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Meet the Canadian-born doctors who can’t work in Canada

Published

2 years ago

February 16, 2023

Thousands of Canadian-born doctors are working abroad at a time when the country is facing an acute shortage of physicians — and there’s little prospect of them practising here because of barriers that block foreign-trained professionals from launching a career at home.

While it’s difficult to establish just how many Canadian doctors are working overseas, a CBC News analysis of publicly available data suggests they number in the tens of thousands.

Since the early 1990s, the number of Canadian international graduates who aren’t matched with residencies has grown significantly. Medical schools, which run the system, privilege their own Canadian-educated students over home-grown doctors trained abroad for the limited number spots that are available each year.

In 2022, for example, only 439 foreign-trained Canadian doctors out of a pool of 1,661 applicants were actually matched with residencies — post-graduate training that is required in order to be licensed. That’s a 26.6 per cent match rate.

That means 1,222 would-be doctors were cut loose and forced to find work elsewhere, according to data from the Canadian Resident Matching Service (CaRMS).

And these are not foreigners — you must be a Canadian citizen or permanent resident to even apply for a residency in Canada.

The number of CaRMS applicants doesn’t tell the whole story.

An untold number of Canadians go to school in countries like Australia, Ireland, the United Kingdom and the U.S. They tend not to apply for residencies at home because they know how unlikely it is they’ll be matched.

Dr. Steve Brennan was one of those students.

Rejected by Canada, he’s now a pediatric pulmonologist and the associate director of the rare lung disease centre at Washington University in St. Louis, Missouri.

Dr. Steve Brennan, born in St. Albert, Alta., works as a pediatric pulmonologist in St. Louis, Missouri. There’s a critical shortage of pulmonologists that work with children. (Submitted to CBC News)

He’s the kind of specialist Canada needs. The American Thoracic Society has said there’s a “critical shortage” of these doctors; fewer than 1,000 of them are actually practising in the U.S. They’re even more scarce north of the border.

Born in St. Albert, Alta., Brennan did his undergraduate degree in social work in Canada. Growing up in a family of nurses, Brennan ultimately decided medicine was his true calling. He applied to a number of Canadian medical schools but wasn’t accepted.

He’s not alone. Few medical school spots are available in Canada — the acceptance rate was just 5.5 per cent last year, according to university data.

Twenty years ago, there were 2,044 first-year medical school positions available at 16 universities nationwide. In 2020-21, there were about 2,800 positions available at 17 schools. Canada has added some eight million people to its population over the same time period.

Brennan went to the University of Queensland in Australia and graduated in 2013 with 100 other Canadian students. He said six of his closest Canadian friends in that graduating class also skipped out on a Canadian residency altogether.

‘Why bother?’

“I didn’t even try to come home. I just knew how hard it would be,” Brennan told CBC News.

“We had someone from the B.C. residency program come to Australia and they basically said, ‘Don’t come back.’ The statistically low match rate means even some of the top students don’t get through. So I said, ‘Why bother?’

“It’s really sad because I went to medical school thinking I’d just come back to Canada. I think that’s what all of us thought. Going to school in Australia — it’s a way to be a doctor, but it’s not actually a way to be a doctor in Canada.”

While he was reluctant to leave Canada, his mum and sister in Vancouver and his dad in Calgary, Brennan turned to the U.S., where international medical graduates are more than twice as likely to land a residency.

“They have enough spots to accommodate every single American student and a ton of internationals,” he said. “They’ve got it figured out.”

Brennan has made a career in St. Louis studying and treating children with asthma, cystic fibrosis and genetic disorders like primary ciliary dyskinesia. He’s married with kids and lives near his in-laws.

Canada is short nearly 17,000 physicians

But he can’t help but think the Canadian system is “a bit cruel” because it keeps Canadian doctors like him away from their own country — and the family and friends they left behind.

Brennan said there’s a reason why the number of internationally trained applicants for Canadian residency positions has fallen steadily from 2,219 in 2013 to 1,661 in 2022 — a drop of 25 per cent in just a decade.

“In Canada, the system is just not really set up to take international graduates,” he said. “Word gets out.

“And that’s a problem because the health-care system cannot rely solely on Canadian doctors. That’s clearly not working. You have to alter the system somehow if you really want to train people in Canada.”

