Human Resources Committee on Oct. 25th, 2011
Evidence of meeting #7 for Human Resources, Skills and Social Development and the Status of Persons with Disabilities in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was program.
A recording is available from Parliament.
On the agenda
- Jonathan Beddoes Dean, Faculty of Engineering, University of Manitoba
- Peter Idahosa President, Alberta International Medical Graduates Association
- Pam Nordstrom Director, School of Nursing, Mount Royal University
- Joan Atlin Director of Programs, Toronto Region Immigrant Employment Council
- Thomas Tam Chief Executive Officer, SUCCESS
October 25th, 2011 / 3:30 p.m.
The Chair Ed Komarnicki
I call this meeting to order.
We have presenters from the University of Manitoba, the Alberta International Medical Graduates Association, and Mount Royal University. The presentations are to be between five and ten minutes, and then there will be rounds of questioning of five minutes. We ask you to respect that time if you can and not read overly quickly, because it's a bit difficult for the interpreters.
We'll start with the University of Manitoba and Professor Jonathan Beddoes. Go ahead.
Professor Jonathan Beddoes Dean, Faculty of Engineering, University of Manitoba
Thank you very much.
Mr. Chair, honourable members of the committee, thank you for giving me the opportunity to present to you this afternoon.
About ten years ago Manitoba embarked on a strategy to increase immigration to Manitoba from the then current 3,000 to 10,000 immigrants annually by 2007, with a deliberate focus on professionals. To assist this endeavour, Manitoba was the first province to introduce the provincial nominee program of Citizenship and Immigration Canada to target and fast-track immigrants who hold qualifications in high demand. The 2007 target of 10,000 new immigrants was achieved with about 70% through the provincial nominee program, and in 2010 nearly 16,000 immigrants came to Manitoba.
As part of this endeavour Manitoba Labour and Immigration alerted professions to the new immigration strategy and encouraged the development of licensing pathways for new Canadians. The engineering profession was singled out as being punitive to internationally educated applicants. Consequently, the University of Manitoba and the Association of Professional Engineers and Geoscientists of Manitoba began to consider ways to encourage applications from internationally educated engineers.
Provincial engineering regulators have always provided a pathway for internationally educated engineers to become registered as professional engineers in Canada through the completion of confirmatory technical exams assigned by the provincial regulator. This pathway often requires three to five years and has a high attrition rate, due to the fact that it tends to be completed in isolation, with little or no support from or contact with other engineers. Given the problems of this process, some internationally educated engineers chose to repeat the entire four-year engineering program at a Canadian university at considerable cost, or leave the profession altogether
Many engineering immigrants to Canada face several challenges. First, many are not familiar with the concept of a regulated profession and the legal requirement for registration to practise the profession, since in many countries the university degree in engineering confers both the right to title and practise. Second, once they understand what the licensing and registration process entails, they often find it punitive and may not have the financial wherewithal to spend three to five years getting their qualifications recognized. Third, without professional recognition, finding an engineering job becomes extremely difficult, but because Canadian engineering experience is required for licensure there's a chicken-and-egg paradox. Fourth, language and communication abilities are frequently insufficient.
The internationally educated engineers qualification program at the University of Manitoba is designed to address these challenges. The objective is to provide an alternative process of equal validity and rigour to the confirmatory exams, but with a higher completion rate in a one- to two-year timeframe. In addition to confirming academic qualifications, additional objectives are to incorporate a labour market component that provides critical assistance in finding that first engineering job, and provide language development and cultural orientation for participants.
The IEEQ program at the University of Manitoba is operated in close collaboration with the Association of Professional Engineers and Geoscientists of Manitoba, the provincial regulator. To enter into the program the engineering background of participants is first assessed by the provincial regulator to identify the engineering disciplines in which confirmatory exams are required. But instead of undertaking these exams, participants take corresponding senior-level undergraduate courses at the University of Manitoba. Successful completion of the normally four to ten courses required is used to confirm their technical background.
In addition to these course requirements, the program contains four additional important elements. First, a co-op work experience term in a local engineering industry gives Canadian engineering experience and helps build a professional network. Second is orientation to the culture of Canada and the culture of professional engineering in Canada. Third is professional networking opportunities within the university and the engineering community. Fourth is development of English language and communication skills. All components of the program are critical to participants gaining professional recognition and success in the Canadian engineering workplace.
