As a Canadian training in the US, my desire has always been to return to Canada once I completed my fellowship. As the time draws nearer, however, I have come to realize that I don’t actually know very much about what it means to be a clinical chemist in my home country. I suspected that there are some similarities with the US, and I knew for certain that there were differences. But what exactly were they?
Let’s start at the beginning. Canada currently has five postdoctoral clinical chemistry training programs: University of Toronto, McMaster University (Hamilton), University of Manitoba (Winnipeg), Université de Montréal, and University of Calgary. The programs accept either Ph.D. or M.D. candidates, and all but one (University of Manitoba) are two years in duration. Toronto is the oldest program and is currently the only one accredited by both Canadian and American societies [Clinical Academy of Clinical Biochemists (CACB) and the Commission on Accreditation in Clinical Chemistry, respectively]. Calgary is the newest program of the bunch, with its first fellow slated to start in July 2013. All of these programs provide very thorough training that is pretty much interchangeable with that obtained in an American program. Perhaps the exception to this rule is Université de Montréal which provides training in French and is most suited for individuals intending to work in the province of Québec. Upon completion of their training, candidates are eligible for certification by the CACB, the Société Québécoise de Biologie Clinique (Université de Montréal), and/or the American Board of Clinical Chemistry (University of Toronto). Because current interest exceeds the number of training positions, a number of Canadians also end up each year in American programs. While some of these individuals choose to stay in the US after completion of their fellowship, many return to Canada and serve as an additional and important source of highly qualified clinical chemists for the country.
For individuals who have trained in the US, returning to Canada poses a number of challenges. For one, Canada uses SI units, which means that we have to relearn all of the reference ranges memorized during our training. This seems like a minor point but it's not completely trivial and is an adjustment that neither our American nor our Canadian-trained counterparts have to make. A much more difficult challenge, though, is to adjust to the financial budget of Canadian labs. In talking with clinical chemists throughout the country, the message is always the same: money is harder to come by than in the US. In some hospitals that I've visited, for example those in Toronto or Vancouver, this is not so evident. The labs offer fairly extensive test menus and also have some instrumentation available for research and development. However, purchasing a new instrument can be quite challenging and requires not only a very strong business case but also extensive conversation with administrators and a fair bit of time. In many other Canadian hospitals, however, the economic restrictions are more evident. In Edmonton, for example, the majority of labs only have a limited, stat testing menu with all routine testing sent to a local reference lab (DynaLIFE). This consolidation is a move on the part of the provincial health authority and is meant to reduce the financial burden associated with lab testing. For similar reasons, implementation of a new test in any hospital requires extensive conversation between the city's hospital-based chemists, DynaLIFE chemists, and representatives of the provincial health authority. Lastly, like in other areas of Canada, a strong business case is essential for bringing in a test and for purchasing new instruments.
Despite these, and other, challenges, working in Canada also has many rewards. For one, the aforementioned financial challenges provide a tremendous opportunity to strengthen one's skills in lab utilization. During my training in the US I've sat through a number of webinars on lab utilization but I've never seen it in action like it's done in Edmonton on a daily basis. Moreover, having limited resources also seems to bring out a more creative side of people that often becomes dormant in times of financial affluence. I've seen this not only in Canada but in other places that I've worked such as England and Hungary. Another great benefit of working in Canada is that you can have a satisfying career along with a relatively healthy personal life. Working only 9 hours per day and taking all of your paid vacation leave is encouraged and most chemists end up doing so. While this is also possible in the US, my experience is that it is more difficult to achieve because of the ubiquitous pervasion of the idea that working long hours is the only means to a successful life. While this may sound a bit harsh, I'm not alone in making this observation – a number of American acquaintances living in Canada have reechoed this feeling. Perhaps this is one of the contributors to Canadians having the friendly, calm, and relaxed attitude that they are known for worldwide.
While there are certainly many other issues that should be discussed in this post, I will stop here for the sake of brevity. I hope that I have aroused your curiosity, dear reader, about practicing clinical chemistry in Canada. The next time you meet us Canadians, don't hesitate to approach with any questions you may have. We are very friendly and always happy to help!