Two internationally trained physicians put down roots in Nova Scotia: A PRA journey

One has only to read the news to be reminded that Canada is at a critical juncture in health care with the system reaching its limits and a dire need for more health care professionals. The Practice-Ready Assessment (PRA) programs offered in seven provinces are increasingly seen as the most efficient way for physicians who have been in practice abroad to enter the medical system and fill the shortage of doctors in remote and rural areas across the country. In Nova Scotia, many communities benefit from the Nova Scotia Practice-Ready Assessment Program (NSPRAP), as internationally trained family physicians relocate to the province through the program to work in family medicine practices during their 12-week field assessment and their return of service years, eventually obtaining full licensure to practise.

A program geared for success

Dr. Stephanie Omoifo and Dr. Amel Aldrebi were part of one of the six cohorts the NSPRAP graduated since the program was launched in 2019, paving the way to their current careers in the province they now call home. “The NSPRAP provided the platform for a smooth transition into the medical practice here in Canada,” says Dr. Omoifo. For Dr. Aldrebi, who came to Canada for a better future for herself and her family, “The program offered a unique opportunity to practise rural family medicine in beautiful Nova Scotia.”

With a rigorous selection process, the program boasts an 80-90% success rate and has helped improve access to health care across the province over the years. Dr. Fiona Bergin, Clinical Director of the NSPRAP, is proud that the program has played a major role in placing another 23 family physicians into practice in rural areas of the province. While the program’s initial mandate was to assess approximately 10 candidates a year, it went into high gear over a year ago when this number was increased to 20 candidates, helping more physicians to join the Nova Scotia workforce as did Dr. Aldrebi and Dr. Omoifo.

Some hurdles and many fulfillments

While both acknowledge that their transition to a new environment brought its share of challenges, the two physicians are not looking back. Dr. Omoifo graduated from the University of Benin School of Medicine in Nigeria. After practising in Nigeria for about seven years, she and her family moved to Canada and lived in British Columbia and Alberta before relocating to the Maritimes. She enrolled in the NSPRAP in September 2021 after being referred by the College of Physicians and Surgeons of Nova Scotia. Despite some difficulties finding accommodations, Dr. Omoifo has fond memories of the field assessments she did in Middleton, about 150 km outside of Halifax, and New Waterford in picturesque Cape Breton: “Two amazing communities where people make you feel welcomed,” she recalls.

A physician in Libya having practised emergency, internal and family medicine for more than 11 years, Dr. Aldrebi moved to Canada and spent a few years in Ontario before relocating to Nova Scotia in February 2021. Her two assessment placements were also in Middleton and New Waterford, and she experienced some challenges as she started the program during the height of the pandemic with full COVID-19 restrictions in place. As English was her second language, she also faced a personal fear of failing. Yet, her determination and the encouragement from the community kept her moving forward. “Everyone I encountered, whether colleagues or patients, were very welcoming and supportive,” she says, adding that “it was worth the struggle.” As for Dr. Omoifo, she still remembers the day she received the final results of her practice-ready assessment: “We had worked so hard and crossed all the hurdles, I was so elated that I finally got to fulfill my dreams.”

Embracing life in the new community

Starting over in an unfamiliar environment is no small feat, and community connections are crucial in making PRA graduates feel at home and convincing them to stay beyond their return of service years. Dr. Aldrebi says that she and her family are settling very well in New Glasgow, a town situated on Nova Scotia’s north shore where she has been completing her return of service since September 2021. “The people here are very friendly and helpful. The patients also make you feel very appreciated and valued.” Hiking, biking and paddling are some of the activities she enjoys in her leisure time: “I have a good work-life balance,” she notes. On a professional side, she appreciates the different practice opportunities it offers since she works in a collaborative family medicine clinic and as a hospitalist at the Aberdeen Hospital, a regional hospital. She enthuses that she works with “an amazing team” that includes “a nurse practitioner, a diabetes mellitus nurse and a chronic wound care nurse.”

Dr. Omoifo, who started her return of service in March of this year in the same county as Dr. Aldrebi, couldn’t have asked for a better community: “The people, so welcoming and wanting to make you feel at home, made it worthwhile.” Her three teenage children have settled in and are enrolled in the basketball games, school band and choir. For her part, she has started playing pickle ball and is currently learning horse back riding. When asked about what she likes most about her community, she answers without hesitation that it’s the medical team: “I am one of the family physicians in the Pictou West Clinic, which is a collaborative practice. We have nurse practitioners, dieticians, two physicians, a pharmacist, a social worker, diabetic nurses and lab tech as part of our team.”

Successful past candidates become assessors and mentors

Grasping how the Canadian health care system functions and learning about cultural norms in Canada are some of the areas where PRA candidates often need to be guided. Dr. Omoifo and Dr. Aldrebi were able to turn to other physicians who acted as mentors during their assessment, and they recognize that this support was highly valuable. Dr. Omoifo affirms she appreciated receiving guidance from her peers: “The previous PRA candidates walked us through some important things we were expected to adopt and the best way to respond to challenging case reports.” Dr. Aldrebi is also grateful for the support she received during her assessment. “The previous NSPRAP candidate was very helpful, providing guidance about the referral system for specialists and certain treatment programs,” she says, adding that she and several physicians in her community who graduated from the program “have developed strong friendships and continue to support each other as colleagues.” In turn, she’s helping new candidates who are doing their assessment and gives them “reassurance and encouragement”, as she’s “very aware of the struggle that international medical graduates go through to be licensed in Canada.”

Being himself an internationally trained physician, Dr. Emmanuel Ajuwon can relate to the challenges PRA candidates are facing during their assessment and afterwards. Spurred by the many calls for help he received from the program’s graduates “to navigate the complexities of the health care system in Nova Scotia”, he started a mentorship program two years ago. He now holds a monthly webinar where he helps international medical graduates “understand the intricacies of working in Nova Scotia, dealing with different patients and problems, completing insurance forms.” He adds that the webinar is currently in the process of obtaining Continuing Medical Education accreditation from Dalhousie University. In addition to mentoring, Dr. Ajuwon has been an assessor for the NSPRAP since September 2019, supervising PRA candidates in clinical practice settings to determine if they are ready to practise independently. Assessors play a crucial part in the PRA process as they ensure physicians enrolled in the program are qualified to provide the best care for Nova Scotians. Dr. Ajuwon finds this role very gratifying:

“If as an assessor I can help bridge the gap, I have a lot of satisfaction doing so.”

Dr. Omoifo confirms how meaningful it was for her to receive supportive feedback from her assessors when she was completing her assessment. “The most fulfilling aspect was reading through their comments”, she explains. “It gave me assurance that I was doing the right thing.” Although recruiting enough assessors to keep up with the number of PRA candidates has been a challenge, Dr. Bergin, the Clinical Director of the program, believes it will improve in the foreseeable future once the NSPRAP graduates are in practice long enough to become assessors. This is exemplified by Dr. Aldrebi’s desire to become an assessor in the next few years and to be part of the solution, because she wants to “give back to Nova Scotia.”

Now thriving in their new community and their medical practices, Dr. Omoifo and Dr. Aldrebi have seen their work and dedication come to fruition, and they hope the journey of future PRA candidates will be as successful and positive.