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 1990.

• Sixty-one percent of working age immigrants who arrived after 1990 held trade, college, or university credentials.

Immigration to Canada

Migrant stock as percentage of the populationin selected countries, 2000

0

5

10

15

20

25

30

Australia Canada U.S.A. France Germany UnitedKingdom

Italy

%

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