Challenges Faced by Foreign-Qualified Doctors in Canada, USA: A Struggle for Recognition & Integration

Dr. Tausif Malik

In both Canada and the United States, the immigration of foreign-qualified and experienced doctors is often seen as a remedy for healthcare shortages and to reinforce medical services. However, a significant number of these highly skilled professionals encounter hurdles, ending up in low-income jobs or unable to practice due to certification criteria, revealing systemic challenges within the healthcare system.

“Canada faces a looming shortage of physicians, with an estimated deficit of nearly 44,000 medical professionals, including over 30,000 family doctors and general practitioners, projected by the end of the decade,” according to RBC’s “Proof Point: Canada Needs More Doctors—And Fast” report.

Despite the pressing need, the report highlights a concerning trend: while 2,400 family physician positions were advertised on government websites by the conclusion of 2021, only 1,496 family doctors completed their residency training that year.

In Canada, family physicians, classified under the National Occupational Classification 2021 (NOC) code 31102, command a median annual income of $216,833. However, this figure varies significantly based on factors such as geographical location and years of experience, as revealed by the federal Job Bank website dedicated to job-hunting and career-planning.

The shortage of healthcare workers encompasses various professions, with projections indicating significant shortfalls in key areas. According to the Bureau of Labor Statistics, the United States is expected to experience a deficit of 195,400 nurses by 2031. Additionally, the demand for home health aides and personal care aides is forecasted to surge by 37 percent by 2028. However, perhaps nowhere will the impact of this shortage be more pronounced than in the field of medicine.

A report from the Association of American Medical Colleges in 2019 highlighted that the country could face a shortfall of up to 124,000 physicians within the next 12 years. This deficit includes a potential shortage of between 17,800 and 48,000 primary care physicians, a situation with profound implications for patient care.

American Medical Association (AMA) President Jesse Ehrenfeld emphasized the consequences of this shortage, stating, “When people don’t have access to routine primary care and preventative services, they live sicker and die younger.”

Furthermore, Ehrenfeld noted that the primary care physician deficit disproportionately affects rural communities and communities of color, exacerbating existing healthcare disparities.

Certification Criteria Hurdles:

Obtaining medical licensure in Canada can be a daunting and time-consuming process for internationally trained doctors. According to data from the Canadian Immigrant Integration Program, only about 42% of internationally educated physicians who apply for licensure in Canada are successful. The stringent certification requirements, including language proficiency exams, clinical skills assessments, and residency training, often present significant challenges for foreign-trained doctors.

Similarly, in the United States, foreign-trained doctors must navigate a complex system of certification exams and licensing requirements set by state medical boards and the Educational Commission for Foreign Medical Graduates (ECFMG). While some states such as Tennessee offer pathways for foreign-trained doctors to obtain licensure, the process can vary widely, leading to inconsistencies and delays.

Impact on Individual Doctors:

The inability to practice medicine in their chosen field not only affects the professional aspirations of many foreign-trained doctors but also has financial implications. Despite their qualifications, they may find themselves working in non-medical roles or low-income jobs to make ends meet.

According to a report by the New American Economy, approximately 263,000 immigrants with healthcare degrees were working in low-skilled occupations in the United States in 2018. This phenomenon, known as “brain waste,” not only represents a loss of talent but also perpetuates underemployment and economic disparities among immigrant communities.

Impact on Patients:

The underutilization of foreign-trained doctors exacerbates existing healthcare disparities and shortages, particularly in underserved communities. Patients in these areas may face longer wait times for appointments and limited access to specialized medical care, leading to poorer health outcomes.

Moreover, the lack of diversity among healthcare providers can result in cultural and linguistic barriers that hinder effective communication and patient care, particularly for immigrant and minority populations. This can lead to misunderstandings, misdiagnoses, and overall dissatisfaction with the healthcare experience.

Impact on Patients’ Families:

The inability of foreign-trained doctors to practice medicine not only affects the individual practitioners but also has ripple effects on their families and communities. Families may face financial strain and emotional distress as a result of their loved one’s inability to secure meaningful employment in their field.

Furthermore, communities that lack access to qualified healthcare providers may experience higher rates of preventable illnesses, increased healthcare costs, and diminished quality of life for residents.

Impact on Economy:

The underemployment of foreign-trained doctors also has economic repercussions, resulting in lost productivity and tax revenue. According to a study by the Migration Policy Institute, the underutilization of immigrant doctors in the United States results in an estimated annual loss of $1.1 billion in potential earnings and tax revenue.

Additionally, the presence of skilled immigrant professionals in low-skilled occupations represents a waste of human capital and talent, hindering economic growth and innovation.

The challenges faced by foreign-trained doctors in Canada and the United States underscore the need for comprehensive reforms to streamline the certification process and facilitate their integration into the healthcare workforce. By recognizing their qualifications and providing pathways to licensure, policymakers can improve healthcare access, strengthen the economy, and promote the well-being of patients, families, and communities across the country.

