Licensing foreign-trained physicians

In recent months the College of Physicians & Surgeons of BC has been pilloried by the local press regarding the licensing of physicians who have received their training outside of Canada. Many of the columns or editorials have contained misinformation or incomplete facts and leave readers with the impression that the taxicabs of BC are occupied by foreign-trained physicians who are unjustly denied a licence to practise here.

Factoid #1: In each of the last 4 years, the College has licensed on average 130 foreign-trained physicians on the temporary register for supervised practice in under-serviced areas of the province. With respect to specialty training, the College looks to the Royal College of Physicians and Surgeons of Canada (RCPSC) to evaluate the national accrediting systems as equivalent and acceptable with respect to Canadian training. The granting of certification as a specialist or a family physician is much more than the completion of the final exam. Successful certificants complete a defined training program and pass a final examination. Foreign-trained physicians who have completed a training program that has been accredited and is approved by the Registration Committee of the CPSBC are eligible for licensure on the temporary register. Upon completion of the examinations of the Medical Council of Canada, and either certification by the RCPSC or the Canadian College of Family Physicians, a registrant is then advanced to the full register. Last year, 80 physicians on the temporary register successfully completed their examinations and received full registration status.

Factoid #2: The extensive list of evaluated postgraduate training programs is continually reviewed and re-evaluated by the RCPSC. For example, the RCPSC has deemed acceptable the training programs in Switzerland, Hong Kong, Singapore, and others. They have also assessed and found unacceptable the programs of Belgium, Pakistan, India, Argentina, and Israel. While the perception is that only undergraduates of Commonwealth countries obtain temporary licensure, last year 35 physicians whose undergraduate degree were obtained in non-Commonwealth countries were granted temporary licensure.

Factoid #3: If you are a physician who obtained your postgraduate training in a program that has either not been assessed, or been assessed and found not acceptable, you face serious challenges in obtaining a postgraduate position or a competency evaluation. Competency evaluations have been initiated in BC with limited funding from the provincial government. They are both time-intensive and expensive. Postgraduate training positions or opportunities for remediation are scarce. St. Paul’s Hospital has but six positions available for foreign-trained physicians to complete a 2½-year family practice residency. A few physicians may obtain a training position in the second iteration of the CaRMs match. CPSBC is only responsible for setting the standards for licensure, not in creating or funding a training program to bring foreign-trained physicians up to the standards set for all physicians, regardless of which training program they have completed.

Factoid #4: There is insufficient capacity in postgraduate training for physicians in BC. The university can barely accommodate graduates of UBC, let alone residents who wish to transfer to another program or physicians who wish to re-enter for specialty training. The Ontario government is notable for its financial commitment to assess and, if need be, train hundreds of foreign-trained physicians to tangibly deal with that province’s physician shortage.

Factoid #5: International graduates who are licensed to practise on the temporary register through recent negotiations are now provided eligibility to bill the full specialty fees. The College, however, will still require these physicians to complete their Royal College examinations in their specialty within the time frame specified by the RCPSC.

—HMO