Thank you very much.
As you know, I am from IMGA. It is a non-profit organization that was begun in the year 2000.
There are more than 600 IMGs currently in Alberta who have acquired their medical degree from various parts of the world. Canada is not fully conversant with the educational curriculum, standard of training, and registration procedures of each country from where these IMGs have qualified. This lack of knowledge about the foreign universities causes extraordinary delays in the evaluation of the degrees and training of the IMGs. On the other hand, IMGs who have immigrated to Canada are not familiar with the Canadian health care system and they invariably become highly frustrated at the very slow pace of their integration.
IMGA has become a bridge between the IMGs and the Canadian health care system. It primarily represents the interests of IMGs, but it also can assist the licensing bodies in streamlining the evaluation procedure and thus expedite the integration of IMGs. This is possible because we understand the needs and requirements of the Canadian health care system, and we also know the requirement of each individual foreign medical graduate.
The important areas that need assessment are language abilities of the candidates, undergraduate medical standards of the foreign country, and the standards of post-graduate training.
We have some challenges, and I will make some recommendations.
Number one, the assessment of the qualifications of the IMGs is the most critical and time-consuming part of registration. Based on current statistics, countries from where the majority of the IMGs are immigrating to Canada should be identified. Teams of experts from Canada should visit these countries and thoroughly review the post-graduate process and standards, the course manuals of foreign universities for equivalency to those of Canadian universities, should ensure that their own countries accredit the foreign medical schools, and study the regulatory bodies and their controls and restrictions in these countries. The committee might consider a federal grant for such a study. English or French language abilities of the candidates may be assessed by appropriate examination, such as TOEFL.
Number two, better coordination of regulatory bodies is required. After successful completion of the Medical Council of Canada examinations, candidates apply to CaRMS, and other provincial examinations, such as OSCE, for entry into the IMGA residency program.
There's a need to have better coordination of these regulatory bodies at the provincial and federal levels. For instance, 121 residency positions remained unfilled after the second iteration for the residency-1 match, while hundreds of LMCC qualified IMGs were still waiting. Family medicine alone had 81 positions that were unfilled, while 2.5 million Canadians do not have a family physician. In the 2008-09 matches to the IMGA residency program, seven positions were unfilled, although funds were available for these positions. Alberta alone has a shortage of 1,300 physicians. I think it's a great loss.
Number three, the shortage of preceptors is an important issue. Monetary and other incentives can attract the recruitment of more family physicians as preceptors. Primary care can be utilized for physician support. The federal government may be able to play a positive role in this regard, such as a task given to those family physicians who act as preceptors.
Number four, community practices can be utilized as a source of supervised training for IMGs in urban and rural areas.
Number five, standardized assessment procedures should be in place that recognize previous clinical experiences all over Canada.
Number six, skills-based bridging courses, or bridging courses that are formally recognized, can fill in the gaps to facilitate smooth integration of IMGs. Courses for ethics and patient autonomy are primary issues in the Canadian health care system. Sensitive issues, such as death and dying, are part of the Canadian medical education that IMGs need to learn. The federal government can initiate funds for such courses at selected locations all over Canada.
Number seven is the need for self-directed learning for IMGs with mentors from community hospitals and post-secondary institutes. A mentorship program initiated as a pilot project in Alberta needs to be supported for the future, as this could be a starting point for all IMGs to get Canadian health care experience and subsequently provide structured training to IMGs.
Number eight, the Calgary clinical assistance program and international medical graduate preceptorship program in Alberta have been successful in providing services in hospitals, under supervision, for IMGs for the past few years.
These IMGs undergo regular evaluations, comparable to those of Canadian graduates. However, most of these programs end in two years, leaving participants without any plan for the future. These experiences should lead to accreditation and licensure of participants.
Number nine, IMGs with less than three years out of practice should be considered for a supervised licence without undergoing further training. Others may apply for residency programs. The fast-track project is currently funded by CIC, and research is expected to be completed by March 2010.
My last recommendation is that IMGs with more than three years out of independent practice but who have been working under supervision for more than five years can be assessed and could become valuable members of multi-disciplinary teams in the specialty and family clinics.
These complex issues can be resolved by our federal and provincial political leaders with the help of experts from provincial licensing boards, the College of Family Physicians of Canada, and the Royal College of Physicians of Canada.
I represent AIMGA, which hopes to play a positive role for IMGs as well as the Canadian health care system.
I thank the Honourable Mr. Devinder Shory for bringing this issue to such a high forum. I want to thank the committee for giving us an opportunity to apprise you of the challenges being faced by the IMGs and discuss some possible solutions. We are all very proud to be Canadians, and it is very moving for the IMGs to know that this House is at least aware of our suffering.
Thank you very much.