By Fabian Dawson
New Canadian Media

Facing a critical shortage of doctors, British Columbia has announced a series of initiatives to get more internationally educated physicians to practise in the province.

Key among the plans include the creation of a new class of ‘associate physicians’ which will allow for international medical graduates (IMGs) to care for patients under the supervision of an attending physician within a health authority acute-care setting.

The province is also expanding the Practice Ready Assessment program, which is the main pathway for internationally educated family doctors to be licensed to work in B.C. The program will triple from 32 seats to 96 seats by March 2024.

The Province said it is working with the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada to allow IMGs to start the accreditation process before they arrive in B.C.

“Doctors interested in moving to B.C. will have increased certainty of being able to practise when they arrive, so they can support doctors and begin treating patients,” the government said in a statement.

As for American-trained doctors, the College of Physicians and Surgeons of BC is preparing bylaw changes to allow those with more than three years’ experience to practise medicine in community settings, such as urgent and primary care centres, community clinics and family practices.

These doctors will be able to care for adult and pediatric patients, as well as provide emergency and urgent care. The bylaw changes will be implemented in the coming weeks, with the intent of allowing these doctors to practise medicine in B.C. communities by January 2023.

Current estimates show that an estimated 20 percent of B.C.’s population does not have a family doctor and relies on drop-in clinics and community care centres.

The latest initiatives announced on Nov. 27 by B.C. Health Minister Adrian Dix follows the implementation of a revised payment model for the province’s doctors that makes them among the highest-paid in Canada. Doctors working 1,680 hours a year and seeing 1,250 patients, will now earn at least $385,000 annually. The average salary for a full-time family physician in B.C. in 2020-21 was $250,000.

“British Columbia has a long history of relying on IMGs to deliver competent medical care to patients. The college applauds this important announcement to expand pathways to licensure for IMGs and improve patient access to high-quality health care,” said Dr. Heidi Oetter, registrar and CEO of B.C.’s College of Physicians and Surgeons.

Dr. Ramneek Dosanjh, president of Doctors of BC said the initiatives are something his group has advocated for.

“We are pleased that the provincial government is making it easier for more U.S. and internationally trained family doctors to come to British Columbia and practise. Given the challenges in our primary care system and the number of patients without a family doctor, these changes will greatly benefit British Columbians,” he said.

Meanwhile, a new report by the Royal Bank of Canada states roughly six million Canadian adults don’t have access to a family doctor — up from 4.6 million in 2019. The situation is particularly alarming in rural communities where only 8 percent of physicians are serving nearly one-fifth of Canada’s population.

And the crisis is set to deepen, states the RBC report, adding that Canada is estimated to be short nearly 44,000 physicians, including more than 30,000 family doctors and general practitioners, before the end of the decade.

“Though 2,400 family physician positions were advertised on government websites by the end of 2021, just 1,496 family doctors exited residency training that year,” said the report authors.

“Many provinces are taking important steps to alleviating shortages. Ontario is making it easier for out-of-province physicians to temporarily practice in the province, while British Columbia is raising family doctors’ earnings. But more should be done to attract internationally-trained physicians who can begin providing care to Canadians quickly,” they said.

The federal government last September said that doctors would receive an exemption to allow them to apply for the federal express entry system, which has a six-month processing time and was previously not available to doctors.

RBC in its report said the number of doctors per capita in Canada is also well behind that of peer countries like France and Germany, according to OECD data.

“What’s more, due to data comparability issues, these figures paint a rosier picture for Canada by including non-practicing doctors (educators, researchers, managers, etc.) in overall physician statistics. With Canada’s population set to rise 7.7% by 2028, addressing this primary healthcare crunch is critical. But easing bottlenecks across the system is more complex than simply recruiting more domestic and international individuals to study medicine.”

The first choke point is a quota system that all 17 Canadian medical schools are subject to, and that limits student admissions to just under 3,000 spots for prospective doctors each year. The second is the disproportionate number of graduates from international medical schools (both Canadian and foreign-born) who don’t end up with residency positions. Over 90% of the roughly 2,100 applicants who went unmatched in the past three years were international medical graduates (IMGs). The third is the expansion of quotas for medical students without a commensurate increase in residency opportunities—a vital requirement to practice medicine.

The final bottleneck is the declining share of medical students choosing to study family medicine—the discipline most in demand in Canada. An incentive drive to encourage more people to pursue this career, and for medical practitioners to take trainees, is urgently needed.

Canada needs more doctors—and fast

Canada will be short about 44,000 physicians by 2028, with family doctors accounting for 72 percent of the deficit.

In addition to closing that gap, Canada will need to train or hire 30,000 more physicians by 2028 to match the average number of doctors per capita among OECD peers.

 Limited residency spots, a lack of professionals to evaluate prospective physicians, and funding shortfalls have created a chain of bottlenecks.

And the shortages are adding pressure to an already strained healthcare system, as patients unable to find family doctors turn to emergency rooms instead.

The bottom line: Hiring and training more doctors specializing in high-demand disciplines will help alleviate chronic shortages. Adding residency spots for fresh domestic and international medical graduates can help address some long-term challenges. And technology and policy that support the current workforce can improve efficiencies. – RBC Economics