This is the winning blogpost from the 2022 Student Writing Competition. We would like to thank everyone who participated in the writing competition, attended the writing workshops, and helped organize the competition. Finally, we would like to give a special thank you to Dr. Rebecca Babcock and Janice MacDonald Eddington, the judges for this year’s competition.

Global Health in Healthcare Providers: The Doctors Without License

By: Angela Tsai, Dalhousie Medicine, Class of 2023

Two days into my cardiology rotation, I was devastated to learn that there would be no residents for the remainder of the week. As a medical student who was not adept in reading an ECG, how could I look after an entire unit of heart attack patients? That was when I was greeted by my saviors – the clinical associates.

On their badge, I was surprised to find the title of “Dr.”, because the only attending physician was in the cath lab trying to unblock a patient’s coronary vessels.

They were confident and independent with their clinical decisions. They signed orders and interpreted lab results like it was their second nature. They called the nurses by their nicknames and knew where to find the hidden charts. I was very intrigued on how much more I could learn from them.

I was quite surprised when the older gentleman told me that this would be his 19th year on the unit. He watched as the staff cardiologist matured from a junior resident to a fully-fledged physician, while he was confined to the role of a “clinical associate” indefinitely, with no chance of promotion. Even more disturbingly, they were only paid ~25% of a staff physician’s salary. They were thrown around to cover multiple units during shortages, and they were always scheduled the undesirable night shifts. In comparison, they were poorly respected by other healthcare professionals.

And what was this marvellous physician’s background? He was a renowned anesthesiologist from a war-torn country. He escaped concentration camps and was thankful to have the opportunity to start a new life. Another clinical associate disclosed to me that he was the department head of Emergency Medicine in a Middle Eastern tertiary care hospital. He had tried to obtain necessary certifications to practice in Canada, but physician colleges were not standardized with their licensing criteria across provinces, and hospitals were not consistent in granting practice privileges to international medical graduates.

To me, global health is about equality. We often emphasize fairness for patient care, but it is time that we strive for justice among our healthcare providers. How could we take pride in our system when we do not respect or appropriately compensate the clinicians who pour in their blood and sweat? How could we expect optimal patient care if we do not give our physicians the proper recognition they deserve?

Regardless of their background, no matter how great or humble, we should not discriminate them based on nationality, ethnicity, or upbringing. If our healthcare system is truly concerned about their competency, they would not be allowed in the clinical setting in the first place. Even if there are knowledge gaps, we could provide additional training for them to overcome cultural and language barriers, but we are in no position to exploit their expertise and labour only because they were not trained locally. Global health is inclusion and justice in healthcare, not only for the patients, but also for the providers who carry the weight on their shoulders.