Canadian-born family doctor struggles to come home through a wall of red tape
Canada is desperately short of doctors — and Dr. Stephanie DeMarchi has been trying to return for 16 months
Canada is grappling with a severe shortage of family doctors — but Canadian-born family physicians working abroad are fighting to obtain the paperwork they need to practise here.
Dr. Stephanie DeMarchi, a general practitioner born in Hamilton, Ont., who has worked in Australia for the past 10 years, is one of those doctors.
She trained at the University of Queensland and spent her residency and years as a GP working in rural Australia. She now wants to come home to Canada to take over from her mother, a family doctor in Hamilton who is retiring soon.
But a tangle of red tape has made the process an arduous one. She's been in a battle with Canada's health-care bureaucracy for nearly 16 months to get the licence she needs to practise.
In April 2022, DeMarchi first opened a Physicians Apply account under a program run by the Medical Council of Canada (MCC), the body that evaluates medical graduates and physicians.
In October, she sat for an eight-hour MCC exam testing medical knowledge. She said the test set her back a few thousand dollars.
Then she moved with her Australian husband and two young children to Canada. She said she assumed the process would be complete in the near term, since she's already a practising doctor.
But the MCC did not come through with the number DeMarchi required for her other licensing applications until May 25. As of now, she still doesn't have all that she needs to work in Canada.
DeMarchi said she had to move back to Australia by herself to keep her Australian licence current while the MCC verified documents like her medical degree, post-graduate certificate and resumé.
Those documents must be approved by the MCC before it can issue a "licentiate," something anyone looking to practise medicine in Canada must have in order to apply for a licence.
She said she's been holed up in Gundagai, a small town in rural New South Wales about 390 kilometres from Sydney, living in a caravan park and working at a local practice while her family is far away in southern Ontario.
"It all feels so intentional, like they just don't want me," DeMarchi told CBC News.
"The process just has to change. It's not only affecting lives but it has the real potential to destroy lives as well.
"I don't know why Canada wouldn't want to have these skilled workers in a time of crisis. I don't know why they haven't created a much more polished, efficient system."
It's not clear who exactly is responsible for the MCC and its perceived failures and shortcomings.
The MCC is a national body that operates across the country. In a statement, Health Canada said it "does not have any authority" over the "independent organization" that assesses physicians' competence.
But Ottawa does provide the MCC with cash.
In June, it floated $28.8 million for the council's "Modernizing Mandatory Physician Activities Enabling Safe Patient Care" framework — a lengthy name for an initiative that's meant to make the medical credentials assessment process less cumbersome.
DeMarchi said she just wants the MCC to return her calls and emails, and speedily review documents issued by a fellow Commonwealth country with a top-tier health-care system.
In a media statement, a spokesperson for the MCC said it's "receiving a higher-than-normal number of applications."
"We are actively working to address the current backlog by, among other things, hiring additional staff in this area of the organization," the spokesperson said.
But the MCC process isn't the only hurdle facing DeMarchi and others seeking the licence they need to practise medicine in Canada.
Like other health-care related files, physician recruitment in Canada is a jurisdictional quagmire.
There's a parallel process that would-be doctors have to go through with provincial colleges of physicians and surgeons, the bodies responsible for licensing doctors.
In theory, the MCC is supposed to be the agency tasked with gathering and verifying foreign credentials and then passing that data on to the provincial colleges of physicians and surgeons. But DeMarchi said she has run into trouble with the College of Physicians and Surgeons of Ontario (CPSO). They want her to reproduce some documents that she's already sent to the MCC.
That might sound like an easy fix but DeMarchi has to pay a steep fee and wait for the Australian regulator to create new copies of documents she's already provided to another Canadian health-care gatekeeper.
"That was a nightmare. It's absolutely ludicrous," DeMarchi said.
"They just keep telling me, 'Look, ma'am, these things take time.' They're not saying, 'This is a Canadian who's studied and trained and she's ready to go, let's expedite this.' Nope."
DeMarchi said the CPSO recently rejected one of her reference letters because the agent reviewing it wasn't sure if the date was formatted on a month-day-year or day-month-year basis. CPSO wants the month first.
DeMarchi said there should be a single point person who handles inter-agency paperwork issues so in-demand doctors don't have to wade through the labyrinthine system by themselves.
"These regulatory bodies, they're not speaking to each other. And us doctors, we're getting the message. Canada is essentially saying, 'We don't want doctors, we don't need you,'" she said.
But Canada does need doctors.
After years of restrained spending by federal and provincial governments and a generation of protectionist policies that restrict access to medical residency programs, Canada's health-care system is short nearly 17,000 physicians, according to recent data compiled by the Royal Bank of Canada.
The problem is expected to get worse.
In the next five years, as the baby boomer cohort retires en masse and the population grows by some 500,000 people per year, Canada will be short an estimated 43,900 physicians, the bank reported — including more than 30,000 family doctors and general practitioners.
Rosemary Pawliuk is president of the Society for Canadians Studying Medicine Abroad and an expert on Canada's physician licensing system.
She said bureaucratic delays such as those DeMarchi has experienced are dangerous — because they mean some sick people won't have ready access to a qualified family doctor.
"It's not just this physician that's being hurt. She's not the only one. Many, many more of us — the public — are being hurt," Pawliuk told CBC News.
"We've got 6,000,000 Canadians without a family physician. They're the quarterback for our system. The family physician reduces your suffering or refers you to somebody who can. The bureaucracy is totally blind to the fact that people are dying, literally dying and suffering because they can't get a physician to treat them."
Pawliuk said there's little accountability for the actions of bodies like the MCC — the federal government, the provinces and the colleges don't have much of a say over how it operates. The web of competing organizations, each with some sort of role in the regulatory process, is a needless headache, she said.
"Every one of these entities has their own little fiefdom to develop. You just get lost in the red tape," she said.
It shouldn't take more than a year for a qualified physician trained in a country like Australia to get licensed to practise, she said.
"That's outrageous, absolutely outrageous. I don't know what the problem is or what's going on."
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