One American physician's long journey to becoming a family doctor in Canada

An American family doctor is frustrated with what she says has been a challenging two-year-and-counting bureaucratic journey to be accepted into Canada.

That's where she has a job waiting for her, tending to some 1,500 patients who don't have a physician.

"We assumed (the process) would be something around six months or so. But clearly, we were wrong...it's been two years," Dr. Ashleigh Duncan said with a laugh.

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But it's no laughing matter for a country with 6.5 million Canadians without a family doctor, and where there are urgent recruitment programs to bring qualified physicians in to practice medicine.

Duncan graduated from Wayne State University School of Medicine in 2009. She's been a family physician at a clinic near Denver, Colo., where she lives with her husband, Matt, and their two children. She began looking for a job in Canada in 2022 to move closer to her parents in Michigan, and away from the gun violence that she says worries her as a young mother. 

"We started doing some research about Canada, and my husband was looking at safety statistics and school safety, (and it) seemed much better in Canada versus the U.S.," said Duncan.

She quickly spotted an opening for a general physician in Morriston, Ont. It was posted by physicians Manu and Pooja Kaushik, a husband-and-wife team who runs the clinic in the small town south of Guelph.

"We're inundated with patient requests, meaning hundreds of patients asking, 'Can we have a family doctor?'” said Dr. Manu Kaushik. "I try my best to accept what I can, but we need help."  

Duncan was one of just three doctors who applied for the position. One Canadian doctor, said Kaushik, turned it down. After meeting Duncan on Zoom and in person, the Kaushiks formally offered her the job in November of 2022.

With the severe shortage of doctors in their region, they expected it would be a quick process to get her certified and in place.

"Maximum, six, seven months," said Kaushik. "I was thinking Summer 2023 she should be here. And we're still waiting."

He showed CTV News a hefty pile of applications from residents waiting for a general practitioner, many of whom will become Duncan's patients. Some 1,500 come from another area GP who recently retired.

Two offices are ready for Duncan, and are sitting dark.

"Everything is done for her to start seeing patients," said Dr. Manu Kaushik. 

"It's hard to imagine when someone who is fully qualified, ready to practice is not able to," said Dr. Pooja Kaushik.

"Despite what we hear, that they're trying to fast track people to come into Canada, (the Kaushiks) cannot get this person to come in. It's mind-boggling,” said Gerald Tot, a patient at the clinic.

His wife, Daphne, said she worries the drawn-out process will put more stress on the clinic's other physicians, who are parents to young children and caregivers to an ailing mother.
"We do not want to lose (the Kaushiks)" she said.

The Kaushiks admit they think about leaving family medicine "on a nightly basis" but say they are committed to their patients.

With too many Canadians without a family doctor, the situation is critical, said Dr. Nancy Fowler, executive director of academic family medicine at the  College of Family Physicians of Canada.

While not commenting directly on Duncan's case, Fowler says it points to fixes needed in the pathway to physician approval, which involves several agencies, like medical governing boards and immigration.

“There's room for a lot of improvement and…breaking down some of the barriers to how we work together will be really critical," she said.

Long road to Canada

Duncan says she has spent nearly US$15,000 so far on her two-year journey through the bureaucratic maze. It has included criminal checks, financial reports, educational certification and two trips to Ontario.

There was a nine-month wait to be licensed by the Medical Council of Canada, the first step in applying to become a physician in Canada.

In contrast, her husband, who is a civil engineer, quickly received professional clearance to work in Canada.

"It was, within 24 to 48 hours that I got approved," said Matt Duncan.

Duncan received good news in July 2023 when she was registered to practice family medicine by the College of Physicians and Surgeons of Ontario.

Things slowed down again, she says, in the immigration system, says Duncan. She applied under the Express Entry profile with Immigration, Refugees and Citizenship Canada where she discovered a "points system" that would affect her application.  

Candidates are given a “comprehensive ranking system" score and if it is above the CRS score required for the next draw of candidates, then they are "invited" to apply for permanent residence. 

Duncan says that despite her 12 years as a physician and her other skills, she discovered her total score under the program was too low.

"We didn't work in Canada, so we lost points for that. We aren't currently living in Canada. We don't have first-degree relatives in Canada, so we lost points for that," she said.

Only when the Kaushiks asked for help from their local MP, Michael Chong, did a new option open. They applied for a note of "interest" from Ontario. That increased her score on the IRCC application and Duncan was eventually invited to apply for permanent residency.

Another delay she says came with the submission of a Labour Market Impact Assessment (LMIA) required by the IRCC under the Temporary Foreign Worker program in May of 2023.

It required the Kaushiks to show there was no Canadian worker or permanent resident available to do the job. They had received three applications to their job ad – only one of which was from a Canadian physician, who then declined to come to the clinic.

The initial LMIA submitted by the clinic's lawyer was rejected because the package needed a letter signed by whoever would be paying Duncan for her medical services. The application, says Duncan, assumed the clinic itself would be compensating her for her work, when doctors in Ontario are paid by Ontario Health Insurance Plan billings.

"We were told that, because the clinic is not paying me, they wouldn't approve the LMIA, because I'm going to be paid by the government, which just does not make any sense,” said Duncan.

Eventually, her application was accepted, but remains "in progress," according to her file. 

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"I've no idea what's going on behind the scenes it would be nice if there was a tracker. We're 70 per cent here, you know? Just so we would know," said her husband, Matt.

Asked why she continues on this complex path to Canada, Dr. Duncan said, "We've definitely thought about pulling out our application and just staying here. But ultimately, it comes back to why we started this process in the first place, and nothing has changed."

CTV News asked the IRCC about whether physicians in demand are given expedited approval. An IRCC spokesperson responded with a statement, saying, "The IRCC continues to prioritize work permit applications from workers in 24 essential occupations in health care, where additional labour is needed to protect and promote the health of Canadians."

Meanwhile, Duncan's name is already on the College of Physicians and Surgeons of Ontario as a practising doctor and is on the call list to provide after-hours and weekend medical services for the local Guelph Health Team, where she is registered to work. But with her still located in the U.S., other physicians in the region including Manu and Pooja Kaushik have to cover her shifts atop their other work.

"If we don't get help, how long can we sustain this?" said Manu. "This is not sustainable," added Pooja.