Dr. Abir Hussein is mentoring the next generation of family doctors, helping more people in her rural community access primary care

As an international medical graduate (IMG), Dr. Abir Hussein’s path to practising family medicine in Nova Scotia was not straightforward.

Born in Kuwait, she studied medicine in Cairo. After graduating in 2002, she worked as a family doctor in Egypt, Saudi Arabia and Kuwait before moving to Halifax in 2009 with her physician husband and their two daughters.

“Most people go to big cities like Toronto, but we had heard that Nova Scotia was a good place to raise our kids,” Dr. Hussein recalled. “We landed in Halifax and fell in love. It was our first time in Canada.”

The couple thought they would soon find rewarding work as physicians. “There were a lot of conflicted feelings when we first arrived,” said Dr. Hussein. “It was difficult and disappointing. There was shock and fear that we might not ever practise in Canada.”

They lived in Halifax for two and a half years, during which time Dr. Hussein gave birth to their third daughter. She studied for her exams, worked in blood collection and raised her children.

“That’s the story for all IMGs – they need to provide for their families,” said Dr. Hussein. “The exams are very expensive. It’s scary—you are building everything from the ground up.”

Her breakthrough came in 2011, when she was accepted into the Clinician Assessment for Practice Program (now called the Practice Ready Assessment Program). The program matched IMG family physicians to underserviced rural communities across Nova Scotia.

Dr. Hussein matched to Yarmouth, N.S. “At the same time, my husband had matched to a four-year internal medicine residency in Saint John, N.B. So I had our three kids by myself in Yarmouth, which was a transition.”

It was the start of her new life practising medicine in Canada for the first time, which was a critical time in her career. “I was having evaluations and I had to prove myself. What made it even tougher was that I got pregnant during this time and had my fourth daughter.”

For an IMG, medical knowledge and expertise remain the same, but the practice and culture of medicine can often be very different, said Dr. Hussein. “In some cultures, doctors make decisions for their patients. In Canada, patients have complete autonomy. I’m sure we can do a better job of orienting IMGs to our system: the culture of patient autonomy, decision-making and teamwork.”

For her, having supportive medical colleagues in Yarmouth helped her gain a foothold professionally. “It’s absolutely vital for any young or new physician to feel comfortable and confident in opening a practice. They need to know that there’s a support system around them.”

She said a support system is especially needed in rural, underserviced communities like hers, where family doctors often stretch themselves too thin. “Many family doctors are not only providing primary care, but also obstetrical care, hospital care, emergency department care and operating room assists. They’re covering multiple services to fill all of the gaps, which can be exhausting for them.”

Adding to the challenge is that patients who lack primary care are often very sick by the time they seek help at their local emergency department or walk-in clinic. “Primary care is the foundation of health care,” Dr. Hussein said. “When it’s missing, there’s a lack of prevention, lack of follow up, lack of chronic disease care, which leads to a bigger load – and overload – in all of the services.”

“People are just too sick, and they’ve been sick for a longer time and present in the advanced stages of illness.”

Now, Dr. Hussein works at Ocean View Family practice, provides in-patient care at Yarmouth Regional Hospital, and is postgraduate site director for the Southwest Nova teaching site with Dalhousie Family Medicine. She’s also a preceptor in the program, mentoring family medicine residents during their two-year rotation at her clinic.

“The residency program is an asset to our community,” said Dr. Hussein. “Residents bring new skills and knowledge to our hospital and provide exceptional care and services. They become part of our community and some of them do stay on.”

Yarmouth’s tight-knit medical community makes the transition from resident to fully practising physician a smooth one. “It’s the collegiality here,” Dr. Hussein said. “Our residents build relationships with consultants, specialists and other family doctors. It’s hard to leave that behind.”

“We have each other’s backs. If a colleague thinks I’m working too hard, they’ll check on me and show their support. It’s an environment you really want to work in.”

Dr. Hussein sees IMGs who have already settled in Nova Scotia as an untapped source of doctors for rural communities. “We should prioritize them and help them to prepare for their exams and assessments. If they are settled in one community, it’s easy for them to move to another part of the province like I did.”

She’s excited that Yarmouth now has a recruitment committee and a physician navigator to help recruit doctors to the area. “They recognize that we need local efforts to recruit and retain physicians,” she said.

More grassroots community involvement means more buzz about the region. “The positive feeling is on the rise,” said Dr. Hussein. “Our physicians are still exhausted, but I think we’re recognizing the issues and the solutions, and we have the interest of other people in the community.”

She’s happy to do her part. “Whenever we have a site visit with a potential new recruit, I always say to my colleagues, ‘Let’s charm them with our collegiality.’ It really is our strength. If we can just get them to visit, we’ll be able to recruit them.”