by Written on behalf of Wise Health Law October 18, 2018 4 min read

Many Canadian students aspire to become medical doctors. However, they face difficult and demanding admission standards to attend a medical school in Canada. The statistics suggest that only twenty-five (25) percent of Canadian applicants are admitted to a medical program in Canada. The unsuccessful seventy-five (75) percent are left to reapply or seek alternative programs. One alternative is a medical education abroad. Recent surveys suggest the number of such Canadian medical students studying abroad is around thirty-six hundred (3,600).

Some Stats on Medical School Abroad

Admissions to American medical schools are slightly higher for applicants at about forty-three (43) percent. Admission percentages to medical schools in Ireland, the Caribbean, and Australia are much higher (but this comes at a cost). In 2011, tuition to medical school in Canada was just over $12,000.00 annually while in the Caribbean it was about $25,000.00, in Australia $42,000.00, and in Ireland $49,800 annually.

Foreign Trained Physicians Returning to Canada

While foreign training is an option for prospective physicians, being admitted and graduating from a foreign medical school is not the end of the journey if you hope to practice in Canada. Foreign graduates must be accepted for a residency position in Canada if they wish to practice here. Competition for these positions is fierce and many Canadian foreign medical graduates end up completing their medical training in the United States or elsewhere.

A Case Study

For one such physician, the return home was anything but easy, as evidenced by a recent decision that made it all the way to the Ontario Court of Appeal.

What Happened?

The physician in question was Canadian born but licensed to practice in the United States. His goal was to specialize in paediatric cardiac anesthesiology. He was successful in obtaining a one year, fixed employment contract, at a Toronto hospital in the Department of Anesthesia and Pain Management. The contract was renewable on the successful completion of certain conditions.

Conditional Contract

The conditional contract was part of the College of Physician and Surgeons (CPSO) Pathway 4 licensing process by which he could qualify to practice in Canada. He was required to comply with, and successfully complete, the Pathways requirements. This was still only a conditional license to practice medicine in Ontario. The physician was also to be supervised for one year by a licensed physician practising in the same hospital. If all went well he would be required to pass a Practice Ready Assessment through the CPSO. In addition, he needed to complete a successful year of practice, comply with the policies and procedures of the CPSO. and enroll in a Masters training program in clinical epidemiology. The CPSO granted him a restricted Certificate of Registration. The restrictions included its automatic revocation on:
  • any concerns being expressed by his supervisor;
  • the supervisor not supplying the required reports to the CPSO (or supplying unsatisfactory reports);
  • the supervisor being unable or unwilling to continue his supervisory role.
Any revocation of the physician's Certificate would also terminate his employment. The physician understood and accepted these obstacles despite the obvious difficulties and risks associated with them. He really had little choice in the matter.

Personality Clashes Among the Team

The physician began work in October. His work involved assignments in all areas of the anesthesia service. Up until the following May, everything went fairly smoothly. His supervisor's reports were positive. He was said to be fitting in nicely and that his clinical performance had been more than adequate. The only negative comment was about his aggressive dealings with members of the team. His behaviour was said to have been more moderate after the issue being discussed. Unfortunately, personality clashes developed especially amongst members of the cardiac team. The doctor was advised to practice in other areas of the service against his wishes. Unbeknownst to him various discussions and informal investigations were undertaken about him. The result was his supervisor refused to continue. His supervisor revised his previously positive report to the CPSO which now spoke of some past medical errors and his poor conduct. The supervisor also advised of his refusal to continue in his role. The result was the automatic revocation of his Certificate and the end of his employment. He was escorted out of the hospital in early June. The doctor offered to return to complete his program to mitigate his damages. The hospital did not respond. The doctor obtained employment in the United States following very positive reference letters from the same doctors that had criticized his performance and orchestrated his dismissal.

Physician Sues for Wrongful Dismissal

The doctor sued for damages for wrongful dismissal, bad faith conduct of his employer given the manner of his dismissal, and defamation. The hospital withdrew its defence of just cause at the beginning of the trial. Despite this, the doctor lost at trial and was ordered to pay costs. He appealed to the Ontario Court of Appeal. The appeal was successful as there had obviously been an admitted wrongful dismissal. As well the court found errors in the treatment of the other causes of action by the trial judge. The matters were ordered to be retried before another judge of the Superior Court. A long and prodigal journey indeed. At Wise Health Law we are respected health law lawyers and litigators. Our firm was founded in 2013 by Valerie Wise and has offices in both Toronto and Oakville, Ontario. We specialize in health and administrative law, and focus on helping health professionals, public hospitals, and national and provincial health professional associations, among others, find solutions to their legal and regulatory problems. Contact us online, or at 416-915-4234for a consultation.

Also in Blog

Health Care Professionals in Ontario Begin the Restart

by Valerie Wise May 28, 2020 3 min read

The Chief Medical Officer of Health for Ontario has issued an updated Directive #2 (dated May 26, 2020) for Regulated Health Professionals in the province. 

Pursuant to the updated Directive #2, all deferred non-essential and elective services by health care providers may be gradually restarted – subject to the rest of the requirements set out in the Directive.

The updated Directive #2 does not provide particularly detailed guidance to health professionals on how to proceed, likely because it applies to such a broad spectrum of health care and health professionals. It does, however, provide some principles to assist health care providers in making decisions as we enter this transitional period.

International Medical Graduates Reinforcing the Healthcare Frontlines

by Mina Karabit May 25, 2020 2 min read

In addition to the mask and hand sanitizer shortages, Ontario’s response to COVID-19 highlights the need for more frontline health care workers. Each regulated health profession’s college responded differently, and we have discussed some of those changes in other posts to keep you apprised.

Today, we focus on the College of Physicians and Surgeons of Ontario (CPSO), who set out to increase the number of available and licenced physicians out on the frontlines through certificates of registration that authorize supervised practice of short duration. The temporary licences authorize practice for 30 days.  

Pharmacists’ Time-Limited Change in Scope of Practice During COVID-19

by Mina Karabit May 05, 2020 4 min read

Undoubtedly, COVID-19 has affected how health professionals practice. Pharmacists across the country are not only experiencing changes in how they practice (for example, accepting emailed prescriptions, where appropriate) but the scope of their practice as well. The latter change is not permanent, although the disruptions in practice may be felt long after the COVID-19 emergency subsides.

On March 19, 2020, Health Canada issued a short-term section 56(1) exemption under the Controlled Drugs and Substances Act (CDSA) that would authorize pharmacists to prescribe, sell, or provide controlled substances in limited circumstances, or transfer prescriptions for controlled substances (the CDSA Exemption).