Internationally Trained Medical Doctors are Part of the Solution in Post-Covid-19 Canadian Healthcare System

Dr Shafi Bhuiyan with colleagues. He and his colleagues argue that COVID-19 has exposed gaps in the Canadian healthcare system.

By Shafi Bhuiyan and team of ITMDs
Toronto, Canada, Sep 3 2021 – Access to quality healthcare is a basic human right, but for many, especially those in vulnerable communities, the right is not fully realized.

The Covid-19 pandemic exposed this systemic inequality and gaps in the Canadian healthcare system.

While surgical backlogs and delayed appointments may be prominent features of the healthcare crisis, the indirect impacts of Covid-19 must be considered. These include a halt in preventive programs, such as cancer screenings, declining health among Indigenous and aging people and for those with chronic illnesses, as well as worsening mental health among health care workers, to name just a few.

Canada already possesses a significant number of educated, qualified, and experienced Internationally Trained Medical Doctors (ITMDs) who can help fill gaps in the healthcare system. For example, Immigration Refugee Citizenship has reported that over 5,000 physicians came to Canada between 2015 and 2021, and this number does not include ITMDs who immigrated via a different method.

Many ITMDs possess much-needed cultural diversity, linguistic skills, and cross-cultural patient care talents. These can be utilized in the long-term care sector, for chronic disease prevention, and with Indigenous peoples and ethnic-racial groups, especially those residing in remote and rural areas across the country. Although 20% of the Canadian population lives in rural areas, only 8 percent of physicians work cfin these areas. Many ITMDs are well suited to provide quality healthcare for some of these communities.

Canada’s annual immigration intake plan is to welcome more than 400 000 immigrants per year in 2021-23, in keeping with the national plan for population growth. Based on data trends from Immigration, Refugee, Citizenship Canada (IRCC), this will likely include at least 900-1000 physicians each year. The need for diversity among physicians will continue to rise to provide culturally sensitive and quality care for all Canadians. ITMDs can provide culturally sensitive care and in-demand language skills to Canada’s increasingly diverse population.

Although the Truth and Reconciliation Commission of Canada (TRCC) Calls to Action were created in 2014, most healthcare calls have yet to be addressed. ITMDs can help address the long-standing shortcomings for this communities’ access to equitable healthcare and could contribute to rebuilding trust in the healthcare system.

The underutilization of immigrants’ education and qualifications has been reported to cost Canada $3 billion per year. Supporting the incorporation of internationally educated health professionals into the healthcare system would benefit Canada’s healthcare system and positively impact the economy.

Integration of internationally educated health professionals / ITMDs into the healthcare system requires a national strategy with a multi-stakeholder approach that focuses on scalable solutions. This strategy needs the engagement of governmental policymakers, regulatory bodies, employers, educational and training entities, service delivery agencies, and ITMDs themselves.

Once ITMDs have proven their expertise, they still require a bridging program to integrate their skills and expertise into the healthcare labor force. A recent survey of selected ITMDs who had participated in a career bridging program showed one-third had passed their licensing exams. These exams assess candidate’s clinical knowledge and skills to ensure they are comparable to Canadian medical graduates. Despite this achievement, another hurdle remains, to secure licensure. This is the residency program, which ranges from 3 to 5 years depending on the field of specialty.

The residency application process is complicated, but to describe it simply, medical students apply – via the Canadian Resident Matching Service, or CaRMS – for residency positions at universities across the country in one or more specialties of their choice. Not only are the total number of residency slots limited, but there are caps on the number of slots reserved for internationally trained versus Canadian medical graduates. The available slots for ITMDs are considerably smaller.

With the 2021 residency match results, data clearly illustrates the inequity i.e. a total of 2,852 Canadian medical graduates were matched. On the other hand, 410 internationally trained medical doctors were matched to residency positions. Over 90% of ITMD’s who have passed their qualifying exams cannot secure a residency due to their limited number and inequitable distribution of the residency slots.

An immediate solution is developing and delivering bridging programs, including in-class training and practicum placements, to support ITMDs’ employment in work commensurate with their skills, training, and experience, such as clinical assistant, research associate, and healthcare manager. Incorporating ITMDs into the healthcare system as licensed physicians can be further achieved via Practice Ready Assessments, increased residency opportunities, and increased post-graduate public health education and training.

