A5

Irving Gold
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The majority of physicians practicing in Canada have gone through a similar education and examination process. Following an undergraduate experience outside of medicine (and for some, advanced degrees), completion of a four-year undergraduate medical education at an accredited Canadian faculty of medicine leads to the degree of Medical Doctor, the MD.

This degree does not grant the holder the ability to practice medicine; MDs must then apply through the Canadian Residency Matching Service to enter into post-graduate training. Applicants identify their preferred residency programs (for example, family medicine in Ottawa, general surgery in Kingston, psychiatry in Calgary, etc.) and are subsequently matched to one of their choices.

During the course of their post-graduate education and at completion, MDs write qualifying exams and a certification exam given by the Medical Council of Canada as well as one of Canada's professional certifying bodies: the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada, or the Collège des Médecins du Québec. At this point, graduates must then apply for a license to practice within their scope of expertise.

The pathway outlined above illustrates the many measures we have in Canada to ensure that doctors are subjected to rigorous assessments and meet the highest standards. We do this to ensure that Canadians receive high quality and safe health care.

The road to practice is a long one (from six to 10 years), but Canada does offer the opportunity for foreign-trained doctors, those who have received some or all of their training abroad, to enter the process mid-stream without having to start at the beginning. Programs are in place in most provinces to assess internationally trained doctors, make recommendations as to how practice-ready these doctors are, and determine how much additional training they need, if any, to meet the Canadian standards.

The Canadian experience is that foreign-trained doctors have made an important contribution to our health care system. Despite their alternate pathway entrance, Canada has been diligent in assuring that these individuals, and the training they received before coming to Canada, are rigorously assessed.

Provincial governments and others have been urging those of us involved in medical education and certification to find quicker and more innovative ways to recognize the credentials that are achieved by physicians trained outside of Canada and to further facilitate their entry into practice. These initiatives will be important if we are to be successful in increasing our workforce in the short term.

The rush to increase our medical workforce must not, however, force us to make decisions that put our high-quality health care system, or Canadians, at risk.

Changes to our system of medical education must be well thought out and unanticipated consequences minimized. We need to ensure that alternate entries to practice do not create a double standard; we must ensure that Canadian students and those coming through alternate pathways are held to the same high standards. If we do not ensure this, we will be trading one problem for another.

Irving Gold is Vice-President of Government Relations and External Affairs for The Association of Faculties of Medicine of Canada.