When I plop myself into Ahmed’s cab at the Somerset-Bridlewood C-Train station, the first thing I notice is a pile of books in the front passenger seat. While waiting for a fare, he had been parked, reading textbooks and pouring over practice exams by the meagre illumination of a book-light.

“What are you studying?” I ask.

“I am a doctor in Pakistan,” he says, “but I need to write exams to work in Canada.” He folds up his books and asks me my destination. “It is hard,” he says, pulling away from the curb.

We drive, chatting about the exams and the difficulties he’s had since coming to Canada: the financial burden of the tests, his struggle to hold down a job and study full-time for the qualification exams.

Even though family and walk-in clinics are swamped with patients, and emergency rooms are beset as never before, Ahmed’s story is not unique. In fact, it is the story of hundreds of qualified doctors from all around the world who are living in Alberta.

It’s doctors like Nicodeme Mugisho, a Congolese expatriate who fled the ravages of war in his home country. Facing an extraordinary personal and financial cost, he has been struggling for Alberta accreditation since immigrating to Canada in 2007. “It’s a hard time, and it’s frustrating.”

The PROGNOSIS

Alberta’s ailing medical system has obvious painful symptoms. Wait-times in Calgary hospital emergency rooms have climbed as high as 16 hours, up 31 per cent from last year. Meanwhile, Dr. Trevor Therman, registrar of the College of Physicians and Surgeons of Alberta (CPSA), claims that there could be as many as 300,000 people in Calgary who do not have access to a family physician, with even higher statistics in rural areas.

Under these circumstances, most Albertans would agree: It’s a waste of expertise to have doctors driving cabs, guarding produce and stocking store shelves.

Twenty years ago half of Alberta physicians used to be general family practitioners (GPs), the other half specialists. Now, GPs make up only about 30 per cent of the provincial doctor force. Therman blames the government’s inadequate fee structure and the so-called brain drain to the U. S. for the decline. According to him, being a family practitioner is simply not lucrative.

The result is that walk-in clinics are overrun. Wait-times average four to six hours, according to an informal Fast Forward Weekly survey of 211 patients at seven doctors’ offices in southwest Calgary over a one-month period.

The boomtowns of the north are suffering even worse. With just 47 family physicians, Fort McMurray has one doctor available for every 1,698 residents, according to last year’s federal census. This is compared to Calgary’s one doctor to every 801 residents.

Numbers like these beg the question: With a shortage of doctors, why are there so many physicians working menial jobs rather than practising medicine?

EXPLORATORY SURGERY

Ahmed and Mugisho are not, after all, alone.

Dr. Albert Kers, former president of the Alberta International Medical Graduates Association, understands their situation. Raised in Calgary, Kers studied abroad, at the medical school at the University of Zagreb in Croatia. He has been involved with the medical accreditation process in Alberta for years. In fact, he himself has run through the gauntlet of accreditation in order to begin practising in Canada.

“We have 600 or more international medical graduates (IMGs) living in Alberta,” Kers asserts. “Of those, 200 are ready to go. They’ve passed their exams, they’ve met the language requirements.”

He is upset that instead of practising medicine, these graduates are in a holding pattern. “They’re scrubbing toilets, and they’re flipping burgers. And while they do that, their skills are wasting away. You need to keep a hand in medicine in order to have everything stick; medicine isn’t like riding a bike, where you can leave it for years and then just jump right back on.”

COMPLICATIONS ARISE

Kers paints a vivid picture of what IMGs face when coming to Canada. “You see depression, you see stress, you see marriages end,” he says. “These people are essentially studying full time to learn the language and learn what they need to know to pass the tests.” He likens the amount of study involved to a full post-graduate course load. “They’re also working full time at low-paying jobs to support families,” he says. “They’re trying to fit being husbands, wives and parents in there somewhere. It’s a lot of stress, and there’s not a lot of help out there.”

Mugisho lost a long-term relationship with his partner back home in the Congo while he was trying to get established in Canada. It’s a loss he attributes in great part to the stress and emotional price that accompanied his struggle to integrate into the Canadian system. “These skills, this education, it is what helps to get you into Canada. But you get here, and you can’t practise. I ended up working as a supermarket security guard. I was depressed.”

The process for an IMG usually begins at immigration. Immigration Canada considers doctors, engineers and other educated professionals to be “skilled workers” — that is, people who can be reasonably expected to make it on their own in their new home, because they have a previous trade or profession that can be useful in Canada. Upon arrival, however, the bulk of IMGs find themselves at loose ends, because they don’t legally qualify to use their skills.

“First, they have to take a qualifying exam,” Kers says. “That costs around $1,000.” There are additional tests for general and family physicians and still more for specialists. “They cost between $700 to $1,500 per exam.” Until September 2008, when they became available in Alberta universities, there were mandatory exams that IMGs could only take in Saskatoon and Vancouver, forcing them to shoulder the added costs of travel and accommodation. The total cost can climb as high as $10,000, depending on specialization. It’s an expensive proposition for someone working as a janitor or retail worker. It can take years, according to Kers — years in which there is often no help with living expenses or the cost of studies.

