PRA programs: Top of mind and an attractive option for internationally trained physicians

More than one in five adults in Canada do not have access to a primary care provider¹; as a result, medical experts and authorities continue to bring forward short and long-term solutions to address the pressing needs in health care. One proposed solution is to integrate more international medical graduates (IMGs) into the Canadian workforce, particularly through the Practice-Ready Assessment (PRA) pathway that fast-tracks the route leading to a licence for physicians who have completed their medical training and residency abroad. Regarded as a safe and efficient way to bring qualified doctors into practice faster and alleviate the strain on a depleted health care system, PRA programs are being brought into the spotlight at a time when they are rapidly expanding.

Numbers on the rise across the board

In British Columbia and Saskatchewan, where the PRA route has been established for many years, increased funding from provincial governments is helping programs to scale up and bring more doctors into communities where they are greatly needed. In 2022, the Saskatchewan International Physician Practice Assessment (SIPPA) program increased its capacity, which resulted in 45 family physicians completing the assessment during that year, compared to 36 in previous years.

Assessments also increased at a rapid pace for Practice Readiness Assessment (PRA-AB) in Alberta, which assesses both family physicians and specialists. In 2022, the program enrolled a total of 92 IMGs in its preliminary clinical assessment, which represents a 35% increase from 2021. Out of those 92 candidates, 67 participants were assessed under the family medicine stream.

Further west, Practice Ready Assessment – British Columbia (PRA-BC) will have the largest increase next year as its capacity will be almost tripling, going from 41 family medicine seats in 2023 to 96 in 2024. Dr. Ryan McCallum, clinical director of the program, explains that the team is currently focusing on planning for the operational changes that may be required to accommodate such a rapid growth. Ms. Mary Chinni, the program’s manager, adds that they are working towards a completely different program model with three intakes a year, from the two currently offered. Another aspect to consider, she notes, is the capacity to host more clinical field assessments and whether there are enough sites to support that influx of candidates so quickly.

Increased funding from provincial governments is helping programs to scale up and bring more doctors into communities where they are greatly needed

Safe and high quality care at the core

Alberta is one of the few jurisdictions where all of the Registration assessments live with the provincial medical regulator, the College of Physicians and Surgeons (CPSA). For Ms. Jill Hastings, the program’s manager, this particularity is one of the big strengths of PRA-AB, since the team benefits from the knowledge and expertise of all CPSA departments. In January 2023, PRA-AB launched a pilot project to condense the assessment process for IMGs with training comparable to that of Canadian universities, waiving the first step of the process (called the preliminary clinical assessment) and facilitating their accelerated entry into the workforce as they complete a supervised practice assessment while working in their practice location. Eligible candidates are still required to do a competency assessment to ensure they provide safe and high-quality patient care. Currently, 86 IMGs are eligible to come through this new accelerated route.

While the assessment has been condensed, Dr. Doreen Oneschuk, a medical advisor for the program, emphasizes that “we are not changing the assessment process itself or reducing standards”. Dr. Samuel Lou, another medical advisor, adds that safeguards are in place during the process: “If any gaps are identified, physicians would be engaged in further educational support through the CSPA’s Continuing Competence Program, such as additional assessments, courses and/or coaching, to make sure they meet acceptable standards.”

Similarly for PRA-BC, Dr. McCallum stresses that even with substantial changes ahead, the program “will not be compromising on the quality in terms of application criteria”. What is clear from consultations, he explains, is that growth must not come at the expense of applicants’ clinical skills. Rather, other areas such as post-program community support and customer service can be refined to make PRA-BC more attractive to skilled applicants.

It is also worth noting that, while the assessment process may differ from one province to another, all PRA programs maintain common standards and share similar eligibility requirements, such as passing the Therapeutics Decision-Making (TDM) Examination. Those standards, developed through the National Assessment Collaboration (NAC) PRA framework, support programs in their admission and assessment decisions.

Expanding beyond rural areas

While the current focus of the PRA is on meeting the needs of rural and remote communities, the scope has been slowly shifting to accommodate more areas experiencing physician shortages. Dr. McCallum explains that PRA-BC, which started integrating urban communities a few years ago, will continue to serve areas where the needs are the greatest, whether they are rural or urban communities.

Alberta has taken a similar approach in serving areas experiencing the greatest needs, and changes are also on the horizon with the PRA-AB sponsorship process. Ms. Hastings points out that currently, IMGs coming for an assessment with PRA-AB are sponsored by Alberta Health Services (AHS), the regional health authority that manages physician resource planning. She explains that in the near future, sponsorship will be broadened to organizations outside of AHS, resulting in more opportunities for applicants to be assessed and to meet the needs of communities across the province.

A collective effort

According to feedback from participants across all PRA programs who completed an assessment in 2022, overall, participants felt supported throughout the program and were satisfied with the different aspects of the process. For programs’ directors and managers, this level of success is to be credited to the tremendous work and dedication of the respective teams who are readily moving those assessments forward and adjusting to a shifting health care landscape. The collaborative aspect and the work across partnering organizations to support the programs are also greatly valued: “We work with the College, the health authorities, the Ministry, and it helps us tie into all aspects of the province, which is helpful”, notes Dr. McCallum. Recognizing that there are still opportunities for improvement, PRA programs continue to heed the feedback they receive to identify and address the challenges and make the process better for assessors and participants.

Overall, participants felt supported throughout the program and were satisfied with the different aspects of the process

The success of the PRA route as a path to facilitate the entry of more internationally trained physicians into the medical profession has spurred other provinces to follow suit, with Ontario set to launch an assessment program this year*. Increasingly valued and expanding across the country, PRA programs are becoming recognized as a source of physicians along with Canadian medical schools. While not a panacea to the shortage of physicians in Canada, they continue to evolve and have positive impacts for IMGs and the communities they eventually serve.

 _____________

¹More than 6.5 million adults in Canada lack access to primary care. (2023, March 14). Healthy Debate.
*Ontario (June 2023) and New Brunswick (October 2023) now offer Practice-Ready Assessment (PRA) programs.