Canada is in its third wave of the COVID-19 pandemic, with emergency and intensive care departments struggling to cope with the number of cases. Yet there continues to be an untapped resource in the fight against the pandemic: internationally educated health professionals (IEHP).
Fauzia, whose last name we are withholding to protect her privacy, is an internationally trained physician from Pakistan who came to Canada in 2007. She says Canada accepted her because of her credentials and because the country needed physicians.
Even though she has successfully passed all the Canadian licensing exams — each medical exam cost around $2,000 — she was unable to secure a residency spot.
Fauzia then volunteered with different hospitals in order to “stay in the field and gain any possible Canadian experience.”
“They assigned me as a greeter to greet patients and visitors coming to the hospitals,” Fauzia said, adding that she was also tasked with closing and sealing envelopes. She even tried to apply for roles within the health-care system, like clinical assistant roles.
She recalls in one interview she was asked about her typing and Excel skills but never anything about her medical background or knowledge. She was also told that part of her responsibilities was to clean washrooms.
“(I) felt so humiliated, this is so demeaning.”
Finally, she decided to apply for a temporary licence that Ontario approved, where hospitals are allowed to hire internationally trained doctors to assist with the fight against COVID-19. However, Fauzia never got a response.
“This is a joke,” she said.
On April 7, 2020, Ontario launched an online portal where IEHPs can apply to be matched to health care-related jobs to assist with the pandemic. According to an email response from the Ontario Ministry of Health, as of April 15, a total of 2,889 IEHPs had signed up on the province’s online portal. Thirty-one employers requested IEHPs, resulting in 20 matches.
Global News reached out to the Medical Council of Canada (MCC), an organization in charge of keeping a consistent standard when it comes to the qualification to practise medicine for physicians in the country.
“Medical regulatory authorities grant licenses to physicians applying to practise medicine in a Canadian jurisdiction for the first time,” MCC said in an email, regarding its process for IHEPs.
One of the requirements is having “a degree of medicine from a medical school that, at the time the candidate completed the program, was listed in the World Directory of Medical Schools.”
HealthForceOntario, a recruitment agency, indicated that in the province there are 13,000 internationally trained physicians and 6,000 internationally trained nurses, medical lab technicians, respiratory therapists and other health professionals. Many of these IEHPs aren’t working in the health-care sector. Instead, many of them are unemployed or working for low wages and in precarious conditions.
A recent study published by Statistics Canada found only 41 per cent of foreign-trained immigrants are working in health care compared to 58 per cent of Canadian-born individuals with a health education. The study also found nearly half of those immigrants are underutilized. The data indicates this underutilization is higher among visible minorities compared to white populations.
“The situation is really bad; I can’t even describe how bad it is. Nurses are feeling the brunt of this pandemic, they are burnt out, experiencing fatigue and emotional breakdown,” said Birgit Umaigba, who is an intensive care nurse in Toronto and a nursing instructor at Centennial College.
Birgit adds that she’s seen physicians assigned to ICU nurse duties due to shortages.
“It would have been better and cheaper to allow internationally trained nurses to work in hospitals rather than asking doctors to fill in the gaps and continue to pay them doctors wages.”
As an instructor, Umaigba has met and worked with many nurses who’ve already been trained, but internationally.
“These nurses are highly qualified, have the ability to work under pressure with limited resources and are trained to work in times of crisis, as many of them come from war-torn countries and deal with highly sensitive situations in a hospital setting.”
Doctors have raised concerns about the current staffing situation in hospitals, including Dr. Michael Warner, the medical director of critical care at the Michael Garron Hospital.
Systemic barriers to practice
There are many systemic and structural barriers in place preventing IEHP from practising their profession in Canada. This includes challenges navigating the health-care system and understanding the complicated process of relicensing, limited access to information, lack of financial resources and having to go through a lengthy, time-consuming and financially draining process to undergo multiple assessments and exams at both the federal and provincial levels.
The exorbitant fees of these assessments and exams have been identified by IEHPs as one of the barriers. On top of medical examinations, IEHPs have to do English Language Proficiency and CASPer (Computer-Based Assessment for Sampling Personal Characteristics) tests. After going through this process, they’re faced with a larger barrier: limited residency spots, as in Fauzia’s case.
From 2016 to 2020, Fauzia applied every year for a residency spot but never got one. It costs her about $1,500 to go through the same process to apply for a residency spot.
According to CaRMS, in 2019 less than a quarter of international medical graduates (IMGs) who applied — 391 out of 1,725 applicants — for a residency position were matched.
For nurses, the situation is even more challenging. In Ontario, internationally educated nurses represent 11 per cent of the total nursing labour force. According to the College of Nurses of Ontario (CNO), 40 per cent of internationally educated nurse applicants never complete the application process due to systemic barriers.
Since the start of the pandemic, many organizations and advocates have called for the use of IEHPs during the pandemic. This includes a proposal by the Ontario Council of Agencies Serving Immigrants, the Toronto Region Immigrant Employment Council and World Education Services.
The proposal, titled “Mobilizing Ontario’s Internationally Educated Health Professionals to Maximize Ontario’s COVID 19 Response,” asked for the mobilization of the province’s almost 20,000 IEHPs.
Many politicians have also called for the use of IEHPs and the elimination of systemic barriers that are keeping these professionals from practising. For example, Brampton, Ont., councillor Charmaine Williams has asked the province to eliminate the barriers faced by foreign-trained doctors to practise in Ontario so they can help in the fight against the COVID-19 pandemic.
MPP Doly Begum also called for the province of Ontario to use the skills and expertise of IEHPs.
“Our government must work together to build a comprehensive strategy to support foreign-trained workers across all fields and ensure that we are preventing brain drain and deskilling among immigrant communities,” Begum said.
Many advocates have also proposed policy recommendations that would allow IEHPs to join the fight against the pandemic and practise in the long term.
Currently, Fauzia works virtually as a part-time telehealth general physician for a Pakistan-based company and gets paid $1 for each consultation she gives.
“IEHPs could have joined the front lines and helped at so many levels,” says Fauzia.
Sara Asalya is the founder and executive director of Newcomer Students’ Association, a grassroots organization working at the intersection of migration, education and social justice.