加拿大华人论坛 加拿大留学移民关于医生移民

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这是发表在vancourier上的一篇文章，讲述医生移民加拿大后的困境。原文在http://www.vancourier.com/issues06/102206/news/102206nn1.html A foreign cure by Jennifer Moreau-contributing writer It's one in the morning on Howe Street in downtown Vancouver. The streets are empty except for cabs circling for club stragglers and the occasional bus. The only sound is the hum of two police cars, pulled to the side as officers arrest a young man. Miguel Salas steps out of the call centre where he earns $14 dollars an hour. He has a slight build, soft voice and dark eyes. Crow's feet appear when he smiles. Dressed in a light jacket and jeans, he stuffs his hands in his pockets and presses his shoulders to his ears. His elbows shake with the cold. "I'm from Peru, remember?" he says grinning. Salas may complain about Vancouver weather, but he shrugs off the graveyard shift. It's not nearly as taxing as the long hours he worked back home as a doctor in a hospital emergency room. Salas is from Arequipa, population 850,000, where the 35-year-old general practitioner started at 7 a.m. at Hospital Goyoneche, and worked 10- to 34-hour stretches. He dealt with blood, broken bones, drunks, schizophrenics, car accidents, asthma attacks, countless deliveries and women bleeding from illegal abortions. He worked in surgery, performed caesareans and removed kidney stones and cancerous tumours. He estimates he saw 150 patients for every 12-hour shift at the hospital. It's work he may never do in Canada, despite seven years of medical school-including a one-year hospital internship covering gynecology, surgery, pediatrics and internal medicine-and one year as a paid physician in the same hospital after he graduated from the National University of Saint Augustine in 2002. Salas is one of an estimated 7,000 international medical graduates looking for work in Canada. And local advocates for these foreign-trained graduates say doctors such as Salas have a five per cent chance at best of obtaining a licence in B.C. Salas says he didn't know what he was getting into when he moved to Canada. The young medical student met his fianc‚e in the mid-1990s. She was born in Peru, but her family moved to Canada when she was a child. She returned to study engineering in Arequipa. The two married and decided they would have a better chance to stay together and raise a family if they found work in Canada, since Peruvian doctors are often sent to remote villages in their second year of practice. Even if Salas had to practise in a small town in Canada, at least it would have drinking water, electricity, and telephone lines, unlike much of rural Peru. (He recalls a friend with a patient with appendicitis who rode four hours on a donkey to get to the nearest operating room.) Salas researched career prospects online and found websites stating Canada urgently needed doctors, but none explained the process or the difficulty of becoming licensed here. The Canadian embassy gave him a list of Canadian universities with medical faculties, which in turn referred him back to the same websites. It wasn't until Salas arrived in Canada in 2003 and met with members of a local advocacy group for foreign doctors that he realized what he was up against. "Sometimes it's very hard," says Salas, who notes his wife is having her own problems establishing a career in Canada. People who know he's a doctor approach him with a problem but he can offer only advice. "I can't do any more. If I had the chance at that time and could give him or her a prescription, the problem would be solved. I could examine him or her and give a diagnostic, but I can't. At that point it's frustrating for me." His first job in Canada was picking blueberries. Then he became a maintenance man for Superstore. Many foreign doctors before Salas have gone through the same frustration. Some work as security guards, taxi drivers or line-cooks in restaurants. Many are too embarrassed to come forward and tell their stories, some fear they will be blacklisted and never get a licence. Their situation prompted a handful of foreign doctors to start the Association of International Medical Doctors of B.C. in 2003. It represents 300 foreign doctors in the province with the goal to get more people like Salas into practice while addressing what they call B.C.'s "critical doctor shortage." Canada needs doctors. B.C. has 8,453 practising physicians, approximately 55 per cent of whom are general practitioners, and 45 per cent are specialists. According to the B.C. Medical Association, the province needs 400 new physicians each year to maintain the current doctor patient ratio as doctors retire, move away or reduce hours of work. And as the baby boomers age, placing more demands on the health-care system, and as the population grows, the demand for doctors will likely increase. Even in 2002, the College of Family Physicians of Canada reported 4.5 million Canadians had trouble finding a family doctor. According to Patrick Coady, the executive director of the Association of International Medical Doctors of B.C., the problem started in the early 1990s when a flawed study led federal and provincial policy makers to mistakenly conclude the country had too many doctors. As a result, provincial governments across the country reduced the number of seats for Canadian medical students. "Now obviously this was insanity," says Coady, the only member of the association who is not a doctor-he works for the federally funded B.C. Internationally Trained Professionals Network. "Other Western industrialized nations were ramping up because they knew that the baby boomers were retiring in a decade. The end result is that we ended up being in an absolutely critical shortage of health-care practitioners, nurses, doctors, and pretty soon technicians." B.C. is behind the rest of Canada in meeting demand. A study by the Association of Faculties of Medicine of Canada found that B.C. had 3.2 medical school spaces for every group of 100,000 people, the lowest ratio of any province in the country. Coady notes the B.C. Liberal government doubled the number of medical graduate seats at the University of B.C. several years ago from 128 in 2002 to 256 by 2010. But the move is not enough to meet the need. Even if this year's 232 medical students graduate on time, B.C. will be short 168 doctors in 2010, according to Coady. He and the association argue the best solution to offset the doctor shortage is to use foreign-trained doctors