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Ontario’s health care system is in turmoil. For years, labour shortages, difficult working conditions, and the growing needs of an ageing population have strained the province’s health care infrastructure. The pandemic has only exacerbated these and other long-standing problems, sparking an exodus of exhausted health care practitioners from their workplaces. Similar pressures are bearing down on medical professionals in other Canadian provinces and territories.
A new policy brief from the Canada Excellence Research Chair (CERC) in Migration and Integration offers recommendations to tackle these challenges. The brief, titled Globally Trained Local Talent: Opening pathways for internationally educated professionals to strengthen Ontario’s health care system [2], explores how policymakers in Ontario can tap into the talent pool of internationally educated health professionals (IEHPs) [3] to rebuild the province’s health care workforce. While its recommendations are tailored to Ontario, they offer lessons to leaders elsewhere in Canada and beyond.
Alongside Naomi Alboim and Karen Cohl,1 [4] the brief was written by two members of the policy team at World Education Services (WES), Joan Atlin, director of strategy, policy, and research; and Karl Flecker, associate director of policy advocacy. WES is dedicated to helping everyone put their education, experience, and skills to work anywhere in the world. A non-profit social enterprise, the organization works with partners across the globe to research, develop, and promote policies and programs that facilitate the social and economic inclusion of immigrants and refugees in Canada and the United States.
WENR sat down with both WES authors to understand the problems currently facing Ontario’s health care system, and what is being done to solve them. What follows is a summary of our conversation.
IEHP Underutilization: A Persistent Problem
IEHPs already provide critical health care services in Ontario. Eleven percent [2] of registered nurses in the province are internationally educated. Ontario is also home to many internationally educated nurses (IENs) who are not registered to practice there. Although collecting accurate data on Canada’s IEHPs can be difficult, the authors noted that thousands of IENs are actively pursuing registration in Ontario.
Despite years of training, many IEHPs are forced to take any job they can find, at times in fields outside of health care, because of systemic barriers to professional registration and practice. According to Statistics Canada [5], nearly half of all immigrants who received their health care education in countries other than Canada are underutilized. Although startlingly high, the data may be underestimating the scale of the problem, recent WES research [6] suggests.
“Ontario and Canada have a very long-standing problem of bringing highly skilled health care workers into the country and then not having a clear strategy for how to get them through the professional licensing process and into a job in their field,” Atlin told us.
The pandemic has forced some changes. The Ontario government has responded by adopting measures aimed at getting IEHPs back to work, such as increased funding for bridging programs to support internationally trained nurses as they pursue professional licensure.
Still, these efforts remain reactive and piecemeal. “It can’t be considered a comprehensive approach,” Flecker noted, pointing out that many qualified individuals will not be able to join Ontario’s health care workforce without a more coordinated policy approach: “We need to start to look at the forest, not just the trees.”
Targeted and Coordinated Efforts
The paper identifies three key areas in which barriers will need to be overcome: immigration status, registration (or licensure) processes, and employment opportunities. To address these challenges, it recommends a number of actions.
To ensure that IEHPs can fulfil professional registration requirements, access positions commensurate with their skills, and meet eligibility requirements for certain funding programs, the brief recommends that policymakers expand pathways to permanent residency (PR). For IEHPs in Ontario on a temporary work or study permit, steps should be taken to accelerate their transition to PR. The brief also suggests that IEHPs be welcomed to Canada with PR status from the outset.
The report also advises stakeholders to address the issues IEHPs face in obtaining professional registration. As the authors we spoke with noted, the registration process is complex. They recommend establishing a navigation hub that those pursuing licensure can turn to for information on what they need to do to obtain registration. In professions like medicine, the brief also proposes replacing Canadian experience requirements with proven alternatives, such as a Practice Ready Assessment [7] (PRA) program. Currently offered in seven Canadian provinces—but not in Ontario—PRA programs assess the clinical skills and knowledge of internationally educated medical graduates over a period of just 12 weeks.
The brief also recommends that bridging programs—which allow IEHPs to fill any knowledge and recent practice gaps they may have to meet registration requirements—be better funded and made more widely available. These changes would make it easier for IEHPs to obtain the professional registration needed to practice in Ontario.
