National Post (National Edition)
WHERE ARE ONTARIO'S INTERNATIONALLY TRAINED DOCTORS?
When the COVID-19 pandemic first struck in Canada, Moises Vasquez knew he had to take action as part of the province's growing front-line response to the virus.
Vasquez worked as a general medical practitioner for eight years in Colombia before immigrating to Canada in 2014 with his then-pregnant wife, also a physician, and two children. Due to language barriers and the costly and complicated licensing process, he hasn't yet been able to obtain his medical licence in Canada.
It also took him five years to find a job in a health-care-related field — a health program co-ordinator at a Niagara-based community health centre.
Yet, in April 2020, he registered on Ontario's then-new Health Workforce Matching portal, which matches available doctors to hospitals in need, as they prepared for the growing deluge of COVID-19 cases.
“It was my call to apply because I knew the system would need that support,” he told National Post.
Several of his close contacts, also immigrant doctors, had also registered on the portal.
More than nine months later, Vasquez and his friends have yet to hear back from anyone.
They are not the only ones, several advocates and foreign-trained medical professionals have told National Post. As Ontario's doctors, nurses and other health-care workers burn out from the stress of the second wave and/or fall sick with the virus themselves, thousands of Ontario's internationally trained medical practitioners remain on the sidelines, eager to step in but with few options to do so.
“It's heartbreaking to see how the numbers are increasing, how our front-line workers are at capacity and know that there are unutilized resources, internationally educated professionals that are eager to support but there is no clear path,” Vasquez said.
As of Jan. 29, a total of 2,660 internationally educated health-care professionals (IEHPs) have signed up on the province's online portal, which launched on April 7, according to data from Ontario's Ministry of Health.
However, only 33 employers in the health sector have requested IEHPs, resulting in 20 matches.
Portal matches, a ministry spokesperson explained in an email, are based “exclusively” on the requirements set out by the employers, not the ministry. “Final hiring decisions rest with the employer,” the email adds.
Around the same time, the College of Physicians and Surgeons of Ontario began issuing 30-day medical licences, called Supervised Short Duration Certificates, as part of a provision within Ontario's Medicine Act designed to accommodate a shortage of physicians during emergencies.
The licence would allow some IEHPs and domestic medical graduates to practise at public and psychiatric hospitals and Crown agencies, and was touted as an option for immigrant physicians to enter the front-line response. However, to be eligible, applicants first have to find a hospital willing to employ them and a physician to supervise them.
“It's a bit of a Catch-22,” said Joan Atlin, associate director for strategy, policy research with the non-profit World Education Services (WES). “You have a licence where an employer needs to commit to hiring someone and supervising them before they can be granted that licence and yet the employer is presumably looking to hire people who are already licensed.”
Since April, only 14 licences have been issued, 12 of which have gone to foreign-trained medical practitioners, the CPSO said. The college, it adds in an emailed statement, does not “play a role in human resources planning,” but rather approves the applications based solely on whether the candidates have fulfilled the requirements laid out in the legislation.
The CPSO did not specify how many applications were submitted, but stated that it had approved “the vast majority of candidates” who submitted formal applications for the licence.
While few applications were submitted, the college did receive many inquiries into the licence, according to Atlin.
Joanna Walters said that when she called the college to ask about the licence, she was told she was ineligible. Walters, who moved to Canada from Jamaica in 2015, hasn't obtained her medical licence because she couldn't secure a spot in a residency program — a near-impossible licensure requirement for most IEHPs. She currently works as a doctor's assistant in Waterloo, but periodically flies back to Jamaica to maintain her family practice there.
“You would have had to get a job and then apply for
that route which would not be the case for the majority of IMGs (international medical graduates),” she said. She added that she, along with other professionals, had also reached out to hospitals in their region to offer their services during the first wave but were told they weren't needed as there was no shortage of doctors.
Walters had also signed up on the portal but as yet, has not heard back.
Advocates have also been in talks with the Medical Council of Canada to launch a standardized assessment tool, called Practice Ready Assessments, in Ontario. The 12-week program already runs in seven other provinces and could speed up the entry of internationally trained physicians into the workforce, according to Atlin.
“If a program like that had been put in place at the beginning of the pandemic, we could potentially be further along … in integrating immigrant physicians who meet the qualifications and pass the assessment from that program.” she said.
