The Kingdom of Saudi Arabia announced a decision to remove all its medical trainees from Canadian hospitals this month. The spat began with Canada taking to Twitter to express its concerns regarding Saudi Arabian detention of women’s rights activists, and a call for the release of its activists.

Escalating diplomatic tensions drastically distorted the relationship between the two governments. Saudi leadership took strong action in retaliation for what it perceived as undue interference: cutting ambassador ties, freezing trade and investments, suspending air transportation, terminating grain imports, and transferring medical care for Saudi patients away from Canada.

Among its major sanctions was suspension of scholarships for approximately 16,000 Canada-based Saudi students, including almost 1,000 medical residents and fellows.

Saudi medical trainees comprise 18 per cent of international medical graduates in Canada and 5 per cent of all Canadian postgraduate medical trainees. Five per cent of the trainee workforce may appear minor. However, balanced with the intricate involvement of these residents and fellows in teaching hospitals and institutions across the country — many in leadership roles with clinical services — the precarious nature of the positions of almost 1,000 physicians leaves the Canadian health-care system scrambling for solutions.

Much of the ensuing dialogue has been around the weight of the degree of uncertainty surrounding Saudi-funded trainees on Canadian institutions and fellow-trainees. Indeed, in a system where residents and fellows are so integral to the fabric of seamlessly co-ordinated care, acute instability in trainee positions places unanticipated demands on colleagues and hospital administrators.

Read more:

The loss of hundreds of Saudi medical residents will ‘put a lot of strain’ on Canadian patients, experts say

Opinion | Bob Rae: What Canada’s Saudi episode tells us about our world

Ottawa was surprised by Saudi Arabia’s angry reaction to its human rights concerns

Accommodating for new gaps in hospital workforces will stretch existing resources, and in a period where Canadian hospitals have already been struggling with physician shortages and patient overcapacity issues, will likely only complicate hospital workflow.

It is important not to overlook the direct impact this will have on patient care. The absence of hundreds of residents at the end of August may spell calamitous circumstances for care provision where hospitals already struggle to match patient volumes and available physician coverage. Other trainees and care providers will be challenged to fill gaps in care alongside administrators.

Yet, largely slipping under the radar is the collateral damage of these sanctions to Saudi trainees and their families. Hundreds of individuals who have dedicated years in training to furnishing careers as physicians are being uprooted after finding their feet and making Canada their home away from home.

Disruption of their educational trajectories with unclear directions leaves them at the mercy of the political forces that graciously supported their education in the first place. While the kingdom has agreed to allow trainees to continue their education elsewhere, it has provided little more than a few weeks to discontinue entire livelihoods in a foreign country and restart them in another.

The kingdom’s sanctions will acutely fracture the stabilities of entire family units, many of whom have accompanied their medical counterparts and have built parallel lives in Canada.

In a heated diplomatic political confrontation, this compromise of optimal patient care and medical education is unjustifiable. Patients will inevitably be affected by these changes nationally, and institutions will be under immense stress.

In these testing times, it is important to emphasize how integral it is for these residents and fellows to receive support. Many of these trainees have been relatively disconnected from their support networks abroad as they have furnished new lives in Canada. Captured as “disappointed” and “confused” in media excerpts, they have been instructed not to comment publicly until further notice — effectively silencing their perspectives. They now turn to their medical institutions and mentors in navigating options and dealing with uncertainty.

It has been admirable to observe the leadership that administrators in medical institutions across the country have taken over the past several weeks. Advocating for the needs of these trainees in negotiations with the Saudi government and collaborating to facilitate support networks and resources, these administrators have made extensive efforts to promote the welfare of these trainees.

Loading... Loading... Loading... Loading... Loading... Loading...

Administrators and physician leaders will need to continue to work together to identify adaptive solutions to appropriately reallocate resources and fill gaps in care.

Trainees caught in the crossfire between two political bodies in conflict are victims as well, with their futures hanging in the balance. Administrators must continue promoting services focused on supporting these trainees and their families through major upcoming transitions.

As we engage in the practice of healing for our patients, we must look inwards and do everything in our power to support our colleagues.

Dr. Arnav Agarwal is resident physician in the Department of Medicine at the University of Toronto.

Read more about: