Ontario is resurrecting a foreign-trained physician assessment program it killed in 2018 to allow doctors who were trained overseas to be supervised in clinical settings and fast-tracked into the work force.David Jackson/The Globe and Mail
Four years after scrapping a similar initiative over cost concerns, Ontario is reviving plans for a Practice Ready Assessment program, which the province’s medical association says could add hundreds of foreign-trained doctors to the overstretched health care system within months.
The province is one of only three jurisdictions in Canada that do not use Practice Ready Assessment programs – nationally standardized systems that allow doctors who were trained overseas, but who are not yet licensed to practise in Canada, to be supervised in clinical settings and fast-tracked into the work force. Other provinces are increasingly using these programs as pathways to licensing more internationally trained physicians, without requiring them to spend years in residency programs or retrain.
Some estimates put the number of foreign-trained physicians living in Ontario but not working in their field as high as 13,000. They are blocked by licensing hurdles and other barriers, because their medical training was done elsewhere.
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A Globe and Mail investigation illustrated how Canada’s lack of capacity for assessing foreign-trained physicians means they are increasingly being lost to other countries, as the global competition for doctors heats up. Compounding the problem is a shortage of postgraduate residency positions for international medical graduates, including Canadians educated abroad, who are finding easier paths to work in the U.S., Australia, Britain and elsewhere.
Ontario, like many provinces, is experiencing a critical shortage of physicians, and has been under increasing pressure to find new ways of adding doctors to its health network. More than three million Ontarians could be without family doctors by 2025, according to a recent study that focused on Ontario Health Insurance Plan records.
The provincial government could not provide any details on the costs or timing of its plans to develop an assessment program. Bill Campbell, a spokesperson for the Ontario Ministry of Health, said the province is building the system with the College of Physicians and Surgeons of Ontario (CPSO), the Ontario Medical Association and the Touchtone Institute, a non-profit that specializes in developing professional competency exams.
He said the province would “develop and implement a Practice Ready Assessment process that would allow physicians with previous practice experience to undergo screening and assessment to determine if they are ready to enter practice in Ontario.”
Rose Zacharias, the head of the Ontario Medical Association, which represents doctors, said her organization has proposed a model for the program that could add several hundred new physicians as soon as this coming spring.
“We need more doctors in the system,” Dr. Zacharias said. “This is a very practical way to do that.”
Foreign-trained physicians already play a critical role in Ontario’s health care system. Nearly a third of all doctors in the province received their medical degrees outside of Canada, according to data from the Canadian Institute for Health Information.
Reducing barriers for physicians who are ready to see patients but don’t have licenses to practice in Ontario is an “immediate solution” to the province’s doctor shortage problem, Dr. Zacharias said.
While groups like the OMA have called for such a program for years, the idea has received more focused attention recently. A group of 100 doctors visited the Ontario legislature on Nov. 21, where they met with MPPs from all political parties and pitched specific proposals. Dr. Zacharias has met with ministers in Premier Doug Ford’s cabinet, including Health Minister Sylvia Jones, to discuss the proposed program. The OMA head said she hopes to see meaningful progress in the new year.
“I think we built a lot of bridges that day,” she said. “We do believe the government is exploring our recommendation.”
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The OMA says the version of the program it has proposed would rapidly assess physicians who have already completed their training and practice abroad, by putting participating doctors under supervision and direct observation for 12 weeks.
In a statement, the CPSO applauded the government and the Minister of Health for acting on what it called “this important file.” The regulator had designed an assessment program for family medicine that was to be launched as a pilot project in 2017 – but that was shelved the following year when Mr. Ford’s government took office and began looking for ways to cut government spending.
“Practice ready assessments will create a clear path to practice for qualified internationally educated physicians and will be an important and timely tool to address physician shortages,” the CPSO said.
“We believe our input on this plan along with those from other critical system partners will increase physician supply while ensuring quality care. We look forward to the government sharing the full details and are ready to begin implementation as soon as possible.”