After years of restrained spending by federal and provincial governments and a generation of protectionist policies that restrict access to residency, Canada’s health-care system is short nearly 17,000 physicians, according to recent data compiled by the Royal Bank of Canada.

A nurse works with a patient in the intensive care unit at the Halifax Infirmary in Halifax on Feb. 25, 2022. Canada is facing a shortage of health-care professionals while thousands of Canadian-born, foreign-trained doctors are working abroad. (Andrew Vaughan/The Canadian Press)

The problem is expected to get worse.

In less than a decade, as the baby boomer cohort retires en masse and the population grows by some 500,000 people a year, Canada will be short an estimated 43,900 physicians — including more than 30,000 family doctors and general practitioners, the bank reported.

Dr. Kate Stewart wanted to help Canada fill the gap. Born and raised in St. Catharines, Ont., Stewart did an undergraduate degree and got her master’s at the University of Guelph.

Rejected by Canadian medical schools, Stewart set out for the University of Queensland, which ranks among the top schools in the world.

She’s now a practising obstetrician-gynecologist in the Melbourne area.

Dr. Kate Stewart (right) is a Canadian-born doctor living near Melbourne, Australia, with her husband Dr. Chamath De Silva (left). Stewart wanted to come home after her medical training but there are significant roadblocks that make it difficult for Canadian doctors trained abroad to return. (Submitted to CBC News)

Stewart was another Canadian who didn’t bother with the CaARMS residency match process after she graduated in 2012.

She knew the chances of getting a position were slim — there were only three ob-gyn residency positions in all of Ontario open to international graduates that year.

She also didn’t want to be separated from her Australian husband, who is an anesthesiologist.

Stewart thought that after she completed her residency and specialist training in Australia, she could come home and live near her parents in Ontario’s Niagara region.

But after doing a deep dive on the process, she realized it was difficult to get the Royal College of Physicians and Surgeons, which oversees the accreditation of specialists in Canada, to recognize her Australian credentials.

While the Royal College has a streamlined process for trained specialists coming from select Commonwealth and other western countries, Stewart would still be forced to sit for an exam — a test that requires at least 20 to 30 hours of study per week for a year.

Stewart said she can’t juggle that with her obligations as a doctor and as a parent to two young girls.

“It’s really not something I’m interested in doing again. I’ve been there and I’ve done that,” she told CBC News.

She’d also be out $8,000 — there’s a fee to assess her “exam eligibility” and a separate fee for the exam itself. The test can’t be done remotely — she’d have to come to Canada.

“I could pick up the phone tomorrow and ring the U.K. or New Zealand and I’d be able to apply for a job there without restrictions. It doesn’t make sense to me why I couldn’t do the same with Canada,” she said.

“I’ve practised and worked and learned in a Western, English-speaking country with similar cultures and values. People coming from countries like New Zealand, Australia, the U.K., they have the capacity to integrate into the Canadian system as good workers, easily.”

Her Australian husband, Dr. Chamath De Silva, was willing to move to Canada — but he also found the process daunting, time-consuming and expensive.

It’s a shame, Stewart said, because the Niagara region desperately needs anesthesiologists like De Silva. Last month, a hospital in Welland, Ont. had to cancel surgeries because there wasn’t one available.

With Canada experiencing such an acute shortage of doctors, Stewart said the roadblocks thrown up by provinces and regulatory bodies are puzzling.

“The country should be grateful that these Canadians are willing to come back and be completely overworked and underpaid,” she said. “And you didn’t even have to pay to educate them.”

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STD epidemic slows as new syphilis and gonorrhea cases fall in US

Published

6 hours ago

November 12, 2024

Anne Joseph

NEW YORK (AP) — The U.S. syphilis epidemic slowed dramatically last year, gonorrhea cases fell and chlamydia cases remained below prepandemic levels, according to federal data released Tuesday.

The numbers represented some good news about sexually transmitted diseases, which experienced some alarming increases in past years due to declining condom use, inadequate sex education, and reduced testing and treatment when the COVID-19 pandemic hit.

Last year, cases of the most infectious stages of syphilis fell 10% from the year before — the first substantial decline in more than two decades. Gonorrhea cases dropped 7%, marking a second straight year of decline and bringing the number below what it was in 2019.

