Royal College fast-tracking certification of foreign-trained doctors

[indefatigable]

A surprising move from the Royal College:

https://www.theglobeandmail.com/canada/article-foreign-trained-doctors-certification/

"The Royal College of Physicians and Surgeons is making it easier for internationally trained specialists to work in Canadian hospitals as it responds to the country’s doctor shortage, and to complaints that some of its policies discriminate against people with overseas medical degrees.
The college, a regulatory body that sets national standards for doctors who specialize in fields such as surgery, cardiology and emergency medicine, has been under pressure to streamline the way it assesses foreign-trained physicians and determines their eligibility to write certification exams. Getting these doctors accredited to work in Canada has become a critical issue as the country’s health care systemhas strained under pronounced staffing problems.
Glen Bandiera, the college’s executive director of standards and assessment, said the regulator is working to remove barriers to licensing for internationally educated doctors by increasing its capacity to review their applications and grant them exam eligibility. Once those changes are complete, he said, the college is planning to provide more flexibility for doctors with foreign training who don’t meet all the Canadian requirements to work in their disciplines. It will do this by allowing them to apply their training to more general disciplines, he said.
The college is also expanding a program called the Practice Eligibility Route, which can take years off the amount of time required for an internationally trained physician to be approved to work in their field. The college, which certifies all specialists in Canada except for family doctors, says this pathway could allow doctors to be cleared to work in as little as two years, instead of seven.
“We want to make it as easy as possible for people who have that competence to demonstrate that competence, regardless of where they trained,” Dr. Bandiera said. “We’re really cognizant of the current health human resources strains in the system.”

I find it surprising since a few years ago the Royal College came out with a study highlighting employment difficulties of many specialists citing  "Poor health system planning often to blame for unemployed docs" highlighting difficulties of some graduates.  So maybe this is going to be targeted to some specialties like EM where there is a healthy job market? Or perhaps the unemployment patterns are more limited to geographical preferences which in theory IMGs won't have and thus will be able to fill in-demand spots?  Given that apparently nearly 40% of graduating orthopaedic surgeons didn't have a job, I'm supposing that more certified orthopods will create an even tighter job market.  I'm also supposing the implication is that a sub-specialized physicians like interventional cardiologist could work as a general cardiologist.  

• 11-18% of newly certified specialists cannot find work at the time of their certification.
• Employment challenges are greater in more resource-intensive specialties.
• Employment challenges vary greatly from province to province.
• It can take more than one year for some medical specialists to find a clinical post.
• 75% of those who are continuing training do so because they think this will make them more employable.
• The majority of specialists surveyed (66%) do find jobs within 12-17 months.

https://newsroom.royalcollege.ca/poor-planning-often-to-blame-for-unemployed-docs-2/

https://www.royalcollege.ca/rcsite/health-policy/employment-study-e?utm_source=newsroom&utm_medium=ad-text&utm_campaign=employment-study

 

[Findanus]

There is a clear motive to flood physician specialties with IMGs, reducing bargaining power. This will also significantly reduce care quality, but those concerns seem secondary to propping up the strained healthcare system, much like how Walmart employs students from abroad rather than Canadians. Cheaper. 

 

The FRCP is valuing the political aspect of the Canadian health care system over the patient care and professional aspects. Patients will receive worse care, doctors will receive worse rewards, but the system persists.

 

My prediction is that a larger number of Canadian doctors will head south.

 

I wonder why I am paying this organization.

[shikimate]

As an aside, maybe they could hire AI for 9$ a month (OAC, see store for details) to replace the radiologists that cost 900K a year. Accuracy is not as good but hey at least it's cheap.

https://www.bmj.com/content/379/bmj-2022-072826

[medigeek]

11 hours ago, Findanus said:

There is a clear motive to flood physician specialties with IMGs, reducing bargaining power. This will also significantly reduce care quality, but those concerns seem secondary to propping up the strained healthcare system, much like how Walmart employs students from abroad rather than Canadians. Cheaper. 

 

The FRCP is valuing the political aspect of the Canadian health care system over the patient care and professional aspects. Patients will receive worse care, doctors will receive worse rewards, but the system persists.

 

My prediction is that a larger number of Canadian doctors will head south.

 

I wonder why I am paying this organization.

Not disagreeing, but it can be a lot worse in the south. Perhaps not the southern states with lower taxes, but you're still an employee taking orders from admin for a set salary in USA. 

[shikimate]

23 hours ago, Findanus said:

I wonder why I am paying this organization.