Initiatives by US and Canadian Governments to Address Challenges Faced by Foreign-Trained Doctors

United States:

1. State-Specific Pathways: Many states in the US have established pathways for foreign-trained doctors to obtain licensure. For example, the California Medical Board offers the International Medical Graduate (IMG) Program, which provides a streamlined pathway to licensure for qualified foreign-trained physicians.
2. Federal Support: The US Department of Health and Human Services (HHS) provides funding for programs aimed at addressing physician shortages, including initiatives focused on recruiting and retaining foreign-trained doctors in underserved areas.
3. Community Health Centers: Federally Qualified Health Centers (FQHCs) across the US often hire foreign-trained doctors to provide primary care services in medically underserved communities. These centers receive federal funding to support their operations.

Canada:

1. Provincial Nominee Programs: Several Canadian provinces, such as Ontario and British Columbia, have Provincial Nominee Programs (PNPs) that include streams specifically designed to attract and retain foreign-trained healthcare professionals, including doctors.
2. Practice-Ready Assessments: Some provinces, including Alberta and Nova Scotia, offer practice-ready assessment programs that evaluate the qualifications and skills of foreign-trained doctors and provide support for their integration into the healthcare system.
3. Bridge Training Programs: Organizations like the Canadian Federation of Medical Students advocate for the development of bridge training programs that help foreign-trained doctors transition into the Canadian healthcare system.

These initiatives by both US and Canadian governments, at both federal and provincial/state levels, demonstrate a commitment to addressing the challenges faced by foreign-trained doctors and maximizing their contributions to the healthcare system. By providing targeted support, streamlining certification processes, and investing in workforce development programs, policymakers aim to ensure that all qualified medical professionals have the opportunity to practice to their full potential, benefiting both healthcare providers and patients alike.

Proposed Reforms:

1. Streamlined Certification Process: Implementing a standardized certification process for foreign-trained doctors could reduce barriers to licensure.
2. Internship and Residency Programs: Establishing specialized programs for foreign-trained doctors could provide them with practical experience.
3. Mentorship and Support Programs: Offering guidance to assist foreign-trained doctors in navigating the certification process could improve success rates.
4. Recruitment Initiatives: Launching targeted recruitment initiatives to attract foreign-trained doctors to underserved areas could address regional disparities.
5. Enhanced Cultural Competency Training: Providing cultural competency training could improve workplace integration and patient care.
6. Policy Coordination: Strengthening coordination between governments and regulatory bodies to develop cohesive policies for recognizing foreign credentials is essential.

These reforms could unlock the full potential of foreign-trained doctors and improve healthcare access for all, benefiting both practitioners and the communities they serve.

Finally, Is it Worth it for Foreign-Educated and Trained Medical Doctors to Immigrate?

The decision for foreign-educated and trained medical doctors to immigrate to countries like Canada and the United States is a complex one, influenced by various factors such as professional opportunities, quality of life, and personal circumstances. While immigration offers the promise of new opportunities and a better future, it also comes with its own set of challenges and uncertainties.

Pros:

1. Professional Opportunities: Countries like Canada and the United States often face shortages of healthcare professionals, creating a demand for foreign-trained doctors. Immigrating to these countries can offer foreign-educated doctors access to a larger healthcare system with more resources and advanced technology.
2. Higher Earning Potential: In many cases, immigrating to countries with strong healthcare systems can lead to higher salaries and better compensation packages for medical professionals. This can provide financial stability and security for themselves and their families.
3. Quality of Life: Immigrating to countries with higher standards of living and better social services can offer a higher quality of life for medical professionals and their families. Access to education, healthcare, and other social amenities may be better than in their home countries.

Cons:

1. Credential Recognition: The process of obtaining medical licensure and certification in a new country can be lengthy, expensive, and complex. Foreign-trained doctors may face barriers such as language proficiency exams, clinical assessments, and residency requirements, which can delay their ability to practice medicine.
2. Loss of Professional Network: Immigrating to a new country often means leaving behind established professional networks, connections, and reputation. This can make it challenging to rebuild a practice and establish credibility in a new healthcare system.
3. Cultural Adjustment: Adapting to a new culture, healthcare system, and working environment can be challenging for foreign-trained doctors and their families. Differences in medical practices, patient expectations, and communication styles may require time and effort to navigate.

Ultimately, the decision for foreign-educated and trained medical doctors to immigrate depends on their individual circumstances, goals, and priorities. While immigration offers the promise of new opportunities and a better future, it also comes with risks and uncertainties. For some, the prospect of practicing medicine in a new country with advanced resources and higher earning potential may outweigh the challenges of credential recognition and cultural adjustment. However, for others, the decision to immigrate may require careful consideration of the potential trade-offs and sacrifices involved.

About the Author

Dr. Tausif Malik is a social entrepreneur, publisher, and academician, renowned for his innovative ventures. He founded and publishes The Desi Buzz, GCC Startup News, Startup Berita, and Halal Biz News, amplifying entrepreneurship globally. Dr. Malik also spearheads AIMBSN, Halal Angels Network, and Startup Villages, fostering startup ecosystems. His groundbreaking initiative, RiseBack.org, offers affordable edtech solutions, providing Indian university programs starting at $50 per month and professional IT courses priced at $250-$350. Through his diverse endeavors, Dr. Malik empowers individuals with access to education and opportunities.