Wednesday, December 2, 2009

I'm a medical student, and I am Canadian

The other day, one of my classmates posted a news article regarding incoming legislation aimed at putting foreign professional immigrants to work as professionals in Canada (including MDs by 2012). The article made particular mention of how, "Media reports have long highlighted the problem of doctors working as pizza makers or cab drivers, for example. Many provinces and territories are struggling to make do with too few physicians, especially family doctors."

He accompanied the article with the caption, "Ugh."

The news became a lightning-rod for quick support from a number of classmates. A selection of their comments are included below:

It's about high time. It pisses me off to see international doctors forced to work in jobs barely requiring a high school diploma. So much for Canada, land of opportunity.


I am totally with [the comment above] on this one. I don't think international education is not as "good" as the Canadian one. It is much better to allow people to use their full potential and contribute to society instead of discriminating them based on where they studied.

Yet at the risk of sounding unfair and non-inclusive, I have to admit that as a future physician, this makes me fairly uncomfortable. Obviously, as the offspring of immigrants myself, I recognize one of Canada's most endearing features is the opportunity it provides to migrant families. At the same time, these opportunities need to be balanced against the needs of the nation itself. A country can't provide opportunities for others when it can scarcely provide opportunities for its own. Now I'm not saying that this will be the inevitable conclusion of such legislation, but I admit I think it could be. I, therefore, bucked the trend and submitted the following response:

I agree that it's wrong for Canada to advertise in other countries that they want professionals, when in fact they have no intention of recognizing those credentials, and when they actually want pizza makers and cab drivers.

It's also true that foreign education doesn't mean an inferior education, and it indeed is fair to recognize on par or superior foreign credentials, so long as you plan to control the number of such professionals that actually come in (and have some kind of QA system in place).

The major concern I would have is that it feels somewhat shortsighted to permanently fling wide the gates to foreign professionals to make up for a "doctor shortage" whose origin lies in the past slashing of medical school enrolments and which is currently being addressed by a restoration of larger medical school class sizes.

When all these extra Canadian doctors start graduating, I think it'll be pretty hard to tighten the tap without someone crying foul.

What I attempted to highlight was twofold. Firstly, Canada recruits immigrants in other countries, and often does so by appealing to the educated class. However, upon arrival, the nation often does in fact relegate such professionals to manual labour and other unrelated fields. Indeed, it would seem more morally acceptable to seek migrants looking for blue-collar work if we intend to parcel them into blue-collar jobs.

Secondly, however, while internationally trained physicians may (and this obviously requires qualification) possess the same or higher abilities as domestically trained physicians, the nation also needs to take care of its own (especially given the not inconsiderable investment that is made for medical education). When we talk about a "doctor shortage", we're discussing a direct consequence of policy in the 1990's which led to the slashing of medical school enrolment by 10%. This came about based on recommendations by the so-called Barer-Stoddart report which projected a surplus of doctors and raised the solution of cutting medical school admissions.

Today, the result of that misguided policy is seen is physician shortages across the country. Yet as Canada responds by ramping up medical school class sizes across the country while simultaneously trying to put boots on the ground through increased immigration, we ought to stop and question the long term ramifications of this policy.

If our doctor shortage is caused by decreased class sizes, and in a few years larger classes will start graduating, then theoretically this shortage will be self-limited. At the same time, if we fling open the gates to foreign-trained doctors, we may very well end up with a surplus shortly.

Stewie, ever the shit-disturber, replied to my comment with the following:

I absolutely support a meritocratic system, where your profession & income are based on your skills & experience, not your seniority, whether you belong in an union or what passport you have.

Let's face it - if you are Canadian-born or grew up in Canada, attended a Canadian highschool, university and medical school, then you have a number of advantages over a FMG (including language skills, cultural awareness, professional connections). If, despite all this, you STILL can't compete with an FMG, it tells me that either a) the FMG is freaking awesome (what's wrong with having more awesome doctors?) or b) you freaking suck (what's wrong with not having sucky doctors?). Either way, suck it up and go cry to yo momma, biznatch! =D

Obviously, this is a good point. While competition may make me and my peers more uncomfortable, it may be positive for the system itself, right?

But the problem is not one of quality, but rather quantity. Jobs for physicians don't magically appear, and once filled they may remain filled until vacated by retirement (which is coming ever later due to recession economics). Canada puts specific limits on the number of medical students it trains each year, and therefore, the number of new physicians entering the system.

However, if foreign-medical grads are simply funnelled into the system at the rate at which they can immigrate, how will that impact the system? These are some of the concerns I think need to be addressed when crafting policy.

