Despite health-care ‘crisis,’ internationally-trained doctors, nurses face barriers to work

Health worker shortages may be at “crisis” levels across Canada, according to those on the front lines. But for Suzanne Harris, a nurse trained in the U.K. who wants to work in Nova Scotia, she says it seems like the health system just doesn’t want help.

Harris is originally from the Maritimes, but lived in the U.K. for 14 years, where she completed her nursing degree.

Even before moving to Nova Scotia almost a year ago, she has been trying to get the paperwork and licensing she needs to work as a registered nurse in Nova Scotia. But she has faced significant delays, bureaucratic red tape and prohibitive fees for each step in the process.

It has led Harris to hit the pause button on her attempts to become a registered nurse in Canada, due to a process she says has been nothing but frustrating.

“To come home where we are so, so short in health care at every level — doctors, nurses, virtually everywhere is short-staffed … it just leaves you feeling like they don’t really want you,” she said.

“They’re in no hurry to get people to come and work in Canada.”

Harris is one of thousands of internationally-trained health workers who have been unable to get their health-care training and education recognized in Canada, due to a complex system of regulation and licensure at both the national and provincial levels.

Doctors and nurses trained in Canada also face barriers moving between provinces, due to licensing issues.

According to a 2020 analysis by Statistics Canada, there were 939,000 adults aged 20 to 44 living in Canada who have a post-secondary education in a health-related field, as of the 2016 census. Of those, 30 per cent were “underutilized” graduates — individuals with a post-secondary degree in a health care field, but who are not employed or work in non-health occupations that require no more than a high school diploma.

The number of adults with an underutilized health education in Canada increased to a total of 288,100 in 2016 from 277,300 people in 2011, Statistics Canada says.

Some of these are people who may not want to work in health care. But many do try, and often when they do, they encounter so many barriers. They either give up or get to a point where it’s been so long since they last worked in their field, they are ineligible, said Joan Atlin, director of strategy, policy and research with World Education Services Canada, which advocates for international health workers.

“There are huge numbers of internationally-educated health professionals who aren’t practicing in their professions in Canada at a time where we have a desperate need for them,” she said.

When they come to Canada, they face a series of requirements, including exams, clinical requirements, educational requisites, “recency of practice” stipulations and, in some cases, they must have Canadian experience in order to get a Canadian license. This creates a catch-22 for anyone applying who is new to Canada, Atlin said.

There are also costs for each step along the way. And while licensing for health professionals is regulated provincially, there are also parts of the process that are handled by national bodies, adding even more layers of bureaucracy and red tape, Atlin said.

“So, there are a whole series of barriers in a complex process.”

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Health system facing major staffing shortages

Currently, Canada is facing an acute shortage of health care workers, which has led to multiple recent emergency room closures and reductions in health services across the country.

The last two and a half years of the COVID-19 pandemic have been gruelling on health workers, and now they are dealing with overflows of patients, many of whom — after delaying medical care during the pandemic — are now sicker and in need of more care. All this has led to a situation where health workers are now so burned out, many are exiting the profession, leaving even more work for those who remain.

And the outlook is just as grim.

The health sector had the second-highest number of job vacancies in Canada at 126,000 as of the fourth quarter of 2021, according to figures provided by Employment and Social Development Canada at a federal health committee meeting in June.

“Over the medium-term, forecasted job openings over the next 10 years will be particularly acute for key occupations, including registered nurses and licensed practical nurses, physicians and personal support workers,” Andrew Brown, a senior deputy minister with ESDC, told the committee June 20.

Dr. Makini McGuire-Brown is one of many internationally-educated physicians who would like to relieve overworked physicians and work as a doctor in Canada.

But despite trying to land a residency placement every year since 2017 after arriving in Canada from Trinidad and Tobego, McGuire-Brown remains sidelined.

She questions why health professionals like her face so many barriers to entering the health-care system when it is in such dire need of workers.

“It doesn’t make any sense,” she said.

“We can help. That’s the whole point. This is not us begging. This is us wanting to use our skills.”

McGuire-Brown, now chair of the Internationally Trained Physicians of Ontario advocacy organization, says part of the problem is that pathways for doctors from other countries to get licensed in Canada are not adequate. Re-doing their residency once in Canada is one option, but it is highly competitive. For every two residency openings, up to 400 applicants are competing, she said.

Another route to licensure for international physicians are practice-ready assessment programs, in which candidates work under supervision and are evaluated over about 12 weeks, after which they must work for a period of time in a rural area. But these programs are not offered in all provinces and there are very few openings.

For physicians who come to Canada on the immigration points system, this leaves few options to work in their field, McGuire-Brown said.

“So, you get stuck here, unable to be a doctor, unable to practice, and then that is held against you, because one of the big things to get into these pathways is recency of practice, Canadian experience,” she said.

“How are you supposed to get it if this system does not have an official way for you to get it?”

Health workers trained in Canada also face barriers

Barriers to getting licensed to work in Canada are not limited to international health professionals.

Canadian-educated nurses and doctors can only work in the provinces in which they are licensed by provincial and territorial regulatory colleges, which each have their own unique criteria and process for application in each jurisdiction.

This limits the abilities of physicians and nurses to be deployed to rural areas of the country, for example, where health professionals are always in limited supply, says Dr. Katharine Smart, president of the Canadian Medical Association (CMA).

“It’s difficult to recruit and retain providers into these areas, often because they cannot get locum coverage if they need a maternity leave or vacation or illness,” Smart said.

Moving a doctor to a rural area for a temporary period is challenging because they must get licensed to practice in those areas, which can take months, and is “quite expensive and there’s a lot of bureaucracy involved,” Smart said.

“That’s often a barrier, especially for physicians that may be willing to go somewhere short term. It’s a lot of paperwork and cost that often just makes it unappealing and again, can make it challenging then to move people to where they’re needed.”

The CMA has proposed the idea of a pan-Canadian licensing program for health workers in Canada, especially doctors, to make working in Canada easier.

Smart took this idea to Canada’s premiers earlier this week during their first in-person meeting as first ministers since before the pandemic.

“We have to move away from being protectionist or competing with each other for scarce resources. That doesn’t really help our country as a whole,” Smart said.

“It’s something that could be done more quickly than other changes that need to happen. And I think we have to be willing to try new things if we want to get different outcomes.”

Tim Guest, CEO of the Canadian Nurses Association, says the registration process for nurses is the same and equally as onerous for Canadian-trained nurses to get registered in different provinces in Canada. Also, some provinces have added additional exams for nurses to take to have their registration from a different province recognized, he added.

His association has been advocating for a single nursing identifier, or a unique number for every nurse in Canada similar to a medical ID number, and better agreements between the provincial licensing colleges to improve the reciprocity of licensure to make mobility easier.

“The reality of it is, the health system is in a significant crisis and I don’t think there’s any way that we can move fast enough to deal with the pressures that it’s under and the pressures that the nursing workforce is currently facing,” Guest said.

But adding resources to colleges looking to streamline licensing requirements to make it easier for nurses to be more mobile in the country could be one solution, he said.

Ultimately, patients need timely access to health treatments, and the current health worker shortages are putting the health system under significant strain, which is why every possible solution is being pursued — including making it easier for those already in Canada who are trained and want to work in health care to get the credentials they need, Smart said.

“That would not solve our health workforce crisis in their entirety,” she said.

“But it would absolutely be helpful to make sure that we’re leveraging people that are here and making sure that they’re able to work in their trade area.”

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