“I’m encouraged, and it’s been a long time since I felt that way” about the nation’s epidemic of sexually transmitted infections, said the CDC’s Dr. Jonathan Mermin. “Something is working.”

More than 2.4 million cases of syphilis, gonorrhea and chlamydia were diagnosed and reported last year — 1.6 million cases of chlamydia, 600,000 of gonorrhea, and more than 209,000 of syphilis.

Syphilis is a particular concern. For centuries, it was a common but feared infection that could deform the body and end in death. New cases plummeted in the U.S. starting in the 1940s when infection-fighting antibiotics became widely available, and they trended down for a half century after that. By 2002, however, cases began rising again, with men who have sex with other men being disproportionately affected.

The new report found cases of syphilis in their early, most infectious stages dropped 13% among gay and bisexual men. It was the first such drop since the agency began reporting data for that group in the mid-2000s.

However, there was a 12% increase in the rate of cases of unknown- or later-stage syphilis — a reflection of people infected years ago.

Cases of syphilis in newborns, passed on from infected mothers, also rose. There were nearly 4,000 cases, including 279 stillbirths and infant deaths.

“This means pregnant women are not being tested often enough,” said Dr. Jeffrey Klausner, a professor of medicine at the University of Southern California.

What caused some of the STD trends to improve? Several experts say one contributor is the growing use of an antibiotic as a “morning-after pill.” Studies have shown that taking doxycycline within 72 hours of unprotected sex cuts the risk of developing syphilis, gonorrhea and chlamydia.

In June, the CDC started recommending doxycycline as a morning-after pill, specifically for gay and bisexual men and transgender women who recently had an STD diagnosis. But health departments and organizations in some cities had been giving the pills to people for a couple years.

Some experts believe that the 2022 mpox outbreak — which mainly hit gay and bisexual men — may have had a lingering effect on sexual behavior in 2023, or at least on people’s willingness to get tested when strange sores appeared.

Another factor may have been an increase in the number of health workers testing people for infections, doing contact tracing and connecting people to treatment. Congress gave $1.2 billion to expand the workforce over five years, including $600 million to states, cities and territories that get STD prevention funding from CDC.

Last year had the “most activity with that funding throughout the U.S.,” said David Harvey, executive director of the National Coalition of STD Directors.

However, Congress ended the funds early as a part of last year’s debt ceiling deal, cutting off $400 million. Some people already have lost their jobs, said a spokeswoman for Harvey’s organization.

Still, Harvey said he had reasons for optimism, including the growing use of doxycycline and a push for at-home STD test kits.

Also, there are reasons to think the next presidential administration could get behind STD prevention. In 2019, then-President Donald Trump announced a campaign to “eliminate” the U.S. HIV epidemic by 2030. (Federal health officials later clarified that the actual goal was a huge reduction in new infections — fewer than 3,000 a year.)

There were nearly 32,000 new HIV infections in 2022, the CDC estimates. But a boost in public health funding for HIV could also also help bring down other sexually transmitted infections, experts said.

“When the government puts in resources, puts in money, we see declines in STDs,” Klausner said.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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World’s largest active volcano Mauna Loa showed telltale warning signs before erupting in 2022

Published

6 hours ago

November 12, 2024

Anne Joseph

WASHINGTON (AP) — Scientists can’t know precisely when a volcano is about to erupt, but they can sometimes pick up telltale signs.

That happened two years ago with the world’s largest active volcano. About two months before Mauna Loa spewed rivers of glowing orange molten lava, geologists detected small earthquakes nearby and other signs, and they warned residents on Hawaii‘s Big Island.

Now a study of the volcano’s lava confirms their timeline for when the molten rock below was on the move.

“Volcanoes are tricky because we don’t get to watch directly what’s happening inside – we have to look for other signs,” said Erik Klemetti Gonzalez, a volcano expert at Denison University, who was not involved in the study.

Upswelling ground and increased earthquake activity near the volcano resulted from magma rising from lower levels of Earth’s crust to fill chambers beneath the volcano, said Kendra Lynn, a research geologist at the Hawaiian Volcano Observatory and co-author of a new study in Nature Communications.

When pressure was high enough, the magma broke through brittle surface rock and became lava – and the eruption began in late November 2022. Later, researchers collected samples of volcanic rock for analysis.

