N.S. regulator streamlines evaluation process for internationally trained doctors

Living just minutes from Fishermen's Memorial Hospital in Lunenburg, N.S., Dr. Claudia Schmiemann has an up-close view of the needs at the local hospital — and she'd like to help.

Schmiemann worked for 23 years as a family doctor at a clinic in her native Germany, where she also acquired training in emergency medicine and palliative care. Fishermen's Memorial recently received dedicated palliative care beds and it's one of many rural emergency departments across the province plagued with closures due to staff shortages.

So far, however, Schmiemann has not been licensed to practise medicine in Nova Scotia.

"Nova Scotia is a nice place to be and I would really love to contribute to the community that I'm living in," Schmiemann said in a recent interview.

"Here I am, ready to work, and to see that people really spend 10, 12 hours in an [emergency department] is sad."

Changes started this month

Schmiemann first started looking into getting licensed here several years ago while still in Germany. Eventually, she and her husband moved here, thinking it would be easier to get people on the phone to have questions answered.

The biggest question: Would Nova Scotia recognize her education and training from Germany? Although she received indications she'd be able to eventually work here, Schmiemann is turned off by the need to do some upgrading and evaluation before she could be considered for a licence. It's a frustration other internationally trained doctors have expressed in the past.

"For an experienced family physician — I'm 54 now — this is not really attractive," said Schmiemann.

Dr. Gus Grant, registrar of the College of Physicians and Surgeons of Nova Scotia, said the process to evaluate doctors trained outside of Canada must remain rigorous in the interest of public safety.

But that doesn't prevent the licensing process from becoming more efficient.

At the beginning of this month, the college launched a streamlined process for doctors who trained outside of Canada and are deemed ready for consideration of getting licensed here.

Grant said the changes are about continuing to uphold a commitment to patient safety and recognizing that not all medical educations around the world are the same, while finding ways to get more competent doctors working in the province at a time when they are needed.

"It's the issue of the day not just in Nova Scotia, but in every province in the country — in fact, in the Western world," he said in an interview.

Using the new process, doctors with "sufficient time and discipline-specific training" would go through a "robust" orientation, followed by "intense and rigorous" assessment of their skills. The assessment would take place where the supervisor who agrees to take on the task is based.

'No question' things will speed up

The doctor being evaluated would be issued a defined licence and practice under supervision, but the time they work under supervision will be reduced by 60 per cent, with the minimum period lowered to six months.

The college estimates 80 per cent of doctors on this pathway will only require the six months. The maximum time for practising under supervision is being reduced from 60 months to 24 months.

Another change is removing the requirement that a doctor pass Royal College certification exams before getting a defined licence. Now they must be deemed eligible for the exam, but don't have to write it. Passing the exam would still be required for a full licence.

There is "no question" the new policy will speed up the assessment process, said Grant.

"Moreover, there's no question that this will increase the pool of physicians eligible for assessment and ultimately eligible for licensure," he said.

That will be music to the ears of the provincial government. Health Minister Michelle Thompson has said immigration will be a key factor in improving health-care staffing shortfalls. For that reason, Thompson and Premier Tim Houston called on regulatory bodies such as the college to find ways to streamline their processes.

Less reliance on standardized exams

Reducing the reliance on standardized exams removes a requirement that has been a bone of contention for many doctors coming here from other countries who worried about their ability to pass a test that would be challenging for most doctors the further removed they are from medical school, something Grant acknowledged.

"I don't know any of my colleagues or any of my med school class that would want to challenge their qualifying exams in the middle of their career," he said.

That's not to say such exams are without value, but Grant said there are other ways of assessing a person's ability to work here as a competent doctor.

"I think historically the licensing authorities, including our college, may have placed an overreliance on certification exams, particularly for mid-career physicians coming from different parts of the world."

Available assessors the limiting factor

Grant estimates 30 to 40 per cent of doctors in the province trained internationally. That level of familiarity helped inform the new process, along with the fact that assessing doctors' fitness for licensure can be effectively done through workplace settings, particularly for mid-career physicians, said Grant.

The limiting step in this process will be the availability of people to provide assessments. Despite the fact people are tired and overworked, Grant said his meetings so far with senior health-care leadership indicate doctors are ready and willing to answer the call.

"I think if we can shine a light on how doing this work will ultimately pay enormous dividends, I'm confident we'll get people to raise their hand to do the work."

The streamlined process could eventually help Schmiemann in her quest to work in Lunenburg, but before getting to that point she must settle the necessary requirements to be approved for assessment. Schmiemann would like to see more consideration given to the training and credentials people from other countries have when they arrive in Canada.

"We definitely have to think out of the box," she said.

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