Why are so many rural doctors in Alberta from South Africa?

dr  Cornelius Nortje is one of five doctors at Lac La Biche, all of whom were trained in South Africa.  As the local recruiting doctor, he says he's never received an application from a Canadian-trained doctor.  (Trevor Wilson/CBC - photo credit)

dr Cornelius Nortje is one of five doctors at Lac La Biche, all of whom were trained in South Africa. As the local recruiting doctor, he says he’s never received an application from a Canadian-trained doctor. (Trevor Wilson/CBC – photo credit)

In January 2014, Dr. Cornelius Nortje at Edmonton International Airport ready to start his new life in Alberta.

Nortje was met at the airport by the chief of staff at Lac La Biche Hospital. The chief of staff had two large down jackets, one for Nortje and one for his wife.

Nortje had never been to Canada before. On the day he and his wife landed, the chief of staff drove them 150 miles northeast to their new hometown.

“We were probably just looking for a little adventure,” said Nortje, who now serves as chief of staff at the William J. Cadzow-Lac La Biche Healthcare Centre.

“Most South African doctors know someone who has either been to Canada or was on their way to Canada and the feedback we’ve always had from them whenever they’ve been here is that it’s absolutely fantastic,” he said.

As the local doctor in charge of recruitment, Nortje says he’s never received an application from a Canadian-trained doctor.

Lac La Biche, a hamlet of around 2,300 people, currently has five doctors, all from South Africa.

According to the College of Physicians and Surgeons of Alberta, 6.5 percent of all practicing physicians in Alberta have completed medical school in South Africa.

Outside of Edmonton and Calgary, 13 percent of Alberta’s doctors were trained in South Africa, according to the CPSA. In the North Zone of Alberta Health Services, South African-trained doctors account for one-third of all rural doctors.

Across the province, the CPSA website lists more doctors speaking Afrikaans, South Africa’s colonial Dutch language, than those speaking Mandarin, Cantonese, Tagalog, Punjabi, Hindi or Ukrainian.

With the ongoing shortage of doctors, the provincial government announced last month that it will allocate some funds to train more rural doctors.

The CPSA has also responded to the pressure. It launched a pilot project to remove some barriers for international doctors from licensed jurisdictions to practice in the province.

Since the 1970s, South African physicians have been one of the largest demographics following the call in rural communities in western Canada.

Community service for the health of the community

The home experience of South African doctors prepares them for rural medicine in Canada, Nortje said.

The country’s medical education requires internship in public hospitals, which are underfunded compared to the separate private system. In addition, medical graduates complete a year of community service traveling to townships and other needy communities before registering as physicians.

“We are thrown in at the deep end,” said Nortje.

“Any doctor who is finished [medical school] must have done 10 c-sections…so everyone has a bit of experience with procedural skills and maybe works a bit more with fewer resources available.

Nortje said hospital rooms designed for two patients would be overcrowded with 10, with some patients on the floor and in the hallways. As a medical intern, he would have to monitor intensive care patients and deliver babies alone without an attending doctor, he said.

That experience translates well to fitting in a small community hospital, he said.

When Nortje started, Lac La Biche had nine doctors, but that number has shrunk. And of the five doctors in the hamlet, only four still work in the hospital.

“We fit in well because you have to be able to do a little bit of everything,” Nortje said of working at Lac La Biche Hospital.

“After 11pm, me and a nurse are in the ER. Anyone can go through that door and you have to be able to handle that.”

Barriers for international medical graduates

Some Canadian medical colleges give doctors with South African training preferential status over their colleagues with other international medical qualifications.

Since 1974, South Africa has been on a short list of countries that the CPSA recognizes as Authorized Jurisdictions.

Physicians trained there may skip some assessment and training requirements that other international physicians need to work in Canada.

The majority of foreign-trained physicians are required to complete medical training in Canada unless they have been recruited to work in their specialty in Canada.

Physicians from Australia, Ireland, Great Britain and the United States can directly transfer skills in all specialties.

Physicians from South Africa – and more recently Singapore, Hong Kong and Switzerland – can transfer to some specialties in Canada.

Each province creates its list of permitted jurisdictions based on the guidelines of the College of Physicians and Surgeons of Canada.

