Outside of the Toronto Union Station, a man walks hand in hand with his wife, enjoying her company and the bustling metropolitan city. Suddenly, he loses all control of his body, folding over and collapsing on the ground beside his panicking wife. She huddles over his body, trying to wake him, but the man lies on the concrete ground, still and lifeless. The distress on her face is clear, and a sinking feeling of her husband's demise inevitably begins to wash over her. Three cab drivers, watching the man's condition worsen, suddenly leap out of their cabs, rushing to the collapsed man. Two of the cab drivers begin to perform CPR, while the third comforts the woman. All three of the cab drivers are unflustered, going about performing a life saving procedure, with a degree of military efficiency. The third cab driver begins asking the woman about the unconscious man’s medical background, muttering words like “nitroglycerin” and “vasodilation” as he converses with her. Soon after, the ambulance arrives, and the third cab driver hurriedly talks to the paramedic, invoking him to take notes as he describes the man’s condition.
It was soon revealed that the three drivers were all new immigrants - trained as physicians in their home country. Yet, they were unable to practice in Canada due to the strict guidelines and barriers to entry. To support their families, they drove cabs from dusk to dawn, unable to practice the profession they had poured years training in. This was the account of Akaash Maharaj - a retelling of an event he witnessed some fifteen years ago in the midst of downtown Toronto (Maharaj, 2020).
This scenario ultimately raises an interesting question that is relevant more than ever today: if there are so many qualified immigrant medical professionals in Canada, why aren’t we introducing them into the workforce? In our current pandemic-burdened reality, it seems almost wasteful to not take advantage of the foreign medical talent present in Canada. Integrating these trained immigrants into the medical workforce would not only alleviate some pressure off the already burdened physicians in Canada, but could also be a valuable asset combating COVID-19 during our global pandemic. Nadeem Esmail, a senior fellow at the Fraser Institute, argues “Canada is in the midst of a physician shortage” and “a physician shortage will grow more acute in the coming years without [...] foreign trained physicians” (Esmail, 2018). Hallway medicine, a term coined in Ontario, is another problem plaguing our healthcare system and is one that is multifaceted and nuanced - yet one of the most obvious solutions is increasing the number of available physicians (Ontario Ministry of Health, 2018). Maharaj also argues that when medical professionals are unable to practice their talents in Canada, it not only strips Canadian society from the benefits of having more physicians available at a given time, but also “deprives them of their dignity” (Maharaj, 2020). Having worked hard in their mother land to attain such a rigorous and prestigious degree, only to go unrecognized in Canada, is an insult to the talents possessed by these immigrants.
However, the preservation of the status quo also presents a robust argument. The Medical Council of Canada Qualifying Examination (MCCQE) Part 1 is an exam that must be passed by every medical professional in order to practice medicine in Canada. In 2018, the Medical Council of Canada released statistics relating to the MCCQE Part 1, highlighting the drastically lower pass rate of International Medical Graduates (IMGs) in contrast to Canadian Medical Graduates (CMGs). In essence, foreign trained physicians scored significantly lower on the MCCQE Part 1 in comparison to medical graduates who completed their schooling in Canada. CMGs boasted a first time pass rate of 95% and a 67% pass rate with repeat test takers - a term for physicians who had previously written the test yet failed to score a passing grade (Medical Council of Canada, 2018). In comparison, IMGs had a 62% first time test taker pass rate and only a staggering 24% pass rate with repeat test takers (Medical Council of Canada, 2018). Clearly, there is quite a large discrepancy between CMG and IMG performance on the MCCQE, perhaps hinting that the lengthy process IMGs face, is both necessary and justified. It can also be argued that the diseases seen in Canada are markedly different than the ones found in foreign nations. Moreover, the medications prescribed, the psychosocial issues faced, and protocols are all different in Canada than the homeland of the IMGs. It then asserts that it is not only required, but rather paramount that IMGs go through the arduous process of attaining their medical licence in Canada, to be able to provide excellent patient care, in their new home.
Dr. Cabbie was a film released in 2014, veiled as a comedy it contained an underlying social critique of the Canadian healthcare system. The plot was eerily similar to the event Maharaj witnessed - a physician from India has recently immigrated to Canada and unable to find a job, resorts to driving cabs. His training saves the life of a woman in his cab when the ambulance takes too long to arrive. Although the movie was far from an Oscar nominee, it brought awareness to an important issue, while cleverly raising points for systemic reform as well as the preservation of the status quo. The protagonist saves the life of a woman in the back of his taxi and eventually starts seeing more patients out of his cab, a result of the agonizingly long wait times inherent in the Canadian healthcare system. However, the protagonist ends up in legal trouble after over prescribing a drug, a consequence of the difference in medical practices and systems in India and Canada. The movie critiques the Canadian healthcare system, bringing to light the confines bureaucracy places on the ability of immigrant doctors to practice medicine - negatively impacting both the availability of physicians to Canadian citizens and the financial and psychological burden it places on immigrants. All the while, cleverly raising a point to highlight how the training these immigrants attained in their home country does not necessarily translate over to the treatment of patients in Canada. Dr. Cabbie, with its tongue-in-cheek title, is not too different from Akaash Maharaj’s tangent on Twitter - both help unveil the magnitude of the current immigrant physician dilemma, albeit in different mediums.
Like most things in life, the solution to this problem is neither black nor white, and perhaps one that lies in the middle. More importantly however, it is vital to acknowledge that a fundamental mishandling of immigrant doctors does exist in Canada, and the message needs to be one that more people are aware of. People like Maharaj are championing this message, and while neither him nor I know the remedy to this dilemma, we can certainly attempt to convey the importance of it to others who may.
References
“2018 MCCQE Part I Annual Technical Report.” Medical Council of Canada, Medical Council of Canada , 2018, Available from: mcc.ca/media/MCCQE-Part-I-2018-Annual-Technical-Report.pdf.
Esmail, Nadeem. “Canada’s Doctor Shortage Will Only Worsen in the Coming Decade.” Fraser Institute, 20 Apr. 2018, Available from: www.fraserinstitute.org/article/canadas-doctor-shortage-will-only-worsen-in-the-coming-decade.
“Improving Health Outcomes and Ending Hallway Medicine - Public Information - MOHLTC.” Ontario Ministry of Health, Ontario Gov, 1 Feb. 2019, Available from: www.health.gov.on.ca/en/public/publications/premiers_council/default.aspx.
Maharaj, Akaash. “Twitterview with the Century Initiative.” Twitter, uploaded by Akaash Maharaj, 27 Oct. 2020, Available from: https://twitter.com/AkaashMaharaj/status/1321089265686728705.
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