American ER doctor has spent 1½ years trying to get licensed in Nova Scotia

A doctor from the United States says the process to work in Nova Scotia is "enormously frustrating and stressful" and needs to be overhauled if it wants to recruit more international physicians.

"Clinically, I would say that Nova Scotia is delusional," said Dr. Thomas Dietz. "How are they going to recruit people with this process?"

Dietz, an emergency room physician, moved to Lunenburg, N.S., with his family this year. But instead of walking to work, he's spending his days walking his dog.

"I'm a 10-minute walk from a hospital that has offered to hire me and I'm sitting on my hands."

He said he's spent the last year and a half bouncing between organizations trying to verify his credentials.

Dietz said he even received a call from Premier Stephen McNeil, who also couldn't help.

'Stunning to me how complicated this is'

It wasn't until last week that he could finally apply for a licence.

"I thought this was difficult, but I was only seeing the tip of the iceberg," said Dietz. "It's stunning to me how complicated this is and how expensive this is."

Dietz's mother-in-law lives in Lunenburg and after spending several summers in the community, his family decided to relocate from their home in Oregon.

He never imagined it would be a problem finding work since the local hospital is dealing with frequent emergency room closures.

In the 2017-2018 fiscal year, the Nova Scotia Health Authority reported the emergency department at the Fishermen's Memorial Hospital was closed for more than 3,400 hours, or 39 per cent of the year.

Dietz said the process of applying to get a licence has been as demanding as a full-time job.

He made his first inquiry in April 2018, which was before the Nova Scotia Health Authority had a recruitment website, so when he couldn't find contact information for recruiters, he mailed them a letter.

It took five months for that letter to be acknowledged.

By that time, Dietz was emailing the team as he found their contact information in the meantime.

He asked to meet with them during an upcoming visit to Lunenburg, but was told he needed a licence first.

Verifying credentials biggest hurdle

That process required him to get his credentials verified by the Medical Council of Canada, which was his biggest hurdle.

Dietz graduated in 1986, and a former school where he completed his internship had changed hands and names several times.

He said the organization verifying his documents spent six months sending letters to a non-existent program.

"They could pick up the phone and call Baylor College of Medicine and say 'did this person graduate from your medical school in 1986?'" said Dietz.

$11K in fees before first shift

He acknowledges some of the delay in following up with different organizations was on his end, as he was busy selling his house, leaving his practice and moving across the continent. 

Dietz said it wasn't until last week that a recruiter finally sent him the three-page document that details the step-by-step process to work in the province. That's when he realized he was still on the first page of the list of things he has to take care of, including setting up insurance, waiting for immigration documentation and getting his hospital credential. 

He also discovered it will cost him more than $11,000 in fees before he works his first shift.

By comparison, he said American recruiters handle most of the paperwork and the fees are only a few hundred dollars.

"I understand that credentialing is an essential part of ensuring quality of care and patient safety, but why is it not this complicated in the U.S.?" Dietz said.

College says it has tried to help

The College of Physicians and Surgeons of Nova Scotia said Dietz's file is an exception. He confirmed Dietz has the appropriate qualifications to work in the province. 

"The process for him was quite simple, submit a document to the College of Family Physicians of Canada, and he was unable to do that," said Dr. Gus Grant, the registrar and CEO.

He said his staff sent multiple emails to Dietz in an effort to help.

"Make no mistake, our No. 1 priority at the college is to license physicians, and more accurately to license competent and appropriately trained physicians," Grant said.

He said qualified physicians from the U.S. can typically be approved for their licence in a significantly shorter time frame than doctors looking to practise in the U.S., and comparing the fee structure is like comparing apples to oranges.

Grant said the verification process is essential because it's so easy to forge documents now.

"We constantly look at our processes in the mirror to try and streamline them," he said. "But there is always going to be a degree of rigour."

Other doctors frustrated

Doctors Nova Scotia, the organization that advocates for physicians, said it was unaware of Dietz's case until now, but it has heard frustrations from other doctors.

"It's not an easy process to navigate for any physician coming to the province," said CEO Nancy MacCready-Williams.

"Sometimes it's lumpy, sometimes it works very smoothly. It's situational, it depends on the physician's own circumstances."

She wasn't sure how many physicians have had struggles, but said there is a working group being led by the health authority looking "trying to make the system work as simply as possible."

Dietz considering giving up

When asked for interviews, both the Health Department and health authority instead sent statements.

The Health Department said it was limited in what it could say because of privacy reasons, and said the matter was under the college's jurisdiction.

The health authority said it's unfortunate that Dietz has faced delays because of complex circumstances.

"Our team has expended a great deal of effort over the last year, and in particular over the last six months, by inquiring on his behalf," wrote Katrina Philopoulos, the director of recruitment.

Dietz has a ways to go with his application and he's thinking of giving up. Remaining steps for Dietz include getting a work visa and arranging insurance.

He said he's been approached by an American recruiter.

"I have three kids and a house, I don't have an income right now," he said. "The problem is, I don't see an end to this process. It's depressing and frustrating and stressful."