Neither the Ministry of Health nor the Ontario
Medical Association would say whether any additional measures are being taken to include IEHPs in the pandemic response. A spokesperson for the OMA, in an emailed statement, said that “all planning regarding increasing the number of health-care providers … includes considerations of retired doctors, already practising but underutilized medical professionals, as well as international medical graduates.”
The ministry spokesperson added that the ministry “continues to strongly advocate for hiring internationally educated health professionals via Ontario Health and in direct conversations with employers.”
The Ontario Hospitals Associations has not yet responded to a request for comment.
With few measures available to IEHPs, many organizations in the province have been working to match professionals to available health-care positions, pandemic-related or otherwise. Many of the professionals, advocates say, do get matched to secondary positions, both paid and volunteer, within the field but aren't able to fully use their medical training.
Emily Kovacs, who runs a Niagara-based non-profit supporting Canadian newcomers, said that 60 of the 178 IEHPs in her service had been matched to positions such as health-care and dietary aide roles, personal support workers or other non-clinical positions at COVID sites and/or longterm care facilities. The roles, she added, come with a contingent on the employer to ensure that they include a possibility of career advancement for the IEHPs in question.
“Non-regulated health fields are available to them and with some volunteer experience, they can bridge that,” Kovacs said. “But what we want to avoid is that they get stagnant in those opportunities and they never end up using their (medical) skills.”
Vasquez, for example, emphasized that while his current role is non-clinical, he can use some of his medical training when co-ordinating between prospective patients and practitioners on his team. “I'm also gaining knowledge of how physicians deal with patients in Canada,” he said, knowledge that could give him an advantage in his own quest to obtain a medical licence.
New immigrant practitioners have also turned to bridging programs, which supply them with additional skills and access to a large network to help them enter the Ontario health-care workforce.
Shafi Bhuiyan, an IEHP, who runs one program at Ryerson University, said he set his clients up with roles in contact tracing, mental health and case management. “My intention is to bring these people into the health system,” regardless of whether they are licensed or not, he explained.
ACCESS Employment, a GTA employment consultancy that also runs bridging programs, has seen its employment rate of internationally trained healthcare professionals increase since the beginning of the pandemic.
“We're seeing people opening their eyes to the skills and experience that the types of clients who we're serving have always had in the labour market … which has really helped (IEHPs) that we serve get into very strong roles,” said Cameron Moser, the organization's director of services and program development.
Many of their clients, he added, have found jobs in COVID-19 research and in pharmaceutical supply chains, aiding the vaccine rollout.
Abby Akintade, who found her current role as a clinical coordinator at Inner City Health Associates through ACCESS Employment, described her job as a “great opportunity” to get to know the public health issues in Canada. “(But) I feel underutilized,” she said.
She said that her experience dealing with communicable diseases in Nigeria should have made her a “go-to resource” when the pandemic struck in Canada. “I definitely believe I have a lot to contribute to the table when it comes to coming up with disease prevention programs, health promotion, health education,” she said.
Since the beginning of the pandemic, politicians, advocates and medical professionals have called on the province to allow more foreign-trained medical professionals to help with the COVID-19 crisis.
On March 27, 2020, the Ontario Council of Agencies Serving Immigrants (OCASI), Toronto Region Immigrant Employment Council, and World Education Services issued a public plea to the province to mobilize its more than 20,000 IEHPs in its front-line response. The letter cited numbers from the Healthforce Ontario, stating that there are 13,000 foreign-educated doctors, 6,000 foreign-educated nurses who aren't working in their fields.
“And there are hundreds, if not thousands more, who have not currently registered with Healthforce Ontario but are anxious to do their part,” the letter adds.
Similar statements have been issued by Brampton Coun. Charmaine Williams and Ontario Liberal Leader Steven Del Duca to the government in March and April. However their pleas, according to Del Duca, have resulted in little from the province.
“It was a lot of fluff, as opposed to any tangible plan,” Del Duca said. Including internationally trained professionals in the response, he said, could have alleviated some of the pandemic burden felt by other health-care workers, nursing homes and other affected regions across the province.
“It's deeply disappointing that Doug Ford did not take this possibility more seriously,” he said. “If we're really going to create an economic recovery … I think we can no longer permit to have this talent sitting on the sidelines, being undervalued and not being brought into the general workforce.”