Wednesday, 01 October 2014 14:36

Wall needs to get house in order regarding physician recruitment

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What follows is an open letter to the Honorable Brad Wall, Premier of Saskatchewan.
Dear Mr. Wall: Saskatchewan people appreciate your efforts to make this province succeed and stand up to the level of the rest of Canadian provinces.
I think it is time for you to provide them with a transparent answer to these two questions: 1. Does Saskatchewan have enough doctors? If the answer is negative, then: 2. Are we doing everything we can to solve that problem?
The doctors-patients ratio in the province is 1.8 doctors per 1,000 inhabitants. That’s far below the national average of 2.1, which is actually one of the worst among the Organization of Economic Cooperation and Development (OECD) countries. Since 2011 the numbers of doctors practicing in Saskatchewan has increased seven per cent (about two per cent annually), but Statistics Canada forecasts population increase in Saskatchewan until 2036 at an annual growth rate between 5.9 and 10.9 per cent. According to the Saskatchewan Surgical Initiative around 15,000 patients are waiting for surgery, 25 per cent of them have waited for more than three months. The rural physicians’ turnover rate in the province is 18 per cent, meaning they are all replaced as an average every five years.
The only medical school of the province, at the University of Saskatchewan, accepts near 100 new students per year, three out of four qualified applicants are turned down every year in Canada, driving 4,000 Canadians to study medicine in other countries to pursue their dreams. Most of them never return. Those who come back are considered International Medical Graduates (IMGs), the same substandard category applied to doctors who immigrate to Canada from other countries. Only 49 per cent of the doctors graduated from the U of S remain in the province. Its School of Medicine is currently on probation by the accrediting bodies, the only such school being put on probation for the second time in Canada. One of the reasons is that its graduates score the lowest in federal exams among all Canadian schools.
Ed Mantler, president of the Physicians Recruitment Agency of Saskatchewan (Saskdocs), stated on May 2013: “Even if we were 100 per cent successful at retaining every University of Saskatchewan medical graduate, we would still have to recruit out of province, the demand is that great.” Saskdocs estimates that 949 family physicians will need to be recruited from now to 2020, but the medical residents from the U of S will provide only 332 of them.
Forty-five per cent of doctors practicing in the province (and 75 per cent of those in rural areas) are IMGs. It has been the solution thus far and seems to be the solution for the future. In January 2012, the federal and provincial Ministers of Health launched SIPPA, the Saskatchewan International Physician Practice Assessment, a solution deemed to make it easier for IMGs to get their credentials recognized in Canada. Unfortunately, the program has opened the doors to licensure for some IMGs while shutting it off for others. What are the reasons?
1. SIPPA has 30 positions available in three yearly intakes. Immigrant doctors and Canadian-born doctors graduated abroad have to compete for these extremely limited positions. As a result, many of them are not accepted. The government did not have to invest a penny to provide education to these doctors. In order to apply to SIPPA they must first validate their credentials, accreditation of the medical school where they studied, postgraduate training and practice, English knowledge, and successful passing of at least one out of three exams from the Medical Council of Canada: MCCEE, MCCQE Part I and MCCQE Part II. Some of them have passed them all by the time they apply. The doctors pay for all this expensive process, including the application. SIPPA only pays for the nine- to 15-week period of training, assessments that are basically a duplicate of the MCC exams and clinical practice. Can anybody think of a way to get an experienced doctor for such a bargain?
Still, I am sure some of these doctors will gladly pay for the expenses of those weeks, if given the opportunity. So, it is not a problem of money. Why then are the capacities limited? Don’t we need more doctors?
2. SIPPA does not accept any doctor who has been without practising for more than three years. A similar program in Manitoba allows five years of currency of practice, and the one in Alberta does not have a limit. As you may imagine, most of this time is consumed by the IMGs going through this hell of a bureaucratic process, studying for these hard exams — similar to those they already passed in other countries years ago — or working to pay for the expensive process.
3. SIPPA expressly closed any other possibility to obtain a licence to practise medicine in Saskatchewan. You may have passed all three exams of the Medical Council of Canada, proved the accreditation of your medical school, your credentials, post graduate training and practical experience, as well as knowledge of the English language. These are the requirements to get a license to practice according to the MCC, but if you are not selected to SIPPA, you are refused the license.
The other option will be to get a residency position into the Canadian Resident Matching Service (CaRMS). This will imply to study for two more years for Family Physician, or four or five more years for other specialties. As you may suppose, this is fascinating for a doctor who probably studied 10 years and practiced another 10 in the country of origin, and who may have held two different specialties in that country. But even thus, the positions in CaRMS are also extremely limited and IMGs are discriminated in the number of positions and the specialties they can apply for, in a flagrant violation of the Canadian Charter of Rights and Freedoms and the Canadian Bill of Rights.
The Government of Canada through the Citizen and Immigration Canada and Canadian embassies around the world stimulates Specialist Physicians (NOC 3111) and General Practitioners and Family Physicians (NOC 3112) to come to Canada through the Federal Skilled Worker Program. Thousands of those doctors and specialists will never be able to practise what they learned if we don’t change the methods we are using to give them access to licensure. They may perfectly end up working as a cashier in Co-op or selling coffee in Tim Hortons. That goes beyond brain-drain: that is a criminal waste of talent, skills, knowledge and experience, not to mention the waste of their careers, time and money for the applicants. While we play that game, Saskatchewan voters are longing for better primary health care and shorter waiting lists for having a surgery or an appointment with a specialist.
From March 3-7, 2012; you led a trip to Ireland by Saskdocs and Saskatchewan Advanced Education Employment and Immigration (AEEI) to recruit doctors to come to practise in this province.
The success was expressed as “more than 30 physician contacts.” Saskdocs also travelled to India in the spring of 2013, where 44 doctors expressed interest to come to practise here. My questions: Were those doctors informed of how difficult it is the process to get their credentials recognized here in Saskatchewan? How many of those doctors are right now practising in the province? Why it is necessary to spend taxpayers’ money in recruiting trips to other countries when we are not capable of giving licensure opportunities to all the IMGs who already live in Saskatchewan?
Your voters are longing for an answer.
Roberto Camba Baldomar, Cabri, Sask.

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