Can American doctors solve BC’s healthcare woes?

0:00Do you want your soccer analysis more direct than an Arsenal set piece? Join me, Max Rushden and the Guardians expert soccer journalist for the latest action and news from the Premier League to the Champions League and all the way to the World Cup. We'll have chat more out of the box than a Dominic Sober's Life pre-gick, more panellists than Chelsea have players, and unlike the AR, we know where to draw the line. For fine margins, fun debates and pool-blooded tackles, football weekly. Listen, wherever you get your podcasts and watch the full episodes on YouTube. This is a CBC podcast. Hello, I'm Matt Galloway, and this is the current podcast. If you want to care for others in a place that cares about you, come to B.C. As part of a government of B.C. campaign targeting health care professionals in Washington State, Oregon, and California, the province has also been making the pitch in person, setting up a truck outside Seattle hospitals, handing out free coffee and tea to doctors and nurses. And these recruitment efforts have, apparently, produced results.

1:02The B.C. government says 414 U.S. health care workers have come across the border to work here in the last year. And that approach is pushing other provinces like Manitoba and Nova Scotia to follow suit. Dr. Anne Hirdman Royal is a U.S. trained pathologist who left her job at a hospital in Tulsa, Oklahoma for a position in the Niemau, British Columbia, Dr. Good Morning. Good morning. I often hear people in the United States and it depends on who they vote for. But if the election isn't going their way, they'll say, I'm moving to Canada. You did this. You moved your whole family here. Why did you do that? Well, you're right. A lot of people say that. But this time, well, two times, I guess, since this re-election, since Trump's re-election, it's different. We were pretty disillusioned during the first election of Trump. But the second time, it just became a toxic soup that felt unsafe for our family.

2:07Had you ever been to Canada before? I had been as a child, but not in a very long time. Canada has a great reputation in many ways, especially for the niceness of the people. And it's close by and primarily English speaking in the Western part, at least. So those were very attractive qualities that made us very, very interested in Canada. When you moved across the border, was there a job waiting for you here? What was that process in terms of landing a position? Yes, there was. There are many jobs available across all areas of medicine. But yes, I had a job in NIMO lined up ahead of time. And it was not too difficult to slide right into that after I was able to get my medical license situated.

3:08Was that a process in terms of getting credentials recognized and proving that you could do the job here? Yes, it took a good while to get all of the paperwork and background in order. I would say for me, I started the process a little earlier than some. And because we wanted to take our time, but it ended up being probably around, for me, around 18 months to get that done. But it has been cut considerably back now in the last year. I would say they've made things a good bit easier. And it can probably be done now anywhere between six to eight to 12 months. What do you make of the Canadian healthcare system? You have a system that has universal care, but we also, and I say we as Canadians know, that there are long wait times in emergency departments or to see certain specialists to find a family doctor, for example.

4:09What do you make of the situation here? Well, I think in some areas, it does, certainly I see the long wait times. But in, at least in my area of medicine, which is pathology, a lot of what I do involves cancer care, cancer diagnosis to assist in cancer care. And those are obviously serious conditions that require urgency, sometimes emergent care. And I have seen really no difference in an IMO at least between the speed of diagnosis and then moving on to surgery or whatever treatments are needed are happening at the same rates as they would in the US, which is great. I would say that for most other types of things, it doesn't seem that different either.

5:13I've heard and not yet experienced, but heard that things like elective surgeries or whatever do take seems to take longer. But I've been very impressed with the resources that are utilized for patient care here. I can let you go, but are you hearing from other people, friends, colleagues down south on the other side of the border who have heard of what you did and heard of your experience and thinking maybe I will make that move? Absolutely. It seems like it's ramping up as well. I hear at least once a week, sometimes daily from people and everyone has been very celebratory of our achievement of they, you know, one of us got out is kind of how it feels sometimes. Is there a word of advice that you would give them?

6:15I would say that it don't be afraid of the daunting, seeming process. It's doable and it is so worth it. It's the best decision we've ever made. Wow. And you're here for good? Oh, I hope so. If the Canada will have us, we don't want to go anywhere else. We're glad you're here. Dr. Ann Hurtman Royal. Thank you very much for talking to us. Thank you for having me. Dr. Ann Hurtman Royal is a U.S. trained pathologist who moved from Tulsa, Oklahoma to Nanaimo, British Columbia. Dr. Reed and McCracken is a family physician and Vancouver health services researcher at Simon Fraser University. Dr. McCracken, good morning to you. Good morning. What do you make of what BC has done? Luring healthcare workers from the United States here into Canada. It seems to be working. Yeah, I'm really excited that we have been able to welcome American colleagues. International medical graduates are people who've received their medical training and started medical practice elsewhere.

