Health Committee on Dec. 9th, 2009

[Dr. Ian Bowmer, Executive Director, Medical Council of Canada]

Thank you, Madam Chair and members of the committee, for the opportunity to present on behalf of the Medical Council of Canada.

The Medical Council was founded by Parliament in 1912 to establish an acceptable national qualification for the practise of medicine in Canada. Every graduate from Canadian medical schools takes our examinations prior to entering clinical practice, and almost all international medical graduates must complete one or more Medical Council examinations to be eligible for Iicensure.

Every year, 12,000 candidates take Medical Council of Canada examinations, which assess basic medical knowledge, clinical skills, and professional behaviours. After passing our final examination and meeting all other credential requirements, the candidate is awarded the licentiate of the Medical Council. This is one of the requirements that provincial and territorial regulators require before issuing a physician a licence to practise.

The council has taken the lead on several successful collaborations with the Government of Canada—through Human Resources and Skills Development Canada and Health Canada—as well as partner medical organizations. We've worked together on measures to enhance the integration of international medical graduates, IMGs.

One such collaboration resulted in the launch of the Physician Credentials Registry of Canada.

The Medical Council and the Federation of Medical Regulatory Authorities of Canada received funding through HRSDC to develop a national repository of verified physicians' credentials.

The Medical Council has been operating this service since July 2007, and we now process about 380 candidates per month. Physicians can submit their documents prior to immigrating to Canada. IMGs applying to more than one jurisdiction can choose to share their verified credentials with multiple organizations at once through the repository, saving time and effort.

While the time for verification depends on the source institution abroad and the type of document, the average is from 81 days for a medical degree to 108 days for verification of postgraduate training. This repository is currently available only to international medical graduates, but we will be expanding it to Canadian physicians shortly.

Opening an account with the registry and sending certified copies of relevant documents is the first step that an IMG can take before coming to Canada. A second step is to take the Medical Council's evaluating examination.

Since 1979, at the federal government's request, the Medical Council has been providing the evaluating exam as a screening mechanism. Since 2008, we have delivered this assessment through a computer-based examination now available at 500 sites in over 70 countries around the world and offered six times a year. It has always been intended for international medical graduates prior to their immigration to Canada. However, at the present time, only 50% of those taking it do so from outside Canada.

Our data show that if a candidate fails this examination one or more times, they have a low probability, less than 35%, of completing the licensing process. We believe the federal government would benefit--

[The Chair, Conservative, Joy Smith]

I am so sorry to interrupt you, but the bells are ringing and we're being summoned back into the House of Commons. If you will be patient, we will be right back to listen to the rest of your presentation.

Committee, I'm sorry, we all have to go to vote.

Thank you.

[The Chair, Conservative, Joy Smith]

Ladies and gentlemen, I know we don't have a complete committee here as of yet, but we will soon.

We need to make some decisions. On paper we have said that we were going to go to neurological disorders, I believe, at 5 o'clock.

Right now, do I have permission for the witnesses to continue...?

[The Clerk of the Committee, Ms. Christine Holke David]

We need quorum in order to make a decision. We have seven, a reduced quorum; we can listen to witnesses.

[The Chair, Conservative, Joy Smith]

We can finish listening to witnesses then.

[The Clerk]

Yes, exactly.

[The Chair, Conservative, Joy Smith]

Why don't we do that. After that, hopefully the quorum will be here.

Dr. Bowmer, could you continue, please?

[Ian Bowmer]

Madam Chair, thank you.

I had covered one of the areas, which was the repository. I was about to tell you about the second step that an international medical graduate can take before coming into Canada, which is the Medical Council's evaluating examination.

Since 2008 we have gone to a computer-based examination, which is now delivered in 500 sites in over 70 countries and offered six times a year. The important part about this examination is that we do know from our data that those candidates who fail the examination one or more times have a low probability of actually completing the licensing process. We believe the federal government would benefit by requiring potential licensure applicants to provide evaluating examination results for consideration with immigration applications.

A third successful joint project has been the development of a national assessment collaboration. This collaboration is in response to recommendation 2b in the Health Canada-supported IMG task force report of 2004. The national assessment collaboration is a partnership of national medical organizations; provincial and territorial governments; provincial, international, and medical graduate assessment programs; and Health Canada. We now have established the ability to deliver a single, new, nationally recognized clinical examination to assess international medical graduates applying for residency positions. A governance structure has been negotiated and will reside within the Medical Council. The examination is centrally coordinated but delivered regionally through the seven existing international medical graduate assessment programs. Three centres are now participating in a proof of concept for 2010.

Fourth is the council's collaboration with the Federation of Medical Regulatory Authorities and the individual regulatory authorities on an application to HRSDC for funding under the foreign credentials recognition program. Building on the success of the physician credentials registry, we plan to develop a web-based national registration process. This will provide international medical graduates, and in fact all physicians, with a single portal where an application to any of the 13 regulatory jurisdictions can be electronically populated from the existing document repository.

We look forward to continuing these collaborative efforts, which I am convinced will provide a fairer and more transparent licensing process for all physicians in Canada and improve the integration of international medical graduates into the Canadian medical system.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much.

