An anesthesiologist from Argentina could already be working in Quebec, but no one is hiring her despite numerous vacancies in her specialty. Daniela Maria Pujol has nevertheless gone through all the steps to practice, and she has a hard time explaining why her application was not selected.
According to the responsible authorities, the College of Physicians and the Ministry of Health and Social Services (MSSS), she should have started her procedures from Argentina rather than once she arrived in the country. The paths leading to work here do not present “any guarantee” that the foreign graduate will be hired, the MSSS also wrote to Duty.
In desperation, and to avoid losing her license to practice, she recently joined Doctors Without Borders missions abroad. The plan now: change provinces.
“It’s inefficiency for me. No one communicates, they don’t put in place concrete measures to make it work,” the doctor denounces. “It’s wasteful,” her partner, Pierre-Yves Léger, says bluntly.
Later, during our interview entirely in French, she will say that she has the impression that each organization “passes the buck, without worrying about the result being there”: “It’s ‘figure it out’! If you find a place, congratulations, if not, too bad! While there is clearly a need [d’anesthésiologistes] “, she summarizes. At least forty positions in this specialty are in fact vacant in Quebec.
This observation is not made in bad faith, nor with a good heart, nor on the corner of a table. The DD Pujol struggled to get to the point where her file “would be placed on hold,” she reports, without receiving any response in a timely manner.
When she arrives in Quebec in 2022, Mme Pujol has a 24-year career behind the lab coat, including 7 in residency, which notably helped her obtain her specialty in anesthesiology. There was no question of her going back to school or doing another residency: “Those were the limits I set for myself,” she says, now 47 years old.
That’s not a problem, she believes. Among the few options for foreign-trained doctors, there is a “restrictive permit” that allows them to practice. “That’s the path we chose,” she says, dubbed “the fast track” by the College of Physicians on its website.
After demonstrating that her training, including postdoctoral training, was equivalent to that required in Quebec, she passed the Medical Council of Canada evaluation exam in April 2023.
This test made him revise all of his medicine, including the general knowledge aspects that had not been part of his daily life for years.
“I studied for six months for this exam and it lasts seven hours,” she says, illustrating its difficulty and the seriousness she put into the process.
No “match”
It took two whole months before she got her result.
In principle, it is Recrutement Santé Québec (RSQ) that must then take care of “promoting” a candidate to health establishments so that the candidate obtains a sponsorship, according to its official website. This sponsorship is then used to request the restrictive permit from the Collège des médecins.
However, two more months pass without Mme Pujol has no sign of life from RSQ. In October 2023, she receives an impersonal email from the service stating that “no establishment has expressed interest in your application to date.”
So it’s really at the stage of matchas she calls it, either twinning with a hospital or another establishment, that her application remains a dead letter. She contacts a few hospitals on her side, without success.
Stay in your country
The problem with all this waiting is that obtaining the restrictive practice permit is a race against time: the aspiring holder must have practiced his or her specialty for 12 months during the three years preceding his or her application.
It is now clearly stated online that RSQ and the Collège des médecins recommend that candidates, due to the length of the process, “maintain their practice in their country of origin if possible while carrying out their process of obtaining a restrictive permit at the same time.”
But for Mme Pujol and Mr. Léger’s priority was to live together in Montreal after their love defied the pandemic. Separated for months because of travel restrictions, and seeing their wedding delayed, they had decided to prioritize the couple as soon as possible.
In anesthesia, we are very sensitive to waiting lists and we want to work to reduce them. Foreigners are part of the solution, we have no choice but to recruit abroad.
Daniela Maria Pujol therefore arrived here in September 2022 with permanent residency, which, in the eyes of the duo, must have been an advantage.
On the contrary, having started her journey once in Quebec, she has now “spent” more than a year without practicing medicine. “I am stuck by the situation.” In order to no longer “lose [son] time”, she has just returned from a mission to Haiti carried out on behalf of Doctors Without Borders.
Quebecers first…
She didn’t feel like anyone could answer her questions clearly or get her application to the right place. “After arriving, it was ‘get organized,'” she complains.
With her partner, she met with the College of Physicians twice. “The second time, we were sent an email with generic links that we had already found a long time ago,” laments Pierre-Yves Léger.
In his opinion, his partner’s failure is partly due to “protectionism,” since the positions posted can be “voluntarily reserved for doctors trained in Quebec,” as is written word for word in an email from RSQ. She prefers to politely talk about “overly bureaucratic processes that help no one.”
Questioned on this aspect, the MSSS — which manages RSQ — says it rejects the word “reserved”: “It is inaccurate to say that the vacant positions at the PEM [plans d’effectifs médicaux] in specialty are reserved for doctors trained in Quebec.
However, this is the term used by an RSQ employee in an email dated 2023 to Mr.me Pujol that The Duty was able to consult.
In his email to Dutythe MSSS says it prefers to talk about “prioritization” of doctors trained in Quebec.
The mechanism actually provides for consultation with the Federation of Medical Specialists (FMSQ) and the Federation of Resident Physicians, in the event that a physician in training would like to take the position targeted by the sponsorship request. “It is very, very rare that we oppose the recruitment of foreign candidates,” says Dr.r Nikola Joly, president of the Association of Anesthesiologists of Quebec (AAQ), which is part of the FMSQ.
…but not at the meeting
Priority is therefore given to Quebec doctors, who are not showing up in sufficient numbers.
There are currently 41 vacancies in anesthesiology, making it the fourth speciality with the most vacancies, after internal medicine, radiology and hematology-oncology. The shortage of 100 professionals in the network, put forward by the AAQ in 2021, would be “still entirely realistic,” according to Mr. Joly.
In total, less than thirty anesthesiologists are trained each year in Quebec, he estimates, and the needs are growing.
“In anesthesia, we are very sensitive to waiting lists and we want to work to reduce them. Foreigners are part of the solution, we have no choice but to recruit abroad,” the doctor summarizes. The shortage of anesthesiologists is also “global,” he specifies.
Given all these pitfalls, Daniela Maria Pujol’s desire to work in Quebec is diminishing. She now hopes to land a fellowshipa scholarship, to pursue another specialized training in Ottawa, another avenue impossible in Quebec without external funding.
“And me, during this time, I just want to work, I just want to do what I know how to do,” she sighs.