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I read with interest in the December 5 issue that the APA Assembly is calling for an end to state medical board discrimination against non-U.S. and non-Canadian medical graduates. I also read with interest on page two about the excitement surrounding the Canadian venue for this year’s APA annual meeting. I’d like to share my experience with Canadian medicine to draw attention to its discriminatory practices in licensing U.S. citizens.
I moved to Victoria, British Columbia, almost three years ago because of family obligations. My wife, who is from Vancouver, became ill, and one of her children (all of whom live on or near Vancouver island) was having serious school problems. Before moving, I was a tenured member of a major U.S. medical school, had received substantial funding from the National Institutes of Health for clinical research, treated acutely and chronically mentally ill patients in a variety of settings, and had trained dozens of psychiatry residents and medical students. I trained at accredited U.S. universities and medical schools, and am board certified.
Since I am U.S. trained, I was told by the British Columbia medical board that I needed to take the equivalent of the U.S. National Boards of Medical Examiners (Parts I, II, and III), known as the LMCC, to be eligible for licensure in British Columbia. This is in direct conflict with the policy of most, if not all, state licensing boards, where the LMCC is accepted as a an "equivalent" to the NBME. In addition, I was told I needed to be specialty certified by the Royal College of Physicians and Surgeons before getting a license. This is also in direct conflict with state medical board policies, none of which require board certification as a requirement for state licensing. Eighteen months and nearly $1,000 later, the Royal College, after having assessed my credentials, stated that I needed to take an additional year of residency in psychiatry before I was even eligible for certification. In the meantime, to support my family, I began commuting to Washington state, where I have worked at two community mental health centers.
I have found a local psychiatrist to sponsor my application for a "temporary license" in Victoria, to help him in his practice, as there is a nine- to 12-month waiting list for nonemergency psychiatric services here. In fact, most psychiatrists have closed practices, and some are beginning to reduce their hours because of cuts in their reimbursements. However, the British Columbia board has refused to meet with me or answer my calls regarding the status of that application.
While APA is to be lauded for its efforts to aid international medical graduates in their pursuit of their chosen career in the United States, it might be of interest to focus on the plight of U.S. citizens wishing to practice medicine north of the border. If changing the licensing procedure in Canada is not practical, states may want to reconsider the ease with which Canadian medical graduates are allowed to practice in the U.S.
Rick J. Strassman, M.D.
Victoria, British Columbia