Public Policy and Regulation Robert Shearer, Director Health Human Resource Strategies Division Health Canada

Today’s Presentation Objective: to use the example of international medical graduates (IMGs) to illustrate how public policy influences regulation in Canada

Agenda Canadian Overview Regulation in Canada Canadian Demographics and Immigration Case Example: IMGs

Canadian Overview Canada consists of a federation of 10 provinces and 3 territories.

Regulation in Canada Authority to regulate professions is derived from the Constitution Act, 1867 which gives this exclusive right to the provinces and territories. Regulation varies across jurisdictions.

Regulation in Canada Regulation of professions takes the form of restrictions on entry-to-practice coupled with rules of conduct. The majority of health professions in Canada are granted self-regulatory powers.

Canadian Demographic Trends Our domestic supply of workers will not meet future labour force demands. All net labour force growth will come from immigration within 10 years. Immigrants coming to Canada are better educated now than those who came before Sixty-one percent of working age immigrants who arrived after 1990 held trade, college, or university credentials.

Immigration to Canada Source: United Nations, International Migration Report 2002, New York, 2002

Immigration and Population Growth in Canada

International Medical Graduates (IMGs)

Physician Shortage All levels of government in Canada recognize the need to deal with the physician shortage issue. Increases in medical seats require time for the effects to be seen in physician supply. There are a number of IMGs resident in Canada who are experiencing difficulties in achieving licensure.

Federal Commitment The 2001, 2002, and 2004 Throne Speeches committed the Government of Canada to work with all partners and stakeholders to position Canada as a destination of choice for immigrants, and to break down the barriers to integration. The 2003 and 2004 Federal Budgets pledged support for the integration of skilled immigrants into the Canadian labour market.

IMG’s Role in Canada There are approximately 60,000 physicians practicing in Canada. Traditionally, the proportion of IMGs in the workforce has ranged from 20% to 30% Currently, 23% of Canada’s physician supply is IMGs. In some jurisdictions, the proportion is as high as 50%.

Policy Impact on IMGs Federal Level –Citizenship and Immigration Canada –Health Canada –Human Resources and Skills Development Canada –Finance Canada All Provincial and Territorial Governments

IMG Entry-to-Practice IMGs face numerous challenges in attempting to enter the supply of practising physicians in Canada. Many are unable to obtain licences to practise due to: –Lack of required preparation, knowledge, and skills; and –Inability to confirm or demonstrate their skill levels due to tight workforce policies, limited access to assessment and/or training opportunities and lack of support to understand licensure requirements.

IMG Taskforce The federal, provincial and territorial Advisory Committee on Health Human Resources created the Canadian Taskforce on Licensure of IMGs. The Taskforce’s objective was to provide recommendations to facilitate licensure. The Taskforce provided six recommendations for implementation.

Recommendations The recommendations were as follows: 1.Increase the capacity to assess and prepare IMGs for licensure; 2.Work toward standardization of licensure requirements; 3.Expand or develop supports/programs to assist IMGs with the licensure process and requirements in Canada;

Recommendations Cont’d 4.Develop orientation programs to support faculty and physicians working with IMGs; 5.Develop capacity to track and recruit IMGs; and 6.Develop a national research agenda, including evaluation of the IMG strategy. It would include the evaluation of the IMG licensure recommendations and the impact of the strategy on physician supply.

Government Activity Citizenship and Immigration Canada, Human Resources and Skills Development Canada, and Health Canada, in collaboration with provincial and territorial governments, have begun implementation of the Taskforce recommendations

Government Activity Several projects are currently under way for the implementation of the Taskforce’s recommendations. Three million dollars has been allocated for assessment of IMGs to provinces and territories.

Ongoing Challenges A large number and variety of players with unique challenges across various jurisdictions Employer community insufficiently engaged on the need for immigrant labour market integration Limited data on future labour demand and supply High expectations among all stakeholder groups for quick progress

Thank You