New rule closes gate on South African doctors

New regulations are making it difficult for doctors from South Africa hoping to establish family practices in Canada and Margot Schweers is outraged the taps have essentially been turned off on a physician pipeline that's been the lifeblood of her hometown.

The 79-year-old woman lives in Fort St. James, a town of about 4,000 that faces significant challenges with just one family doctor left to serve the area. Schweers says the situation is becoming intolerable, with clinical appointments difficult to obtain and the emergency ward at Stuart Lake Hospital in Fort St. James open only on weekends as health authorities scramble to fill the doctor shortage.

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"This is a problem for Fort St. James because for years we have only had South African physicians and now we are no longer able to recruit out of South Africa," said Schweers.

"I am old, for me it doesn't matter, but can you imagine if you are a young woman and pregnant and each time you have a different doctor. Vanderhoof has 14 doctors and we have one. That is outrageous. We have 4,000 adult people here. It's just a catastrophe."

Last year, federal and provincial health ministries met with South African government officials and agreed to stop recruiting that country's doctors. The BCCPS changed its bylaws in December and no longer accepts the credentials of family doctors who are international graduates unless they were trained in Canada, the U.S., the United Kingdom, Ireland, Australia, or New Zealand. The new rule does not yet apply to specialists.

Northern Health had no alternate but to close the emergency ward in Fort St. James when the husband and wife doctor team of Augustus and Marni van der Spuy moved to Vanderhoof in February. The van der Spuys continue to see patients one day per week at the Fort St. James medical clinic, sharing the workload with Dr. Paul Stent, but their duties in Vanderhoof made it impossible for the van der Spuys to continue their hospital work in Fort St. James.

Schweers can't understand why the province, in agreement with other provincial jurisdictions across Canada, would cut off one of its most reliable sources of medical expertise. Last year alone there were 41 South African doctors writing certifying exams to work in B.C. and 15 more who were approved by the B.C. College of Physicians and Surgeons (BCCPS), more than from any other country.

"I was really ashamed when I talked to my doctor," Schweers said. "I find it so horrible to belittle those people. They study for years, they pay for their education and they wrote their doctor thesis. They don't come here to clean floors. I really hope Health Minister Mike de Jong is listening."

When Stent arrived in Fort St. James from South Africa in 1989, he was able to work out the formal regulatory details of his employment while he saw to patients. Since that time, the Fort St. James team of doctors has been almost exclusively South African-trained. But the rules have changed, and the gate into B.C. has closed.

For general practitioners trained outside of the accepted six countries, before they are allowed to work as doctors in Canada they now have to go through a performance assessment. However, there is no system in place in B.C. to prove the competency of those potential recruits.

"We are very much hoping to implement a competency assessment program at some point," said Susan Prins, director of communications for the BCCPS. "The difficulty with these kinds of comprehensive workplace assessments is they are very resource-intensive and quite costly to implement.

"With the limited health dollars, the ability to adequately fund these kinds of assessment programs becomes quite significant if you weigh them against other worthwhile initiatives, one of which might be increasing the number of postgraduate residency positions for international medical graduates."

Saskatchewan does provide that assessment service, which keeps South Africa open as a potential source of family physicians. In 2009, Saskatchewan had 1,832 medical doctors, and of that total, 277 family doctors and 96 specialists were South African, the highest per capita concentration of South African physicians of any province in Canada.

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