I want to say a special thank you to you for your patience during the votes. We are going to have the bells ring again at 5:15, and my apologies for that, but we have to go vote.

Having said that, I now need permission of the committee to go into questioning because we had decided previously we were going to do something else.

Pardon me?

[Carolyn Bennett, Liberal, St. Paul's, ON]

We have another witness.

[The Chair, Conservative, Joy Smith]

I'm so sorry, my apologies.

I'm really trying to make sure everyone gets on.

Okay, Canadian Resident Matching Service, Dr. Sandra Banner.

Go ahead.

[Sandra Banner, Executive Director and Chief Executive Officer, Canadian Resident Matching Service]

Thank you for the opportunity to present the work of the Canadian Resident Matching Service to the Standing Committee on Health.

The Canadian Resident Matching Service is the access point to postgraduate medical education in Canada. All applicants, whether they're internationally trained or Canadian trained, must enter at the first level, which is PTY1, and CaRMS is the doorway into that process. It's an electronic application process, it's a matching service, and, of course, it's a data repository.

We've been serving the needs of international medical graduates for as long as the organization has existed, which is since 1970. We're not-for-profit. We really sit in the middle of the medical education community.

The goal of the electronic application and matching service is to have a completely transparent, fair, and accessible system. It is often misunderstood, but the Association of Faculties of Medicine of Canada sets the criteria for ranking in our selection system, not the match itself. The match only offers the process.

Since 2006, when the Association of Faculties of Medicine changed their policy and opened up the matching and selection process to international medical graduates, we have been able to witness an incredible increase in the number of international medical graduates who are attempting to enter the postgraduate medical education system in Canada. I'll give you an example.

In 2003, there were approximately 600 internationally trained medical graduates who would register every year for an opportunity to have access to our postgraduate system, but after the change in policy, we now see between 1,600 and 2,000 who register each year to be matched somewhere in Canada for postgraduate training. I think these numbers will mean something to you and have some consistency, and I think we can begin to depend on them.

Since 2008, CaRMS has sponsored an annual international medical graduate information symposium. We partner with other sister medical organizations, and with the assistance from the Ministry of Health in Ontario, we have been able to offer workshops and seminars to more than 400 international medical graduates to try to help them understand the system, the timing, and how to negotiate entering medicine in Canada. Feedback from both internationally trained physicians and workshop organizers reinforces how valuable this symposium has been to all attendees.

Since 2000, CaRMS has also identified a subset of international medical graduates, who are Canadians studying abroad. We define them as Canadian citizens or permanent residents who were legally in Canada prior to getting a medical education, whereas international medical graduates have traditionally been people who became Canadian citizens or landed immigrants after obtaining a medical education somewhere in the world. We see this other subset as those who started out with Canadian status, and then went abroad to get a medical education. Through a grant from Health Canada we have been researching this particular group of Canadian students who elect to study medicine in more than 25 countries around the world.

Now I want to go back to numbers, if I may. As I told you, since 2006 we have seen a consistent number of international medical graduates registering each year, consistent at somewhere between 1,600 and 2,000, but about 50% of that number are those who have been coming back each year. They were not successful the year before, or the year before that, so they're recycling, in a way, through the matching process, and 50% are new to the system each year. Again, that number is now quite consistent. So about 800 each year have never been in the match before, have just written their exams, and are new in attempting to enter the postgraduate system.

There's a final piece of information I want to share with you. In 2008, this group of Canadians studying abroad represented 24% of this new cohort; in 2009, they were 31% of this new cohort; and this year, because we're now in the match of 2010, they are as high as 40% of new internationally trained medical graduates entering or attempting to enter our system.

This subset of international medical graduates is a growing proportion of the international medical graduates who are attempting to attain licensure in Canada.

[The Chair, Conservative, Joy Smith]

Thank you so very much.

Now I need to ask if it's the will of the committee to go into questions. We were going to go into something else, but do I have the will of the committee to continue on with that?

[Some hon. members]

Agreed.

[The Chair, Conservative, Joy Smith]

Okay, we'll do that now.

Also, we were going to get into the topic of neurological disorders a little later, but we're going to have bells at 5:15, and there are only two issues we have to deal with, so....

I would suggest that has to do with family day. Those dates--February 15 and 16--will not work, so I suggest we deal with that when we come back after break.

Is that okay with everybody?

[Some hon. members]

Agreed.

[The Chair, Conservative, Joy Smith]

Thank you.

We'll now go to questions and answers....

Did you want to say something?

[Patrick Brown, Conservative, Barrie, ON]

We could probably talk about it briefly at the end of this meeting. It would take only five minutes.

[The Chair, Conservative, Joy Smith]

If the bells ring, I have to get back. We have 15 minutes only.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

So 5:10.

[The Chair, Conservative, Joy Smith]

Okay, then, we'll stop at 5:10? Let's do that.

Let's start with Ms. Murray.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Madam Chair, I'll be sharing my time with Dr. Bennett.

[The Chair, Conservative, Joy Smith]

Okay.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Or do you want us to do five minutes each?

[The Chair, Conservative, Joy Smith]

Five minutes each, please.

Thank you.