Thursday, May 10, 2012

I've been everywhere, man (Musings on fast-tracking those with foreign credentials)

This blog is a revised version of a recent personal blog, 'Want to work in Canada as a medical technologist? Forget it!'
Last updated: 16 May 2012 (see Addendum below)
 As a promoter of international job mobility, it has long saddened me that foreign-trained medical laboratory technologists from English-speaking nations such as Australia, NZ, and the UK face so many obstacles when seeking work in Canada. 
Do physicians and nurses face similar obstacles? Perhaps not, because everywhere in Canada, I hear physicians with British, New Zealand, South Africa, and Aussie accents. And since 'Down Under' countries are always holding job fairs in Canada for nurses, I suspect that mobility may be reciprocated, i.e., Aussi and Kiwi RNs can work in Canada without too much difficulty. But for medical technologists, it's a different story. Working in Canada is onerous, indeed.
If you are a physician or nurse, I encourage you to read (even skim) the technologist-related details below to assess how job mobility for your profession compares.
This blog derives from a Dark Daily report: "Medical laboratory technologists with foreign credentials to get fast-track acceptance in Canada."

Its title derives from an old Hank Snow ditty, I've been everywhere, man.

I love Dark Daily, but its headline and article are misleading. If I were asked about foreign-trained medical laboratory technologists from AU, NZ, UK, and USA, where English as a second language is a non-issue, and where education and training are world class, my response would be:
  • All the fast-tracking in the world won't help.
As background, Canadian employers (mainly government-funded health regions) are always moaning and groaning about the shortage (soon to become worse with impending retirement of baby boomers) of nurses and physicians, as well as other health professionals such as medical laboratory technologists and diagnostic imaging technologists. In response, governments have created various fast-track schemes that supposedly will allow faster immigration and employment of qualified needed health professionals. 

First, USA grads do not qualify because their general certification does not include histotechnology. In Canada, besides clinical chemistry, hematology, clinical microbiology, and transfusion science, general certification requires education and a clinical rotation in histotechnology.

Second, obtaining subject certification for USA grads in the other 4 main disciplines is out because Canada offers subject certification only in clinical genetics and diagnostic cytology.

Reasons that CSMLS does not offer subject certification in other disciplines include
  • Cost (subject exams are costly to maintain) 
  • Employer preference for flexible grads who can work in all disciplines
  • Fear that employers may use those with subject certification to work in lab sections for which they are untrained
Accordingly, the path to employment in a clinical laboratory for a USA-educated and trained medical technologist / clinical laboratory scientist is a torturous path:
  • Step 1: Attend an educational institution (Canada or US) and take a course equivalent to an histotechnology course taught at Canadian institutions. For example, see MLS 250 at the University of Alberta.
  • Step 2: Convince a potential employer to provide a clinical rotation in histotechnology. In Canada this is ~4 weeks. And it's next to impossible because employers can barely offer clinical rotations to Canadian-trained students.
  • Step 3: Apply to CSMLS for a 'Prior Learning Assessment'.
  • Step 4: If eligible, arrange to write the CSMLS general certification exam (based on a competency profile) covering the five disciplines specified on the CSMLS website.

In my experience, education and training 'Down Under' and in the UK are excellent and in some ways exceed that of the typical Canadian graduate, since Canada rejected the BSc as entry-level several years ago.
This decision created barriers for Canadian medical laboratory technologists to work outside Canada. 
People who did not support the BSc were employers and bureaucrats in provincial government departments of health. Reasons for rejecting the BSc varied but included:
  • They perceived the BSc as entry level for nurses  as credential inflation leading to increased salaries without sufficient return on investment and they were determined to stop this happening for medical laboratory technologists.
  • Employers wanted the cheapest possible medical laboratory technologists, those who could be 'turned out' as quickly as possible and paid as little as possible. 
  • In their short-sighted view, with the move to increased laboratory automation and centralized testing, who needed a technologist whose education and training took 4 years?
Canada has two programs that provide both a BSc and professional certification by CSMLS:
All other programs are 2- or 3-yr diploma programs at technical institutes or community colleges (equivalent of USA 'associate degrees').
For interest, UA MLS grads enjoy international job mobility. They are eligible to write the American MT(ASCP)* exams and many have. (*To change once the ASCP's Board of Registry and NCA merge to form a single USA certification agency.)
This allows UA MLS grads to work in the USA and many did during the mid-90s when laboratory jobs greatly decreased in Canada and many educational programs closed.
As well MLS is the only Canadian program whose grads are eligible to work in NZ without writing certification exams. 
What about job mobility for technologists trained in other English speaking countries besides the USA? Can university educated and trained UK, Oz, and NZ grads easily work in Canada as med lab techs?;

Unfortunately, no. The main reason is that programs in these countries, while providing education in the 5 basic disciplines, do not require clinical rotations in all 5 disciplines.

For example, NZ graduates of university programs  are ineligible to work in Canada because they may do a year's rotation in only 2 disciplines, e.g., 6 mth clinical rotations in their 4th year in each of 2 disciplines (e.g., hematology and transfusion science or clinical chemistry and hematology, etc.), as in the Massey University program.

