It was around 5 p.m. I was sitting in the chief medical resident’s office on the 14th floor at the Toronto General Hospital, beginning to wrap things up for the day.
Wayne Gold, the Deputy Physician-in-Chief of Education, stepped into my office and said, as he often does, “Walk with me,” before turning around and heading for the elevator bays. He told me we were going to see how the Saudi trainees were doing.
Recently this had become a routine for Wayne. Earlier this month, we were abruptly notified via email that in the wake of diplomatic tensions between Saudi Arabia and Canada, the Kingdom had decided to withdraw all Saudi trainee physicians from medical programs across Canada. The arrangement between Saudi Arabia and Canadian universities has worked like this: Saudi trainees (who have already graduated from medical school and are either residents or fellows) receive high-quality, specialized medical education in Canada and then return home to offer the citizens of Saudi Arabia the benefits of this training. Canadian universities receive funding from the Kingdom, along with some of the best and brightest trainee physicians from Saudi Arabia, who enhance their own training programs and provide quality medical care to Canadian citizens at no cost to Canadian taxpayers.
The announcement that the Saudi trainees had to go came as a sudden shock. The 216 trainees at the University of Toronto log 70–80-plus-hour work weeks, including 26-hour shifts up to three times per week. That is 17,280 hours of work per week, which will evaporate once the trainees leave.
Mine and Wayne’s first destination was the emergency department, to see a Saudi trainee who has been at the University of Toronto for the past three years. He had been coming in to complete additional work shifts despite Saudi trainees having been relieved of their clinical duties. (This was done so they could focus on making the necessary arrangements to move forward with their careers and their lives.) Despite everything that had been going on up to that point, he received us with a smile on his face. It was clear that he appreciated our visit, and we made it clear that we appreciated him. His positive attitude and demeanour have made difficult days easier. His hard work and dedication have made patient care more manageable and enhanced the quality of care overall. We told him that we were going to miss him and that we would love to have him back if this situation is resolved. We tried our best to remain optimistic.
Then we went up to see another trainee who was just finishing up his shift in the coronary intensive care unit. We sat down together at a large conference room table and talked for a while about nothing in particular. Both Wayne and Pete Wu, the site director at the Toronto General Hospital, had been spending time with him on a frequent basis since the Saudi announcement, discussing more serious issues. This time, we mainly just enjoyed each other’s company before having to say goodbye. I left with a heavy heart.
Imagine that after a couple of years in a new country—where you have developed close relationships with fellow trainees and staff physicians, where your family has settled into the community, and where you have just started a prestigious training program after working hard for years in order to secure the position—you are suddenly told that you must leave almost immediately. How does this affect your eligibility to write the board certification exams that are required in order to practise medicine independently? What program and what country will you need to organize a move to next? And what about your friendships, and the friendships your spouse and children have developed?
Just writing out those questions makes me feel anxious, sad, and frustrated.
Despite the incredible stress, anxiety, and sadness that the Saudi residents must be feeling, many have continued to work 26-hour overnight shifts across the teaching hospitals in Toronto. They have continued attending their scheduled clinical duties during the day, even though they know that this work may not help them get their degree. They do this to help ease the transition for their non-Saudi colleagues, who would be forced into working even longer hours with very little notice. This selflessness is characteristic of what we have come to expect from our Saudi colleagues. Their resilience under these trying circumstances make their abrupt departure from our program and our lives easier and at the same time more challenging for us to deal with.
The Saudi trainees have enriched our clinical environment with their extensive knowledge base and expertise, and their diverse backgrounds have broadened our perspectives on patient care and education. I still hold out hope that there will be some resolution which will allow them to stay. I am troubled by the uncertainty that their futures hold, but I am also confident they will become excellent practising physicians whether they train here or elsewhere. For the sake of our institution and our patients, I hope it is the former.
On August 27, the Saudi trainees were advised by the Saudi Ministry of Education that they may remain in their positions in Canada until they have arranged for alternative assignments.
The comments section is closed.
Yes these are difficult personal circumstances for the individuals caught in the middle of a sudden diplomatic spat. But you could also easily tell a story about meeting Canadian doctors (trained in and outside Canada) who have been unable to match to a residency due to a lack of residency positions driven by a lack of supervision resources and funding. You would meet great Canadians who have worked just as hard as these Saudi doctors and are vying to return to Canada and their families and friends and relationships. They would also be amazing colleagues – if our system would give them a chance. We need to revisit our reliance on foreign cash and free labour going forward and instead focus our resources, supervisors and empathy on Canadian doctors waiting for a residency position.
Wayne Gold has always been amazing teacher and one of a kind human being. TGH and UofT is lucky to have him. I am proud to be a team 5 member (3 times)!
Glad that my Saudi colleagues’ situation got sorted out!
why does the Cdn Government not train doctors to go back to countries which have dire needs? The Saudi Govt pays Canada to train doctors here , so it is “free labour” for the Canadian Medical system. Graduates who are Canadians or PRs who have trained overseas by going there or immigrating from other countries are blocked from accessing residency positions. By not training Canadians or PRs who can stay we have a shortage locally. This change by Saudi now exposes the status of using Saudi money for medical labour and neglecting access to immigrants and those who are Canadian and trained overseas or opening spots to other countries where we could be humanitarian and provide increasing care worldwide. The Canadian system is self serving and needs change, which will cost!, thanks to alienating a country and displacing hard working Saudi residents. We have created this problem and humanitarian wise we are not really doing that much for the wellbeing of the health needs of First Nations or worldwide developing countries- are we able to criticize Saudis of human rights issues when we are not reaching achievable goals ourselves. Hopefully this change will open up the debate locally and expose our own deficiencies. We are wasteful of the talent pool we have in Cdn and leave them to flounder by never getting access to post graduate training. That is as much an injustice as what we may allude other nations may do to their citizens for seeking freedoms. We have denied immigrants and returning citizens their rights to provide a medical career and needed care to the population- primarily to protect the existing medical professionals monopoly and keep remuneration to a smaller pool. The value of services provided for money spent is sub-optimal, which is another issue.
It’s all about funding , Canadian residents cost over 60k a year each, Saudis cost nothing so if you want to replace Saudi residents by Canadians IMGs then you need to find a source to fund that which is not available at the moment,
Many Canadians who had to train offshore would pay the 60K or 100K themselves for the opportunity of a spot. My neighbour is a physician, her daughter had to go to the Caribbean for medical school. I’m sure she would pay the same as the Saudi rate to get a residency space in Canada. Instead she goes to the USA.
The Canadian medical system would have much more room to train more doctors (from within or abroad) and provide access to doctors if they only had the funding to pay more doctors. Are we as citizens willing to pay more taxes? Or should we be grateful for the opportunity to train Saudi doctors while their government is paying us and providing their services. Hummmm
Thanks for your supportive opinion and I really appreciate that. Your words reached my heart. As a Saudi doctor who had the honour training in Canada I must Say: Thanks Dr. Chris Kawala for the Golden words. I Hope you the best and all the success.