I am only paying them because the hospital stipulates CME for privilege. Since I am also doing American board CME requirement I might inquire if I can stop the royal college. I just realized some of the people here who are only American certified aren't doing Mainport so I might not renew it this year and see what happens.

What's also scammy about RC is even if you "Anticipate a temporary leave for four months or longer for family or health reasons", you still gotta pay $495. Like come on, at least before they mail you a plastic little membership card to carry around. Nowadays you gotta go online and print your own. FML.

[bearded frog]

¯\_(ツ)_/¯ there are rural areas with a severe lack of specalists (and GPs). This is already common in peds, more often than not the local pediatricians in remote areas are foreign trained. If they are willing to work where Canadian trained docs won't then fair enough!

[Edict]

There are many ways where this can be watered down. 

The Royal College may be pressured to do this but they can make it such a reform that effectively still makes it difficult for less qualified or uncertain foreign specialists to get a job here.

Currently, academic hospitals routinely hire foreign specialists directly or after unaccredited superfellowships here, there are clearly ways for them to hire high quality foreign specialists without any retraining.

Also, this won't really affect oversubscribed community hospitals as community hospitals will usually prefer a Canadian trained doctor if they are present. 

With that being said, I always have believed that doctors should aim to write their USMLEs giving them to flexibility to move to the US. Don't forget, you don't need to be US BC to get a job in the US, Canadian BC is enough to practice in the US. The USMLEs give you the ability to get a state medical license in any state, while Canadian exams will work in some but not all. 

This will likely be used to fill in spots in rural undersubscribed areas, which I think is fair for the health system as a whole, we need people in those places and local Canadians will do fellowship after fellowship not to go there, and lets face it, there are so many structural barriers that stop specialists from working rurally, there are no quick fixes because most of our specialists have been raised in large urban centers, trained in these centers and may have spouses who can't find fulfilling work or lives in rural settings, not to mention the specialists themselves may not want to work in those settings.  

 

[Findanus]

13 hours ago, Edict said:

There are many ways where this can be watered down. 

The Royal College may be pressured to do this but they can make it such a reform that effectively still makes it difficult for less qualified or uncertain foreign specialists to get a job here.

Currently, academic hospitals routinely hire foreign specialists directly or after unaccredited superfellowships here, there are clearly ways for them to hire high quality foreign specialists without any retraining.

Also, this won't really affect oversubscribed community hospitals as community hospitals will usually prefer a Canadian trained doctor if they are present. 

With that being said, I always have believed that doctors should aim to write their USMLEs giving them to flexibility to move to the US. Don't forget, you don't need to be US BC to get a job in the US, Canadian BC is enough to practice in the US. The USMLEs give you the ability to get a state medical license in any state, while Canadian exams will work in some but not all. 

This will likely be used to fill in spots in rural undersubscribed areas, which I think is fair for the health system as a whole, we need people in those places and local Canadians will do fellowship after fellowship not to go there, and lets face it, there are so many structural barriers that stop specialists from working rurally, there are no quick fixes because most of our specialists have been raised in large urban centers, trained in these centers and may have spouses who can't find fulfilling work or lives in rural settings, not to mention the specialists themselves may not want to work in those settings.  

 

I don't think that the ultimate aim is to increase rural physician numbers here, rather it is to increase urban physician access.

 

Most of the population increase that Canada is seeing is from immigration from a few countries, and those immigrants prefer to settle in Vancouver and Toronto. There is a lot of strain on the health care systems in those regions.

 

I do not agree with the RC as it is a relaxation of standards to prop up a failing system.

 

 

[Edict]

6 hours ago, Findanus said:

I don't think that the ultimate aim is to increase rural physician numbers here, rather it is to increase urban physician access.

 

Most of the population increase that Canada is seeing is from immigration from a few countries, and those immigrants prefer to settle in Vancouver and Toronto. There is a lot of strain on the health care systems in those regions.

 

I do not agree with the RC as it is a relaxation of standards to prop up a failing system.

 

 

The challenge is, as Canadian physicians, we have not offered any great solutions. The reality is, there may be some arcane rules that can be streamlined here. The other reality is, Canada is not a closed door to IMGs right now, so these reforms are unlikely to open the floodgates anyways. Most likely, nothing will change from these reforms. 

While there are certainly health challenges in urban areas, the shortage isn't driven by physician shortages but rather by other shortages like facilities etc. There is no specialty that has an urban shortage that does not also have a rural shortage. The rural shortage is worse because in rural areas, the population is aging, Canadian immigrants are predominately working age and students rather than those who are in need of healthcare. Rural areas have also produced less doctors per capita than urban areas, and because people tend to prefer to settle where they grew up or trained more doctors prefer urban areas.