The IEEQ program was introduced on a pilot scale in 2003, with up to 12 participants annually and funding from the Province of Manitoba. The program became permanent in 2007. This permanency has allowed enrolment to climb to 35 to 40 participants each year. Concurrently, the University of Manitoba approved an associated post-baccalaureate diploma that provides graduates with an academic credential, in addition to the professional credential.
IEEQ program participants have arrived from 30 countries, the top five being the Philippines, Ukraine, India, China, and Pakistan. Participants are generally between 30 and 45 years old and usually have spouses and children. About 25% are women.
All participants have a previous bachelor-level engineering degree from their country of origin, with three to twenty years of engineering experience prior to arrival in Canada, but rarely do they have any Canadian engineering experience. There are currently 45 participants enrolled in the program. All 86 graduates to date have registered with the provincial regulator as engineers in training. About 90% of the graduates have developed engineering careers, most often facilitated by the co-op work experience component of the program. Through a one- to two-year investment in the program, graduates move from low-paying jobs to engineering positions, resulting in a huge impact on the well-being of the participant and their family. Furthermore, the tax advantage to Manitoba and Canada is significant, with the government investment in funding the program paid back by participants in three or four years as they move from a low to a higher level of income and taxation.
Many immigrant agencies serve and offer support to internationally educated engineers, most often in the form of language and communication development, cultural training, professional job shadowing, or volunteer opportunities. Rarely, though, do these initiatives meet the licensing requirements as does the IEEQ program at the University of Manitoba.
The success of this program at the University of Manitoba has spawned several similar programs elsewhere. Ryerson University in Toronto began a bridging program a few years ago. In 2010 the University of Saskatchewan, University of Regina, and the Association of Professional Engineers and Geoscientists of Saskatchewan began collaborating to provide a similarly structured program that includes cultural orientation and co-op work experience. In Manitoba beginning in 2008, the agrology profession also established the internationally educated agrologists program, a partnership between the University of Manitoba and the Manitoba Institute of Agrologists, which was modelled after the IEEQ program.
In 2009 there were 155 applications to the Association of Professional Engineers and Geoscientists of Manitoba from internationally educated engineers. There were nearly 2,000 such applications to Professional Engineers Ontario. Nationally 36% of applicants for professional engineering licensure in 2009 were immigrant engineers. For these immigrant engineers to realize their full potential and fully contribute their skills to the well-being of the Canadian industry and society there must be an expeditious, efficient, and effective process so they can become professional engineers in Canada. However, the program at the University of Manitoba accepts about 30 new participants each year, only a fraction of the 155 applicants. Likewise, the capacity at Ryerson is only a small fraction of the nearly 2,000 applicants.
It is clear that the success of the Internationally Educated Engineers Qualification Program at the University of Manitoba provides real benefits to the individual, the engineering profession, the province of Manitoba, and Canada. It more than halves the time for internationally educated engineers to enter the Canadian engineering profession. Accordingly, governments at all levels should endeavour to make resources available to allow this and analogous programs to expand to meet the existing and growing demand.
Mr. Chair, thank you very much for the opportunity to present this program to the committee this afternoon.
The Chair Ed Komarnicki
Thank you for that presentation.
Go ahead, Dr. Idahosa.
Dr. Peter Idahosa President, Alberta International Medical Graduates Association
Thank you, Mr. Chairman.
Honourable members of the committee, it's a special privilege to be here to give this presentation, because sitting before you is a true product of today's topic. I'm a physician currently working in the Foothills Hospital in Calgary, Alberta, the Peter Lougheed Centre, as well as the Rockyview General Hospital under a special licence, a “supervised licence”, despite the fact that I was trained as a family physician and have between 14 and 16 years of experience as a family physician in South Africa.
The Alberta International Medical Graduates Association that I represent is a manifestation of what exactly is going on today. We consist of doctors trained or educated in countries other than Canada. It includes individuals and organizations interested in the various challenges facing international medical graduates in Alberta. The most challenging obstacle is having our members' foreign qualifications recognized by the College of Physicians and Surgeons of Alberta. It's a similar situation across Canada.
