(WPO7b) Cultural Sensitivity and Equity in Healthcare Delivery II

This session focuses on cultural sensitivity and equity of care within healthcare services. It offers insights of foreign doctors and other professionals from globally diverse medical systems. Presentations range from advocating for integration of oral hygiene care as the missing gap in comprehensive healthcare; advocating for policy changes to ensure healthcare equity in rural and indigenous communities; and rethinking the contributions foreign medical doctors, including women doctors, in supporting culturally sensitive care to the 6.5 million people in multicultural Canada who are at risk of worsening health from lack of access to a family doctor and timely access of care. Tags: Health and Care, Migration and Immigration, Work And Professions

Organizer: Cindy Sinclair, University of Toronto; Chair: Cindy Sinclair, University of Toronto

Presentations

Cindy Sinclair, University of Toronto; Shefali Chaturvedi, Rajasthan Dental College and Hospital; Samiksha Krishna Puppalwar, Fanshawe College

Bridging the Gaps- Systemic Oral Healthcare Discrepancies in Canada

Canada, a welcoming country for many be it engineers, artists, accountant or healthcare professionals. The mass immigration witnessed in the last few years is unlike anything that has been recorded in the history of this alluringly scenic country. As an immigrant the picture painted is vaguely different to what it really is. Friendly people, diverse culture, beautiful summers and catastrophic winter storms, all surpassed the expectations, but one thing that is a bit dispiriting, is the limited opportunities for foreign trained healthcare professionals. Currently, Canada welcomes around 500,000 new immigrants, one of the highest rates per population of any country in the world. Apart from employment and housing, healthcare is a significant challenge faced by most immigrants. As a key component of overall health and quality of life, oral health is recognized globally as a basic human right. However, it is observed in numerous studies that oral health needs of immigrants have been largely unmet. The misuse of the Healthcare system is another reason impacting Healthcare equity. One of the most significant reasons for this is the surge in mental health disorders and homelessness. The crosslink between the two is also a major concern and a projection towards change in dynamics of handling the system overall. Lack of jobs and inflated living expenses has led to the rise of unsheltered population in the country, hence leading to more neglected individuals devoid of necessary care. Access to care is a multidimensional concept that has often been defined as the ability to obtain needed health care. Cost barriers, lack of dental insurance, language, and cultural barriers might be predictors of limited access to dental care among immigrants. However, a publicly funded healthcare system which excludes Dental care where in 90% cost of oral health care is privately funded while only 10% is publicly funded is the largest contributing factor. Investments by the Federal government into Dental services for high-risk groups have failed to resolve pervasive oral health disparities among Canadians. Furthermore, based on current enrolment levels, with less than 500 Dentist graduating annually Canadian Dental schools may not be graduating enough Dentists to meet future needs. Immigration Canada invites internationally trained dentists as permanent residents to fill in this gap, however, the path laid down to become a licensed Dentist is financially burdensome, extremely rigorous, mentally and emotionally taxing and an embarrassment for the candidates. With passing rate as low as of 22-24%, it defeats the very purpose of inviting Foreign Trained Dentists to the country. The pandemic made us reflect on the current Healthcare system, where the ratio of Healthcare professional to patient was significantly low. Evidently, the Dental Healthcare System might not be well equipped to handle the massive influx of new Canadians that would be in-dire need of care. Through this presentation, we outline how addressing disparities in Canadian Dental care will require the engagement of Dentist on multiple levels of care, negotiation with both Dentists and Policymakers, along with sustained oral health data collection to develop provincial and national decision-making strategies. Only then equity-focused climate of Oral Healthcare in Canada can be achieved.

Amir Salamat, University of Toronto, Temerty Faculty of Medicine; Cindy Sinclair, University of Toronto

Looking Forward: Integrating Immigrant Medical Doctors to Support Equitable Healthcare.

