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#EXECUTIVE SUMMARY
Canada’s health care system is understaffed and facing both recruitment and retention challenges. As part of a wider health human resources (HHR) strategy, the National Newcomer Navigation Network (N4) is investigating internationally educated physicians and nurses as a key demographic to help meet staffing needs. This report explores the barriers that internationally educated health professionals (IEHPs) experience on their path to licensure in Canada, as well as some facilitating factors. The research is the result of 76 individual and organization stakeholder visits during 2022 and provides a snapshot of the everyday realities of frontline and lived experience professionals at this time.
In parallel to this work, N4 has developed recommendations for internationally educated nurses and internationally trained physicians, and a toolkit for employers seeking to employ them. These tools are linked below.
Through consultation with a wide range of stakeholders, the N4 team discovered that the following overarching, pan-Canadian barriers are contributing to the challenges in quickly licensing and onboarding IENs and ITPs:
- A complex immigration system at both provincial and federal levels
- Difficulties with system navigation and finding the correct, personalized pathway
- A dearth of information to inform decision-making pre- and post-arrival in Canada
- Challenges with interprovincial mobility, leading to competition between provinces
- The high cost of licensure exams, assessments, and documentation
- Lack of opportunities for both IEHPs and Canadians to build cultural competency and facilitate IEHP integration
- Discrimination based on country of origin, ethnicity, language, and resulting poor mental health and wellbeing
- Language exams which are expensive, do not prioritize vocational knowledge, and produce results valid for only two years
For ITPs, pathways were narrowed by a lack of residency spots and lack of capacity in provincial Practice-Ready Assessment programs. Stringent recency of practice requirements were a barrier, forcing physicians to return to their home country to practice or try to build informal networks in Canada to find Canadian experience. ITPs reported a lack of customizable training and bridging options.
For IENs, bottlenecks at the credential assessment and bridging stages were a reported issue. As well, registered nurses experienced a deskilling into practical nursing or unregulated care roles.
However, there are also some promising facilitators that can be explored by organizations and policy makers, including:
- A strong commitment from provinces to funding system navigators who are experts in IEHP licensure, and who can move IEHPs through the right pathways to practice
- Integration of immigration pathways with licensure so that IEHPs are directly connected with foreign credential recognition and training at arrival
- Additional mentorship and peer support to improve mental health and wellbeing
- More information pre-arrival about pathways and requirements, which would include the ability to complete parts of the licensure process in parallel with immigration
Ultimately, the equitable and efficient licensure of IEHPs is a team effort requiring the input of parties from the provincial to the federal level, and the injection of sustainable, sufficient funding.
The companion documents to this report are recommendations documents for internationally-trained physicians and internationally-educated nurses, and a recruitment and retention toolkit for employers. These resources are forthcoming on the N4 website in spring 2023.