It is well publicized that within Canada there is a huge shortage of family physicians. Approximately five million Canadians do not have access to family physicians, which is very sad. International medical graduates account for only approximately 25% of physicians in Canada. Despite the growing physician shortages, IMGs continue to be an underutilized resource by the strained Canadian medical system.
Addressing this perennial dilemma has been an uphill battle. The sole reason is due to the provincial regulatory bureaucracy constantly devising various means, in a selective and biased manner, to limit recognition of the foreign qualifications of several immigrants who have settled in Canada.
The general misperception and misinformation in the public is that these IMGs have inferior knowledge and skills compared to graduates of Canadian medical schools. However, a direct comparison study done by Andrew Moran compared 24 IMGs with 21 Canadian medical graduates in a family practice residency program in 2006 and 2008 at St. Paul's Hospital in Vancouver. It showed that IMGs and Canadian graduates had similar results in evaluation reports. The results of these in-hospital training evaluation reports indicated that IMGs are seen by their teachers as competent physicians. Consequently, in clinical practice there are no valid statistics at the moment to show that IMGs are not proficient in patient care.
The Canadian government's pan-Canadian framework for the assessment and recognition of foreign qualifications shows that within one year an individual will know whether their qualifications will be recognized, be informed of the additional requirements necessary for registration, or be directed toward related occupations that are commensurate with their skills and experience.
For IMGs, the assessment and recognition process can take many years--sometimes from 10 to 15 years. There may be cases where it is not appropriate or practical to come to a licensing decision within one year. However, exceptions should exist, such as where an IMG, as a newcomer, requires an extended practice-based or workplace-based component to their registration process to continue. The foreign qualification recognition process may seem fair, transparent, and timely, but it is inconsistent across Canada, and marred by bureaucratic bottlenecks.
My first recommendation is to have a simplified system of assessment. It should be realized that cases involving well-known qualifications should be treated in a simpler way. If the recognition authority reaches the conclusion that recognition cannot be granted in accordance with the applicant's request, alternative or partial recognition should be considered to facilitate integration of IMGs into the Canadian medical system. Recognition bodies should take an active role in specifying the steps needed to be taken by IMGs through clear, coherent, objective, and unambiguous pathways, to enable them to get their qualifications recognized.
My second recommendation is standardization. The ruling medical authorities, as well as the provincial bodies, should consider forming a partnership with the Alliance of Credential Evaluation Services of Canada, national information centres, and other assessment agencies. These centres should publicize standardized information on the processes, procedures, and criteria of the assessments used for foreign qualifications for specific professions, especially foreign-trained physicians. This information should automatically be given to all, as well as any persons making preliminary inquiries about the assessment of their foreign qualifications. This currently does not exist.
Third is timelines. The untimely process in the evaluation of qualifications causes a delay in IMGs entering the medical system. In addition, this slow process causes IMGs to have further distance from their medical skills. A specified timeline should be given to applicants and adhered to by all regulatory bodies. Applications should be processed as promptly as possible, and the processing time should not exceed three months.
Fourth is educational credits. Each academic year of study, as recognized by the official designated authority in the country of origin, should be granted as at least one academic year of recognition within Canada. That doesn't exist now.
Fifth is the availability of recognized funding for clinical transition programs. The current limited opportunities for foreign-trained doctors to obtain clinical experience through recognized externship, hands-on hospital experience, and continuing medical education programs for IMGs to complete any theoretical or clinical skills deficits have to be addressed. These CME programs will help IMGs become familiar with the Canadian medical system and gain educational credits, while maintaining their certification. This could be achieved through more funding, either as grants or loans directly to IMGs. Most of these IMGs are either permanent residents or citizens at the moment.
Seven, a one-stop shop for foreign qualification recognition is highly advocated. It would be helpful to deal with one regulatory body, and for applicants to understand the full menu of options from the onset. The application procedures should be expedited. There should be a single enhanced written test, and one practical clinical examination instead of the current myriad of multiple tests that are so varied and confusing. At the end of the day, they do not guarantee a licence or recognition of qualifications.
Increasing the residency training positions, or having well-defined practice assessment programs to avoid backlog, with the aid of clarity of direction from this one-stop centre would be most helpful.
Finally, a pre-qualified pool system, whereby applicants are pre-screened and pre-qualified by the regulatory authority before immigrating to Canada, would be an added advantage. We recommend advancing the timing of foreign qualification recognition in the immigration process.