The chemical makeup of certain crystals within the lava indicated that around 70 days before the eruption, large quantities of molten rock had moved from around 1.9 miles (3 kilometers) to 3 miles (5 kilometers) under the summit to a mile (2 kilometers) or less beneath, the study found. This matched the timeline the geologists had observed with other signs.

The last time Mauna Loa erupted was in 1984. Most of the U.S. volcanoes that scientists consider to be active are found in Hawaii, Alaska and the West Coast.

Worldwide, around 585 volcanoes are considered active.

Scientists can’t predict eruptions, but they can make a “forecast,” said Ben Andrews, who heads the global volcano program at the Smithsonian Institution and who was not involved in the study.

Andrews compared volcano forecasts to weather forecasts – informed “probabilities” that an event will occur. And better data about the past behavior of specific volcanos can help researchers finetune forecasts of future activity, experts say.

(asterisk)We can look for similar patterns in the future and expect that there’s a higher probability of conditions for an eruption happening,” said Klemetti Gonzalez.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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Waymo’s robotaxis now open to anyone who wants a driverless ride in Los Angeles

Published

7 hours ago

November 12, 2024

Anne Joseph

Waymo on Tuesday opened its robotaxi service to anyone who wants a ride around Los Angeles, marking another milestone in the evolution of self-driving car technology since the company began as a secret project at Google 15 years ago.

The expansion comes eight months after Waymo began offering rides in Los Angeles to a limited group of passengers chosen from a waiting list that had ballooned to more than 300,000 people. Now, anyone with the Waymo One smartphone app will be able to request a ride around an 80-square-mile (129-square-kilometer) territory spanning the second largest U.S. city.

After Waymo received approval from California regulators to charge for rides 15 months ago, the company initially chose to launch its operations in San Francisco before offering a limited service in Los Angeles.

Before deciding to compete against conventional ride-hailing pioneers Uber and Lyft in California, Waymo unleashed its robotaxis in Phoenix in 2020 and has been steadily extending the reach of its service in that Arizona city ever since.

Driverless rides are proving to be more than just a novelty. Waymo says it now transports more than 50,000 weekly passengers in its robotaxis, a volume of business numbers that helped the company recently raise $5.6 billion from its corporate parent Alphabet and a list of other investors that included venture capital firm Andreesen Horowitz and financial management firm T. Rowe Price.

“Our service has matured quickly and our riders are embracing the many benefits of fully autonomous driving,” Waymo co-CEO Tekedra Mawakana said in a blog post.

Despite its inroads, Waymo is still believed to be losing money. Although Alphabet doesn’t disclose Waymo’s financial results, the robotaxi is a major part of an “Other Bets” division that had suffered an operating loss of $3.3 billion through the first nine months of this year, down from a setback of $4.2 billion at the same time last year.

But Waymo has come a long way since Google began working on self-driving cars in 2009 as part of project “Chauffeur.” Since its 2016 spinoff from Google, Waymo has established itself as the clear leader in a robotaxi industry that’s getting more congested.

Electric auto pioneer Tesla is aiming to launch a rival “Cybercab” service by 2026, although its CEO Elon Musk said he hopes the company can get the required regulatory clearances to operate in Texas and California by next year.

Tesla’s projected timeline for competing against Waymo has been met with skepticism because Musk has made unfulfilled promises about the company’s self-driving car technology for nearly a decade.

Meanwhile, Waymo’s robotaxis have driven more than 20 million fully autonomous miles and provided more than 2 million rides to passengers without encountering a serious accident that resulted in its operations being sidelined.

That safety record is a stark contrast to one of its early rivals, Cruise, a robotaxi service owned by General Motors. Cruise’s California license was suspended last year after one of its driverless cars in San Francisco dragged a jaywalking pedestrian who had been struck by a different car driven by a human.

Cruise is now trying to rebound by joining forces with Uber to make some of its services available next year in U.S. cities that still haven’t been announced. But Waymo also has forged a similar alliance with Uber to dispatch its robotaxi in Atlanta and Austin, Texas next year.

Another robotaxi service, Amazon’s Zoox, is hoping to begin offering driverless rides to the general public in Las Vegas at some point next year before also launching in San Francisco.

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