June 20, 2023

Helping patients by tapping into their knowledge of medicine is a doctor’s obligation across countries and continents. But is practicing as a physician the same throughout the world? Definitely not.

Critical practice details vary from Melbourne to Mumbai, Atlanta to Athens. “Prescribing medications and therapies, for example, names of pharmaceuticals and billing practices, can be completely different,” explains Dr. Alan Ruddiman, an internationally trained rural generalist physician for more than 33 years. He lives and works in Oliver, BC, on the traditional lands and territories of the Syilx Okanagan First Nations.

Dr. Ruddiman is the outgoing co-chair for the Joint Standing Committee on Rural Issues (JSC), one of the four Joint Collaborative Committees (JCCs). Alongside Dr. Steven Yau, Medical Director for International Medical Graduates (IMG) programs at UBC Continuing Professional Development, he is the co-chair of the BC Physician Integration Program (BC-PIP). 

The BC-PIP offers mentorship to doctors who have trained outside the country in acclimatizing to Canadian culture and adjusting to our medical systems. This British Columbian-born program supports the successful transition of IMGs: from provisional registration at the College of Physicians and Surgeons of BC to being fully licensed to practice medicine in the province.

“More than 25 percent of physicians working in Canada were trained outside the country,” says Dr. Yau. “And in recent years, that group included many Canadians who studied abroad. In rural communities, that professional contribution can jump to as high as 75 percent.”

“Like any one of us starting a new job, even if you’re not moving to new country, there’s always an adjustment process integrating into the new workplace,” adds Dr. Yau. “We know international doctors might get tripped up on things they don’t know about. There are cultural differences and nuances in how we communicate with patients, even if they had been trained and worked in countries similar to Canada. It’s been recognized that there’s a need for these topics to be brought to their attention.”

In Canada's rural communities, some 75 percent of doctors received their training outside the country (photo: shapecharge/iStock)

Such a program is exactly what Dr. Ruddiman needed more than three decades ago when he first landed on Canadian soil. As a young physician, he found it challenging to find his way and negotiate the many social and professional hazards, and to build a new professional network in a new country.

“We think we all speak English and it will be the same, but the way Canadian medicine works is often very different than in other countries,” says Dr. Ruddiman. “There’s massive upfront overload in the acclimatization to new country: banking, social norms, how the medical system is organized. It’s quite overwhelming. I don’t think we should ever take an international physician’s resiliency for granted. They need help.”

After moving to BC in 1996, a physician colleague and mentor encouraged Dr. Ruddiman to join the UBC Faculty of Medicine in 1997, and through this, he began to connect with colleagues, fostering life-changing relationships. In 2007, he joined the provincial Joint Standing Committee on Rural Issues and in 2015, he served as President of Doctors of BC.

During this time, Dr. Ruddiman began supporting recruitment and retention of doctors in rural communities, and found that most doctors serving those areas were IMGs. Those first rocky experiences, combined with a lifelong commitment to learning, propelled Dr. Ruddiman to help create the apolitical BC-PIP in 2008. Dr. Yau became involved in 2014.

The JSC, through JCCs—a partnership between Doctors of BC and the BC government—provides the funding and guidance for the program. Together with UBC Faculty of Medicine’s Continuing Professional Development academic unit, doctors can participate in professional educational and mentorship opportunities, such as BC-PIP.

Collaboration and partnership are key in such a program. The BC-PIP Advisory Committee formed in 2017 and now continues to work closely with health authorities, the Ministry of Health and the Rural Coordination Centre of BC (RCCbc), as well as other stakeholders, to support the learning and professional needs of IMGs, and how to best instill clinical courage and confidence in doctors new to the province.

Participants must be registered in the provisional class with the College of Physicians and Surgeons of BC to be eligible to enroll. Once finished, they submit a Proof of Completion of the BC-PIP to the College of Physicians and Surgeons of British Columbia.

The BC-PIP requires physician participants to attend the IMG one-day orientation conference, and to complete six online modules, which include an introduction to the BC and Canadian medical systems, BC medical billing, safer opioid prescribing, understanding WorkSafeBC and ICBC, continuous learning and professional practice management. As well, participants have can choose from several optional learning activities: Personal Learning Plan (PLP)—a free and personalized concierge service that supports IMG physicians to identify and achieve their practice goals—and the IMG Peer Support Network,  a coaching and mentoring program. They have eight months to complete the hybrid formatted course.

The hybrid BC-Physician Integration Program includes six online modules that doctors can complete on their own time when it's most convenient for them (photo: SDI Productions/Getty Images Signature via Canva.com)

“This way, doctors start to build very meaningful relationships right out of the gate,” says Dr. Ruddiman. “They learn early on about health care in the province, and a lot about what the population mix and unique population needs looks like. And, why it’s really important that we consider and address the healthcare needs of vulnerable populations, including Indigenous, First Nations, Metis and other groups in BC.”

More than 1,400 physicians have participated in the BC-PIP since 2008. The BC government aims to triple the Practice Ready Assessment (PRA-BC) intake by March 2024: from 32 candidates a year to 96, making the program even more integral in aiding IMGs.

Reflecting on his own journey, Dr. Ruddiman is proud of how BC-PIP has matured. With a deep sense of gratitude, he looks forward to the program evolving under the new co-chair, Dr. Ian Schokking.

For the future, Dr. Yau believes BC-PIP can be expanded to benefit other new-to-BC physicians, including those who graduated from Canadian medical schools, moved from other provinces or territories, had scope of practice changed, and those returning to practice after absences or other life changes.

“The career of a doctor should not be limited to clinical practice: we need educators and leaders, too,” he says.

By providing a support program like BC-PIP, he hopes new physicians’ transition into practice will be much smoother, allowing them to thrive in the healthcare system beyond their roles as medical experts—ultimately benefiting all British Columbians.

Find out more about the BC-PIP.

Read more about the UBC International Medical Graduates program.