With this and the many other recommendations I've handed in, I want to thank you for your time for listening. I look forward to a very fruitful deliberation today.
The Chair Ed Komarnicki
Thank you, Dr. Idahosa.
We will move to Ms. Nordstrom. Go ahead with your presentation, please.
Dr. Pam Nordstrom Director, School of Nursing, Mount Royal University
I believe you have copies of my presentation.
The Chair Ed Komarnicki
All right. Go ahead.
Director, School of Nursing, Mount Royal University
Mr. Chair and honourable members of the committee, thank you for the opportunity to tell you what we've observed regarding assessments of internationally educated nurses.
I'm here as director of the School of Nursing at Mount Royal University in Calgary. One of my responsibilities is to work with internationally educated nurses. I do want to clarify, though, that I'm not here representing the Alberta nursing regulators.
Over the past six years we've taken some good directions based on the recommendations that were described in a document called “Navigating to Become a Nurse in Canada”. However, we're clearly experiencing a nursing shortage, and our successful initiatives are being taxed by the number of people accessing our services.
Although our initiatives have been very successful in where we've come from in the last six years, we are unable to track and to speak to outcomes.
I'm going to provide you with my recommendations first and then proceed to explain why I've identified these points and how they link to the funnel that's on top of that slide.
We need to support data-sharing to improve understanding of IEN recruitment and retention patterns; we need policies to support stakeholder collaboration to improve flow through the funnel, which I'm about to explain; we need sustainable recruitment plans of international nurses; we need to build databanks of assessment tools and incorporate intelligent technologies; and we need to measure outcomes along the funnel.
Mount Royal has had considerable experience in pioneering initiatives for internationally educated nurses over the past decade. I won't take time to describe each of our studies, but I've presented the ones we've received funding for under the slide “IEN initiatives at MRU”. Our learnings from these initiatives are the basis for my comments and recommendations.
What have we learned?
We've chosen to use a funnel to describe the recruitment and retention flow, at least from our perspective. The reason we want to use a funnel was that it showed that a much larger number of IENs start the process than actually end up working. However, the shape of the funnel isn't perfect, in that it doesn't show proportions, if we used the analogy “leaks”, of where the leaks might be in our funnel.
The different stages in the funnel are essentially sequential. IENs, who either refer themselves or are brought through the recruitment process through a formal agency recruitment, contact the professional regulator, and if the professional regulator is unable to determine, by paper documentation, that they have the competencies to enter practice in Canada as a nurse, they'll refer them to Mount Royal, where we do an assessment of their skills and competencies. I'll speak to that in just a moment.
A report on their assessment is referred to the regulator, who then determines if they need a bridging program. And once they've completed the bridging program they move on to write the national exam and then move into the workplace.
At each phase of that funnel, IENs may choose to continue or they may to choose to step out and come back later. And certainly the push and pull factors in the context they live in are at play in terms of immigration or family needs, but we haven't identified those in the funnel specifically.
Our experience over the past five years certainly indicates that the countries of origin impact the number of people who are coming through that funnel. Currently, 75% of all internationally educated nurses who apply to our regulator, the College and Association of Registered Nurses of Alberta, are referred to us for further assessment. Just over half of those who are asked to contact us actually do. And once they've contacted us, just over half of those proceed.
Approximately 200 IENs come through each year, and we've assessed over 1,200 IENs in the past five years. Of those who are required to go through the assessment process, 70% are required to do remediation. That may sound high, but remember, the IENs who are good to go, so to speak, who have met the requirements, don't come to our assessment centre.
We've also learned that our assessment strategies must be comprehensive to reflect the complex nature of our practice. So we have a series of tests. Certainly language and communication are a challenge, and the regulator requires that all English language requirements be done prior to their assessments. Partnerships with regulators, government, and employers are essential for this process to work.
The purpose of an IEN assessment is twofold: to assess IEN competencies that aren't evident in their paper documentation to the regulator, and to provide IENs an opportunity to demonstrate their capacity for practice as a Canadian nurse. We use a constellation of tools and it takes one to four days depending on the nature of the assessments required. We've benefited greatly from our provincial government grants that fund centres in Edmonton and Calgary. The average cost, based on our studies, is about $1,000 per assessment. IENs need anywhere from one to four assessments, so it's an average of $4,500 per IEN. But the candidate does not have to bear those costs. It's important to know that we report to the regulator what our assessments are and the regulator makes a decision on what bridging is needed.
