Are immigrants the solution to Canada’s health-care worker shortage? Q and A with a Laurier nursing migration expert

In recent months, news headlines have been dominated by concerns of labour shortages in Canadian health-care systems. For insight and analysis, we spoke to Margaret Walton-Roberts, a professor of Geography and Environmental Studies at Wilfrid Laurier University.

Walton-Roberts’ research focuses on the global migration of nurses. She is currently leading the Global Nurse Migration Pathways project, funded by the Social Sciences and Humanities Council of Canada, which is comparing three distinct migration models to establish international best practices. Her latest book is titled Global Migration, Gender and Health Professional Credentials: Transnational Value Transfers and Losses.

We keep hearing in the news that we have a shortage of health-care workers in Canada. What factors have created this issue?

We don't really know how many health-care workers we have across the country. We have 13 completely different health-care systems, and we don’t have very effective health workforce data to understand trends like inflows and outflows. This raises many questions. Are we training enough medical professionals? Are we making the job attractive enough to retain the ones we have trained? When we bring professionals into our country, are they being effectively integrated into the health-care system? 

We are in a pandemic and health-care workers are burnt out, and they are leaving because they’re unhappy with how things have been going. It’s a very challenging job and it's not made any easier when it's constantly in the crosshairs of austerity. The quick fix has been, “We'll just import some more health-care workers, or we'll just work short-handed,” and I think we've pushed it too far.

How does gender play into this issue?

Gender is a big deal because more than 75 per cent of health-care workers around the world are women, and yet they tend not to hold the senior leadership positions in the occupation. Caring professions are generally undervalued because they are heavily feminized. We always think of them as a cost, not an investment. 

What sort of barriers do internationally educated health-care workers face when they come to Canada?

The main barrier is having their credentials recognized. The majority of health-care professions in Canada are regulated, meaning that there is usually some kind of body that controls licensing and recognition. Since the 1980s, the federal government has been providing funds to professional regulators to encourage them to streamline their systems. And now in Ontario, we have provincial fairness commissioners, or ombudsmen, who are overseeing the process of recognition for foreign-trained professionals, asking for it to be fair, transparent and objective, and that the fees charged are only enough to recover costs.

Has recent media coverage of this issue resulted in any regulatory change?

The provincial government is working with regulatory agencies to figure out what can we do to address this backlog. Ontario has introduced a supervised practice experience partnership model where you can hire a nurse whose credentials haven’t been fully approved yet and they can start working under the supervision of the employer. At the end of their work period, the employer can say, “Yes, they meet the safe practice and communication requirements.” And that’s it. Then the nurse is granted their license and can be hired. That has been a successful strategy so far.

Historically, the preeminent concern for regulatory agencies has been public safety. They need to protect the public by making sure the person who has the credential can do what they are supposed to do. But now they are recognizing that they also play a role in labour market entry, and they have a responsibility to make their processes as efficient as they can.

You recently wrote about the ethical considerations of health-care worker migration. What are Canada’s obligations as a destination country?

Canada has an active immigration policy and people come here under all kinds of different migration categories. Every year, thousands of those immigrants will have health-care training from their home country, and I believe we have an ethical obligation to utilize their skills to the best ability that we can. If we are taking them from countries that possibly have a health-care worker shortage of their own, we can't just let those skills go to waste. They may not necessarily go into exactly what their previous occupation was, but we need to identify opportunities for them to enter a relevant alternative career. And we need to create career laddering opportunities.

Canada signed the World Health Organization's Global Code of Practice on the International Recruitment of Health Personnel, and the spirit of that code is that we need to protect the ability of all countries to meet the needs of a universal health coverage approach. We need to have better bilateral agreements that manage the global migration of health workers and provide partner countries with some benefit from these movements so that these countries do not send workers to Canada at the expense of their own health-care systems.