients will inevitably be affected by these changes nationally, and institutions will be under immense stress.

Administrators and physician leaders must work together to identify adaptive solutions to appropriately reallocate resources and fill gaps in care.

Services focused on supporting these trainees and their families through major upcoming transitions are sorely warranted. As we engage in the practice of healing for our patients, we must look inwards and ask ourselves if we are doing everything we can to support our colleagues.