Doctors’ cozy club limits our health care system

Canada doesn’t have a shortage of doctors; we have a closed shop that prevents foreign-trained doctors from practicing. The medical establishment prevents them from relieving our doctor shortage.

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About 5 million Canadians don’t have a regular family doctor. As a result, hospital wait times continue to grow. One study revealed that Canada has fewer physicians per capita than comparable nations: 2.7 per 1,000 people.

That puts us at 26th in countries of the Organization for Economic Co-operation and Development.

It’s not a lack of trying from foreign-trained doctors. They spend thousands of dollars to become certified as doctors.

To become licensed in Canada involves verifying one’s medical degree and previous practical experience, passing a language-proficiency test, and completing a Canadian medical residency or practicum. This can take up to a decade to complete and can cost as much as $28,000, including lost income from when they could be working.

Despite the effort, about one-half of the 1,000 doctors who immigrate to Canada every year abandon their medical careers (Walrus, May, 2021).

Doctors are retiring at an alarming rate. By 2026, 20 percent of Canada’s doctors will be 65 or older, according to the Canadian Medical Association.

The medical establishment ensures that Canada is short of doctors. The number of residencies for foreign-trained doctors is limited. And even when a foreign-trained doctor gets one of the rare positions, the chances of getting a license is low. Last year, Ontario had licensed only about two dozen spots — a negligible sum in a province with 31,500 practising physicians. British Columbia licensed zero.

The method of determining the number of residency positions is arcane. According to the Canadian Federation of Medical Students, “Provincial and territorial Ministries of Health determine the total number of residency positions available, the specialties in which they are available, and the proportion open to CMGs [Canadian medical graduates] versus [foreign-trained doctors].”

Investigative reporter for the Walrus, Jagdeesh Mann, attempted to find out how the quotas are calculated in B.C.:

“But attempting to understand how exactly quotas are calculated each year in B.C., for example, proved to be Kafkaesque. Starting from the College of Physicians and Surgeons of B.C., I was redirected to CaRMS and the University of British Columbia, then to the Association of Faculties of Medicine of Canada, and finally to B.C.’s Ministry of Health.”

Meanwhile, the already limited number of residency spots granted to foreign-trained doctors has declined since 2013.

The problem is about to get worse. By 2026, 20 percent of Canada’s doctors will be 65 or older, according to the Canadian Medical Association. Many doctors will be retiring soon.

When my doctor retired two years ago, I went without a doctor for over a year. I only got one after a referral from a friend.

The medical establishment is racist. Of the residencies that did go to foreign-trained doctors, most went to doctors from Europe. Only 15 percent went to those from Asia and another 15 percent to Africa. This, despite the fact that many immigrants would like to have doctors who are familiar with their customs and language.

Doctors hold a lot of power in determining the number of residencies. A doctor shortage ensures that they are in demand but they could loosen their grip on the number of foreign-trained doctors without damaging their fragile egos.

New doctors need to give up sense of entitlement

There are more doctors than ever before; yet two million Canadians can’t find one.

  image: davegranlund.com

An estimated 30,000 Kamloopsians don’t have a family doctor, although only about one-half of them are looking if national averages apply.

Something doesn’t add up. Why can’t Canadians find a doctor if there is a surplus? It’s complicated.

First, recent graduates of medical schools can’t find the residency they want. Without a residency, they will never become doctors.

This year, 2,980 will graduate from Canada’s 17 medical schools. They will compete for 3,308 residency spots. That would seem like every graduate should get a spot. However, 917 of those spots are in Quebec which means that there is a shortage for English-speaking graduates.

Then there is the arcane process of matching graduates to residencies which leaves some out. Health reporter André Picard says:

“But matching a graduate to a residency spot is a complex process, overseen by the Canadian Resident Matching Service (CaRMS). Medical students apply to CaRMS in one or more specialties; committees select who they wish to interview and rank them; graduates rank the programs and, finally, an algorithm spits out a match, and the student is legally bound to take that residency spot (Globe and Mail, May 1, 2018).”

Graduates have become pickier. They get assigned in residency specialties where they don’t want to work. As a result of preferences and the complexities of CaRMS, 115 graduates are unmatched this year. Jobs are waiting for them -there are 78 unfilled positions, 65 of them in family medicine.

The unmatched graduates have invested a lot. They have accumulated an average debt of $100,000 during four years of training. Taxpayers have invested a lot. We are on the hook for their subsidized education. The cost of training a medical student is $250,000.

Also, some graduates want a regular job where they work only 40 hours a week as in a hospital in a so-called “hospitalist” position. At $150 an hour, a hospitalist makes $300,000 a year with no overhead. Compare that with a doctor in his own private practice. After paying staff and rent, a doctor would have to earn $400,000 a year to take home that much -and they’d work longer hours with less medical equipment and fewer support staff such as nurses. But there are only so many hospitalist positions.

One-half of Canada’s physicians focus on sports medicine or palliative care says Dr. Danielle Martin on CBC’s the Current:

“. . .they’re not practicing what we would think of as full scope full service cradle-to-grave primary care family medicine, and that is what those people who are lining up at Dr. Pengilly’s clinic and asking [for a primary caregiver].”

Doctors need to abandon their sense of entitlement says Picard. We need more general practitioners, especially in small cities and rural Canada. Enrolling in medical school doesn’t entitle graduates to jobs wherever they want, in the speciality of their choice.

“Becoming a doctor is hard,” says Picard, “It’s also a privilege. We need a system that ensures the right doctors are working in the right places, not on where personal desires can trump societal needs.”