Selvy Kumaran has spent nine years training to be a doctor, but the road to her final residency was recently blocked by the federal government.

Medical school graduates like Kumaran need to complete supervised residencies in their chosen fields, such as family medicine, general surgery or pediatrics, before they can be licensed to practise medicine in Canada.

Many apply to hospitals in the U.S. to increase their chances of landing one.

But some recent graduates have struggled to obtain the proper documentation from Health Canada to complete a residency outside the country.

Kumaran sent out 200 applications and completed 20 interviews — a process that cost her more than $20,000 — and was matched with her second choice, a pediatrics placement in Michigan on March 16.

'Statement of need' required

In order to live and work in the country, medical residents must secure J1 visas from the U.S. government. Prior to getting a visa, they are required to obtain "statements of need" from the Canadian government. The paperwork signals to U.S. authorities that there is the need for doctors and that a job will be available when the resident returns to Canada. Since 2015, Health Canada has restricted the number of statements of need given out to doctors in each specialty.

Kumaran submitted her application to Health Canada at 1:07 p.m. on March 16 — seven minutes after the application process opened.

But Health Canada sent her an email saying the department had already handed out 30 statements of need to pediatric residents and that she would have to apply again next year. Kumaran said by that time, it's possible she wouldn't be considered for a residency.

"I've spent so much money, I've spent so much time, I've worked so hard for this, and the fact that everything came down to seven minutes is just shocking," she said. "I was completely devastated. Honestly, I didn't know what to do at that point."

Selvy Kumaran (far right) and her family. Her sister Jananie (second from left) completed her residency in psychiatry in Michigan and will start work at the Regina General Hospital in July. At the time, the number of statements of need handed out was unlimited. (Selvy Kumaran/Facebook)

Health Canada said it processes applications for statements of need on a first-come, first-served basis from the time the application is received by email. A spokesperson said the decision to deny statements of need to applicants is done with "a great deal of consideration" and in consultation with the provinces and territories.

But on Thursday, Health Canada reversed its position, citing technical difficulties on the online system's opening day. The department emailed Kumaran a statement of need after all.

A spokesperson for Health Canada told CBC it received an unusually large number of applications to its online submission portal this year and received numerous complaints of inaccurate time-stamps on applications. The federal department discussed the issue with the provinces and territories and sent out 55 more statements of need to doctors with a variety of specialties.



"Health Canada will be examining options to improve the efficiency and durability of the application system and consulting with the provinces and territories on enhancements for future years," a spokesperson said in a statement.

Saskatchewan recruiting specialists

Kumaran was born and raised in Regina but attended medical school in the Caribbean at the American University of Antigua. She is considered an international medical graduate, meaning that her application for a residency match is considered after students from North America.

After she was initially denied a statement of need, multiple physicians in the province wrote letters of support to Health Canada on her behalf emphasizing Saskatchewan's need for pediatricians. Kumaran personally reached out to two MLAs, two MPs, the province's health minister, the federal health minister and a senator.

A spokesperson for Saskatchewan's Ministry of Health said the province is looking to hire physicians. There are currently eight available pediatrician job postings on saskdocs, the province's physician recruitment agency.

The province said it is actively recruiting for a number of specialties, including anesthesia, pediatrics, diagnostic radiology and internal medicine — all of which are allotted a limited number of statements of need.

"Pediatricians are very, very needed here in the province and I just think it's unfair for Canada to say that we aren't needed," Kumaran said.

Calls for change

Rosemary Pawliuk, president of the Society for Canadians Studying Medicine Abroad, said Health Canada is holding back good doctors.

She said teaching hospitals consider their degrees stale after a year of waiting for a statement of need.

Rosemary Pawliuk, a spokesperson for medical students with international degrees, said Canada needs medical specialists, including pediatricians. (CBC) "They get a job. They've competed. They've won. They've demonstrated their merit and then Canada just knocks them out at the knees. You can imagine the devastation that is caused," Pawliuk said.

"We are the only government, the only country in the developed world that limits statements of need."

While Health Canada only set aside 30 statements of need for pediatrics residents, Pawliuk said there are 36 job openings for that specialty in B.C. alone.

The doctors' shortage in Canada could be helped by more doctors completing their residencies, she said.

"People are dying on wait lists. People are not able to get in to see their physicians. People are not having access and as we age and as more physicians, baby boomer physicians retire, it's only going to get worse," Pawliuk said.