“It makes it easier for South African doctors to come here and come to Alberta if the training is recognized as similar to Canadian residency,” said Dr. Michael Caffaro, Assistant Registrar at Alberta’s College.

While South African doctors have a more direct route to practicing in Canada than most other international medical school graduates, some requirements for doctors from South Africa have become more restrictive over the years.

Physicians must pass competency tests followed by a three-month assessment period at the hospital before being registered as physicians here.

dr Peter Bouch, who practices at Red Deer, emigrated from South Africa in 1993 after a patient told him about an open position in Canada.

He wanted to travel and Canada was a country that made it easier to transfer his credentials. He said 30 years ago he faced far fewer barriers to entry than doctors do today.

“In the good old days of faxes, I sent a fax and they said sure,” he said.

Without an interview, a local health board invited him to be the new doctor in Whitemouth, Man. He was able to take his competency exams in Canada after beginning his practice.

I sent off a fax and they said sure. – dr Peter Bouch

Caffaro said he doesn’t know if there are fewer South African doctors practicing in Alberta than before, but the trend over the years has been that more internationally trained doctors from other countries are practicing in the province.

In January, the CPSA announced a pilot that would waive certain requirements such as clinical review exams and the first three-month assessment for international medical graduates. The program is designed to encourage more physicians from eligible jurisdictions to apply for a position in Canada.

Caffaro said the pilot could also be a step toward adding more countries to the list of eligible jurisdictions in the future.

“There are no other jurisdictions yet,” he said. However, together with the postgraduate education experts, it would be expected that there would be an interest in actually looking at how we can expand the list.”

Medicine Exodus

For years, the South African government has expressed concern about the steady brain drain to other countries, particularly in the Commonwealth.

Many doctors who came to Canada from South Africa cited the safety of their families as part of the impetus to move.

According to a United Nations report, South Africa has one of the highest homicide rates in the world. Initially, the post-apartheid homicide rate steadily declined, but statistics suggest it has risen since 2011.

“Safety is definitely, I think one of the biggest things for me,” said Nortje. “They have alarm systems and response units that people hire privately to monitor their homes.”

Nortje was working in a Cape Town hospital one night when a doctor from Nigeria went to a gas station to get some food. But his colleague never returned. Nortje said he found out the man was killed two days later.

dr Tracy Lee Lindenberg, another doctor at Lac La Biche who was trained in South Africa, said she was held up in her car with a knife point when she was stopped at a stop sign in the middle of the day.

She recalled seeing hundreds of people and a police officer across the street. For years afterwards, even in Canada, she said she would get palpitations if she stopped at a stoplight when it appeared someone was approaching.

“It just made the decision to move so much easier,” she said.

Five years ago, Lindenberg moved to Canada with her husband and six-month-old daughter.

She said many of the medical challenges are similar to her experiences in South Africa and her family has embraced their new lifestyle of Lac La Biche, ice fishing and snowmobiling.

“I really fell in love with the rural aspect,” she said. “People here were just so welcoming and I felt so much at home.”

doctors wanted

On Jan. 26, the province announced it would provide $1 million to fund four Alberta post-secondary institutions that are exploring ways to train physicians in Grande Prairie and Lethbridge. It is part of an effort to train more Albertan doctors who wish to practice rural medicine.

Resident Physician Topher Mostert, who currently works at Lac La Biche, is part of a Red Deer University of Alberta apprenticeship program that includes a rural rotation.

Trevor Wilson/CBC

Trevor Wilson/CBC

Mostert, who grew up in Fort Nelson, BC, wants to pursue a career in rural medicine and said the residency validated his decision.

“I can tell you that I will not go back to a city. I prefer small-town medicine,” he said.

“Every day is different. And it’s nice to see the same patients and have that continuity of care.”

Nortje hopes Mostert could join the team at Lac La Biche.

Meanwhile, Lac La Biche medical clinic is trying to fill its current doctor shortage as one of its five doctors is due to retire this spring.

The community has hired two internationally trained doctors who are already based in Alberta. One studied in South Africa and the other trained in India.

Both are waiting to complete their investigations before joining the team at Lac La Biche.


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