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Open the Border to U.S.-Trained Emergency Physicians

Published online by Cambridge University Press:  28 December 2017

Daniel Seitz
Daniel Seitz*
Affiliation:
Queen’s Medical Center and Department of Surgery, Division of Emergency Medicine, University of Hawaii, John A. Burns School of [email protected]

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Type
Letters
Information
Canadian Journal of Emergency Medicine , Volume 20 , Supplement S2 , October 2018 , pp. S87
Copyright
© Canadian Association of Emergency Physicians 2017 

To the editor: Canada is currently facing a progressively worsening emergency physician (EP) shortage, and yet significant barriers still exist for U.S.-trained EPs to practice in Canada. The Collaborative Working Group on the Future of Emergency Medicine in Canada estimates that in 10 years there will be a shortage of about 1,500 EPs. When you consider that Canada’s 11 Fellow of the Royal College of Physicians of Canada (FRCPC) emergency medicine programs graduate about 60 EPs annually, it is no wonder that the heavy lifting in emergency departments across Canada is performed by family practice physicians.

The current policy of the Royal College considers the applications of EPs with an equivalent 5-year duration of postgraduate training. In other words, it will consider U.S.-trained EPs who graduate from 4-year programs and have at least 1 year of approved fellowship training. However, to reach an equivalent duration of training, the Royal College will accept only 1 year of fellowship training. This means that all EPs from 3-year residency programs in the United States are prohibited from practicing emergency medicine in Canada through the Royal College. In the United States, 80% of allopathic emergency medicine training programs are of 3 years’ duration. There is no pathway for these EPs to practice in Canada through the Royal College short of repeating their core residency training. Doors are essentially closed to the over 95% of U.S.-trained EPs who either come from 3-year programs or have not completed a 4-year residency and approved fellowship. Several provinces have established alternative pathways, most notably Ontario’s Pathway 4. However, none of these alternative pathways offer any options of becoming Canadian board certified in emergency medicine.

It is time that the Royal College reassesses its closed-door policy towards American trained EPs. Revising this policy would facilitate the recruitment of well-trained EPs, some of whom are Canadian citizens wanting to return home. A revision of this policy could be implemented easily by requiring a cumulative 5 years of training and practice, and a passing score on the Canadian Board exams. Increasing the number of board certified EPs in Canada would strengthen the board, would be a response to the EP shortage, and increase safety in emergency departments across Canada.