To help registered and unregistered IEHPs find commensurate employment, the brief also urges stakeholders to do more to connect IEHPs with employers.
Finally, the paper calls for the incorporation of all these recommendations into a comprehensive, provincial human health resources strategy. “These three prongs are interconnected, and success cannot be achieved unless all three are addressed,” the paper notes. “The strategy should foster system-wide programs, policies, and investments aimed at internationally educated professionals rather than the current reliance on piecemeal, time-limited approaches.”
A Part of a Bigger Picture
The authors noted that the goals and recommendations of the brief align with WES’ commitment to advancing the social and economic inclusion of immigrants, refugees, and international students. “It’s part of WES’ mission to ensure that people who come to Canada with education, skills, and experience are able to fully use them to contribute to their new society,” Flecker said.
Fortunately, many other organizations and advocates share similar goals. Since the start of the pandemic, WES has been working with partners to call attention to the underutilization of IEHP talent. The organization has worked to inform and connect stakeholders at numerous events [8], including those organized by Employment and Social Development Canada (ESDC), Pathways to Prosperity (P2P), and Metropolis. WES also identified [9], in a nationwide scan, more than 150 organizations, programs, and researchers that support IEHPs in Canada.
More recently, Atlin and Flecker, along with other WES colleagues, organized a forum where leaders from the hospital, long-term care, and home care sectors spoke about the role of IEHPs.
The forum, held on April 11, fostered what some participants called a “deep and useful dialogue,” according to Atlin. It provided a venue in which stakeholders could explore their vision for building a provincial strategy that effectively integrates IEHPs alongside those who are domestically trained.
The forum also made a point of amplifying the voices and experiences of IEHPs. One internationally trained doctor shared that for the past seven years, she has had to commute between Jamaica and Canada for the sole reason of complying with the recent practice requirement of the province’s medical regulatory bodies. Sadly, challenges like the one she shared also face many other IEHPs.
The event also drew stakeholders from government ministries, occupational regulatory bodies, employer associations, and community organizations that support immigrant health professionals. The forum stressed that developing and implementing a comprehensive strategy to address the problem of IEHP underutilization would need to involve all stakeholders in the health care ecosystem. Flecker noted that overcoming a persistent history of IEHP underutilization and rebuilding the health care sector are challenges that no single stakeholder alone can fix.
A Step Forward
Shortly after the brief’s publication, the Government of Ontario launched A Plan to Stay Open [10], which outlines legislation aimed at increasing the ability of the province to “recruit and retain more doctors, nurses, and personal support workers.”
If passed, the legislation would invest $142 million to launch a new “Learn and Stay” grant, which would reimburse the tuition fees of nursing graduates who agree to work in an underserved community for two years. More importantly, the plan and the legislation would remove some of the barriers that currently keep IEHPs from quickly resuming their professions in Ontario. Most notably, the plan would prohibit professional regulatory bodies from requiring Canadian work experience as a qualification for registration. These steps align closely with the brief’s recommendations.
Flecker and Atlin note that the work of advocates played a role in the plan’s introduction. “There were many advocates working behind the scenes. Many others over the last two years have been advocating for this to happen.”
While Atlin and Flecker welcomed the plan, they also emphasized the importance of further advocacy and research to promote and influence future policy changes. Flecker noted that research is still needed to answer important questions, such as “how many internationally educated nurses are there in different parts of the health care sector? Where are they located in terms of occupational rank? How are they being treated? What do they need to be able to advance in their careers so that the system has an ‘end-to-end’ supply of qualified medical practitioners?”
The authors hope that the new initiatives signal the start of more comprehensive changes. Summarizing the situation, Atlin quoted the brief’s conclusion: “The talent is here, the need is evident, and the time for systematic change is long overdue.”
1. [11] Naomi Alboim is a senior fellow at the School of Policy Studies of Queen’s University and the Canada Excellence Research Chair in Migration and Integration program at Ryerson University. Karen Cohl is the Director of Crystal Resolution Inc., which provides consulting services to organizations working to expand access to justice and address immigration policy issues.