Imagine me, a single thirty year-old living in the bustling city of New York, out at a bar on a Saturday night.
“What do you do for a living?” – someone inevitably always asks.
Sometimes, for fun, I make up stories. I tell people that I specialize in cleaning elephant poo at the Bronx Zoo or something ludicrous like that. It is so much more interesting than just saying, “I’m a doctor.”
But when I do say that I am a doctor, people’s reaction is usually “Oh wow.” They think that I must live in luxury on the Upper East Side, drive a Mercedes-Benz or some other fancy vehicle, and travel to exotic lands every couple of months. They picture a doctor, noble and heroic, who goes to work every day and saves lives. Countless lives. They would imagine me shouting out a patient’s blood pressure, cutting them open, performing chest compressions, while pearls of sweat drip down my face, the sweat of hard work, of responsibility, of grandeur. Then the patient lives, wakes up, and thanks me with hugs and tears.
Well, all that is flattering, but none of it is true. I do not save lives every day. As a matter of fact, rarely, if ever, a single act performed by one person saves any lives. Granted, there are days that I intubate or resuscitate a patient, but without my presence, someone else would have taken on the same tasks. Moreover, the outcome of resuscitations is rarely favorable. On most days, I go to work, spend a lot of time in front of the computer reviewing charts and documenting, adjust some medications here and there, auscultate a few chests and backs, order some lab work, curse at the printer for being jammed again, document some more, and call it a day. I am not saying that these actions are not important – they are – but in a smaller, less valiant way than what the public imagines.
Most people also do not know that just because you are a doctor does not mean that you have a job. According to the 2013 report from Royal College of Physicians and Surgeons of Canada titled “Too Many, Too Few Doctors? What’s Really Behind Canada’s Unemployed Specialists,” one in six specialists cannot secure employment in Canada. Not that there is no need for specialists. Those with joint pain know how long the wait list is to see a rheumatologist. Cancer patients have experienced the anxiety in waiting to be evaluated by a radiology-oncologist.
Finding a job is even more difficult for International Medical Graduates (IMG) such as myself. Allow me to take you on a tour onto an IMG’s journey.
After repeatedly being placed on the wait list for Canadian medical schools, I decided not to wait any longer and pursued my medical education abroad, more specifically, at St. George’s University in Grenada. Without any kind of government subsidization, I searched for private loans and worked for a while to save up for the exorbitant tuition fee. After I obtained my medical degree, my initial plan was to return to Quebec, my home province where I would complete my residency. However, I found out that was impossible because Quebec requires all IMGs to have passed both exams of the Licentiate of Medical Council of Canada (LMCC) in order to qualify for residency application. Here is the paradox: one cannot register for the last part of the LMCC exam without having completed at least one year of residency. I gave up that option and eventually matched into a residency in Internal Medicine in New York. That was not easy either, as I was only allowed to pursue a specialty considered by Quebec to be “in need” in order to obtain the visa required to work in the U.S. From what I remember, the specialties considered to be “in need” by Quebec at that time were: Internal Medicine, Family Medicine, Oncology, Hematology, Rheumatology, Geriatrics, Plastic Surgery, Dermatology, and Anato-pathology. Most of these specialties also have a yearly quota, for example, Health Canada only allows four to five IMGs to pursue Rheumatology outside Canada.
Now I am almost at the end of my residency, and to my very pleasant surprise, I matched into a Pulmonary and Critical Care Medicine fellowship at Rutgers University in New Jersey. I did apply in Canada as well, however not in Quebec, because Quebec programs did not accept IMG applicants. Now comes the tricky part: I need Quebec’s endorsement and Canada’s permission to pursue the specialty that I am passionate about. Without Canada’s permission in the form of a letter called the Statement of Need, I cannot extend my visa and would not be allowed to stay and work in the U.S. Every October, Quebec and the rest of Canada come out with a list of medical specialties that they consider to be “in need.” If your chosen specialty does not appear on the list, your province or country will not issue that Statement of Need on your behalf. The result is you are without a visa.
Why not come back to Canada, you say? That was my original plan all along, but the length of training in Internal Medicine in the U.S. being two years shorter than in Canada, I cannot practice as a licensed internist in Canada unless I find an empty spot in the middle of a residency program. You can imagine how difficult that is, and the paperwork that is involved. So should I return to Quebec or Canada, you might find me working as an overqualified burger flipper.
Confused? That is ok. This is indeed a very complex and confusing process that my peers and I learn as we go along.
A Quebecois SGU classmate and friend of mine just matched into Rheumatology in NJ for which Health Canada had alloted five spots by this year. He waited with trepidation to see if he would be one of those five, and luckily he was. Another Canadian classmate of mine, also from Quebec, finished Neurology and wished to continue his training in Neurocritical Care but was not “allowed,” so now he is doing a fellowship in Epilepsy at Yale University. Prestigious position, no doubt, but not what he really loves.
Why are there only five spots allotted to Canadian IMGs who wish to train in Rheumatology abroad? It cannot be a question of funding because the Canadian government is not involved in our training in the U.S. And if Canada has not contributed a single penny to our medical education and training, why does the government restrict what we can or cannot practice? These are questions that we ask ourselves again and again because we do not know who would have the answers, if there is any answer at all.
As for myself, those who know me know how much I love critical care and appreciate pulmonology (respirology in Canada). After all these years of trial and tribulation, to finally arrive where I want to be is a truly rewarding feeling. I am now in the process of working things out, but as of this moment, a piece of paper stands between me and my chosen career.
Next time somebody asks me what I do for a living, saying that I work in the zoo might not be as far-fetched as it sounds.