Health Committee on April 1st, 2010

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

I have heard there have been some changes over time in terms of assessment prior to coming to Canada. For people who are coming to Canada with qualifications to a much greater degree, have a number gone through a pre-assessment process and have a good understanding of where they're going to fit into the system? Have things improved? It sounded as if over the last few years we've had some improvements there.

[The Chair, Conservative, Joy Smith]

Who would like to take that comment?

You're asking very hard questions, Ms. McLeod.

Mr. Boone.

[Jim Boone]

Each province has its own pre-assessment program, but each of them has defined its own way of assessing foreign-trained physicians. It's difficult if you're an IMG and you're interested in applying to multiple provinces. It gives them their best possible chance: the more programs they apply to, the more universities, the better chance they have. However, if they're assessed in B.C., for example, that's an enormous amount of investment of their own time resources. You have to be a resident of B.C. to be assessed there so they can't realistically apply to any other province. Likewise with Quebec: you're assessed as an IMG in Quebec, and it's difficult to apply outside Quebec because you have to be a resident of Quebec to be assessed in Quebec. Likewise in Ontario.

So we're really pigeonholing the IMGs provincially and not allowing them the flexibility to apply to positions across the country, which reduces the selection and reduces the opportunity for the applicant.

[The Chair, Conservative, Joy Smith]

Thank you so much.

We'll now go to Dr. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair, and thank you to all of you for coming.

I'm going to focus on licensing exams and how long it takes, etc. What is the cost of the licensing exams and what is the average number of years an IMG waits before taking them?

[Dr. Ian Bowmer]

I'm not sure I can answer that totally accurately, Madam Chair, but the current cost of the evaluating exam is $1,200. The current cost of the qualifying exam part one is $800, and the current cost of the qualifying exam part two is $1,600, which in terms of the cost is almost the same as the three-step examination the U.S. administers. But Dr. Varastehpour is correct that the Canadian graduate does not have to do the evaluating exam.

The time for an international medical graduate to move through the system depends on whether or not they pass.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Sorry, that wasn't the question. What is the average number of years they wait before taking the exams?

[Dr. Ian Bowmer]

They're eligible as soon as they... We do not require their documents to be source-verified prior to taking the exam.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

I know that.

[Dr. Ian Bowmer]

So they can take that immediately, and we offer that six times a year.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

In my community I have now met 100 IMGs, actual count, who have not been able to afford the exams. When they've brought their children over they are working two jobs and they cannot afford the $1,200. Some have waited four and five years to have the money to take the exams. I'm wondering if we have data on that.

[Dr. Ian Bowmer]

I don't know the people who don't take the exam; I only know the people who do. But I would say on the issue of the cost that we are a not-for-profit charitable organization, and at this moment all the exams are cost-recovery, except for the qualifying examination, which is subsidized by an endowment the council has. So in terms of the cost as an issue, if that's an access issue, that is a problem for those individuals.

I just point out that any of us--and I'm a licensed physician in Newfoundland--if we do not practise for two years, have to do remedial work. So delaying a candidate for more than two years automatically requires them to have further education. So that is an issue.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Have some of the reasons for the delays been looked at? One of them is certainly the money. Were there other reasons for delaying?

[Dr. Ian Bowmer]

First of all, I think people should be encouraged to take this exam offshore so that they are not in the position of having to find alternative work. My advice to international medical graduates, if they're here, is to keep going back to their home countries to practise, so they're at least presenting themselves as fully practising physicians during the time that they're waiting for the exams.

A person who passes can actually get through the examination system within about 18 months. It is possible to do it in 12 to 18 months, but they would have to pass each exam, and the timing would... We offer part one twice a year and part two twice a year, so it is possible to do it within 18 months.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

What is the average pass rate for an IMG compared to a Canadian graduate?

[Dr. Ian Bowmer]

If you look at the performance on the part one exam--and they have to have passed the evaluating examination to have done that--about 90% to 95% of Canadian graduates will pass, and it's somewhere in the neighbourhood of about 65% to 70% for IMGs if they pass part one the first time. It drops down to about 50% to 60% if they've taken more than one opportunity to take the exam.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

That's--

[The Chair, Conservative, Joy Smith]

I'm sorry, Dr. Duncan; your time is up.

Thank you, Dr. Bowmer.

Now we'll go to Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Madam Chair, like Ms. Duncan, I have concerns about medical graduates. I've met some in Barrie on some of the position recruitment tours, and they have really been challenged with the process in Canada. I think it's important that we understand it a little better.

First, what are the costs for the medical equivalency exams in Ontario, or in Canada, for both the exams and the books? What is the cost of the exams for foreign-trained doctors to become accredited in Canada ?

[Dr. Ali Varastehpour]

It's $5,000, roughly.

[Patrick Brown, Conservative, Barrie, ON]

It's $5,000. What is the cost of the books?

[Dr. Ali Varastehpour]

You can study as many books as you can. The single recommended textbook is about $150.

[Patrick Brown, Conservative, Barrie, ON]

How many textbooks do you need?

[Dr. Ali Varastehpour]

Myself, I studied from American books because I'm USMLE-certified, so I knew where to look. For me, that was not the issue, but if you come from eastern Europe, as I do, where we didn't have one single written exam, you are seeing multiple-choice questions for the first time in your life. It takes some time to get used to that. That's why I was talking about bridging programs during the course of my conversation. I passed with 90%, but there are people who pass it with 100%. That does not mean anything.

In order to safely practise medicine, and I'm sure even Dr. Bowmer would agree, even 60% on the evaluation exam is enough. People are coming here with an evaluation exam taken in their home country, at any time and at any number of attempts with any school, and they pick and choose their specialty. This is the crux of the matter.

[Patrick Brown, Conservative, Barrie, ON]

I know a couple of stories in my riding. They're both doctors from eastern Europe, and because they were making $10 an hour, it took them three or four years to save up enough money to pay for the exams and the books. It sounds like a very arduous process. Hopefully we can look for ways to alleviate this situation.

Fleur-Ange, maybe you could help me on this. Do you know how many foreign-trained doctors have passed the equivalency exams but have not been able to be placed into residency? One thing we've heard is that there is certainly a lack of residency spots for foreign-trained doctors. On an annual basis, do we know whether that gap is getting bigger or smaller?