Internationally Educated Health Professionals in Canada

A Potential Solution to the Healthcare Workforce Crisis

By Mélanie Bédard

Canada is facing a healthcare workforce crisis. Burnout, labour shortages, the COVID-19 pandemic, an aging population, and increasingly demanding working conditions are only some of the factors to blame. 

In Quebec, this crisis is alarmingly evident. Estimates indicate that 1.2 million Quebecers are without a family doctor, and over 864,000 are on the waitlist for a family physician. For those without a family doctor, the Quebec government offers the option to access the Guichet d’accès à la première ligne (GAP), which allows people who are sick to speak to a healthcare professional, have their symptoms assessed, and ideally, get an appointment. However, this is not a perfect solution. A high call volume and lengthy wait times are not uncommon. This means people often do not get the doctor’s appointment they are desperately searching for.

Many Canadians believe the answer lies in the hands of internationally educated health professionals.

Who Are IEHPs?

Internationally educated health professionals, or IEHPs for short, are defined by the Canadian government as “skilled newcomers who have been educated, trained or worked in a role that supports the delivery of health care and health care supports outside of Canada.” This includes, but is not limited to, health professions such as doctors, nurses, dentists, and pharmacists. 

In Canada, 26.2% of physicians are internationally educated. These numbers are similar across the Canadian healthcare workforce with 22% of physiotherapists, 34% of pharmacists, 6% of occupational therapists, and 9% of nurses being internationally educated. However, when taking into account those who are not working, it is likely that the number of IEHPs in Canada is much higher. In fact, 47% of IEHPs in Canada are considered either unemployed or underemployed. Underemployment refers to those who are working in positions where they are not utilising their full range of experience and skills. 

IEHPs have long been on the Government of Canada’s radar. In 2005, the Internationally Educated Health Professionals Initiative was created. Through this initiative, the federal government allocated 18 million dollars annually to help bring IEHPs into the Canadian workforce. However, almost 20 years later, little information is available on the effectiveness of this initiative.

IEHPs continue to face obstacles when looking to get licensed in Canada - but why?

Barriers

IEHPs face many barriers when trying to get licensed in Canada. Financial burdens from expensive qualifying exams and resettlement costs are often one of the most pressing barriers. This often pushes IEHPs to take “survival jobs” in order to account for these costs. Access to required residency training and other clinical requirements is limited. IEHPs are often competing with Canadians who trained abroad, with data suggesting that the majority of residency spots allocated for internationally trained physicians often go to Canadians who trained abroad and not immigrants. This provides little opportunity for IEHPs to obtain and demonstrate competencies within the Canadian context. Language fluency can also be a barrier. This can make it difficult to navigate the recertification processes. English or French language tests are often a standard requirement for licensure in Canada. This is especially pertinent in Quebec where French is often required for healthcare providers. Many logistic barriers also exist. In Nova Scotia, IEHPs face processing times three times longer than domestic applicants, with respiratory therapists waiting up to six times longer than their Canadian counterparts.

Bridging programs exist in Canada to help IEHPs increase their chances of getting licensed. These programs are catered to many specific healthcare careers. The Michener Institute at the University Health Network in Toronto offers bridging programs for radiological technology and ultrasound scanning. However, these bridging programs are often costly and offer limited spots. A bridging program at l’Université de Sherbrooke only offers three spots per year.

An interesting, seemingly win-win option is the National Assessment Collaboration’s Practice-Ready Assessment (PRA) offered by the Medical Council of Canada. This 12-week program allows internationally educated physicians to gain experience in Canada and obtain a license. After completing the program, physicians must commit to work in remote or rural areas. The program thus provides a streamlined path for IEHPs to obtain licensure and provides remote and rural Canadian communities access to physicians. However, this option is only available in seven provinces and is very competitive. Additionally, since many medical licenses are issued at the provincial level, this makes it difficult for IEHPs to move around in Canada once licensed.

Other Countries

Perhaps Canada should look to other countries such as the United Kingdom or New Zealand, where IEHPs represent a large proportion of the healthcare workforce. In 2021, approximately 50% of new doctors who joined the workforce in the UK were internationally educated. In New Zealand, 41.2% of doctors working in 2022 were international medical graduates.

This begs the question: what is Canada doing differently?

IEHPs represent an untapped resource that Canada could utilise as a solution to the current healthcare workforce crisis. However, it remains unclear why the Canadian government isn’t doing more to remove barriers for IEHPs to get licensed. Lack of resources for training opportunities may be part of the problem, and this is certainly an area that could be addressed to make it easier for IEHPs to practice their profession. In Canada’s time of need, IEHPs may just be the solution we’ve been searching for.