Get Med.ucated with Maria Margaritas

The Caring Support Podcast had another exciting and educational conversation this week with the amazing Maria Margaritas!

Maria is an educational coach and the founder of "mariA. think outside the box MED.ucation" providing on-demand digital courses, blogs, and coaching for international medical graduates and internationally trained healthcare professionals (IMGs-ITHPs) to improve their medical communication skills for Canadian healthcare settings in order to achieve personal and professional success in Canada.

Come along with us and let’s get ‘Med.ucated with Maria’!

Could you tell us a little bit about yourself?

Maria: Well, I have a Master's in Educational Psychology, and I'm also an accredited Ontario Certified English Language teacher. I have a degree in Psychology and Counseling. I help internationally trained physicians that came from another country or physicians that are Canadian who studied abroad with their applications in terms of their personal statements, their CVS and interview skills. I also help guide them with exams like the Casper exam, which is a situational judgment test. Most of them don't have familiarity with that. So that's what I help them with. It’s 100% virtual, so I'm helping people all across Canada and in other countries as well.

What made you start "mariA. think outside the box MED.ucation"?

I had lived abroad for about eight years and when I came back to Canada, I took a volunteer position to help internationally trained physicians with their IELTs, which is the English exam they have to write and have in their portfolio in order to get into their licensing stream. I started with that and that was all done in person. Then, once they got into their residency programs, they sometimes moved to different provinces, so I started helping them online.

During this, I went to Montreal to do my Master's, and from there I just kept helping them with their editing, their research papers and presentations since some had never done a presentation before. Once I graduated in 2019, I couldn't find a job and because of COVID, everything in Montreal got locked down in March right after that. In 2020, at the suggestion of my clients I started helping more of their friends and family. It was at that time that I decided to just like take it on the road and turn it into a business.

I found that the demand was high and people really needed help from somebody who really understood what they needed to do and also understood how to explain things so that they could really talk about their experiences. So ‘MariA. Think Outside The Box MED.ucation’ was born during COVID and it took off from there.

My clients were and are mostly referral based, which means I wasn't advertising or anything.

There was a time when I was in Montreal where I needed to go to the doctor, and I couldn't get a doctor. It took many months for me to finally see a doctor and at one point I was even told that I would have to travel far away in order to see a Doctor at all. It was then I got to learn from a patient's perspective what it's like not to have a doctor. At that time, COVID had just ramped up and people were left in Emergency Rooms waiting over 24 hours for medical care. People were scared to go anywhere, and nobody really understood what was happening. It was kind of scary.

Then it occurred to me that I am helping all these doctors who could be helping during this pandemic, but there's all these obstacles in their way. I would have loved to have any of them as my doctor. My question became why aren't we doing anything to get them into the system? What is going on? That's when I really got more into the political side of it and more looking at what they needed to do and how to get them seen for the competencies that they had.

With the push for more immigrant healthcare workers to come into the country, what are some of the big struggles that Immigrant Healthcare Workers are facing when coming to Canada?

I can't speak for everyone, and I don't want to generalize, but what I've experienced while working with newcomer IMGs, International Medical Graduates, is that first they must get settled. That first step is a big deal because even if you read everything online and you're given papers from the government and you do all kinds of searches on the Internet, you really don't know what is ahead of you until you are already here. You don't know where you're going to live. You don't know the people in your neighbourhood, so it really takes a lot to settle in and really understand where you are. Each person’s experience is different depending on where the newcomers are coming from and then what their financial and family situation is. Getting their kids into school, getting a driver's license, getting a health card, all of those things come into play when they are first getting settled. Getting settled usually takes a few months to a year or more, depending on their situation. Wherever they end up, one of the first things they should do is seek out the local settlement organization. They know what to do and what next steps need to happen. Some smaller communities won’t have a settlement organization and that’s where they can begin to struggle.

After that, there’s tackling regulatory requirements and those differ between provinces and even nationally. For example, seven provinces have the Practice Ready Assessment, which is a 12-week training program that they can go through if they are eligible. It's up to them to figure out if their province has that and if not, then they have to consider relocating to another province which could mean a lot of moving just to find somewhere they can settle and work in their desired field.

They're on their own to figure all this out because there’s no central database where they can go in and it will tell them step by step, first do this, then do this, and then do that when it comes to living in Canada and then being a doctor here.

Something that can negatively affect their career even getting started is their recency of practice. When they begin the process, they start by doing their Canadian Exams. If they haven't worked with patients for two years, then they are no longer eligible to apply.

Then they only have two options. One, they have to go back to their country and start practicing again, which is not always possible because of expense, time, and it can even depend on what's happening in the world - they might not even be able to go back. It's also very taxing on their families to have to leave again.

The second is that they need to find a way to get Canadian clinical experience, but there are very few options for them and they have to find those on their own. Again, there's no database where they can go in and say, who's going to let me go into their clinic or hospital to be able to get my Canadian experience? Those opportunities are very rare, so most IMGs don't get them unless they know someone or they're in the right place at the right time.