7:16Are actually very common in Canada widely. 25 to 30% of physicians that are practicing in Canada trained elsewhere. And so right now we've been able to see that there's been an ease of transfer of qualifications from our American colleagues. And I think it's great that they're able to come and work here. What difference is it making? I said 414 healthcare workers and it's doctors, nurses, nurse practitioners have, according to the BC government, made that trip across the border. What difference is it making in terms of access to care? So I don't think we know that yet. Certainly part of the stuff that I study is the gaps that we currently have in primary care, particularly. And we do know that a chunk of that problem is related to having enough doctors to provide care. There are other problems with primary care access that are related to how the services are organized,

8:18the expectations that we set for what reasonable services, that kind of thing. So we don't know exactly what the impact is. Certainly there's lots of job openings and now there are 414 less of those job openings open. But I think that speaks to, you know, we do need to have some metrics and some monitoring of the changes to our healthcare system that can tell us what the difference. For example, these new 414 folks are having. What is the opportunity? There's been a big jump in the number of people in BC with access to primary care. It's almost 83% now from something like 71% in 2022. That's closed that gap to some degree, but there are still people who are looking for care. There are long wait times and what have you. And you would see this in your own practice as well. What is the opportunity here, do you think? Yeah. So the opportunity, adding a new physician to our system, for example, a full-time equivalent of a family doctor,

9:21we can estimate that approximately 1,000 people may be able to gain access. What we need to remember is that many physicians are also leaving the system because they retire, they become unwell, they die. And so there, yeah, there's a, there's a natural flow to the human resources of the physician workforce, just like everywhere else. And so we do have the potential. I think the other thing we need to recall too is that we actually have a large number of other qualified international medical graduates from countries other than the US. And for other approved jurisdictions that have ease of access who are here and ready to work, but still face significant requalification challenges. And so that's something that we need to be thinking about as well that it's probably time now for us to take a look at how we're getting everybody who's interested in working in the system into the system because certainly we do have a gap.

10:30There are many job openings still waiting for the right person to hop in there. And that shouldn't be an either or situation. Again, you hear the stories of somebody who is a doctor trained abroad who's here driving a taxi or something like that because they can't get qualified. What could be done in this moment, if this is an opportunity, what could be done to ensure that everybody is part of this effort to try to address the gap in care and make sure that we can have doctors who are here who want to be here who can work here. Yeah, so I think we've seen it with with what we've done with our American colleagues, you know, Dr. Herdman Royal mentioned that it took her about 18 months to from the time of application to being able to be practice. And then that process has been reduced to six to eight months. And I think we can take a look at the process that's being used for other physicians. How long is that for other physicians? How long is that wait? Do we know?

11:31So we have some data that is very disheartening. It can take four, five, ten years for people to get the qualifications that they need to practice. There are significant barriers. And we also see that there are some areas of the world that international medical graduates come from where that delay can be even longer. Latin America, Asia, that kind of thing. And so I think there's a real opportunity here. We have so many people who are interested in working, including our colleagues from the US. Let's take a look at what is the minimum appropriate qualification checks. And then let's get those people in the system. Dr. McCracken, good to speak with you. Thank you very much. Thank you. Dr. Rita McCracken is a family physician in Vancouver Health Services researcher at Simon Fraser University. Do you want your soccer analysis more direct than an arsel set piece?

12:31Join me, Max Rushden and the Guardian's expert soccer journalist for the latest action and news from the Premier League to the Champions League. And all the way to the World Cup will have chat more out of the box than a Dominic Subbers Live pre-kick. More panellists than Chelsea have players. And unlike the AR, we know where to draw the line. For five margins, fund debates and pool-blooded tackles, football weekly. Listen, wherever you get your podcasts and watch the full episodes on YouTube. Who's your favourite writer of all time? And if you could sit down and have dinner with them, what would you ask? It might be tough to get a dinner date, but I can try to give you the next best thing. I'm Mateo Roach. On my podcast bookends, I sit down for honest conversations with some of today's literary stars. People like Zadie Smith, Ken Follett, RF Kwong, and Louise Penny. Whether you love books or just want a new perspective on your everyday, check out bookends with Mateo Roach, wherever you get your podcasts. Josie Osborne is BC's Minister of Health. She is in Victoria this morning.

