CRARR CALLS FOR INQUIRY INTO FOREIGN-TRAINED MDs' DISCRIMINATION AT WORK AND EXPULSION FROM MEDICAL SCHOOLS

Montreal, March 30, 2011 --- The Quebec Human Rights and Youth Rights Commission should initiate another inquiry into the issue of foreign-trained doctors who experience discrimination in their residency which in turn leads to arbitrary evaluation, failure, and consequently, expulsion from their postdoctoral studies program.

Last November, the Commission concluded after a two and half year investigation which began in 2007 in response to CRARR’s request, that foreign-trained MDs have been victims of systemic discrimination at the selection stage of the medical residency process. Since December 2010, CRARR has begun to document six cases of MDs who were admitted in residency programs, but after several months of working in hospitals, the MDs experienced situations which terminated their careers as doctors in Quebec.

When looking at these different cases as a whole, a pattern emerges of troubling personal actions and institutional practices in hospitals and medical schools in which these residents were enrolled:

In hospital employment:

❏ Physical and verbal conduct that is openly vexatious and disrespectful on the part of some supervising doctors and other hospital staff, often in front of other professionals and patients, creating a toxic work environment for female foreign-trained doctors in particular (in one case, an Arab female doctor became depressed and anorexic due to constant put-downs at work);

❏ Arbitrary and at times factually incorrect comments in evaluation forms that were made without providing to foreign-trained MDs the opportunity to rebut or provide their version of what occurred;

❏ Abusive evaluation practices that disregard the principles of natural justice;

❏ Absence of workplace integration measures, despite the Law on Equal Access to Employment in Public Organizations (Law 143), which requires hospitals and universities, among others, to implement employment equity measures such as cross-cultural training for managers, means to prevent discrimination and harassment, review of job related criteria and procedures, etc.;

In medical schools’ evaluation:

❏ Explicit deviation from the principles of natural justice and standards of fairness and objectivity in administrative evaluation structures (such the Program Evaluation Committee, which has the power to recommend an intern’s exclusion, and the Review Committee, which reviews the Program Director’s decision to expel an intern from the program);

❏ Refusal to take into account major procedural flaws in evaluations, obvious contradictions in different supervisors’ comments and administrative anomalies job-related evaluations, and blatant discriminatory statements by supervisors that are based on the intern’s ethnic or national origin;

❏ Application of a “zero tolerance” approach to principal determinative criteria of “professionalism”, that are vague and undefined, and that open the door to biased and arbitrary interpretations, such as the criteria of “Communication abilities : patients, families, health professionals”; the “ability to self-criticize”; etc.). In one case, one “inadequate” mark for professionalism is deemed to be totally unacceptable and leads to internship failure, even if the person marking the intern is involved in a personality conflict.

Expulsion from the residency program or medical school leads the Order of Physicians to revoke the residency permit and the practical unlikelihood to apply for future residency in Quebec or even in the rest of Canada.

For Algerian-born Zaara Bouchouareb, who completed her first year of residency without problem but who now faces expulsion from the intensive care and general medicine programs at the Université de Montréal, “the population of Quebec desperately needs doctors but the institutions of Quebec make this place into a graveyard for foreign-trained doctors.”

Dr. Bouchouareb has filed a complaint and a grievance of harassment against her supervisor last Fall. The investigations have begun in both cases, but the Program Evaluation Committee dismissed this fact and this past Monday, proceeded to recommend her expulsion subsequent to two negative evaluations.

As for Dr. Omar Addou, a Moroccan doctor who was expelled from the orthopedic surgery program at the Université de Montréal last week despite evidence of biased, incorrect and partial evaluations in his file, “The biases and gaps in the administrative structures of the program are so obvious that one would say that the institutions thoroughly dismissed the human rights commission’s recommendations which were made last Fall concerning our professional integration”, he said.

According to CRARR, this new development requires that the human rights commission launch a second systemic investigation, this time focusing on the obstacles of intentional and systemic discrimination in the residency and medical schools’ postdoctoral studies programs, with the view to audit the compliance of these institutions with equality and employment equity standards.