Canada’s urgent healthcare worker shortage may be due in part to the lack of accurate data about internationally educated healthcare professionals who have moved here.
World Education Services, a nonprofit organization that provides credential evaluations for international students and immigrants planning to study or work in Canada and the U.S., says there are gaping holes in the data collected and shared about newcomers who were healthcare practitioners in their home countries.
Though current data shows nearly half (47 per cent) of internationally trained healthcare professionals are either underemployed or underutilized, a recent WES policy brief suggests the scope of the problem might be far larger.
“We simply don’t know how many IEHPs are in the country…how many successfully re-enter their careers, or how long it takes them to become licensed,” the brief, released this past March, states.
Caroline Ewen, co-author of the report, says Canada lacks a pan-Canadian, comprehensive data collection and sharing system about internationally educated health professionals.
“The different sources of data need to be linked effectively, and they need to be connected and speak to each other to inform an accurate picture,” she told New Canadian Media. “Right now … all sorts of different agencies and organizations are collecting small pieces, but they aren’t linked in a comprehensive way.”
This has led to alarming discrepancies between data collected at the federal and provincial governmental and non-governmental levels about the potential talent pool that actually exists. That’s an even bigger problem now, given the shortage of healthcare workers plaguing the country.
Having accurate data “underscores pretty much anything you would do if you want to make evidence-based decisions,” says Ewen, who is also WES’ manager of policy and advocacy.
“You need to be working from an accurate base of evidence, and right now we don’t have that to gauge the effectiveness of policies or programmatic interventions.”
Accurate data also affects budgeting and funding decisions, adds Joan Atlin, WES’ director of strategy, policy and research and a second co-author.
“In order to do a proper cost-benefit analysis and design and invest in the right solutions, we need accurate data,” Atlin says. “Without it, we can’t budget for and invest in solutions at the appropriate scale.”
Data Gaps
Immigration, Refugees and Citizenship Canada (IRCC) is one of the main federal agencies that collects data on newcomers’ intended occupations. Between 2015 and 2020, more than 24,500 healthcare professionals entered Canada and became permanent residents, IRCC says.
But that number only includes people who declared their intended occupation at the time of arrival. Since IRCC doesn’t collect that data systematically for all immigration streams, “other data sources tell a very different story about the size of the potential talent pool,” WES’ briefing note says.
For instance, in 2019, IRCC reported only 205 new permanent residents in Ontario declared nursing as their intended occupation.
However, the College of Nurses of Ontario (CNO) – an independent regulator created through provincial legislation – reported 4,500 new internationally educated nurses were pursuing professional registration that year alone – out of a total of more than 14,000 who are trying to get accredited for work.
The discrepancy, the brief explains, could be due to the fact that many of those nurses arrived as temporary workers (including through the caregiver immigration pathway). However, this is difficult to ascertain, says Ewen, as IRCC does not collect the educational qualifications of temporary workers or residents in a systematic way.
Additionally, Atlin says, data collected about the intended occupation of permanent residents is self-declared. Some people may opt not to declare if they believe it will negatively impact their immigration applications, thereby potentially blurring the actual figure.
In an emailed statement, IRCC spokesperson Rémi Larivière said “the number of permanent residents in any given year who declare an intended occupation is not directly comparable to the number of foreign nationals pursuing accreditation in the same occupation in Canada.”
The main difference, as per the email, is that the former is derived solely from the declaration on the permanent resident application, while the latter comes from “the full range of programs and pathways, including as students, temporary workers, sponsored family members, refugees, protected persons, etc.”
Gaps also exist in the College of Nurses of Ontario data, Ewen says. For instance, though the CNO reports to the Fairness Commissioner on fair registration practices, it doesn’t “clarify when those 14,000 began the registration process.”
Kristi Green, a CNO spokesperson, said in an emailed statement that the College registers nurses “who have the skills and competencies…to practice safely, whether they are educated in Canada or abroad.”
Additionally, she says, the College shares reports on their website and with “other organizations,” including “partners in the healthcare system,” though it does not have a data-sharing agreement with IRCC.
She says part of the College’s efforts to make its data available and transparent “includes looking at new-to-us organizations that might benefit from specific CNO expertise in this area.”
“What we have direct line of sight on is the number of applications open with CNO to seek registration in Ontario,” she wrote, adding that “you do not need to be living (in) Ontario or Canada when you apply.”
She also said the College is modernizing its registration practices, which included launching the Supervised Practice Experience Partnership (SPEP) earlier this year with Ontario Health.
The program provides current applicants registering to become nurses an opportunity to participate in a work experience to help complete evidence of practice and language proficiency requirements.
Ethical obligations
The WES brief recommends collecting educational background and intended occupation for all classes of immigrants, including those who transition from temporary work/study permit to permanent residence or citizenship status. It also recommends standardizing reporting processes for occupational regulatory bodies.
Ewen says a government or at-arms-length government agency should be the “main player…coordinating and implementing a data strategy.”
The idea is “having government oversight towards a centralized body that can actually design and implement an actual strategy for how all these different pieces could be interconnected, and bring together the different players who are already doing this in very disparate ways,” she says.
This echoes recommendations from a separate study earlier this year looking at Canada’s ethical obligations of recruiting IEHPs. The study found “Canada has neglected health workforce planning issues and lacks basic information” about the supply, demand and diversity of its workforce, and suggested improving the “quality and co-ordination of data collection and utilization through enhanced Federal government oversight.”
Atlin says until the system can offer IEHPs “a pathway back to their profession,” it will only continue “creating problems rather than solving” them.
In April, the Canadian Medical Association and Canadian Nursing Association sent a briefing to the House of Commons Standing Committee on Health identifying the creation of a Data and a National Workforce Agency as one of eight policy pillars to alleviate the health human resources crisis. This included committing $50 million over four years to first enhance health workforce data standardization and collection processes across provinces and territories.
The Canadian Health Workforce Network has also made a call to action “for better planning, better care and better work through better data.” Seventy experts have signed on behalf of a professional medical organization, and an additional 326 medical experts have signed on as individuals.
“I think the desperation of a shortage right now, and the understanding that a program here and a program there and a little investment here and a regulatory tweak there is not going to solve this problem,” Ewen stresses. “It needs to be a holistic, systematic, systemic solution.”
