Foreign-trained doctors — known in health-field lingo as international medical graduates (IMGs) — have been a lifeline for Newfoundland and Labrador ever since Sir Wilfred Grenfell established his mission in St. Anthony and Labrador in the early 1900s.
In a 2008 study, Memorial University medical school researcher Maria Mathews and others found IMGs have played an indispensible role in rural regions, even if their average stay lasted only a few years.
“While IMGs do not stay in the province long after getting their licence, they do, over the short term, meet the need for family doctors in rural areas,” the authors wrote. “Ending provisional licensing would significantly reduce Newfoundland and Labrador's supply of doctors.”
It was easy to see why many IMGs eventually left, but the inability to retain domestically trained doctors was more troubling.
“Although some IMGs may move to larger Canadian centres to be part of familiar religious or cultural communities, it is important to identify and address the reasons why graduates from Memorial and other Canadian medical schools choose not to stay in the province,” the authors wrote.
Since that study came out, another factor has come into play that may or may not serve as a further obstacle, depending on whom you talk to.
In 2019, the College of Physicians and Surgeons of Newfoundland and Labrador (CPSNL) established what are known as practice-ready assessments (PRAs), programs run by the medical school in which newly arrived family medicine applicants are licensed provisionally and monitored for a period of 12 weeks.
The measure was taken to more closely harmonize licensing in this province to a broader Canadian standard.
The difference is that IMGs now have to more closely match that standard in order to even be considered for a licence.
Dr. Linda Inkpen, registrar of the CPSNL, says the standards needed to change for a variety of reasons.
“This is not just to make mobility of physicians easier. This is also to protect the public,” she said in an interview Wednesday, Aug. 18. “Our mandate is not to recruit physicians, but it’s to be sure that we protect the public and keep a very sharp eagle eye on patient safety by making sure that our physicians here in Newfoundland and Labrador are qualified as close to Canadian standards as we can get.”
The Newfoundland and Labrador Medical Association (NLMA) welcomes that fact, but worries the change is causing a drop in applications.
“Physicians now have to meet a higher minimum standard before they can come to work in Newfoundland and Labrador than used to be the case, so that eliminates some right off the bat,” said past-president Dr. Lynette Powell.
Powell, a Grand Falls-Windsor physician who recently lost her own family doctor, says she’s only aware of two current PRA candidates sponsored in the Central Health region.
“Two doctors is not going to do a lot,” she said.
She agrees the modernized standards were necessary, but wonders if the government could have been better prepared for any shortfalls.
“All of us agree we have to adhere to minimum standards. We need to know that physicians coming here are capable of doing the job,” she said.
“I don’t think (the government) really wrapped their heads around exactly what it was going to mean for rural Newfoundland and Labrador in particular.
According to the CPSNL, however, there has been no drop in the annual number of licences issued since movement to harmonized standards began in 2013.
“From a straight-up numbers perspective, that’s not the case,” said Jaime Osmond, associate registrar of licensing and quality.
“Every year in eight years there’s been an increase in physicians. It’s never dipped at all.”
That amounts to about 20 additional full-year licences each year, he said.
The exception was 2020, when numbers skewed in a variety of directions because of the COVID-19 pandemic. Osmond suggests travel restrictions would have put a damper on IMGs.
“So, the question then is, where are they and what are they doing?” says Inkpen, responding to Osmond’s numbers.
“I think it’s fair to say that physicians are choosing to practise very differently than they were 10, 20, 30 years ago.”
She admits the evidence is only anecdotal, but it jibes with observations made by several others, including the province’s health minister, that many family doctors have scaled back how they operate, reducing hours and frequently switching to virtual consults.
“All we have the evidence (for) is to tell you you’ve got more (licences),” said Inkpen, who is retiring from her role at the end of the year. “Now, somebody please find out if you’ve got more, then why are we in the situation that we’re in?”
While recruitment is not in the mandate of the college, Inkpen says she has some ideas how the province can up its game.
“We think that one highly professional recruiting office for the province would help, rather than having four (regional health authorizes) competing against each other for recruitment,” she said.
“It appears to have made a difference in some other provinces.”
The province’s 2021 budget laid out plans to merge administrative functions of the health authorities with a view to eventually merging them into one authority, as is the case with other smaller provinces such as Nova Scotia.
However, recruitment still doesn’t appear to be on the radar.
“At this time, we are not actively working on specific recruitment initiatives with the other regional health authorities,” an Eastern Health spokesperson said in reply to a query, “however, we are open to exploring such opportunities should they arise.”
Peter Jackson, Local Journalism Initiative Reporter, The Telegram