In contrast, a typical Canadian grad may spend 3 mths in a hematology lab and one month in a transfusion service lab, only one-third of the total time spent by NZ grads in these labs, and in the case of transfusion science, one-sixth as much. But NZ MLS grads are not eligible to write the CSMLS general certification exam without obtaining equivalent clinical rotations in all 5 disciplines.

Is this not nuts, given that NZ MLS grads clearly have more basic education than most Canadian grads, as well as more practical experience in at least 2 clinical laboratories?

OZ and UK grads are similarly stymied if they want to work in Canada because graduates of Australia and UK's university programs can specialize. Examples:
Why do these medical laboratory technologists face significant barriers to working in Canada? Is it all about protecting public safety by ensuring medical laboratory professionals meet Canadian standards of education and training? Or is it about protecting Canadian jobs for Canadians?

And why do graduates of Oz, NZ, UK, and US programs who are certified by their county's professional body and have worked for years in one or more areas of a clinical laboratory, need to write the CSMLS general certification examination covering all 5 disciplines to work in Canada? Beats me.

If the educational programs of foreign-trained technologists are deemed equivalent to Canadian programs (or better), foreign-trained candidates must still write the CSMLS general certification exam to work in almost all Canadian medical laboratories.
Most Canadian provinces have regulatory bodies that de facto require that medical laboratory technologists be certified by the CSMLS as a condition of employment in a clinical lab that performs diagnostic tests on patients.
For lab professionals with experience (e.g., those who trained 10-15 yrs ago), and who have likely worked in one discipline (perhaps two) for years, writing an exam covering knowledge and competencies in 5 disciplines is not easy. And getting clinical rotations in Canadian labs is pretty much impossible.
I personally know NZ-, UK-, and USA-trained lab professionals who are better educated and trained than many Canadian grads, have ample current experience, and would make valuable contributions to Canadian labs and be exemplary employees. But they cannot work here, despite the fast-track 'BS' of our governments.

True fast-tracking would allow
  • Different routes that don't require candidates to re-learn  specific disciplines (e.g., histotechnology), which they will never work in;
  • Restricted licenses to practice and work only in the area or areas for which they are well qualified.
The situation is different for those for whom English is a second language:
Besides becoming fluent in English, these technologists often need to upgrade their education and training to Canadian equivalency. As but one example, in transfusion science, the association of the Rh blood group system with severe hemolytic disease of the fetus and newborn would not have been taught in Asian countries where almost everyone is Rh positive.
Upgrading programs are rare but exist. If candidates pass English language competency tests, successfully complete whatever minimal upgrading is deemed necessary, write and pass the CSMLS general certification exam, they still may not be hired if their English remains weak. That's the reality of today's clinical laboratories where staff are stressed to the max, mainly due to under-staffing.  
If asked, I often advise foreign-trained grads to enroll in a Canadian medical laboratory technology program. It's a tough sell because they have to support themselves and their families. But in the end, this route can prevent much grief and frustration.

Not a pretty picture....

Talk of fast-tracking foreign-trained medical laboratory technologists / medical lab scientists / biomedical scientists is largely smoke and mirrors.

Your thoughts and experiences are valued. Please offer feedback anonymously (or provide your name in the body of your response) by commenting below.

 Whether medical technologist, nurse, or physician:
  • Is there an impending shortage in your country that would benefit from greater international job mobility?
  • Does international job mobility of needed health professionals work well in your country? 
  • Do foreign-trained workers face significant barriers? 
  • Is fast-tracking a reality? 
Similarly, have you tried to work in another country and what obstacles, if any, did you face?

For fun
'Golden oldies' by Canada's inimitable Hank Snow
And just because I love it:
 As always, the views are mine alone.

ADDENDUM (16 May 2012)

Thanks to 'Anonymous,' who left a comment but perhaps withdrew it:
Well, it seems that both nurses and doctors have to sit exams in Canada in order to work here.... I wonder if it is possible to flood the ears of those desperately in need of lab staff with credentials of American or Australian or New Zealand educated professionals, so that the potential employer is motivated to seek change in the requirements.
The comment motivated me to suss out the following info on foreign-trained physicians and nurses wanting to work in Canada.

Source: Global Medics
The basic core requirements for medical registration in Canada: 
A medical degree from any country that is listed in the International Medical Education Directory (IMED)
GP or specialty training that has been completed in Australia, Canada, Ireland, New Zealand, UK or USA
Authentication of medical certification by the Physicians Credentials Registry of Canada (PCRC). 
Some provinces require full verification before they will issue your license. Others will allow you to complete PCRC verification after starting work in Canada. Most provinces also require completion of the Medical Council of Canada Evaluating Exam (MCCEE).
Before taking the MCCEE, internationally-trained physicians must apply to the Physician Credentials Registry of Canada (PCRC) and send a certified copy of your final medical diploma. The MCCEE is a computer-based examination available at 500 test centers in 72 countries. 
Also see Info for foreign-trained medical doctors


See Info for foreign-trained nurses

Process is similar to that for medical technologists (assessment, national exam). Exam info:
Canadian Registered Nurse Examination