for a fraction of the cost and time to get a Canadian through school and into practice. But getting a licence to practise as a doctor in Canada as a foreign-trained doctor is extremely difficult. To work as a doctor, Salas and thousands like him must pass Canadian national standards exams. In B.C., they must repeat their postgraduate training, which means at least a two-year residency-a paid position in which medical graduates work under the eye of a licensed physician. Once completed their residency, they are eligible for a licence from the College of Physicians and Surgeons of B.C. Only foreign medical graduates from a select group of countries with postgraduate training familiar to the college-such as South Africa, the United Kingdom, Australia and New Zealand-can practise in B.C. right away, as long as they pass national standards tests within three years. Coady says there is a valid reason why. The college is a group of self-regulating doctors, set up more than 100 years ago with a charter from the provincial government to license doctors and protect the public from malpractice. The original doctors were trained in Britain and every medical faculty in Canada outside of Quebec was modelled after the British system, which was also copied in Australia, New Zealand and South Africa. "So it's not surprising that if you were from one of those countries that your education is not only understood, but it meets the standards, because it's exactly the same." But times have changed and so have the countries from which immigrants to Canada come from. Whereas they once hailed from Commonwealth countries, foreign-trained doctors come to Canada from China, India, Philippines, Eastern Europe, Russia and Iran. In B.C., an estimated 600 to 900 foreign-trained doctors need a residency, but the only program for international medical graduates in the province, run at St. Paul's Hospital, accepts a mere 18 each year. (Until last year, when it was increased by the provincial government, the program took in only six foreign doctors a year.) Competition for the program is fierce, with 60 to 70 qualified applicants vying for a spot each year. Dr. Rod Andrew, who has been with the program since its inception in 1992, believes the initial 70 applicants are nowhere near the number of immigrant doctors studying to pass their exams. Some have given up. "I think it's a dreadful waste of talent," he says. "You've heard the stories of pizza delivery, taxi drivers. That is true, I've met them." Alfredo Tura is one of the lucky ones. Last May he was accepted into the residency program at St. Paul's. Now president of the Association of International Medical Doctors of B.C., he's pushing for more residency positions. Even though Tura got his medical licence in Italy in 2001, but had to retrain as a nurse to get work in the medical field in B.C., all the while taking his exams to earn his licence in B.C. Tura says his experience of trying to become a doctor was difficult. "There was a feeling of emptiness, of powerlessness. You don't know what to do, you can't plan anything, but you still want to do it. That's who you are, you are a physician." Despite the difficulties, Tura doesn't blame the system. "I don't think that the system is fundamentally wrong, I think that the system was not prepared for this," he says. "It's a big and difficult process. I think that this system is slowly moving in that direction. That's why I find this system civilized, because if you lobby, if you believe in something you can make change... That's why I love Canada because I think there is still the chance to do it. In many countries you can't." However, Tura says not everyone who comes to this country with a medical degree has the right to become a doctor. "You have to prove yourself," he says adding some may have gone to substandard schools, or may be out of practice for years. "Only the best ones should get in the system. Definitely many people are good but unfortunately they are not in the system. That's what is bad." Tura, Coady and the association have ramped up their lobbying on behalf of foreign-trained doctors. They appeared in Vancouver filmmaker Jiyar Gol's documentary Health Care 911: The Plight of Immigrant Medical Doctors, which aired Sept. 30 on TV. Members from the association also met Oct. 2 with B.C. Health Minister George Abbott to pitch several proposals to ease immigrant doctors into practice. Their top recommendation was for the government to introduce "clinical assistant" positions in which foreign medical graduates work as paid doctors under a temporary licence and supervision of a full-fledged doctor. These assistants could be sent where they are needed the most. Clinical assistants could ease the workload while learning about the Canadian medical system, the association argues. And they would have a better chance to compete for residency positions since they would go through three to six months of orientation, training and evaluation before applying for clinical assistant positions. Alberta employs clinical assistants in Edmonton and Calgary, a move Coady says has been highly successful in addressing the shortage of physicians there. The association discounted the growing use of nurse practitioners to address the shortage of doctors, calling it "robbing Peter to pay Paul" because the province also has a shortage of nurses. The association also wants orientation training, which dramatically increases rates of success for internationally trained medical graduates. Homegrown doctors become familiar with the Canadian system during their undergraduate training, yet for foreign-trained doctors, this element is crucial for surviving in a new system. The association also wants profession-specific English language training for foreign doctors based on need. Regular English classes don't cut it for doctors, who often need specific terminology. And some doctors wouldn't need mandatory language testing because in some countries, such as India and Iran, they complete their medical education in English. The association also recommends a plan for expanding the number of residencies for foreign medical graduates, a goal that's impossible if there's no staff to train them. That's why the association is urging UBC to reallocate "preceptors," who train student visa doctors from countries who pay to get them Canadian residencies. They often come from wealthy countries such as Bahrain, the United Arab Emirates and Kuwait. Once they are done their training, they must return