Why some N.S.-born doctors who didn't go to Dal medical school aren't coming home

Some Nova Scotia-born physicians say they may never come back to work at home in part because they weren't accepted at Dalhousie University.

"I think a lot of people get frustrated, saying, 'Why aren't there more doctors?'" said Dr. Nicky Eustace, a family physician from the Annapolis Valley who is now working in Morrison, Ill.

"I want people to know that we're just not training them. Supply and demand: you need to make more doctors in order to have them to stay."

The province funds 63 seats to reserve them for Nova Scotia students at Dalhousie's medical school each year, while recruiters at the Nova Scotia Health Authority have set a target of hiring 110 physicians — including family doctors and specialists — each year to tackle the doctor shortage.

After graduating from Queen's University, Eustace started the process to apply to Dal, but pulled out of the costly process when she learned her grades were "just a few points away from the cut-off."

She passionately wanted to be a doctor. Eustace was working for two physicians in Nova Scotia and had a job in admissions at a hospital. 

But her only option to get into a Canadian medical school was to do a second degree. That, plus medical school, would have led to an astronomical debt load.

"That would have been really difficult and probably not feasible for my family," she said.

Looked down on for being 'foreign graduate'

Instead, Eustace applied to the Medical University of the Americas in Saint Kitts and Nevis.

When she finished, she was again faced with challenges to get a residency spot in Canada.

"You were looked down on, being a foreign graduate. Yes, a Canadian, but a foreign graduate," she said.

Eustace ended up in Morrison, a small town where she is one of two practising family physicians.

"They needed me here," she said. "I'm practising here as a proud Canadian every day."

Eustace's frustrations are not isolated.

Dr. Nicole Graves shared a similar experience that led her to study at the University of Queensland in Brisbane, Australia.

Graves is from Windsor, N.S., and earned an undergraduate degree at Dalhousie in microbiology and biochemistry. She applied to medical school in 2009, but was not accepted.

"I had decent grades from my undergrad and had done a considerable amount of extracurricular work for points towards my admission — including volunteering at the hospital, volunteering with a literacy organization, working two part-time jobs and doing honours research," she wrote in an email.

"I was quite disappointed at the time when I did not get in, but it was a common theme among others in my cohort."

Trying to make it work at home

Graves then stayed at Dalhousie to complete a master of science degree when a friend recommended she try the University of Queensland.

She was accepted immediately and made the move, always thinking she would come home.

"I attempted a few times to do electives back in Canada during my time in med school with varied success. I managed to get an elective observership during my holidays in second year with a family doctor in my hometown, which was great, but I attempted twice to do clinical rotations through Dalhousie with no success."

After graduating, she faced more hurdles, including "exorbitant exam fees" and the cost of flights home for interviews.

"I had a few friends in med school who went through the process and it just added a huge burden on their already large debt," she said.

Dr. Andrea Rideout, the assistant dean for admission at the faculty of medicine, said the school is doing what it can to balance marks with extracurricular work, but the reality is that it's up to the province to decide how many seats will be allocated to Nova Scotians.

"Dalhousie is the medical school for all the Maritime provinces, so to have our entire class of Nova Scotians wouldn't be fair to New Brunswick and P.E.I.," she said.

The class of 108 students includes the 63 from Nova Scotia, guarantees 30 spots for New Brunswick and six for P.E.I. students. The remaining nine spots are for students outside the Maritimes, which are also funded by the Nova Scotia government.

There are an additional 10 possible spots funded through a partnership with the government of Saudi Arabia, but those are assessed and paid for separately, and do not affect the number of Nova Scotians admitted. Last year's class had no participants from that program. 

Each year, Dalhousie receives about 1,000 applications for the 108 seats. Rideout said about 40 per cent of those applicants are from the Maritimes.

"The fact of the matter is that consistently the number of qualified applicants to come into medical school exceeds the number of seats that we have," she said.

"We often get calls from people on the wait-list feeling like they've been rejected. They haven't been rejected. The fact that you're on the wait-list means that you're qualified and you're capable of studying medicine. Our limitation is the number of seats that we have available."

Admission process constantly reviewed

Rideout said the admissions process is constantly reviewed, making sure they have the appropriate balance of "smarts and hearts."

The Health Department said this year, the province did increase funding to medical schools, but instead of adding seats, the money created 10 family residency spaces.

"We know the location of residency training [versus medical school] is known to be the strong predictor of where physicians choose to work," the department said in a statement.

The department said the number of seats was increased by eight in 2003, and then by 10 in 2008. Those filling the additional seats started finishing their training in 2014 if they opted for a family medicine route.

Not coming home any time soon

But for Graves and Eustace, the lack of space means they will not be coming home any time soon.

Eustace spent a year and a half earning her Canadian credentials, leaving the door open to move back to Nova Scotia and be close to family. She said she feels guilty every time she hears of the doctor shortage, but doesn't feel welcome to come back.

She has also never been approached by recruiters.

"I just think I had this sour taste in my mouth. You didn't train me. Why would I want to come home?"

Meanwhile Graves is now finishing her third year of post-grad training. Her goal is to work in a rural community in Australia when she's finished.

"I think I would ultimately like to move back to Nova Scotia at some point, but the current climate is definitely a turnoff. I work more manageable hours here and earn more for my time than I would in Nova Scotia — which is necessary when you have over $200,000 in debt."

Graves said it's sad she wasn't able to stay in Canada to pursue her dream of being a doctor.

"I have had to make some pretty big sacrifices in missing almost every major family event, and have missed a lot of milestones for my close friends," she said. "I love what I do, so I am grateful that I had the opportunity to go to med school — even if it wasn't in Canada."