I think there's a lot that we can do by connecting the dots and streamlining this process.

Is there a specific process they should follow (or tips that you can offer) to find a job and be successful in their career once they arrive in Canada?

The first thing that they should do is contact any settlement organization that is in their community, which helps them with getting their health card, a driver's license, maybe finding an apartment, things like that. If there's no settlement organization where they are, they could go to the public library. Libraries are an amazing source of free resources. Libraries have free Internet, so if you have a device, you can use it for free, all you need is a free library card.

Another place to seek out is places of worship or multicultural communities that that they resonate with. There, they might be able to speak to someone who knows and understands where they're coming from.

It's important to get involved with the community they are in, so seeking out any community centers in the area where they could get involved with something, make some friends, do something social, or even get more information because some community centers will give courses or free sessions or be able to offer some direction.

There are three websites that are good for settlement. The first one is settlement.org, which is an Ontario organization, but available to anyone in Canada. Each province has a website similar to settlement.org and can generally be found by looking up the provincial website.

The next one is wes.org/ca. WES, World Education Services, is a non-profit where they help international students, immigrants and refugees achieve their educational and career goals.

N4is another great resource. N4, newcomernavigation.ca , has a lot of free courses. They have a special program right now for internationally trained health professionals where they are helping ITHPs to understand what they need to do in order to work in their profession in Canada.

Another suggestion I have is to volunteer at any of the organizations that I already mentioned, like community centers, the library, settlement organizations, etc. You can volunteer to gain experience, but also to get to know people in your area. Through that you'll see that there are more opportunities and you might meet the right people at the right time and get yourself in the right position that it would be the most helpful for you or your family.

For health professionals, mcc.ca is the Medical Council of Canada, where you can find out what exams you need to write in order to be eligible to get your license and physiciansapply.ca is specifically for physicians where they can create a portfolio to get all their documents together for the application process.

What would you like to see happen in the future in regard to the regulations/process surrounding immigrant healthcare workers coming to work in Canada?

There's a lot of things that can be done. Some things are simple, some things are more complicated because we have a very archaic system that hasn't been changed since 1960 or something like that. What I really want to see happen in the country is for the money that's being spent on recruiting newcomers into Canada to first be spent on newcomers who are here already and have gone through immigration and written all of their exams so that they can be trained and get onboarded into the health care system and be used to their full potential.

That's not just newcomers, it's also Canadians who studied abroad. We have people here who are qualified to do these jobs. They need training on systemic things here in Canada. It would be the same if I moved to the States, I would need to learn how the system works there. It's different. It doesn't mean I don't know what I'm doing or I wasn't educated in a good way. It just means that I don't know how they do things in their culture of that organization. It’s the same thing if you're in the same city and you move from one job to another, you still have to learn the culture at that new place.

We need a national onboarding process or every hospital and clinic should have some kind of onboarding process for IMGs so that they can streamline into the system and understand and then be tested again, at the NTC, which is what the practice-read assessment is, but it's not available to everyone.

Something I advocate for the most is to stop/slow down recruiting new people into the country when we've already got so many hundreds here and they're not being utilized for the skills that they have. Continuing to recruit means that new people are going to come in with the same issues. It's very disheartening and the government is still spending a lot of money on that.

Immigration consultants are still going to other countries and telling all these medical professionals, come to Canada. Life is so great. It's a safe country. They have the spiel that they tell people to convince them to stop their practice in their country and come to Canada, but they don't tell them all these other things. As an advocate for the people that I work with once I know their stories, I find that very sad that Canada would do something like that when they have so many other options and a lot more resources that they can be using to their advantage and spending less money or at least allocating money in different ways. We need to make the most of the resources that we have here.

Is there anything else you want to tell us about today?

There are two things I'm going to add. One is, you know, I'm going to talk about what I'm going to be doing and the other thing is that I wanted to let everyone know that ITPO and WES just published a paper about ‘expanding pathways to licensure for internationally trained physicians in Ontario, how to get there and Why It Matters’. If you are an internationally trained health worker you can go to wes.org/ca to read it. Like I mentioned, it was published by ITPO, which is the Internationally Trained Physicians of Ontario and WES and that was just published in January 2023, and you can download it for free. It'll give you a real, very accurate background of what needs to happen and what is happening. It’s a great read.

The other thing I'm going to add is that in the spring I'm going to be launching a membership site. It is for internationally trained physicians, and it will help them to prepare for their tests and gather the documents that they need for their application. If you need feedback and support for crafting a CV, personal statement, or interview, you can contact me and ask questions at info@mariathinkoutsidethebox.ca. If you want to know when that's going to be launched, you can go to mariathinkoutsidethebox.ca and subscribe for the newsletter. This membership gives members exclusive access to a supportive community, that allows them to connect directly with me and like-minded colleagues while engaging with the content at their own pace throughout the year.

Thank you for inviting me and letting me talk about these things and help the people who need help and give them some light in their darkness.

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