to their country to practise. According to Coady, the university makes double or triple the fees it would receive from the provincial government for training Canadians and immigrant doctors. The visa students work unpaid for years during their residencies, according to Coady. By designating those preceptors for foreign-trained doctors and Canadian medical student residencies, Coady believes B.C. could quickly train more doctors, many of whom want to stay in Canada. The association calls it a "win-win situation" since more residencies would be open to Canadian grads and immigrants while B.C. would see a net increase of licensed doctors, all with existing staff at UBC. The association suggests incrementally increasing the cost for student-visa doctors from the wealthier countries to compensate for any lost revenue to the university. But Dr. Kristin Sivertz, co-associate dean of postgraduate training at UBC, says a fix is not so simple. She says student-visa doctors make up 10 per cent of 900 resident doctors and that the university barely makes enough from their fees to cover the costs of training them. The student-visa doctors only study specialties, which cost significantly more than family physician residencies, so they don't take up family physician spaces that foreign doctors would need. There is also a limited number of doctors available to train residents. Under advice from the university's lawyers, Sivertz would not say how much each country pays under the visa students program, except to say it's a negotiated fee. The original concept of student-visa doctors was to give quality training to doctors from countries that have underdeveloped medical systems. "It's an international effort for a developed country, like Canada, to help other countries with their medical systems because if we want to complain about ours, it's nothing compared to many jurisdictions in the world." Sivertz says Canada's high standard of living attracts doctors from around the world, and historically, we have done a poor job reaching out to poor countries. But UBC has started to do that. But Coady disagrees. "Let's be honest here, these doctors are paying double or triple to get into residencies, and they're working for free for years," he says, adding that the association has talked to some student-visa doctors who say their countries pay considerably more than the $150,000 to $180,000 our provincial government pays for Canadian graduates to do a two-year family physician residency. The association wants a review of the top universities in the countries where most of Canada's immigrants come from. The hope is that if the medical schools make the grade, the number of countries deemed acceptable to the Canadian medical system and physician colleges can be increased. Dr. Elliott Phillips, deputy registrar at the B.C. College of Physicians and Surgeons, checks the paperwork and background of each doctor who applies for a licence in B.C. He agrees B.C. suffers a shortage of doctors, but points out the provincial government is responsible for regulating the number of medical students. He says the college also doesn't review medical training in foreign countries. Instead, it uses a list of acceptable institutions reviewed by the Royal College of Physicians and Surgeons, a nationwide body that oversees medical education standards. The provincial college's mandate is to ensure the public gets healthcare that's professional, ethical and above all competent. "The average Canadian just wants a doctor that is competent... so that infers, if we are going to bring someone, that their post-graduate training meets our standard, or is familiar to us." Expanding the list of acceptable countries isn't as easy as it sounds. Phillips says evaluating the medical training of countries around the world is a huge undertaking. It would take enormous amounts of time and would need to be followed up every few years. "Who guarantees that in three years, or four years, or five years, things haven't changed so drastically that the quality of postgraduate training hasn't changed dramatically?" He notes, however, that the college's list of acceptable foreign medical jurisdictions from the Royal College has not been reaccredited. B.C.'s Minister of Health, George Abbott, says expanding the list of acceptable foreign medical institutions is a "very interesting point." "I've discussed the possibilities about doing something with the college and the federal government," he says during a phone interview with the Courier, adding that such an evaluation could involve the other provinces. "There's no point in gathering knowledge several times. It's far more useful to gather it once and share it." Abbott says the Oct. 2 meeting with the association went well. He says he asked his staff to review all of the suggestions from the immigrant doctors and plans a follow-up meeting with them in a couple months. But Abbott says he doubts the number of residencies available to foreign doctors will be expanded in the near future, noting the number was tripled from six to 18 last year. And though Abbott says international medical graduates are an untapped resource, the public should not expect any sudden moves by the provincial government. "We're not going to be responding overnight to this," he says. But Coady thought the meeting with the minister went well. He noted Abbott made it clear that implementing any of the associations proposals came down to finances. "It really is about money," Coady says. "Everyone in the health-care sector is looking for money." As lobbyists, politicians and bureaucrats debate his future as a medical professional in Canada, Salas packs his bags for Peru. He needs to fly home to get a stamp from the Peruvian health minister to process his paperwork in Canada. "Some things I can't understand," he says. "I have to go there just to sign a book. That's it. And they will print the stamp on my diploma." Without the stamp his medical diploma is useless in Canada. Salas is hopeful but unsure about the future. Even though he loves Canada, he may move to the U.S. "I don't want to do that, I want to stay here. I know that the system needs doctors. I want to practise. That's the only thing. That's my passion, I want to practise medicine," he says. "If the Canadians need doctors, let's try to find a way to find doctors to help the Canadians. If they need me, I'm here. Just let me know where I can go." published on 10/13/2006

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