Developing a clear roadmap will facilitate ITMDs’ integration into the Canadian healthcare system and foster diversity and equity in health research, management, and patient care.
There is a worldwide health crisis. If we cannot save a life despite having a huge pool of foreign-trained physicians ready to serve any time, we are neglecting untapped human resources to the detriment of our health.

The inclusion of ITMDs in the health system will benefit the healthcare system, patients, and the community and have a positive impact on society by reducing wait times and ensuring a better quality of life.

ITMDs are here, ready, willing, and qualified to serve Canadians as we work together to strengthen our healthcare system. There is no better time than NOW! Let’s work together to make healthcare more available and accessible to all Canadians so that no one is left behind.

  • The authors are from Asia, the Middle East, Africa, and South American countries.  
  • The co-authors are Drs Bhuiyan S, Orin M, Krivova A, Fathima S, Walters J, Uzonwanne G, McGuire M, Mohammad A, Alamgir AKM, Radwan E, Tasnim N, Tazrin T, Parungao J, Saad W, Shalaby Y.


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The Future of Food & Water Systems in Pakistan & Central Asia?

Farmer working in a paddy field in Pakistan. Credit: Faseeh Shams / IWMI

By Clara Colton Symmes
COLOMBO, Sri Lanka, Sep 3 2021 – An intense monsoon season in Pakistan means the country’s food system faces the challenge of both extreme floods and extended droughts.

In an effort to address these challenges through cross-sectoral collaboration, Dr. Mohsin Hafeez, IWMI’s Country Representative for Pakistan and Regional Representative for Central Asia, convened a regional dialogue in advance of the UN Food Systems Summit (which is scheduled to take place at the United Nations, September 23) .

Human actions are at the root of much water scarcity, but these international dialogues are an opportunity for humans to be a part of the solution by working to reconcile our damages through transforming how we approach food systems.

Pakistan ranks 88th out of 107 countries on the Global Hunger Index and extreme weather, intensified by climate change, has made farming a challenging venture there. Much of Pakistan’s food is now imported from overseas.

Dr. Hafeez’s work centers around improving the resiliency and efficiency of Pakistan’s water systems. This includes innovating water capture and storage systems in Islamabad and Rawalpindi, where he is working to introduce nature-based solutions like recharging groundwater with rainfall runoff.

By convening April’s regional dialogue and organizing four provincial dialogues in the time since, Dr. Hafeez provided the collaborative platforms necessary for reaching sustainably-managed water sources in his region. It is only through cross-sectoral dialogues and work that Pakistan will achieve sustainable food systems management.

“There is an urgent need for promoting inter-sectoral cooperation through evidence-based information to ensure water-food-energy security and environmental sustainability for food system transformation in Pakistan,” Dr. Hafeez said.

The pre-summit hosted in Italy was another opportunity to bring together diverse stakeholders in food systems in the leadup to the UNFSS. On the IWMI blog, we will be exploring what country managers in Uzbekistan and Pakistan hope to achieve through the UNFSS process.

A Q&A with Dr Hafeez:

How are water and food systems connected?

Water supply systems are first and fundamental in food systems. In Pakistan more than 90 to 95% of our total water resources is used for irrigating crops. It’s a water system intrinsically linked with the food system.

When there is a water shortage, we see a direct impact on food production because this is an arid environment, and farmers are not able to do agriculture without the artificial applying of water.

What are the most pressing challenges facing food and water systems in your region?

Pakistan is a food insecure country. We don’t even have food to eat, let alone nutritious options. Around 45% of the children have stunted growth. People don’t have enough food to meet their caloric needs. We’re importing all the other major crops in the last 4 to 5 years from overseas.

And the food system is dependent on water. When we don’t have enough water, the farmers are not able to grow anything, which impacts the lives and livelihoods of everyone.

If you’re talking about even the linkages between the water system and food system: the current water storage systems are only able to cope for 30 days of water supply.

Then there is also the issue of water quality. There is a lot of wastewater and effluents that mix directly into the into the water supply system including the canals and water networks. This also impacts the food system, so that what we grow may not have a same nutritious value.

