PRESCRIPTION FOR EQUALITY
Foreign-trained doctors fight back
It’s no secret that Canada’s immigration policies and its practicalities have never quite matched up. This is especially true for medical professionals.
For decades, there haven’t been enough licensed physicians and surgeons to meet demand. Yet there are hundreds of fully trained physicians and surgeons who have immigrated here and can’t get licensed.
COVID-19 has highlighted the growing discrepancy and Black Lives Matter has heightened the awareness about institutionalized discrimination, which is exactly what five physicians are calling the licensing system that disadvantages internationally trained doctors and puts them into “indentured servitude.”
The five physicians want the B.C. Human Rights Tribunal to overturn the licensing system. And they want decision makers to be required to take awareness and sensitivity training to overcome their unconscious biases and recognize the harms they have caused international medical graduates.
All five immigrated to Canada expecting to practice in their specialties. And why wouldn’t they?
Their credentials helped move them to the front of the immigration queue.
But reality set in very quickly for family medicine practitioners Navid Pooyan and Asal Vahabimoghaddam, internal medicine specialist Farhad Barazandeh Noveyri, general surgeon Shailendra Singh, and anesthetist Vahid Nilforushan.
Using the words of George Floyd, who died after a Minneapolis police officer pressed a knee to his throat for nearly nine minutes, the five physicians say they have a similar feeling of dyspnea — not being able to breathe.
“We need to know the reason behind the ‘Murder of Talents’ we endure after investing so much time, money and energy through many exams over many years,” they said in a written statement. “We feel arrested by the system, which has forced upon us discrimination based on our ethnicities.
“We feel the knees of the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada in our necks and our hands tied behind our backs by the licensing bodies.”
Their 33-page complaint was filed earlier this month, only a few days after provincial Health Minister Adrian Dix lamented a shortage of surgeons and anesthetists to deal with a COVID-related surgical backlog that had grown by more than 30,000 since March.
Dix’s ministry, along with the University of B.C. and the B.C. College of Physicians and Surgeons, the Canadian Association of Faculties of Medicine, and the
Canadian Resident Matching Service, are all named as respondents.
Since 1993, the provincial colleges of physicians and surgeons have designated university medical faculties to administer all postgraduate training that is essential to becoming a licensed practitioner.
That, the complainants argue, gave them a monopoly and the ability to protect their own graduates from competition by setting different rules for international medical graduates (including Canadians who studied abroad) and not allowing them to compete for residency positions in all disciplines.
UBC, however, does make exceptions for graduates from Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates. The university has contracts with sponsors willing to pay a $100,000 per year visa trainee fee to UBC to secure their residency positions.
In 2020, Canada had 3,027 positions available in 37 specialties, but international medical graduates were restricted to applying for only the 325 in family medicine, psychiatry, internal medicine and pediatrics.
When the selection process concluded recently, 77 per cent of international medical graduates failed to get a precious spot on the path to licensure.
“This feeds the prejudice that graduates of international medical schools such as us are inferior,” say the complainants. “It is assumed we are not good enough to compete, when the fact is, we are prohibited from competing.”
But international medical graduates have to pass all of the same examinations as graduates of Canadian and American medical schools. Plus they have to do an extra clinical assessment, and each year, international medical graduates must compete for a limited number of those spots.
Twice, Vahabimoghaddam was turned down for the assessment. This year, she filed an incident report after one of the assessors slept through parts of it, “snoring for the majority of the time.”
Her incident report was ignored and Vahabimoghaddam subsequently received a poor mark on that portion of the exam.
Of the complainants, Pooyan is the only one to have secured a two-year residency. He’s now working at a Coquitlam clinic.
But he’s locked in a battle with the Health Ministry over the contract that international medical graduates are forced to sign, requiring them to work in an underserved community for up to three years — a requirement struck down as unconstitutional in 2002 by the B.C. Supreme
Court when the province attempted to apply it to all newly licensed physicians.
The ministry refused his request to work in Coquitlam, even though the ratio of physicians to patients is 1:1,400.
Chetwynd, however, was on the list of underserved communities with a physician-to-patient ratio of 1:775. So was Williams Lake, with a ratio of 1:289.
The ministry provided no reason for its refusal, and in November, demanded Pooyan pay $247,716 for breach of contract. That penalty was increased to $480,375 in 2018, the year after he signed the contract.
Of the five complainants, three are still trying for licensure by taking extra courses and even going to other provinces. But after eight years of trying, one of them has given up.
Unable to work in his specialty of gastrointestinal medicine here, Barazandeh Noveyri returns for months at a time each year to practice in Iran.
Never before have physicians, surgeons, specialists and other health-care workers been so badly needed as the COVID cases continue to rise globally, along with a backlog in cancelled surgeries that’s estimated at 28 million worldwide.
B.C. and Canada can’t afford to waste the talents and the training of those who are already here.
It’s time to open the door to this closed shop.