North rolls out red carpet for IMGs

They come to Ontario from all over the world, looking for peace and tranquility, economic gain and a better future for their children, but many of them have their hopes dashed. For every international medical graduate (IMG) who succeeds in qualifying to practice in Ontario, four to five others are reduced to driving cab or flipping burgers.

Dr. Elena Kolb, a family physician practicing in North Bay, was one of the lucky ones. A graduate of Minsk Medical University in Belarus and a veteran physician with 18 years of experience, Dr. Kolb immigrated to Canada in 2001 with no knowledge of the long and frustrating qualification process IMGs have to endure here.

She spent her first few years in Montreal, learning English, studying from dawn to dusk in a medical library and writing the Medical Council of Canada and equivalent U.S. exams, then had to write an additional series of qualifying exams when she applied to the Ontario IMG program.

"Of the 400 or 500 people writing the first exam, they took 100 with the best marks and invited us to take a second, oral exam," she recalled. "Out of the 100, they took 42 into the program."

Dr. Kolb wrote the American qualifying exams when she learned that IMGs have a much better chance of being accepted south of the border. In Canada, she said, between 10 and 12 per cent of IMGs who pass their exams are accepted, while in the U.S., it's 80 per cent.

"Ninety per cent of the IMGs I met in Montreal were aiming for the U.S. They were smart people. Everyone who wanted one got a residency position."

Another IMG who succeeded in running the gauntlet is Dr. Prashant Jani, a pathologist at Thunder Bay Regional Health Sciences Centre. A graduate of Pune Medical College in India, Dr. Jani immigrated to Toronto in 2001 with his wife and two children and spent his first year in the country working as a pathology assistant at Toronto General Hospital.
That experience was crucial when it came time to write his exams, he said, because he knew what to expect.

"Initially, it was really tough for us. I'd leave home at 7 in the morning and, after finishing work, I'd go to class until 10 at night. I'd get home at 11:30, go to sleep at 12:30 and wake up the next morning at 6. I never got to see my kids. When I got home, they were sleeping and, when I left in the morning, they were sleeping."

Dr. Antonio Visbal, a general surgeon practicing in Kirkland Lake, wrote a series of qualifying exams after immigrating to Canada with his partner in 2004, but was excused from serving a residency because of his considerable experience. A graduate of the University of Cartagena, Dr. Visbal left his native Colombia to escape the country's violence.

Bombings

"I was an innocent bystander in three bombings and, after the third one, I said no more."

Employed at the time as chief of surgery at Santa Clara Hospital in Bogota, Dr. Visbal also had to deal with the results of the country's violence in the operating room.
Instead of a residency, he had to participate in a six-month assessment program.

"There was only one spot at the University of Toronto and 200 general surgeons were applying for it - all of them trained in their own country. I got that one spot. That's how difficult it is."

Dr. Visbal ended up in Kirkland Lake because of a requirement that he practice for five years in a community underserviced for his specialty, general surgery, but he has no regrets.

"I practice in a very nice environment, the hospital is very good and the people I work with are very nice," he said. "The community appreciates my work and the patients are very grateful, so I feel that I am doing something good for myself, my practice, my career and my patients.

"When we were in Colombia, we always wanted to live outside the city in a small town in the mountains, close to a lake, but we couldn't because of the violence. When you live in the countryside in Colombia, you always have problems."

In Kirkland Lake, he and his partner enjoy skiing and snowshoeing in winter and canoeing and hiking in the summer.

Dr. Kolb's introduction to Northern Ontario came as a bit of a shock at first. The University of Ottawa residency program was her first choice because her son was attending Concordia University in Montreal a little more than an hour away.

"When I received my letter, it said, ‘Dear Dr. Kolb, congratulations, you are accepted into the Family Medicine Program, University of Ottawa, Sudbury.' I had no idea what Sudbury was, so I googled it, connected the dots and observed this long green line stretching 700 kilometers from Montreal. I cried for 10 minutes, but what could I do? I couldn't refuse."

Driving north on Highway 17, the future looked a bit brighter, she recalled. "It was the beginning of September and it was so pretty." During her residency, she spent time in Sudbury, Elliot Lake, Kirkland Lake and North Bay. "The people I worked with were so good to me. I just loved it," she said.

Dr. Kolb planned to open a practice in Sudbury when she finished her residency in October 2006, but ending up marrying a surgeon in North Bay and opened a practice there.

Lifestyle

The Northern Ontario lifestyle has also agreed with Dr. Jani.

"Thunder Bay is much better than Toronto and one of the best places in Canada. It can't be better than this. The community is very nice and the people respect you even though you're from another country and a different colour.

"It's also great for the kids. To take my child to dance class, it takes five minutes. For music class it's two minutes and for swimming, it's five minutes, so we don't spend much time travelling and we have Lake Superior and the mountains very close to us."

Aside from his work as a pathologist, Dr. Jani teaches yoga and organizes three festivals every year with proceeds from the events donated to the Cancer Centre.

Recent provincial government initiatives may finally succeed in removing some of the obstacles encountered by IMGs hoping to practice in Ontario. The passage of Bill 97, the Increasing Access to Qualified Health Professionals for Ontarians Act, is one of several measures designed to address a shortage of 2,000 physicians in the province.

The Act changes the mandate of all 22 health regulatory colleges and recognizes them as key partners with the Minister of Health and Long-Term Care in facilitating the certification of physicians and other health-care professionals.

A new registration process adopted by the College of Physicians and Surgeons of Ontario to fast-track doctors who have practiced in other provinces and in the U.S. will also help to clear the logjam.

The number of residency positions for IMGs, claims the Ministry of Health and Long-Term Care, has increased from 90 in 2004 to 200 today. According to ministry statistics, 630 IMGs are currently in residency training and, for the fourth consecutive year, the CPSO has issued more certificates to IMGs than to Ontario graduates.

New Decima research commissioned by the College of Family Physicians of Canada (CFPC) confirms that approximately 4.6 million Canadians do not have a family doctor. This figure includes approximately one million Ontarians.

A recent CFPC Report Card on the status of the family medicine workforce in Canada gives a "D" grade for health human resource planning, indicating "poor progress, falling well below expectations."