According to the Canadian Medical Association 6.5 million Canadians do not have access to primary care and instead have to turn towards walk-in clinics and emergency departments. This turn over leads to an overwhelming response especially in the emergency departments leading to staff burnout. Only 8% medical professionals are able to support 18% of Canadians in rural and remote regions. Physicians as a result are under extreme pressure and suffering from burnout (53% report a high level of burnout). Meanwhile, 70% of ITPs have between 3-10+ years of clinical experience.
The recent introduction of Practice ready Ontario has been a major breakthrough for Internationally Trained Physicians (ITPs) in Canada, since Ontario was one province without a practice ready assessment pathway. However, many barriers remain, with recency of practice being a major one. Below are two ITP stories that are representative of the stories of many ITPs.
Dr. Niazi's personal story:
“I came to Canada in 2022 and my last day of practice was in March 2022, I was repeatedly told by senior matched residents to go back and obtain recency of practice in order to apply for CARMS 2024 as my practice was now more than two years ago. This was easier said than done. Entering into the expensive licensing process without a proper job limited me financially to travel back and gain recency of practice.”
Dr. Black's personal story:
"I came to Canada in 2017 and could not return home to practice because of my two small children and the burden of my spouse and I trying to provide for our family with menial jobs all while trying to secure the days in Canada requirement for Citizenship. Since then I have not matched 4 times and I am now without recency of practice."
These stories represent those of many ITPs. Thousands of physicians have immigrated to Canada in recent years. Between 2015 and 2021, 2,270 new permanent residents to Ontario identified their intended occupation to be either a primary physician or a specialist physician. More than 3,600 have become permanent residents through the Express Entry and Provincial Nominee Programs since 2015. Without an official way to practice medicine in Canada when they arrive, ITPs are disadvantaged from accessing almost all licensure pathways due to recency of practice requirements. 24% ITPs go back to their country of origin once a year to attempt to maintain recency of practice but they cannot not stay for more than 2 months thereby limiting their fulfillment of the currency of practice criteria of several PRA programs. 7.2% of ITPs have left Canada long-term to maintain recency and 66.8% could not leave Canada to maintain their recency of practice. The most common reasons identified through surveys were financial barriers, civil unrest in war torn countries, “meeting days” in Canadian citizenship requirements and economic instability in home countries.
Route to licensure | Currency of practice requirement |
Medical Residency-CaRMS | Within the program descriptions listed by various university programs on the CaRMS website, it is common to see programs requiring or favouring "recent practice". |
Practice Ready Assessment (selection of programs) | "At least 6 months within 3 years preceding commencement of the first clinical field assessment" “Currency in practice – section 2-8 of the CPSBC bylaws – must show evidence of a minimum of 24 weeks (960 hours) of clinical practice as a general/family practitioner in the immediately preceding 3 years.” |
Royal College of Physician and Surgeon pathways (certification) | Neither certification by RCPSC nor licensure by a regulatory body mentions recency, but active physicians are more likely to be licenced. |
MLPIMG | “must not have been out of independent practice as a General/Family Practitioner for longer than five years...” |
This barrier prevents/prevented:
in part, 1007 ITPs from matching through CaRMS in the 2023 match
in part, 1007 ITPs that did not match through CaRMS in 2023, from entering a faster route to licensure (PRA/MLPIMG).
Create a National Regulated Clinical Assistant Role that counts as recency of practice
Accept current licensed Clinical Assistant roles as recency of practice.
Reduce the required time in hours and consider virtual care.
Regulatory bodies can provide a short supervised license to practice in order to maintain recency of practice.
Add other positions such as volunteering, observerships, electives, externships, or supervised practice as a contributory factor for recency of practice.
Consider total clinical hours; no continuity requirement.
Working collaboratively with ITP organisations will allow health policy stakeholders to make changes that will lead to the faster integration of ITPs to help the citizens of Canada.
Edited by: Dr. Makini McGuire-Brown