“You can take out a loan,” says Mugisho, “Or you can just take your time and work survival jobs until you have saved enough. But even then, there’s no guarantee that you’ll get into a residency.”

There are, in Alberta, at least 200 IMGs who have made it through their exams and emerged on the other side ready to enter the workforce in their chosen field, but less than half of them will begin the residency period that marks the next stage of their accreditation.

The 80 special residency spots available to Alberta IMGs — up from 50 last year — are unique in the country, according to Therman. “In the rest of Canada, IMGs who have finished their exams have to compete with Canadian-trained graduates for residencies. In Alberta, we decided to do things a little differently.”

Even with the scaled-down competition and the stress of exams behind them, Alberta’s IMGs still have more hurdles to face. “Residency is boot-camp. It’s the bottom of the totem pole,” explains Kers. Residents make vastly smaller salaries than fully licensed doctors and act almost as assistants to the licensed physicians. In addition, residencies can take the better part of a decade. Five years is the standard residency for a family physician. Specialists can tack onto that as many as three years, depending on their field. “If you’re a doctor who’s been practising for years back home, five or eight years of residency can be pretty disheartening,” says Kers.

Therman, however, defends the practice. “Most people don’t understand that graduating medical school doesn’t make you a doctor. It’s a ticket to train as a doctor. We have procedures, and we have systems in place in Canada that we have to abide by, and that’s what residency teaches. Doctors elsewhere do things differently, and we need to make sure that they’re ready to work in the Canadian system before we let them practise. We have to make sure that no doctor practises in Alberta or Canada that isn’t qualified to do so.”

The U.S. and Canada co-accredit, meaning that a qualified doctor here is essentially a qualified doctor across the border and vice versa. Graduates from a handful of other countries also receive a slightly fast-tracked program: South African doctors, for example, receive what is known as a “Part 5 Licence,” meaning that they can practise under supervision while they take their exams. This has led to a large influx of South African doctors in Canada, to the point where Canada is being accused by the South African government and international media of head-hunting medical professionals.

“We’re familiar with the South African medical system, and it is very similar to the Canadian system,” Therman explains. “The same is not true for many other countries.” Furthermore, the task of determining which countries or institutions could be considered for co-accreditation is daunting. With thousands of different medical systems all over the world, standardization of medical practices is almost impossible. According to the CPSA, India alone (where many of Canada’s IMGs originate) has over 200 identifiable health systems. “It’s a big task... definitely not something that Alberta can do alone. We’d need a lot of help from the federal government and the other provinces.”

Mugisho and Kers support Therman’s stance on the need to ensure the highest standard of care for the public, but nonetheless believe that there needs to be some innovation to fix what they perceive as a damaged system. They insist that there needs to be more work from all levels of government and from learning institutions to develop co-accreditation systems with more parts of the world. They understand, however, that theirs is an uphill battle.

THE CURE?

Even so, things are not altogether bleak for Alberta IMGs and their prospective patients. In addition to the growing number of residencies for foreign graduates, new resources are becoming available to help mitigate the financial and personal cost of the accreditation process.

One such resource is the Immigrant Access Fund (iafcanada.org), a non-profit organization that provides low-interest “micro-loans” to IMGs and other skilled professionals seeking their Canadian accreditation. Momentum Calgary, the Edmonton Mennonite Centre for Newcomers and a stable of corporate partners formed the organization, which provided $1 million in funding for exams and licensing last year. The loans, which are personally guaranteed by Alberta philanthropists and the funding for which is provided by the government of Alberta, HSBC, the Royal Bank of Canada and Western Economic Diversification Canada, are designed to take the financial burden off of skilled immigrant workers, allowing them to maximize their potential.

Mugisho, who was seriously rethinking entering medicine after all of the hardships he had faced, nonetheless, has found a way to help IMGs and Alberta’s beleaguered medical system. After finding a position as a clinical aide at the Calgary Urban Project Society, he counts himself luckier than most IMGs. Drawing on his own experiences for inspiration, he has opened the Blue Sky Staffing Network (blueskystaffingnetwork.com), a website dedicated to helping other IMGs to find placement as clinical aides in Calgary clinics, under the supervision of licensed doctors.

“You’re forced to work these survival jobs, but then when you go for your interviews for residency, they ask you what you’ve been doing, and you have to say ‘driving a cab,’ or ‘working at the grocery.’ It hurts your chances, but you don’t have any alternatives. Working late at night, guarding the grocery store, I had a lot of time to think of a better strategy. Maybe others can benefit from this.”

With initiatives like Mugisho’s, the help of organizations like the IAF and new measures by the provincial and federal governments, the hope persists that lines and wait times for patients, as well as accreditation hurdles for IMGs, might gradually be scaled down to more manageable levels.