Internationally trained physicians currently have no route to work in Nova Scotia, but a report that recommends bringing back a program that tests their skills is now in the hands of the provincial government.

With the elimination of the old program, which was cancelled in 2015, Nova Scotia lost the ability to fill 40 physician vacancies in rural areas, even as it grappled with a doctor shortage. In all, there are currently 66 family doctor vacancies.

Most doctors trained outside Canada can't come to Nova Scotia and immediately begin practising because their credentials aren't recognized.

However, under the previous Clinician Assessment for Practice Program, or CAPP, they would first work for a period under the supervision of another physician who would make sure the foreign-trained doctor's skills were up to snuff.

CAPP was cancelled by the College of Physicians and Surgeons of Nova Scotia as new national standards were being brought in.
'Extremely high priority'

Last year, the Nova Scotia Health Authority determined starting a new program was "an extremely high priority," said Grayson Fulmer, the senior director of medical affairs at the Nova Scotia Health Authority.

Fulmer led a working group, which was formed in September, that was tasked with developing the new business model for the program.

"We've done astronomical amounts of work very, very quickly to try to address this. Realistically, the challenge was getting all of our ducks in a row and getting the right players at the table."

The lack of a foreign-doctor program means a "major gap" in recruitment, said Fulmer, noting CAPP was axed right about the time the province's regional health authorities were merged.

"When we take a look at that and say 10 to 15 physicians each year were lost from that program, and that's cumulative year over year, over year."
Health Department review

The Department of Health and Wellness is now reviewing the recommendations in the report.

"When the review is complete, we will have a better idea about next steps and implementation timeline. The goal remains to launch the program as soon as possible," the department said in a statement.

    'This isn't a low-stakes game. We need to ensure the quality is there.'
    - Grayson Fulmer, Nova Scotia Health Authority

Dr. Gus Grant, the registrar and CEO of the College of Physicians and Surgeons of Nova Scotia, said last fall that CAPP was cancelled in part because it was expensive and used a significant amount of resources.

The program required participants to work in rural communities for four years, but Grant said the retention rate was low beyond that point.

Fulmer points out that the program's loss meant that Nova Scotia could no longer recruit from a major source — internationally trained doctors.

"That accounts for a fair chunk of our need. From this perspective, we're trying to do everything we can now to recruit physicians to Nova Scotia. It's a highly competitive environment," said Fulmer.
Following other provinces

Nova Scotia has some catching up to do.

At the same time CAPP was cancelled, British Columbia launched its revised program. That province has trained 87 internationally trained physicians since 2015, according to its website.

Six other provinces also have their programs up and running, including Newfoundland and Labrador, which received so many applicants its program is full for the next two years.

One benefit of starting the program now, said Fulmer, is that Nova Scotia is able to learn from the challenges other provinces have faced.

For example, he said, it took Ontario 18 months from the creation of its program to the time the first candidates were admitted because those who would be conducting the assessments had to be trained first.
Ensuring quality

That delay could be the same in Nova Scotia. If the program is resumed, it will be open to 10 family physicians in its first year.

It's up to the College of Physicians and Surgeons to determine who meets the qualifications to even be accepted into the program. Then, the candidates will be trained through Dalhousie University.

"This isn't a low-stakes game," said Fulmer. "We need to ensure that the quality is there, and that we're complying with the College of Physicians and Surgeons as well as the broader national assessment criteria standards are being met."

He said the assessments in other provinces typically last 12 weeks.

"By the time the physicians who meet the criteria go in, this is literally a yes or no answer after a short period."

The program will initially be open only to family doctors. But Fulmer said they're developing the business side of it so it could be adapted to specialities in the future.

Grant said testing specialists in fields with the greatest need could be an option.

The provincial government announced money to start the new model in the 2017 budget.

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