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Monthly Archives: August 2015

Stormy weather for the markets

The following article is authored by Charles Cullen, a CanAm Physician Recruiting Partner from RBC. To learn more about Charles you can view his profile on our Partner page.

RBC’s view of the markets

Over the past several weeks, market volatility has increased meaningfully and many global equity markets have begun corrections of varying degrees. This has been accompanied by (and in some cases caused by) increasingly negative headlines from China and other emerging markets (EMs) and a sharp sell-off in commodities.

While we believe that this corrective phase could have more weeks to run, we also remain of the view that the secular bull market in stocks that began in 2009 still has significant room to run.

Continue reading …

Hanging in licensure limbo

AIT (Agreement on Trade) was created with the idea of making things easier — if a physician was licensed in one Canadian province, the notion was that they should be licensed in all provinces.

CanAm CEO John Philpott says the CanAm Physician Recruiting team was very pleased when they heard about AIT, but it didn’t take long for them to realize it wasn’t going to work the way they’d hoped.

Philpott is married to a family physician from Newfoundland who was once trained and fully licensed to practice there. She’s worked in PEI and Nova Scotia since then, but would not be able to return to her home province to practice without a huge struggle.

“If she wanted to go back to Newfoundland to do a week-long locum, she’d have to fill out the same paperwork as a doctor coming from India,” Philpott says. “It’s insulting for a Canadian medical school graduate to have to fill out a form to see if they prequalify for licensure in another province.”

It’s also expensive and time-consuming. Philpott says once the pre-qualification comes through after 2-3 weeks of waiting, it’s then up to the physician to collect their paperwork, pull their diplomas off the wall, and spend a lot of put putting together their full application.

Phil Jost, CanAm’s Regional Manager and Vice President of Operations, says AIT is letting them down because it was “broken from the very beginning” when it comes to addressing international medical graduates (IMGs). Each Provincial College has their own approach and requirements for licencing IMGs, and therefore has different types of restricted/provisional/defined licences unique to that province.

Shortly after the AIT decision became public, Philpott penned an article in The Medical Post in 2009 about the Health Ministers’ first meeting concerning provincial licensing. He wrote that the Ministers were feeling frustrated regarding the paperwork required for licensing a physician from one province to another, and he believed there had to be a better solution.

But the Medical Council of Canada announced they needed more time to come up with a plan, and promised a decision in eight months. At that point, they asked for a year-long extension. But it’s been five years now, without any action, and Philpott says he’s frustrated with the wait.

“Canada has 10 different licensing authorities — one per province — plus three boards covering the territories, and we have a population of about 30 million. But California has a single licensing board for a population of 33 million,” says Philpott. “Why do we need so many licensing authorities in Canada?”

Philpott says there is “very limited portability” of doctors throughout the country, and it’s frustrating because it limits the amount of jobs a physician can accept — and makes it harder for provinces to secure the medical professionals they desperately need.

Just in the last two weeks, Philpott has fielded two calls from Newfoundland requesting an orthopedic surgeon and an obstetrician — both within very short notice. Although he has excellent candidates who would be happy to accept the positions, Philpott wouldn’t be able to get them licensed in Newfoundland in time.

“They are licensed in numerous other provinces, but it would take me 6-8 weeks to get them licensed in Newfoundland — and that’s if I really pushed — so they can’t go,” says Philpott. “Who is suffering in this situation? It’s the patients.”

Philpott says the colleges argue the rules are in place to protect patients and ensure top-quality healthcare, but he doesn’t believe it’s necessary to separate each province.

“If you’re Royal College certified with a full license somewhere in Canada, why can’t another province respect your province’s credentialing?” says Philpott. “You would think a doctor working in Amherst and seeing a patient from Moncton should be able to cross the border and see the same patient in Moncton, but that would be illegal. It’s ludicrous.”

He and Jost say many physicians are unhappy with the difficulty involved in practicing in different provinces, but many of them won’t speak up for fear of being reprimanded by their College.

“They’re afraid their College will single them out and make their lives difficult — just like an employee of the government won’t speak out against the government,” says Philpott.

Philpott hopes to sit down with the all of the Health Ministers in Atlantic Canada to discuss the possibility of merging the Colleges of Nova Scotia, New Brunswick, PEI, and Newfoundland. He’s already met with a few and they are all very interested in talking about it more.

Jost says there’s been talk of a national licensing system but he’s yet to see any action.

“The different Colleges all have their own territory, and they don’t want to give up their power,” says Jost. “There are also arguments that a national system would make the provinces compete with each other, and that physicians would all rush to the larger provinces — like Ontario.”

Services like PhysiciansApply.ca make it easier for international medical graduates (IMGs) to have their credentials source-verified, so Philpott believes it’s disheartening that Canadian physicians do not have the same kind of service.

“We should have them in a database, so if a physician wants to move to a different province, it’s just a matter of forwarding their file and sending a letter of good standing from their College — and perhaps a reference or two,” says Philpott. “All of that could be done in 24 hours. It would be so easy.”