Certainly, I think it's fair for an immigrant physician with the correct qualifications to work as a physician in Canada. But if we're going to set up this paradigm, then the nation itself will have to be ready to put the brakes on the immigration of physicians. Be ready to say: "Stop, you can't immigrate because we already have enough doctors this year, and if we let you in, we also have to let you practice because you're qualified. So even though you meet our economic criteria, you can't come in." Is that realistic? Over to you.

This is a very contentious topic, indeed it steps on a lot of nerves and balances the needs of the nation against discrimination against foreigners, the opportunities afforded-to we are all standing on. In the end, I'm not arguing against fairness for migrant professionals, but that such policy has to be robust enough to look out for the country itself and not be an open tap as it may turn out to be.

Kushima put gave his two cents in support of this view:

Kushima: I don't think they should be allowed to practice medicine so easily. Not sure about other fields, but medicine is always a protected field in each country. Which country out there recognizes foreign credentials in medicine without extra exams/training? Each country's healthcare system is different, and it is an expensive area too. Aside from good or bad education elsewhere, there is so much difference in the way healthcare is delivered from country to country and different emphasis based on different cultures.

Kushima: It's possible for them to practice here, just very difficult, which I think is reasonable becasue only the best of the best should be allowed to pass the threshold.

Andy: Well I think it's reasonable to accept foreign professionals, but if you're going to do that you're going to have to be tight about how many you let in. We control how many doctors we train... If you're going to let doctors practice from foreign countries, you better control that too.

Kushima: Exactly.

It's obviously not a simple issue, and it boils down to more than just our itchy equality fingers. As the poster of the article noted, "This is currently one of the top-commented articles on CBC. While it's important to extend opportunities to all, there are also many of cons that have been raised and are better expressed by commenters in the CBC article."

Of course, trusting Internet comments? That's a little dicey in my books.


Michael said...

A country can't provide opportunities for others when it can scarcely provide opportunities for its own.

First of all, that's patently incorrect. We as a nation are proud to provide food-aid and peacemakers to 3rd world countries, despite the fact that poverty and crime still exist in Canada. And I would hardly call the doctor prospects poor - one of the reasons many of us chose this profession was that as far as prospects go, it's a hell of a lot better than most fields.

You are also implying that every "Canadian" medical student and resident should be guaranteed a future job (or at least opportunities for job availability) before letting international students compete...

Once again, while that might be good for those particular students (there's only about 14000 Canadian medical students & residents, less than 0.05% of the Canadian population)... what about for the rest of Canada? What's more important - providing the best quality healthcare (which we would get from recruiting the best talent from around the world), or protecting a few jobs for a select group of highly privileged people?

I respect that as a future doctor, this worries you as it may affect your career opportunities. (As a future doctor, this worries me too, especially as I think I'm going to fail PBD tomorrow lol).

However, I think it's disingenuous to paint your argument as one that is based on "the needs of the nation". The needs of the nation are clear - more doctors. Not just for the sake of more doctors, but to provide equitable access to the best quality healthcare to all. "Too many doctors", on the other hand, is not really a problem for the nation... it's more of a problem for the OMA & CMA.

And to address Kushima's point - a Canadian hospital would always much rather hire a Canadian MD than a foreign MD even with the degree equivalency for the reasons he says. So of course it'll only be "the best of the best" who will get jobs. What I have a problem with are great international doctors not being able to find jobs while inferior Canadian residents get a 'free pass' to go on and provide questionable diagnoses at your local walk-in medical centers.

Kushima said...

there're international grads who get MD jobs here in Canada, though only a small proportion. who can say those who don't are more qualified than the canadian trained? nobody can tell.

there may be a shortage of doctors, but to a large extent it's because the government can't afford to have more. what you and i think and want probably don't matter to them much in their decision making. with free health care (the current model anyway), one way to control cost is to limit the number of people who can bill. timely and quality care for all is just an ideal, and it'll always be limited by financial realities.

i hear what you're saying abt "equal opportunity" for both the domestic and foreign trained. but would you still go into medicine if, after 14 years of post-secondary education and $150,000 in debt, you're not sure if you'll be able to practice? since the whole MD-training process is highly controled, especially at the admission stage, it's only reasonable to ensure most of these people (barring exceptionally bad cases) go out to do what they're trained to do. if there's not some kind of protection/privilege for the canadian grads, they might as well allow many people to get trained as MDs (like getting a bachelors) and the select the best afterwards. too bad cost will be an issue in that case. so the selection process has to take place at some point, and in canada it happens at the beginning.

i actually wrote a longer comment on this issue yesterday but decided not to post it since i rather not get into a debate before an exam, but we can certainly talk about it more tomorrow lol

Kaiba said...

Shouldn't you guys be studying for PBD... ... shouldn't I be studying for PBD??