Why is water storage so essential in Pakistan?

80% of annual rainfall happens during the monsoon season, which is around 60 to 90 days between July and September. The remaining nine months we receive only 16-20% of the water supply.

Water systems here are not resilient, so water storage capacity is quite low. And when we face extreme climate shocks like droughts, this stresses the water and food systems. Either we are facing three months of floods, or nine months without enough water.

What would a water secure world look like for Pakistan and what needs to happen in order to achieve that?

We need to make water systems more efficient, and that will only happen if we improve the efficiency of the irrigation system, which would make water more available for the other sectors. We also need to make water systems more resilient.

There has been a lot of focus on building large dams, but they require a lot of capital resources. I believe we should also focus on improving water resilience through nature-based solutions like rainwater harvesting and groundwater recharging at the localized level.

We need local, nature-based solutions and the government of Pakistan is planning to introduce 3000 small ponds across Pakistan so farmers will have more water available.

A holistic approach and reliable database on water resources and their usage across Pakistan is key to achieving food, water, and energy security. We are the fifth most climate-vulnerable country in the world and there is an urgent need for promoting inter-sectoral cooperation through evidence-based information.

We also need groundwater management policy. Even though we have a national water policy and provincial water acts, we don’t have a comprehensive groundwater plan. Ministries, like those for climate change and food security policy, must stop working in silos and collaborate.

The regional dialogue we convened did this. It brought ministries together and made them talk about how each could help the other in the water, food, energy (WEF) nexus.

How were you able to give voice during the dialogue to historically underrepresented groups like smallholder farmers, women, children, and rural communities?

We invited people from various government and private sectors and farmers. But because they were held in English, we faced the challenge of a language barrier. Many rural farmers do not speak English. So, we invited some and did what we could to help them with translators.

Another challenge is that this dialogue was conducted virtually, and many smallholder farmers did not have access to that. So, we had only two or three farmers participate.

But we had many government agencies that are directly involved in the farmers community. They were able to represent the farmers and a group called the Farmer’s Federation was also able to attend.

Woman working in a paddy field. Credit: Faseeh Shams / IWMI

How do events like the regional dialogues and then the larger UNFSS affect water systems in your region? And what would you like to see as a result of the UNFSS?

When people talk about the food systems, they talk about production, the food value chain, and consumption. And they often ignore the importance of water. This is really the first time in 10 years when we’re talking holistically about food in a way that includes every aspect of the system.

At a recent provincial dialogue, part of the Member State Dialogue, we had people working on nutrition, agriculture, the value supply chain, traditional agriculture, water, and policy. It provided a platform where people worked together and thought beyond their own specialty: identifying real issues and how they could be improved in the future together.

Pakistan joined a UNFSS coalition for developing countries facing food insecurity. The Pakistani government is emphasizing the need to build resilient societies and improve food accessibility. There will be actions and pledges made to invest more into food systems areas which have been typically ignored.

What upcoming IWMI projects do you think will affect the kind of food system transformation desired by the UNFSS?

IWMI and International Food Policy Research Institute are designing a CGIAR Initiative to scale up the integrated management of water, energy, food, land, biodiversity, and forests for inclusive, sustainable development in transboundary river basins in the context of a changing climate.

The NEXUS Gains Initiative will be a game changer, but also many other IWMI projects will be helpful in interconnected thinking about improving the food security and water systems.

As IWMI and the other One CGIAR centers work together, we will be able to make change in a more systematic, holistic way that will change the mindset around food systems and ultimately improve the resilience of water supply systems.

What is making you feel hope about the future of food and water systems in Pakistan and Central Asia?

The current government is Pakistan is saying that food security is one of their highest priorities. They have initiated so many social initiatives in that field, including a resource program where they are providing food to vulnerable communities, with a focus on gender and the stunted growth of children.

The government also emphasized a need to understand the challenges in agriculture sector, linking from the basic production system towards the value supply chain, because as I mentioned that 22% of the system level losses are there.


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Clara Colton Symmes, Princeton-in-Asia Fellow, International Water Management Institute (IWMI), Sri Lanka

In an Interview with Dr Mohsin Hafeez, Country Representative – Pakistan, Regional Representative – Central Asia