13:31Minister Osborne, good morning to you. Good morning. You said that BC wanted to capitalize on what you called uncertainty and chaos in the United States. What is the pitch that your province is making to doctors down south? We saw the discontent down south after Trump was elected and began to hear very divisive rhetoric, anti-science comments, and knew that that must be very disheartening for medical professionals, health care professionals to hear, and saw an opportunity with the work that we've been doing to fast track credentialing. We knew that if we made a pitch, if we made an invitation to US trained professionals to follow their hearts up here to British Columbia, that they might follow, and they have done just that. And so the pitch is that we aren't consumed by uncertainty and chaos. Is that what it is? The pitch is that we have a universal public health care system where you don't have to pull out your wallet in order to get health care, that we have stable, safe, inclusive, welcoming communities here,

14:33that we have fantastic recreational opportunities, education for kids, opportunities for spouses to work. The British Columbia is a really amazing place to live and work. So we took a chance and we made the pitch, and we're just absolutely astounded by the reaction. So the data from the government suggests that 414 people, doctors, nurses, nurse practitioners, have made that trip across the border. Do we know what difference that is making? They are making in terms of access to care in your province? We know that with the gaps we have in the system, and we're feeling the strain like provinces across Canada are everything we can do to fill a vacated physician or fill something with a physician, a nurse practitioner, a psychologist, physiotherapist, anything we can do is going to help. With the 414 people who have accepted job offers, there are many more in the application process right now. And in fact, over 1,300 people have become licensed or registered qualified to work here in British Columbia,

15:38and they're still in that process. So we know it's going to make a difference. That's attaching patients if you're a nurse practitioner, primary care provider, it's joining a team that's looking for nurses in emergency room departments. This is making a difference, and it's kind of really adding a lift for healthcare workers here in British Columbia to welcome these new American colleagues. Emergency room departments are interesting because you have in your province you would well know this. More than 250 temporary hospital and emergency room closures by November of last year, according to the ambulance paramedics of BC. That puts pressure on the entire system, but it also creates uncertainty and chaos if you're a patient who's going to the ER and the ER is closed. How is bringing people here going to address issues like that? Do you see a solution in those rural communities in particular if you're able to bring doctors in from abroad? Yes, and we are seeing this. So some of our smallest communities in British Columbia have American professionals who are moving to them.

16:40And sometimes it literally as a matter of just one nurse or physician to add to a team in a small rural community that gives them what they need to have the stable, predictable emergency services that people really depend on. So we're going to build on this by continuing to recruit professionals from the U.S. from other countries as well. At the same time that we're taking action to build long-term solutions. So we have a new medical school opening this fall in British Columbia. That's the long-term plan. We know we've got to stabilize these services. That's what people depend on. That's what people need. Your government has been able to reduce the wait time in terms of people having their qualifications to recognize from the United States as we heard to about six to eight months. And yet there are thousands of people in this province, in this country, who are internationally trained, who can't work in their field. And they're waiting as we heard from Dr. McCracken for five, ten years, maybe longer. Why is there that difference? Well, there's work to do. There's absolutely work to do. What's the difference, though? Why is it that you can accelerate the process for people from the United States

17:44and that process for those from elsewhere is upwards of a decade? Well, this work is done through regulatory colleges. So the College of Physicians and Surgeons, for example, who licenses and regulates physicians here, looking at the education, the qualifications, the experience of a person. And this is really done with public interest, public safety at heart. And so this is about ensuring that the person has the right skills and qualifications to be able to practice in British Columbia. For some countries that takes longer to do, there are disparities across certain countries where one school is not the same as another school. And there are some countries that have systems that are a little more similar to what we have here in Canada. That is not to say that people cannot get qualified. But as you said, for some, it takes a long time. And that's incredibly disappointing. For those individuals who really want to be serving here in the health care system. And that's why we are working with the College, really trying to take a team BC approach here

18:44to being able to accelerate the credentialing process from people from different jurisdictions all over the world. That's also disappointing for the patients who are looking for care. What specifically can be done to accelerate that process? Is there an opportunity if you can accelerate the process for one group and make it a priority that is a priority for all groups? Yeah, I believe there is an opportunity. And again, it's just getting down to doing that actual work. So we've done that with nursing and with physicians from the US. We have systems where we're looking at now with countries like the UK, Australia, New Zealand, South Africa, the opportunity to accelerate credentialing there. And then India, Asia, there are all kinds of opportunities there. But again, it just takes the time to do that. And that's why we're going to be focused on it. And let you go. But are you getting calls and texts from your colleagues and other provinces saying, what are you doing and how can we steal your idea? Yes, I am. I've had conversations with other health ministers asking how we did it. And we're really happy to share because you know, all of Canada wins with this.

19:45This is an incredible opportunity for those US trained professionals who want to follow their hearts up here and be part of a system that really values their work where they are respected and welcomed to Canada. And your senses, and we heard this from Dr. Herdman Royal, that there are many other doctors, nurses and nurse practitioners in the United States who are ready to make that leap. There are every day when I speak to a physician or nurse or somebody who has moved here, they tell me about their colleagues from their former clinic or hospital who've reached out to them. They're reaching back even just that networking effect alone is going to bring more people. Josie Osborne, good to speak with you. Thank you for your time. Thank you. Josie Osborne is British Columbia's Minister of Health. She was in Victoria. You've been listening to the current podcast. My name is Matt Galloway. Thanks for listening. I'll talk to you soon. For more CBC podcasts, go to cbc.ca slash podcasts.