Different approaches: Three provinces strategize on drawing U.S. specialists to Canada

Know an expat or American physicians dreaming of coming north to practise in a publicly funded system, be close to family or perhaps indulge in a love of curling? Several Canadian provinces are looking to make that easier, but they're taking a variety of approaches. Ontario, Nova Scotia and Alberta have recently tweaked their rules to enable U.S. board-certified specialists to cross the border and get right to work—in the case of Alberta, the new rules also apply to international medical graduates from a handful of jurisdictions. The College of Physicians and Surgeons of Nova Scotia announced on March 6 that American board-certified physicians would be eligible for full licensure without needing Royal College of Physicians and Surgeons of Canada (RCPSC) certification. These specialists don’t need to go through any programs or deal with restrictions on their practice. “We have sufficient knowledge and experience with American training and American practice to be comfortable in accepting their qualifications as is, and recognizing that is acceptable for Nova Scotia,” says Dr. Gus Grant, CEO and registrar for the CPSNS. All provinces permit American family physicians to directly obtain licensure, as the College of Family Physicians of Canada has listed the U.S.—along with Australia, Ireland and U.K.—as an approved jurisdiction where doctors may directly apply for designation from the college. The same is not true of the RCPSC, which requires American-trained specialists to go through a training assessment and an exam before granting certification. Many provinces have set up alternative pathways to licensure that often involve things like practice-ready assessments and a period of probation. These new programs are different: they’re dramatically reducing barriers and letting doctors get to work faster. “I’m confident that other provinces are looking at this closely,” says Dr. Grant of Nova Scotia’s direct new pathway. Indeed, just a few days before Nova Scotia made its announcement in early March, the College of Physicians and Surgeons of Ontario (CPSO) voted at its council meeting to adjust one of its alternative pathways to registration. While this change still needs executive committee approval—a rubber-stamp process—it would allow U.S. doctors to directly obtain a restricted certificate to practice independently, waiving the previous requirement of a year of supervision and an assessment. (Such doctors hold a restricted certificate until they pass the RCPSC exam, but it’s not necessary to ever take this step.) “Given the similarities between Canadian and U.S. training programs and the comparable standard of U.S. board certifications with RCPSC certification, the current supervision and assessment requirements may be unnecessarily burdensome,” the CPSO wrote in its March council materials. “This is another step. We’ve been working on ways to improve the process for years,” says CPSO senior communications advisor Shae Greenfield, who says the previous pathway had been in place since 2008. Meanwhile, in January, the College of Physicians & Surgeons of Alberta (CPSA) launched a five-year pilot to allow specialists from Australia, Ireland, U.S. and U.K. to practice in the province right away, with three months of supervision on the job. The new process shortens and simplifies the pathway already in place that entailed doing an exam and participating in a longer practice readiness assessment program. (The new program still requires paperwork, a fee of $10,000 and an opportunity to move to full registration after a year.) “This is about what reasonable things you can do to help register qualified physicians faster by removing administrative roadblocks while maintaining safeguards for your citizens,” says Dr. Michael Caffaro, assistant registrar of registration for the CPSA. “My guess is that provincial collages are saying, 'No, this is enough, we’re going to just make a call that the American board exam is good enough for us,'” says Rosemary Pawliuk, executive director of Society for Canadians Studying Medicine Abroad. “We’re in a crisis situation and all this bureaucracy isn’t helping,” says Pawliuk. She says many existing rules limit the number of doctors, which controls the cost of healthcare, a concept popular decades ago. Such an approach is not longer useful as Canada faces an urgent doctor shortage. Indeed, according to an RBC report, Canada was short 16,800 physicians in 2020 and that will bloom to 44,000 by 2028. Dr. Grant says doctors don’t move too often, but this new pathway may enable some to undertake a relocation without facing hurdles that might dissuade them. “I can’t think of any of my med school classmates who’d be willing to do certification exams mid way through their career,” he says. “I have no way of guessing at the size of the effect this may have on Nova Scotia. Whatever the size of the effect, I am content the effect will be positive.” Notably, the most dire shortages across the country are among family physicians, and these new programs won’t impact those numbers. In Alberta, the number of physicians applying to the college to have their their eligibility reviewed has already increased. Dr. Caffaro says the province could see new-to-Alberta doctors on the job as early as April under the pilot. Pawliuk thinks the provinces are wise to remove barriers for stateside doctors. “Many people who study medicine in the U.S. want to come back to Canada,” she says. The RCPSC exam is extremely difficult to pass, she says, even for experienced, practicing doctors. And passing often entails seeking out old exams from past students, which favours those who have close connections. Working around the RCPSC in this manner shows that provinces can bypass its rules. “I’m quite confident I will be excluded from the Royal College’s Christmas card list this year,” jokes Dr. Grant. “But I can I can say this: the Royal College should not be surprised by our announcement.” Dr. Caffaro says the RCPSC and others who regulate medicine are trying to change and find a better balance between rigorously assessing physicians coming into Canada and increasing numbers. “Everyone is trying to retool. Some are moving faster, some slower,” he says. “What we did 20 years ago, it isn’t going to work. We need to change things up.”

Different approaches: Three provinces strategize on drawing U.S. specialists to Canada

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