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Vol 38  No 3
September 22, 2005


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Turnover of medical grads a problem in Atlantic Canada

By Sharon Gray

A discussion paper prepared for the Leslie Harris Centre of Regional Policy and Development and the Faculty of Medicine raises concerns about the role of international medical graduates (IMGs) in providing physician services in Atlantic Canada.

IMGs provide physician services, often where there is difficulty in attracting a doctor, such as rural communities in Newfoundland and Labrador. Dr. Rick Audas, a faculty member in Community Health and principal author of the report, said the shortage of physicians in the province means that there are more IMGs who enter into practice under provisional licenses than in most parts of Canada. “Basically doctors who don’t meet the qualification for full licensure in Canada come to our province for a fixed term and in that time they have a training allocation to write the licensure exams. If they are successful, they often move to central or western Canada.”

Dr. Audas said the result is that Newfoundland and Labrador is actually subsidizing training IMGs for the rest of the country. “These individuals gain the right to practice through a provisional license and anecdotal evidence suggests that obtaining a provisional license is far more common in Newfoundland and Labrador.”

This creates an on-going problem for many communities since they face regular and rapid turnover of physicians. “This is a particularly worrying trend for two main reasons,” said Dr. Audas. “First, recruiting a new physician ­ particularly from abroad ­ is expensive. If regional health authorities are required to replace physicians every two years, which is typically the amount of time necessary to obtain a full license, this means a considerable outlay of financial resources that would be more efficiently spent on the actual provision of health care.”

The other problem is that patient satisfaction is, at least partly, a function of developing a long-standing relationship with a physician. “This becomes far more difficult when the physician serving that community only remains in a position for a relatively short period.”

Another issue is that IMGs who fail to achieve full licensure may stay on in practice in the province. “If physicians don’t pass the licensing exam then they don’t move,” said Dr. Audas. “It may not mean they are ineffective physicians but it does mean they haven’t been able to pass the Canadian exam, which should worry us to some extent. We are supposed to have a national healthcare system where all Canadian citizens are treated roughly equally, but in rural Newfoundland you may be treated by a physician trained to a different standard.”

Dr. Audas said future research needs to focus on understanding what factors contribute to provisionally-licensed IMGs migrating from Atlantic Canada. “Is there something we could have done to encourage them to stay? Do they need better continuing medical education opportunities? Are spousal and cultural factors important? We need to find out how to make better matches at recruitment in order to encourage better retention ­ an international medical graduate who has practised in a rural area may be a better fit to a rural area in Newfoundland than one who practised in an urban centre.”

The Role of International Medical Graduates in the Provision of Physician Services in Atlantic Canada may be viewed at www.mun.ca/harriscentre/reports.php. A paper on the results of the study will be published in the upcoming issue of the Canadian Medical Association Journal.

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