Fifteen years of medical training and unable to work

Immigrant doctors struggle to meet Canada's licensing requirements.

Mahmoud Alkhatib is already a neurosurgeon but can’t practice in Canada. - SAMSON LEARN
Mahmoud Alkhatib is already a neurosurgeon but can’t practice in Canada.

Mahmoud Alkhatib is washing dishes at home in Clayton Park. A glass breaks and slices open his right hand, blood bursting forth. It’s a long cut, one that can’t be treated with a bandage and rubbing alcohol. He has to go to the hospital.

Arriving at the emergency room, he gets in a line of wounded people. He gives his medical information to the woman at the desk. She tells him to take a seat.

He sits down, holding his hand. Blood is streaming from the cut. It will form a light scar from his thumb to his wrist. Alkhatib knows it needs stitches. He’d do it himself if he had the materials at home.

Two hours later, he’s taken to a small operating room. Eventually a physician stitches up the wound. Alkhatib asks why it took over two hours to be treated. He’s told they’re short on physicians.

Alkhatib is a physician. He studied medicine for over 15 years, but he can’t find work in Canada. He’s a neurosurgeon who can’t get a license in Nova Scotia, and he’s running out of options.

As a kid living in Syria, Alkhatib became fascinated with medicine. He saw how doctors operated on a family member involved in an accident and was intrigued.

“I love medicine,” he says. It’s “what I want to do.”

After studying for six years and working in a residency for another six, Alkhatib decided to specialize in something that fascinated him: the nervous system. He moved to France and studied neurosurgery for another five years. He could have stayed there for work but he chose to move to Canada. His family lives here, he got married here and this country has a clear need for specialized physicians. It seemed like a perfect place to start his medical career, and build a life.

Arriving in 2008, Alkhatib found he couldn’t just leap into his field. It wasn’t as simple as showing the medical boards his degree and receiving a license. It was a long, complicated process, one that required time and money. For the 42-year-old Alkhatib, it was a barrier to his dream.

Earning a medical license in Canada is difficult for anyone, no matter where they’re from. It takes over 10 years of studying at medical schools to earn a degree, but that is no guarantee of a license. For immigrants to Canada, this process is even more difficult. Canada only grants license approval for people who’ve earned a degree from this country, the United States and about 29 other jurisdictions. Degrees from other countries are not automatically approved. International medical graduates have to endure three rigourous examinations.

The Medical Council of Canada arranges an evaluating exam (which tests medical knowledge) and two qualifying exams (which test clinical knowledge).

Each of those cost anywhere from $1,000 to $3,000. The College of Physicians and Surgeons of Nova Scotia used to offer a clinical assessment program for international medical graduates in family medicine, but it was cancelled in May.

After the exams, immigrants don’t receive a license. They apply to medical residencies to become fully licensed. But many struggle to find open residencies, as spots are limited. It’s a difficult and frustrating experience for immigrants who want to practice medicine. It’s doubly upsetting for Alkhatib. He wants to practice in his field, not learn it again.

“There are not many residencies,” says Mohja Alia. She works at the Immigration Services Association of Nova Scotia, managing employment programs and overseeing counselling for landed immigrants. Alia and other ISANS workers help international medical grads figure out the certification process, but many still never get licenses. She says ISANS tries to connect immigrants to work in their field, while also proposing alternative careers to fall back on. It’s a difficult task.

After spending six years in a medical residency, Alkhatib has no desire to return to it. He’s asked to be assessed in neurosurgery but that option is unavailable. He has to go to residency, but he refuses. He won’t take the examinations. Alkhatib wants to leap back into neurosurgery. He’s waited long enough—he’s earned it.

In France, Alkhatib worked obsessively for his degree. He entered the country without knowing how to say “Hi.” He would wake up, study French in the morning, then wander the hospital in the afternoon, absorbing everything he could. It was his life. Alkhatib spent every day at the hospital, from 7am to 7pm, taking every opportunity to learn.

In Canada, he’s back at square one. His education and training are seemingly worthless.

“It’s funny,” he says, laughing bitterly. Being stuck in a treadmill of bureaucracy has hurt his psyche. While pleasant and kind, Alkhatib’s eyes betray his frustration. His voice is weary and worn-out.

The average wait time for neurosurgery in Nova Scotia is almost 100 days. With only a handful of neurosurgeons, the province could use a specialist like Alkhatib. With no options in Nova Scotia, Alkhatib turned to Quebec, which would accredit him much faster than residency. He would work in a hospital and receive a license. He just needed a hospital to sponsor him, but he never found one. Quebec was another dead-end.

Meanwhile, Alkhatib found the only work he could in the medical field: as an assistant. He now works for Leona Burke, who runs an independent blood collection service. Instead of operating on the nervous system, he draws blood and puts it into carefully labelled vials.

Even with his vast training, people don’t think he’s capable of drawing blood. They’ll often ask if he’s done it before, or demand that Burke do it. One woman simply looked at Alkhatib and walked away, leaving before he could speak. Furious, he didn’t chase after her to explain his experience. He has no time for people like that.

Burke appreciates his help, as she’s short on staff, but knows he can do better. “If you were a car mechanic, would you want to work on bicycles?” she says. Now Alkhatib has turned his attention southward, attempting to gain accreditation from the United States. A friend of his was able to complete three fellowships in America, which led to a job at a Quebec hospital and a Canadian medical license. Alkhatib is applying for American neurosurgery fellowships now. It takes several written exams, which are glorified training for him.

The Canadian medical licensing process for immigrants being insurmountable, Alkhatib is adapting his dream and looking elsewhere. Like a third of the male immigrants who come to Canada, he’ll be leaving the country.

It was Alkhatib’s dream to work here, but now he plans on moving elsewhere to find work. Alkhatib chased a dream across the globe—from Syria to France to Canada. But the path to a medical license in Nova Scotia was one journey too far.

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