Despite the Terrible Shortage, Why Do Doctors Drive Uber in Canada Instead of Treating Patients?

Canada, with its cold climate and warm welcoming system, looks like an attractive destination for qualified immigrants. However, the challenges of starting out and integrating into society remain great, typically for doctors.

For the past few months, patients have had more and more difficulty finding a family doctor across Canada. Family doctors and people seeking care are all sounding the alarm. The Canadian Medical Association (CMA) urges key stakeholders to work together to address the structural issues that are decimating primary care across the country.

Family physicians provide comprehensive support to patients, ensuring they have continuity of care and the help they need to navigate our complex healthcare system. The lack of access to family doctors is creating a growing crisis.

 

Severe Shortage

Statistics Canada reported in 2019 that approximately 4.6 million Canadians did not have regular access to a primary care provider. In addition, a worrying gap is being created between supply and demand: in December 2021, 2,400 positions for family physicians were advertised across Canada on government recruitment sites. However, in 2020, just over 1,400 family physicians left the postgraduate education system to transition into practice.

This trend is not new: in the six years between 2015 and 2021, the percentage of medical graduates who chose family medicine rose from 38.5% to 31.8%. Meanwhile, the average age of family physicians today is 49.

Family physicians are under immense pressure. Whether it’s administrative tasks like updating electronic medical records, processing medical forms, coordinating care between various agencies and providers, or managing increasingly complex care plans for an aging population, expectations of family physicians have never been higher.

Additionally, many work in hospitals, long-term care facilities, and specialty practice areas, including obstetrics, anesthesia, and emergency medicine, which takes up time in their practice. Without access to a family doctor, patients go to emergency departments, overloading other parts of the healthcare system.

Katharine Smart, M.D. FRCPC, President of the Canadian Medical Association, stressed that family medicine is the foundation of the health care system. The federal government must show leadership and collaborate with the provinces and territories to rethink family medicine and establish the offer of interdisciplinary team care. This will improve efficiency, increase the health system’s capacity and better respond, in a holistic, sensitive, and timely manner, to the needs of patients and doctors.

 

Lost Competencies

In an interview with Al-Estiklal, Marouane, a newcomer doctor to Canada, said: “Being able to practice after getting the equivalency of medical diplomas in Canada is a long process that requires years of study. The whole process is arduous and very expensive.”

He added: “This forces new immigrants to take up self-employment that has nothing to do with their field of specialization, while the health sector suffers catastrophically from shortages and the lack of doctors. Because of the strength of the unions that represent doctors, no government can change the conditions for practice permits in a way that allows the health sector to benefit from newcomer immigrant physicians.”

The CMA urges governments to partner with family physicians to find solutions, including creating a national data framework to better assess and forecast future needs for family medicine across the country and the introduction of a national licensing model to facilitate the interprovincial mobility of existing staff.

Carol Renner, expert on political studies and intellectual history, pointed out that many foreign physicians are working in the country. “Of course, foreign doctors have to be licensed to practice in the province or territory they wish to work in, and to be licensed, they need to demonstrate/prove Canadian medical school knowledge equivalency and all other criteria Canadian applicants are required to provide. There are also grants and financial assistance available for some physicians in some jurisdictions and at certain medical schools.

“However, we do have foreign-educated doctors driving cabs or are under-employed because they are required additional training that they didn’t have the time, money, or will to obtain in order to practice. What a waste, in my view. That’s why many provinces have developed programs and processes to assist prospective candidates negotiate the process.

“All internationally educated doctors must have their education credentials assessed by the Medical Council of Canada, take courses, exams, and training to be licensed by a Canadian province to practice medicine in Canada.”

 

Cumbersome and Expensive

With health systems currently struggling with a shortage of doctors, the outgoing president of the Canadian Medical Association suggests creating a single national system for issuing licenses to practice.

At present, each province issues its medical practice licenses within its territory. Dr. Katharine Smart believes that this system is very cumbersome and expensive, especially for doctors trained outside of Canada.

She believes a national licensing regime would verify the credentials of foreign-trained physicians through a single, lean mechanism for the entire country.

“It doesn’t really make sense that (all) the provinces independently accredit each university or each country,” Ms. Smart said. “It would be logical for it to be done once, for the whole country.”

Dr. Smart, who is a pediatrician in Whitehorse, Yukon, says foreign-trained doctors come to Canada hoping to practice their profession but are often stymied by an expensive and complicated licensing process.

She believes that many of these doctors eventually leave for other countries where it is easier to practice. “Many are never able to enter the system and finally practice medicine.”

The issue of cumbersome systems for foreign-trained physicians has recently come to a head in several provinces. In September 2022, Ontario Health Minister Sylvia Jones asked the province’s professional colleges to develop plans to accredit internationally trained doctors and nurses more quickly.

“The College of Physicians and Surgeons of Ontario has already taken steps to facilitate interprovincial (accreditation) on as little as one day’s notice, to meet urgent needs,” Shae Greenfield, the college spokesperson, said.

He added that the College had also proposed to the government to create a new temporary registration class specifically designed to support mobility between provinces and territories.