The Saudi-Canada Crisis Will Damage People’s Health

How an international spat over human rights will exacerbate Canada’s doctor shortage

Former Saudi Health Minister Abdullah al-Rabia and a doctor, pictured in scrubs and surgical masks, consult during a surgery in 2010.
Former Saudi Health Minister Abdullah al-Rabia, left, talks with a doctor during a surgery in 2010. (Hamad Olayan / AFP / Getty Images)

It’s been less than a week since Canada urged Saudi Arabia to release peaceful human-rights activists held in detention, but already the kingdom has responded with several aggressive moves. It expelled the Canadian ambassador, summoned its own ambassador back home, froze all new trade and investments with Canada, suspended flights to and from Toronto, and recalled about 16,000 Saudi students. The kingdom also decided to transfer Saudi patients in Canadian hospitals to other countries, and ordered Saudi medical residents currently in Canada to leave the country.

These moves are likely to have a direct and deeply damaging impact on Saudi and Canadian patients, and on the Canadian health-care system as a whole. That’s why, even as the Canadian government doubles down on its position with regard to human-rights activists, it would do well to consider immediately fast-tracking citizenship for Saudi medical residents.

Canada’s national organization representing academic medicine, the Association of Faculties of Medicine of Canada, reported that 799 medical residents who completed their M.D. degrees in Saudi Arabia were enrolled in post-M.D. training programs—with 95 percent of them employed through a legal work visa. This represented the largest cohort of international medical graduates in Canada, almost double the next largest group, which came from Ireland.

Canada needs these highly skilled individuals. Having completed their medical degrees, they’re now enrolled in residency programs across the country, where they train in specific areas of clinical medicine before being fully licensed to practice independently. They’re responsible for direct patient care on a daily basis, assisting in clinics, emergency departments, and operating rooms. They also do administrative tasks, like writing discharge paperwork and prescriptions. Their work is crucial to enabling institutions to provide round-the-clock medical care. In academic teaching hospitals, they also help attending physicians contribute to research, policy, and leadership initiatives that advance the profession.

The abundance of Saudi medical residents within the Canadian health-care system is a direct result of the King Abdullah Scholarship Program, which is coordinated by the kingdom’s ministry of education. Launched in 2005, the initiative’s goal was to become an “important source of support for the country’s private and public sectors by developing, qualifying, and preparing the necessary human resources” for their burgeoning labor force.

Vital to this goal was educating doctors who were expected to return to Saudi Arabia to build the medical infrastructure with expertise gained from abroad. Through the program, Saudi medical residents were paid by the kingdom, and Canadian institutions were also paid an additional annual stipend to help these doctors train. This generous financial incentive is the main reason for the proliferation of medical personnel from Saudi Arabia treating Canadian patients.

But this arrangement is now in jeopardy, as the Saudi-Canadian feud shows no signs of letting up. The impact on patient care could be significant, with experts warning of strain on a system that is already struggling with patient volumes. The president of the Ontario Medical Association, the largest provincial physician organization in the country, issued a statement that decried the decision to remove Saudi residents, who represent a core part of the medical workforce, and whose departure will adversely impact care at various levels.

If Canada were to grant Saudi medical residents a fast track to citizenship, Riyadh would probably withdraw its financial support of these individuals. But unlike practicing Saudi doctors in Canada—who can bill the Canadian government for their income, and are thus not formally financially tied to Saudi Arabia—medical residents need to be funded. The Canadian government would have to commit to paying their salaries for the duration of their training programs. And the recent decline in health-care payments meted out to provinces by the federal government would need to be reversed in order to reflect this new reality.

It would be an investment, but a worthwhile one. Canada is experiencing a well-documented shortage of doctors, which has been linked to a population that is growing in age and size. Cutbacks to residency-training programs by the provincial governments who fund them have exacerbated wait times for primary and specialist care. In creating an expedited citizenship program for Saudi medical residents, the federal government would be staving off the possible health-care crisis that could result from their abrupt exodus. These residents may also prove to be invaluable to the tens of thousands of Syrian refugees resettled in Canada, with whom they may share a common language.

It’s important to note that the Saudi government’s decision to transfer patients from Canadian hospitals to other countries could wreak havoc on their health, in addition to becoming a logistical nightmare for the system. The exact number of Saudi inpatients across the country is unknown, but research has clearly demonstrated that patients who are transferred between hospital facilities—let alone countries—experience worse health outcomes, including increased mortality and prolonged lengths of hospital stay.

As Saudi Arabia continues to fume at Canada, the lives and livelihoods of individuals are being bartered for political posturing. The result is a significant public-health risk to patients and a further blow to an already strained system.