Navigating the confusing ELP standards

There’s often a bit of confusion over ELP (English Language Proficiency) when it comes to licensure, so CanAm Physician Recruiting has been looking into rumours of recent changes. Here’s what we’ve learned:

The issue of ELP was discussed at a recent meeting of the Federation of Medical Regulatory Authorities of Canada (FMRAC), held in Fredericton.

Every province has a different set of standards. British Columbia and Alberta adhere to the pan-Canadian standard and apply that to even francophone medical schools here in Canada, and Saskatchewan does the same — except they will exempt a Canadian Studying Abroad (CSA) if they have a passing mark in Grade 12 English 1030 or 1040.

Prince Edward Island famously made headlines for denying licensure to a Canadian-born doctor simply because her medical school was not listed on the English Proficiency Policy adopted by the FMRAC and the College of Physicians and Surgeons of PEI.

In Nova Scotia, however, there appears to be room for exemptions. Saba University of Medicine was added as an exempted school/country in 2013, and individual applications are sometimes exempted based on the discretion of the College of Physicians and Surgeons of Nova Scotia.

We are told the CPSNS may look at referring to passing grades in high school English when it comes to licensing a Canadian studying abroad, providing these courses are somewhat standardized across the country. However, in some provinces a recent immigrant is only required to pass “English as a second language” in order to graduate from high school, so it remains to be seen if this solution would work.

The CPSNS’s policy may be changed in the coming months, so stay tuned for more information as it’s available. In the meantime, here is our perspective …

CPSNL conforms with ELP standard set out by FMRAC but ads that if post-graduate training was completed in an English country, it will exempt the physicians. However, if the physician has taken an ELP exam and failed to meet the minimum standard which CPSNL requires, then they will demand the physician to retake the exam.

CanAm became aware of this policy when a Saudi IMG radiologist who had completed seven years of post-graduate training at McGill and passed the FRCPC, MCCEE and MCCQE but had answered “Yes” to the pre-application question “Have you ever taken an English Language test?”

This candidate, whose spoken English is better than most Canadians, has passed the TOEFL-Ibt /IELTS seven times but has failed to obtained the minimum standard set out by CPSNL in the verbal category. Although he has passed the minimum standard in each component of written and verbal English, just not on the same exam.So being 110% truthful on the pre-application has caused great frustration.

The cost of ELP is $300 U.S. so this physician who has interviewed and obtained an job offer to work in one of Canada’s most rural regions where the local dialect is so thick you would think they speak a foreign language. To make matters worse, he is a radiologist who would have very little to no interactions with patients — not to mention, living in a rural location where it would be doubtful that anyone would pass the ELP test.

CanAm would like to see a registrar from each College across Canada take the TOEFL-ibt or IELTS exam and publish the results. We are betting 50% would not meet the minimum standard set out by FMRAC. CanAm has witnessed numerous physicians taking the ELPs exams multiple times. Does it make sense that a physician can pass the MCC and even Royal College exams but not have a basic grasp of the English language? I guess common sense is not that common. What happen to picking up the phone and interviewing the candidate?

Sifting the B.C. numbers: Is there a doctor shortage or what?

CanAm’s perspective:

CanAm couldn’t agree more with Les Leyne’s article (see below). Like BC, Nova Scotia is facing the same dilemma. CanAm has held meetings with the senior health bureaucrats and the astounding attitude is that Nova Scotia has too many doctors.

We assume this is based on statistical data from sources such as CIHI. But what these statistics don’t show is that present-day physicians — particularly Family Physicians — don’t see the volume of patients and don’t work the full work week as physicians in years past.

Nova Scotia may have the highest percentage of physicians-to-population ratio in the country, but we also have one of the largest — if not the highest — elderly patient and physician populations.

We also need to consider the number of retired physicians who maintain a licence, physicians who maintain a Nova Scotia licence but work full-time in another province, the number of part-time physicians, the volume of patients seen per physician, and the years of services a physician delivers.

Please have a look at Les Leyne’s article, and weigh in with your feedback …  

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Exerpt from Les Leyne’s article Sifting the B.C. numbers: Is there a doctor shortage or what?

Doctor shortage? What doctor shortage? There were 831 more doctors billing the Medical Services Plan under the general­ practitioner category last year than there were 10 years ago. That’s a 17 per cent increase.

Across all specialties, there are 1,848 more doctors billing for services than there were 10 years ago, a 22 per cent increase.

You’d think that kind of apparent growth rate in an occupation would be enough to handle population
increases and the higher patient loads that arise from the aging population.

But it isn’t. The doctor shortage is a fact of life across B.C.

Buried in the mass of data churned out by the Health Ministry is a report that either sheds more light on or confounds the situation, depending on perspective. It was not widely shared, but the MSP Physician Resource Report looks at a decade’s worth of billings by B.C. doctors.

The statistics are complicated and wide open to interpretation. But the numbers suggest doctors by and large are seeing patients for fewer days a year than they once did, and the average number of patients they’re seeing has dropped.

Read Les Leyne’s full story on CanadianHealthcareNetwork.ca

Read the MSP Physician Resource Report