Year after year, “immigrant” medical doctors submit applications to the Canadian Resident Matching Services (CaRMS) for a family medicine residency training to continue their medical career as family doctors. Very few are selected due to lack of retraining spots while millions of patients suffer from lack of access to a regular family doctor or timely and critical services. As per the Government of Canada’s website, 6.5 million people do not have a family physician or nurse practitioner they see regularly. That is a dramatic increase from the 4.5 million in 2019 (Duong, D, and Vogel, L.). In the Province of Ontario, one of Canada’s most highly multicultural and diverse provinces, almost three million people do not have access to a family doctor as determined by the College of Family Physician of Ontario. This doctor-shortage escalation leads to longer wait time for primary care services, reduced access to preventative care that eventually will cause lead to increasing rate of mortality and morbidity from chronic illnesses such as diabetes and high blood pressure, as well as delay in diagnosis critical illnesses such as cancer in the early stages of disease, and finally an increased burden on health care system, specially emergency services and diagnostic facilities such as medical imaging as eluded in the literature. There are many factors that contribute to this shortage, including but not limited to the aging physician population, generational retirement, (in general older generation of doctors work longer hours compare to new regeneration), heavy physician workload that leads to burnout and even early retirement or reduced working hours. Physician financial problems and other geographic /provincial disparities also cause dissatisfaction among practicing physicians while many communities and rural areas in the country face immense challenges as they try to absorb and retain health care professionals in their communities. For decades medical schools and governments have been developing programs to entice new physician graduates to work and practice medicine in areas of country where the needs are high but the doctor shortage gap keeps widening. With Canada’s commitment to accepting nearly 1.5 million new immigrants by 2026, the crisis will become greater, not only in rural and underserviced communities but also in urban cities. More patients will suffer, and the injustices to humanity will become more acute. Argument: Patients and families are suffering from shortage of physicians while It is extremely difficult for immigrant doctors to be recognized as a physician and enter into health care system in Canada. Looking forward, we believe a plan as highlighted below would be a feasible way to integrate more immigrant doctors to help provide the serious humanitarian health care needs of patients. Plan: Based on the above, there are benefits of facilitating integration of immigrant doctors into the Canadian health care system. It could be done by 1) Facilitating of evaluation and recognition of international medical credentials; 2) Designing and implementing transitional programs, that train and help immigrant doctors fill the knowledge and other gaps and get culturally ready, which are required and essential to meet the Canadian standards of medical practice. This can be done by mentorship and academic training and continuous evaluation programs. Similar programs in other provinces such as Nova Scotia, Alberta, Manitoba, and Saskatchewan are already in place to handle doctor-shortage problem in these provinces. It could be worthy to think and consider a federal and universal approach to train and absorb newcomer immigrant doctors in Canada. We are exploring the possible ways to use and adapt other provinces experiences and approaches in the Ontario setting; 3) Alternative career in medical fields. Immigrant doctors can be trained to work in other healthcare fields based on their experiences, such as training and working as physician assistant, registered nurse, operating room assistant, respirologist technician, psychologist, lab technician, etc. Moreover, it is expected their training will be shorter compared to new students. Therefore, they can start providing services to the healthcare system faster. Raise awareness of the range of medical and healthcare skills immigrant doctors bring to Canada. Explore licensure and other professional pathways to effectively utilize immigrant doctors’ skills as a method to address the doctor-shortage crisis while ensuring equitable healthcare access for all.

Natasha Shokri, University of Toronto

From Residency to Resilience: A Narrative of Happiness Among Immigrant Women Doctors in Canada

Recent studies affirm a significant link between the happiness medical staff, including doctors, and the quality of healthcare services rendered which directly influence the patient-doctor relationship. This dynamic, in turn, affects patient satisfaction and outcomes, serving as an indicator of hospital and physician success. Furthermore, it has been evidenced that the occupational well-being of physicians positively correlates with the quality of patient care delivered, underscoring the notion that happier doctors are pivotal in providing superior overall care. The dynamics of the doctor-patient relationship also emerge as a pivotal determinant in the mutual happiness and satisfaction of both parties, where positive interactions and trust are foundational. Studies have illuminated the intertwined nature of doctors perceived work conditions and their psychological well-being, underscoring a complex interplay with the caliber of care delivered. Programs aimed at increasing patient happiness, such as Dr. Happy, have demonstrated beneficial effects on hospital stays. While the investment in physician well-being offers both personal and fiscal advantages for healthcare institutions through the heightened efficiencies of happier physicians, this benefit stands in stark contrast to the realities exposed by The Happy Docs Study within the Canadian healthcare system. This study reveals the considerable stress and potential emotional and mental health adversities that resident physicians face during their training period.Top of Form The Canadian healthcare system is substantially bolstered by its immigrant workforce, with the 2016 Census data revealing that immigrants constitute approximately 20% of the physician population, accounting for around 28,000 individuals. Post-census, the influx of immigrant physicians has continued, with an additional 3,500 joining the Canadian healthcare sector. A similar trend is observed across other healthcare professions, where immigrants represent about 24% of the workforce, translating to nearly 300,000 healthcare professionals. These statistics underscore the critical role of the immigrant workforce in sustaining Canadas healthcare services. In this vein, the well-being of immigrant doctors in Canada, particularly women, becomes paramount. Research indicates that immigrants in affluent countries like Canada often grapple with subjective well-being assimilation challenges, with their happiness and life satisfaction indices trailing behind those of their native counterparts. This has profound implications for the health and well-being of immigrant doctor populations within the Canadian health system. A nuanced understanding and advocacy for the happiness of doctors is vital for the enhancement of their overall well-being and the consequent quality of care provision. Eventhough the impact of migration on the happiness have been subject of extensive research, non of these studies focused on the women immigrant doctors. Given the significant role that a doctors happiness plays in the quality of their service, which in turn impacts patient satisfaction and the happiness of medical outcomes, and considering the pivotal role played by immigrant women doctors in Canadian healthcare, their level of happiness and well-being is markedly underexplored. This paper seeks to address this gap through a phenomenological study rooted in conversations between a social justice educator and a medical doctor both of whom are immigrant woman. This dialogue-centered approach aims to distill the lived experiences of immigrant women medical doctors regarding their happiness, articulated through a narrative framework. The authors lived experiences will serve as a foundational case study to catalyze further research in this field.

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Non-presenting author: Kawalpreet Kaur, Maharaja Agrasen Medical College