“We’ve been decreasing the percentage of foreigntrained doctors in Canada, as a percentage overall, but at the same time making certification of a foreigntrained doctor contingent on working in a rural area. That means we have concentrated them in rural areas.”
– JOHN DAVID STANWAY, SENIOR ANALYST, CANADIAN INSTITUTE FOR HEALTH INFORMATION
Visit a doctor somewhere in rural Manitoba these days, and odds are he or she did not earn their medical degree in Canada.
Yet, Canada’s percentage of foreign-trained doctors has actually declined since the 1970s, according to a new report.
The Canadian Institute for Health Information (CIHI) this summer released findings showing the percentage of Canada’s foreign-trained physician workforce has actually dropped from 33 per cent to 22 per cent in 2007.
The decline is seen in all provinces and territories, with the major reason for the decline in the number of foreign-trained doctors relative to the overall physician workforce being that the huge wave of British-and
Irish-trained doctors who were coming here to practice in the 1970s is now retiring.
At the same time, slightly fewer numbers of international medical graduates are setting up practices in Canada, the report says.
Today, one in five doctors has earned their degree outside Canada; in the 1970s, the ratio was one in three.
Why we see foreign-trained doctors still concentrated in rural areas is the result of deliberate policies, said John David Stanway, a senior analyst with CIHI. Foreign-trained doctors must serve two or three years in an underserviced area as part of the provisional licensing.
“We’ve been decreasing the percentage of foreign-trained doctors in Canada, as a percentage overall, but at the same time making certification of a foreign-trained doctor contingent on working in a rural area,” Stanway said. “That means we have concentrated them in rural areas.”
Unfortunately, they’re not sticking around long, this report confirms. Foreign-trained doctors have a much greater tendency, than the previous wave of Brits and Irish doctors, to move elsewhere within a decade of arrival.
The report also notes the major shift in countries from where Canada now sources doctors. Whereas in 1972, a major portion came from Britain and Ireland, by 2007, South Africa and India were supplying this country with most of its international medical grads.
Dr. Derry Decter, a Brandonbased physician advocating that a medical school be created at Brandon University to graduate new doctors who would commit to serving in rural areas, said the CIHI findings underscore the need to rely less on foreigntrained docs.
“It doesn’t make sense to me to raid the Third World for scarce physicians,” he said. “The obvious solution is to train our own docs.”
That is, in fact, what Canada as a whole has begun to do.
Dr. Ian Bowmer, executive director of the Medical Council of Canada points out that this country is about to see an influx of Canadian-born and trained doctors, as larger classes in medical schools across Canada begin to graduate. More Canadian medical schools have opened and more spots for medical residents have been created, he noted.
Yet, the rural shortage won’t disappear if all these new doctors still don’t want to practice rurally.
“The policy levers that need to be pulled right now are to attract all these physicians to rural practice,” Bowmer said, adding that he sees governments actively engaged in efforts to both recruit and retrain both IMGs and Canadian medical graduates in rural service.
Another part of the solution is “to create an environment where the lifestyle for physicians and other health-care workers actually improves,” he stressed.
Dr. Dean J. Sandham, dean of the University of Manitoba’s faculty of medicine echoes that view.
This fall the university’s faculty of medicine welcomed a 110-member class, representing a 53 per cent increase in enrolment in undergraduate medicine over the last nine years here. Forty-nine of them are coming in with experience either of living, working or volunteering in rural areas.
“We’ve been working hard on our admissions process to create an index that allows us to put extra value to people who have a commitment to working in rural and remote areas,” Sandham said.
The faculty of medicine is also currently hiring an assistant dean to improve and enhance both the education and the lifestyle students experience when they’re placed outside the Winnipeg area during the course of their studies.
“What we need to do is try to make these rural careers appealing to people.”
Meanwhile, the provincial government this summer announced an allocation of $2.1 million for a multi-tiered approach to recruit and retain physicians across Manitoba, especially in rural areas.
The cash will be put toward recruitment of specialists, rural physician relief so that doctors can take temporary leaves, and to cover costs such as moving expenses for physicians setting up practice in rural areas and grants for 10 second-year students taking part in the Northern Remote Physician Practice Initiative.
In addition, $90,000 in funding will be used to co-ordinate the repatriation of Manitoban and Canadian medical students studying in other provinces or abroad.
The CIHI report notes that over a quarter (27 per cent) of Canada’s foreign-trained doctors actually grew up in Canada but have studied overseas.
The CIHI is a non-profit, independent organization collecting and analyzing information on health and health care in Canada.