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Mahmoud Alkhatib is washing dishes at home in Clayton Park. A glass breaks and slices open his right hand, blood bursting forth. It’s a long cut, one that can’t be treated with a bandage and rubbing alcohol. He has to go to the hospital.
Arriving at the emergency room, he gets in a line of wounded people. He gives his medical information to the woman at the desk. She tells him to take a seat.
He sits down, holding his hand. Blood is streaming from the cut. It will form a light scar from his thumb to his wrist. Alkhatib knows it needs stitches. He’d do it himself if he had the materials at home.
Two hours later, he’s taken to a small operating room. Eventually a physician stitches up the wound. Alkhatib asks why it took over two hours to be treated. He’s told they’re short on physicians.
Alkhatib is a physician. He studied medicine for over 15 years, but he can’t find work in Canada. He’s a neurosurgeon who can’t get a license in Nova Scotia, and he’s running out of options.
As a kid living in Syria, Alkhatib became fascinated with medicine. He saw how doctors operated on a family member involved in an accident and was intrigued.
“I love medicine,” he says. It’s “what I want to do.”
After studying for six years and working in a residency for another six, Alkhatib decided to specialize in something that fascinated him: the nervous system. He moved to France and studied neurosurgery for another five years. He could have stayed there for work but he chose to move to Canada. His family lives here, he got married here and this country has a clear need for specialized physicians. It seemed like a perfect place to start his medical career, and build a life.
Arriving in 2008, Alkhatib found he couldn’t just leap into his field. It wasn’t as simple as showing the medical boards his degree and receiving a license. It was a long, complicated process, one that required time and money. For the 42-year-old Alkhatib, it was a barrier to his dream.
Earning a medical license in Canada is difficult for anyone, no matter where they’re from. It takes over 10 years of studying at medical schools to earn a degree, but that is no guarantee of a license. For immigrants to Canada, this process is even more difficult. Canada only grants license approval for people who’ve earned a degree from this country, the United States and about 29 other jurisdictions. Degrees from other countries are not automatically approved.
International medical graduates have to endure three rigourous examinations.
The Medical Council of Canada arranges an evaluating exam (which tests medical knowledge) and two qualifying exams (which test clinical knowledge).
Each of those cost anywhere from $1,000 to $3,000. The College of Physicians and Surgeons of Nova Scotia used to offer a clinical assessment program for international medical graduates in family medicine, but it was cancelled in May.
After the exams, immigrants don’t receive a license. They apply to medical residencies to become fully licensed. But many struggle to find open residencies, as spots are limited. It’s a difficult and frustrating experience for immigrants who want to practice medicine. It’s doubly upsetting for Alkhatib. He wants to practice in his field, not learn it again.
“There are not many residencies,” says Mohja Alia. She works at the Immigration Services Association of Nova Scotia, managing employment programs and overseeing counselling for landed immigrants. Alia and other ISANS workers help international medical grads figure out the certification process, but many still never get licenses. She says ISANS tries to connect immigrants to work in their field, while also proposing alternative careers to fall back on. It’s a difficult task.
After spending six years in a medical residency, Alkhatib has no desire to return to it. He’s asked to be assessed in neurosurgery but that option is unavailable. He has to go to residency, but he refuses. He won’t take the examinations. Alkhatib wants to leap back into neurosurgery. He’s waited long enough—he’s earned it.
In France, Alkhatib worked obsessively for his degree. He entered the country without knowing how to say “Hi.” He would wake up, study French in the morning, then wander the hospital in the afternoon, absorbing everything he could. It was his life. Alkhatib spent every day at the hospital, from 7am to 7pm, taking every opportunity to learn.
In Canada, he’s back at square one. His education and training are seemingly worthless.
“It’s funny,” he says, laughing bitterly. Being stuck in a treadmill of bureaucracy has hurt his psyche. While pleasant and kind, Alkhatib’s eyes betray his frustration. His voice is weary and worn-out.
The average wait time for neurosurgery in Nova Scotia is almost 100 days. With only a handful of neurosurgeons, the province could use a specialist like Alkhatib.
With no options in Nova Scotia, Alkhatib turned to Quebec, which would accredit him much faster than residency. He would work in a hospital and receive a license. He just needed a hospital to sponsor him, but he never found one. Quebec was another dead-end.
Meanwhile, Alkhatib found the only work he could in the medical field: as an assistant. He now works for Leona Burke, who runs an independent blood collection service. Instead of operating on the nervous system, he draws blood and puts it into carefully labelled vials.
Even with his vast training, people don’t think he’s capable of drawing blood. They’ll often ask if he’s done it before, or demand that Burke do it. One woman simply looked at Alkhatib and walked away, leaving before he could speak. Furious, he didn’t chase after her to explain his experience. He has no time for people like that.
Burke appreciates his help, as she’s short on staff, but knows he can do better. “If you were a car mechanic, would you want to work on bicycles?” she says.
Now Alkhatib has turned his attention southward, attempting to gain accreditation from the United States. A friend of his was able to complete three fellowships in America, which led to a job at a Quebec hospital and a Canadian medical license. Alkhatib is applying for American neurosurgery fellowships now. It takes several written exams, which are glorified training for him.
