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.