We have a program called “Bridge to Canadian nursing”. Once the assessments have been done and the IEN is needed or requires some bridging, she can apply to the program. We have eight courses they can take, but they take only what they need, and they bear the cost of this tuition. We've noticed that the average course-taking has gone up over the past couple of years, but that also reflects the countries of origin from which recruitment's been occurring. Of IENs who engage in this part of the process, 95% complete their studies.
We are seeing many IENs, but because of the limited information that flows through the funnel, we can't speak definitively about the yield to the workforce or outcomes. We know there are leaks and losses within that funnel. We don't know the scope and magnitude of those losses, because of the limitations on information-sharing across the system of stakeholders, so we're unable to measure our flow-through in concrete outcomes and costs. We know IENs sometimes get lost in that funnel, and we don't know the reasons for this, although we have many anecdotal pieces of information.
In summary, I go back to the recommendations I presented at the beginning. Assessment and bridging courses are critical tools for access to the RN profession. But we need the ability to track so we can use a unique identifier that started with IENs at the beginning of the funnel and followed them all the way through. This would help us to get accurate information and a strong sense of outcomes. It would help us to understand why the IENs are leaving the system.
We need coordinated, regular engagement by all stakeholders and at all levels of the government to coordinate policy development that makes sense to those who are implementing it and actually improves the situation for IENs. We need sustainable recruitment plans so that stakeholders and resources are aligned and sufficiently nimble to be able to manage the expansion and compressions of recruitment.
The processes we've developed for assessment, at least in the western provinces and in collaboration with Nova Scotia, are serving IENs and regulators well, at least better than they were when the “Navigating to Become a Nurse in Canada” document was written in 2005. But we need to invest in databases of assessment tools and use intelligent technologies that make these tools accessible to IENs and the assessors while still maintaining security.
The Chair Ed Komarnicki
Could I get you to wrap up as quickly as you can, perhaps with a summary?
Director, School of Nursing, Mount Royal University
And we need to support measurements of outcomes.
Thank you, Mr. Chair, for the opportunity to make this presentation.
The Chair Ed Komarnicki
We'll open it up to rounds of questioning. Perhaps if you've not gotten everything into your spoken portion, you can deal with it then.
We'll start with Ms. Hughes.
Carol Hughes Algoma—Manitoulin—Kapuskasing, ON
I have a couple of questions.
This will be for anybody who wants to jump in, but this is specifically for you, Mr. Idahosa.
When I'm looking at this, it says, “In 2007, IMGs represented about 23% of the total physician workforce, a decrease of 33% from the late 1970s.” There's been a decrease, and I'm wondering if you have any idea what has contributed to the decrease.
President, Alberta International Medical Graduates Association
Thank you, Ms. Hughes.
I think the reason the decrease has been like that is because right across the border, in the U.S.... When I discussed it with a number of colleagues, most of the provincial regulatory bodies impose all these barriers and difficulty. Why do you want to sit in a place? You come to Canada. This is a home. You've got this feeling, and it's a nice place.
But do you sit, for five, ten years, trying to get a licence as a physician. You were at home working as a physician, and you come to Canada and you're driving a taxi cab or you're working at Walmart. You could go across to the U.S. and write the U.S. MLE exam, and in under a year, two years, you'd become a certified physician working in a hospital—a defined pathway.
Because of the discouragement, a lot of people have moved out. Some of them have lost dreams, fallen by the wayside and decided to do something else. I know some physicians who have given up because of what's going in. It has been very frustrating.
That is the reason the trend is falling. A lot of people are losing hope.
Carol Hughes Algoma—Manitoulin—Kapuskasing, ON
To add to that, when they go across to the United States are they recognized in any state?
President, Alberta International Medical Graduates Association
The U.S. has a standard process, one pathway; they call it the ECFMG. You put in your certificate, they assess it, then you write the exam. It's a three-stage exam. It's one pathway. Truly, that is ECFMG.
After you finish the exam, you now decide which state you have to go to. It's a clearly defined, very easy, straightforward simple process. It's not what we have here, that you go from one province to the other and it's a different ball game.