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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
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
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