On the outside, looking in
Online posting: April 25, 2000
Re:Licence requirements for international medical graduates: Should national standards be adopted?, by L. Nasmith, CMAJ 2000;162(6):795-6 [full article]
I agree with some of the statements Dr. Morris Van Andel, deputy registrar of the College of Physicians and Surgeons of British Columbia, made in a recent issue of CMAJ.1 The college has mandate to protect the public from incompetent physicians, whether they were trained in Canada or elsewhere. When I chose Canada as my home, I did not expect to receive anything on a silver platter and I understood that I would have to work hard to achieve my dream (which is now a nightmare). The point is, all medical licensing authorities (MLA) in Canada have gone too far due to a lack of vision and understanding of physicians who trained outside Canada by withdrawing our rights to fair assessment and to practise medicine, even with restricted registration.
Assessing credentials and training of doctors who trained outside Canada is difficult, so I believe the MLAs chose the easiest way by giving priority to graduates from privileged countries. This is discrimination and that's why BC's Human Rights Commission has passed its ruling against the policy of the BC college.
Many physicians from "diploma mill" countries referred to by Van Andel are currently holding prominent positions in Canada, so questioning the training provided in these countries is a direct attack on their credibility and character. We have already been tortured emotionally and psychologically by the MLAs and others, and no more derogatory comments are needed.
Unfortunately, MLAs do not do anything voluntarily to deal with graduates of these "diploma mill" countries unless they are forced to, and then they react by introducing another policy just to shut us out.
We keep hearing that there is a serious shortage of family physicians in our country, but when I tried to respond to this need with enthusiasm, I faced many challenges and a lack of cooperation from every direction. Sometimes I wonder if there really is a shortage of FPs, or is it just exaggeration to milk governments for more money or to keep this rich pie for special interest groups. If I am not wrong, technically, a graduate from a Canadian medical school can practise medicine in one of the underdeveloped countries to help meet the needs of those with few medical services with almost no hassles. When graduates of a foreign school try to provide a similar service in Canada, they have no such luck.
The same issue of CMAJ also discussed special programs for international medical graduates,2,3 but MLAs must realize that not all of us can get into these programs. It is not because we are stupid - there are simply not enough places available, and each position that is available has its own questionable restrictions and demands.
CMAJ also mentioned that some Canadians are currently studying medicine in privileged countries.4 These people must really appreciate the extent of suffering and discrimination that we are currently experiencing as physicians from underdeveloped countries. I do understand these students' dilemma, but being from privileged countries will always place them ahead of international graduates from less fortunate countries. Please forgive me if I do not cry about their problems.
It is unfortunate that some foreign-trained physicians, especially those from underdeveloped countries who are currently working and holding respectable and high-profile positions here, turn their backs when new arrivals ask for their assistance or respond to a job posting. I guess they forgot who they are and why they came here.
Some of us (definitely not me) could have become famous some day like Norman Bethune, Marion Powell and other Canadian doctors like them. However, it is sad and a shame for our society that instead of practising our chosen profession, we have to beg, fight and waste our energies and talents trying to convince others of our worth.
I think the best route for all foreign medical graduates living here is to do what our Jewish colleagues did so long ago, when they developed the idea of creating their own health care and teaching facility, which led to the creation of the Mount Sinai Hospital in Toronto.5 In recent years, Canada's demographics have changed tremendously, but the essence of discrimination is still alive and well at all levels. However, it remains hidden, hunting and hurting us in the name of public safety, fear of the unknown, country of graduation, lack of trust and arrogance.
Regardless, the desire to practise medicine and help the needy remains alive. Deep down I am pessimistic that this and other health care issues will ever be solved. I hope I am wrong.
Kourosh Dinyari
Toronto, Ont.
kourosh.dinyari@sickkids.on.ca
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References
- Kent H. College to appeal discrimination ruling. CMAJ 2000;162(6):854.
- Nasmith L. Licence requirements for international medical graduates: Should national standards be adopted? CMAJ 2000;162(6):795-6.
- Andrew A, Bates J. Program for licensure for international medical graduates in British Columbia: 7 years' experience. CMAJ 2000;162(6):801-3.
- Sullivan P. Shut out at home, Canadians flocking to Ireland's medical schools - and to an uncertain future. CMAJ 2000;162(6):868-71.
- Barsky LM. From generation to generation: a history of Toronto's Mount Sinai Hospital. Toronto: McClelland & Stewart; 1998.
