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B.C. quietly employs foreign-trained doctors as equity and care concerns loom

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Dozens of foreign-trained doctors are now working under special licenses requiring supervision in B.C. hospitals, while more are being recruited for deployment as family doctors in urgent care centres, CTV News has learned.

Health Minister Adrian Dix confirmed that the province has employed “associate physicians” in acute care, with 120 more positions posted in an effort to get an estimated 400 internationally-educated doctors into B.C.’s health-care system. 

“Working in team-based centres, sponsored by health authorities and overseen by the college -- that we would not waste the talent of all these people and their extended training, but use it to add to and support the healthcare system,” he said in a one-on-one interview.

Dix emphasized that only those with degrees and at least one or two years of hands-on training are eligible, and that they’ll be working in a highly-regulated sector under the supervision of fully-licenced doctors.

“Having them actually working in the system -- boy, what a good idea,” he said. “Why haven't we done that before?”

CONCERNS OVER QUALITY OF CARE

CTV News spoke with numerous family doctors, both on the record and on background, who were enthusiastic about welcoming new colleagues and helping them beef up their skills, but were apprehensive about restricting associate physicians to urgent care centres alone.

“Health authorities are already struggling to staff the UPCCs with physicians as it is, so who is going to be responsible for the oversight and quality control?” asked Dr. Jennifer Lush, an award-winning GP in Victoria. “Are we looking to just put warm bodies in clinics or are we looking to deliver top-quality healthcare to British Columbians?”

Dr. Vanessa Young, who has been a family doctor for three decades, suggested associate physicians work in group practices run by primary care physicians to both supervise and mentor them on a path to full licensure, which is not an option under the current model.

“It could be a fantastic help in our system,” she said, “but it needs to be done carefully.”

The College of Physicians and Surgeons of BC said in an emailed statement that the employment contract between associate physicians and health authorities would include “ensuring that the supervisor and the AP are working together at the same site with ongoing interactions throughout the day.”

OPPORTUNITY OR EXPLOITATION?

The college also noted that while the medical community is outspoken about associate physicians in the wake of a presentation they made to doctors on Friday, the new category of licensure has been in development for a few years and is now being implemented. A pilot project for a community primary care doctor will take place in Northern Health soon.

Some doctors raised concerns that internationally-trained doctors – who face such a labyrinth of tests, fees and practical exams to become licensed that some start medical school all over again in B.C. because it’s faster – could be pressured into tenuous or unattractive jobs.

Someone who was a surgeon in another country may be offered an urgent care job with working conditions Canadian-trained physicians are unwilling to do, and feel stuck without a reasonable path to full licensure.

“We would hope that anyone in the health-care system is able to practice where they want and where they're most needed,” said Dr. Eric Cadesky, a family doctor in Vancouver. “It's important that we integrate people and allow them to go and to be the best doctors they can be.”

The president of the Doctors of BC pointed out that other parts of Canada have “clinical associates” who also work under the supervision of physicians, and recognizes the potential pressures and precarity of the jobs.

Dr. Josh Greggain says on the plus side, a urologist or heart surgeon from another country no longer has to work a menial job to make ends meet, but it’s a frustration that it’s so difficult to get them fully certified and trained to B.C. standards.

“It's a real challenge right now because the federal immigration policy has allowed for lots of physicians to be in the country,” he said. “But the province hasn't had enough residency spots or enough licensure to get people licensed.”

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