The COVID-19 pandemic has created unprecedented pressures on health systems globally: the WHO is estimating a projected shortfall of 18 million health workers by 2030. Health authorities in Canada are anticipating a continuation of serious shortages of health care professionals in medicine, nursing, dentistry, pharmacy, and respiratory therapy, to name just a few. Public concern around access to care is justified. With the population over 80 set to double over the next 13 years in Ontario, the demographics of an aging population many with chronic medical conditions will increase the demands on our health system to provide a range of healthcare services.
It seems unbelievable, in this context, that 47% of internationally educated health professionals (IEHPs) are unemployed or underemployed in Canada. Thousands of internationally trained health professionals arrive as both temporary and permanent residents every year, and yet unique barriers related to immigration, professional licensure, and labour market integration persist and intersect in highly complex and often opaque policy subsystems.
While we have seen bright spots in terms of standalone policies and programs being introduced in recent months, what is missing is a coherent, end-to end strategy to integrate IEHPs in the Canadian health workforce.
It was in this context that, on April 11th, 2022, WES brought together IEHPs and leaders in the hospital, long-term care, and home care sectors in a virtual forum to share their vision for system-level strategies to effectively integrate internationally educated professionals as Ontario strives to rebuild its health workforce. Through hosting the forum, WES sought to contribute to the growing call for a comprehensive approach to addressing the underemployment of IEHPs in a way that acknowledges the interconnectivity of immigration, licensure, and workforce integration
The forum engaged 140 attendees from a range of sectors and provinces, including individuals from occupational regulatory bodies, provincial and federal government, health sector employers and employer associations, and national bodies including the Medical Council of Canada and the Canadian Nurses Association. Interestingly, over one quarter of attendees (26%) represented occupational regulatory bodies or associations of occupational regulatory bodies.
The forum addressed 2 key questions:
- What is the role of IEHPs in rebuilding Ontario’s health care workforce?
- What is our collective vision for a comprehensive provincial strategy that systematically addresses the integration of IEHPs from immigration to licensure to workplace inclusion?
The first hour of the event saw panelists Donna Duncan (Ontario Long Term Care Association), Joanna Walters (Internationally Trained Physicians of Ontario), Kelley Myers (VHA Home HealthCare), Paolo Varias (Long-Term Care Administrator and Internationally Educated Nurse), and Ru Taggar (Sunnybrook Health Sciences Centre) share their vision for how to advance IEHP inclusion in the health workforce. The second half of the forum involved an open moderated discussion where all attendees were encouraged to share their perspectives.
Financial costs and lengthy timelines associated with the process of registration create significant barriers for professional re-entry for some IEHPs. During the forum, Long-Term Care Administrator and IEN, Paolo Varias, commented that “the challenge for IEHPs is not only the required examinations, but the amount of time that it takes for the assessment… and the cost associated with the registration processes.”
Frequently, requirements for professional registration in health occupations include proof of recent safe practice. Because there are insufficient opportunities to retain recency of practice in Canada, there is a continued necessity for some IEHPs to frequently return to their home country to retain this requirement. Physician Joanna Walters shared: “To keep my recent years of practice, I’ve been going back and forth [between Canada and Jamaica] so I can practice as a physician for 5 or 6 months at a time, and then return to Canada to also keep my permanent residency.”
Data gaps prevent policy and decision-makers from obtaining a full and complete picture of the landscape of internationally educated talent in Canada. On this, a challenge shared by Ru Taggar, Executive Vice President & Chief Nursing and Health Professions Executive at Sunnybrook Health Sciences Centre, was “not knowing what the untapped opportunity is”. She added: “not having data regarding this matter…across the sector is really hindering our ability to understand this [issue] in a more precise way.”
Forum participants and panelists also touched on the complexities and jurisdictional issues that limit the development of effective, systemic solutions. CEO of the Ontario Long-Term Care Association, Donna Duncan, commented that “this is a provincial issue. This is a national issue. This is a global issue, and unless we engage with newcomers in good faith, and are fully transparent and support them in their journey to be able to work in [their] chosen profession, then what is the point of immigration?”. She added “We’ve got to have that commitment to supporting internationally educated health professionals in any discipline on that pathway to credentialing, and so we do need to work in partnership with the federal government to make sure that that’s possible.”
The importance of peer and mentor supports for IEHP integration were also discussed, including the importance of a whole-of-community approach to recruitment and retention, particularly in northern, rural, and isolated communities.
Panelists and attendees also highlighted the issue of moral hardship that occurs as a result of being unable to return to your chosen profession. In addition to being a health workforce issue, some stakeholders have argued that the unreasonable barriers to professional re-entry facing IEHPs in Canada constitute a human rights violation.
A number of discrete opportunities for action were raised, including expanding successful models of workplace-based assessment (e.g. Practice-Ready Assessment) and career laddering, avoiding ‘pop-up programs’ that lack sustained funding and incentivize competition over collaboration between employers, simplifying examination requirements and avoiding costly duplication of paperwork for professional registration (for example, language proficiency testing), and setting concrete time frames for processing of IEHP applicants for professional registration.
Critically, any and all strategies going forward must center the voices of internationally educated health professionals. Panelist Paolo Varias commented: “one integral part of the approach is to ensure that the voices of the IEHPs are involved in the articulation of problems, because naming the problems [is] the first half of finding the remedies. Their stories will assist us to have a better understanding of challenges and opportunities.” Kelley Myers agreed, adding “the first voices and the strongest voices need to be those who are having that lived experience to really be identifying those barriers that need to get busted through.” The importance of transparency, trust-based relationships, and true collaboration between all stakeholders came through loud and clear from participants.
With so many residents of Canada lacking access to care, solving the widespread underemployment of immigrant health professionals is more urgent than ever. The forum demonstrated the need for all voices to be at the table to build comprehensive policy remedies from a strong base of evidence.
Rebuilding a strained healthcare system will require new modes of collaboration that prioritize the end of IEHP underutilization while also supporting domestically trained healthcare professionals. Our system is reliant on both sources of talent to provide inclusive, diverse, high-quality healthcare for all. WES is keen to continue playing a role in bringing stakeholders together to advance the conversation.