The Canadian medical licensing process for immigrants being insurmountable, Alkhatib is adapting his dream and looking elsewhere. Like a third of the male immigrants who come to Canada, he’ll be leaving the country.
It was Alkhatib’s dream to work here, but now he plans on moving elsewhere to find work. Alkhatib chased a dream across the globe—from Syria to France to Canada. But the path to a medical license in Nova Scotia was one journey too far.
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This article appears in Jun 18-24, 2015.
Very true.I was one of the CAPP candidate and studied for six months for exam.On 1st April CPSNS sent us an email that exam is cancelled .
“He moved to France and studied neurosurgery for another five years. He could have stayed there for work but he chose to move to Canada.”
So he could’ve stayed in France to work as a neurosurgeon, where he trained. But he made the choice not to.
“Arriving in 2008, Alkhatib found he couldn’t just leap into his field. It wasn’t as simple as showing the medical boards his degree and receiving a license. It was a long, complicated process, one that required time and money. For the 42-year-old Alkhatib, it was a barrier to his dream.”
This implies that instead of researching whether he’d be able to use his professional training from France in Canada, he just hopped on a plane and got here and was like “wat?” There are plenty of resources to look into this before uprooting your life to move to another country. For a neurosurgeon, this doesn’t make him sound too bright.
“He has to go to residency, but he refuses. He won’t take the examinations. Alkhatib wants to leap back into neurosurgery. He’s waited long enough—he’s earned it.”
He’s earned it in France, not Canada. If he wanted to work as a physician in Canada, he should’ve applied as an IMG to residency after finishing his MD.
“The average wait time for neurosurgery in Nova Scotia is almost 100 days. With only a handful of neurosurgeons, the province could use a specialist like Alkhatib.”
Because it’s Nova Scotia. There are a lot of physician shortages in the prairies and the maritimes because everyone wants to live in Toronto or Vancouver. Can you guarantee he’d stay in Nova Scotia and practice? No. I mean in this article alone they talk about how his patients don’t think he’s even qualified to draw blood (I took away that they imply it’s because he’s an immigrant) so he’s probably already itching to move to a more multicultural center like Toronto. There’s nothing wrong with living in Toronto, but I would guess (similar to areas of the prairies) that a lot of immigrants don’t feel that warmly accepted in most places other than big centers like Toronto. So saying that there aren’t enough neurosurgeons in Halifax doesn’t mean accepting a bunch of immigrating neurosurgeons will help the issue unless you can force them to live where you want.
This man took my blood. He knows what he is doing. Per the Chronicle Herald the population of Nova Scotia is still in decline. Put it together, its not hard. Let people who are qualified work. Canada is a land of immigrants. Unless you are aboriginal we are all immigrants. So he moves on to Ontario. Who cares, Canada benefits. And yes, I am an immigrant but I am white so people do not notice.
I think Anon905 might be on the wrong track by assuming that “there are a lot of physician shortages in the prairies and the maritimes because everyone wants to live in Toronto or Vancouver.” First of all, Nova Scotia doesn’t have a physician shortage; in fact we actually have MORE physicians per capita than any other province: https://www.cma.ca/Assets/assets-library/d…
But more to the point, the “immigrants want to be in big cities” thing is hugely overblown. In fact, in the past decade, there were the ONLY two major cities in Canada where international immigration declined: Vancouver and Toronto. In 2001, international immigration to Toronto and its suburbs was about 120,000. Last year it was 75,000. Part of this is because educated and professional immigrants are increasingly moving to smaller cities (including Halifax, which still needs a lot more, but did have its highest immigration levels in a decade last year), and more and more immigrants to Toronto are refugees with fewer marketable skills.
So I don’t think physician shortages have anything to do with immigrants wanting to be in larger cities. We often assume immigrants by and large want to live in the biggest and most multicultural cities, but the data doesn’t actually show that.
This story isn’t about any of that, though, it’s about a nationwide problem with recognizing foreign credentials. This isn’t a case of a guy moving on to Ontario or Alberta–he might leave the country. That’s a loss for this province, and a loss for the whole country.
It is a fact that the US, Canada and Britain have high medical standards that must be met before a person is granted a licence. Many countries do not match the standards set in Canada and the US. Because an immigrant to Canada completed medical training elsewhere, this does not confer the automatic right to practice medicine here. These practices and procedures must be researched prior to emigrating to a new country.
My father was a (Polish-born) medical doctor who immigrated to NS in 1953. His background – finished his training at the Polish School of Medicine at Edinburgh University after WW2 broke out. Worked as a medic with the British army, then after the war was in Africa as a doctor working in rural communities in countries like Zimbabwe, Botswana, Malawi (or whatever they were called then). He went back to the UK, then to Canada. I do not think he had any difficulties, certainly nothing like years of retraining and examinations, because by the time I joined him in early 1954 he had been established in a country practice for several months already, with, as far as I know, full hospital privileges at the hospital in Windsor. So why today do these fully qualified doctors have to jump through so many bureaucratic hoops when we know there is a shortage already, which is only going to get worse as all the boomer doctors retire!