Evidence of meeting #11 for Health in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was across.
A video is available from Parliament.
Conservative
Conservative
The Vice-Chair Conservative Dan Mazier
But please do not let this.... We have witnesses, and we have to get on with it.
Liberal
Doug Eyolfson Liberal Winnipeg West, MB
I understand. I just insist on responding. I will be quick.
First of all, my apologies for sending it “reply all”. The reference I made was not to denigrate any Catholic values. The reason I brought this up was that there has been a statement.... No denigration on the part of the organization, but I have been hearing, in the House, several petitions brought forward by the Conservative Party regarding a claim that our party wants to remove charitable status for religious organizations, which is untrue and which is included in the text of that. That is why I brought this up.
There is no denigration of this organization. There is no denigration of people who follow the Catholic faith. There is simply asking members to prepare for this particular point being brought up and giving clarification to the point.
That's all I had to say.
Thank you, Mr. Chair.
Conservative
The Vice-Chair Conservative Dan Mazier
Thank you, and thank you for being brief.
Thank you to the witnesses for being part of the study today.
We have three parties in front of us. From the Canadian Physiotherapy Association, we have Krissy Bell. From World Education Services, we have Shamira Madhany. From Catholic Community Services of York Region, we have Dr. Ali Amiri and Dr. Antanina Hulko.
We will start with Krissy Bell.
You have five minutes for your opening remarks, after which the floor will be open to questions.
Krissy Bell Chief Executive Officer, Canadian Physiotherapy Association
Thank you, Mr. Chair and members of the committee, for the opportunity to appear today on behalf of the Canadian Physiotherapy Association, which represents more than 30,000 credentialed physiotherapists.
Physiotherapists are first contact primary health care professionals. They are evidence-based, regulated practitioners who help Canadians recover from injury and illness, manage chronic conditions, and maintain mobility and independence. Our profession plays a key role in relieving pressure on the health care system, keeping people out of emergency rooms, shortening hospital stays and supporting faster recovery after surgery and faster return to work after injury. In the management and treatment of back pain, osteoarthritis and coronary heart disease alone, physiotherapy reduces the financial burden on the health care system by $232 million a year.
Over the last decade, the number of physiotherapists educated outside of Canada—what we call IEPTs—has grown steadily. In 2014, they made up about 14% of the workforce. Today, they account for nearly one in four, or 25%, of all practising physiotherapists in Canada. That's more than 7,600 individuals, and our numbers have been growing.
IEPTs are keeping physiotherapy services available and accessible to Canadians at a time of growing shortages. They help meet patient demand, particularly as the population ages and chronic conditions increase. They don't just fill jobs; they strengthen professional excellence.
Yet, despite this success, many internationally trained applicants still face long, complex and costly pathways to practice in Canada. It can take up to two years to become licensed, with fees approaching $2,000. That's just for the clinical assessment and does not consider bridging or language programs they may take to ensure their success.
As a partner, the CPA supports the ongoing work of CAPR, the Canadian Alliance of Physiotherapy Regulators. The alliance is making real progress by doubling exam sittings, digitizing credential assessment and launching a new pre-approved credentialing pathway to speed up recognition. However, system-level bottlenecks remain, and that's where federal leadership can make a real difference.
Supporting the integration of IEPTs through faster credential recognition bridging programs and targeted incentives will yield immediate and measurable results to both patients and the health care system.
On the domestic side, we have 15 accredited physiotherapy programs in Canada. We're very excited that we have one more in pre-accreditation. In 2023, these programs offered 1,166 student seats. About 950 students graduate each year, while 1,800 new positions open annually. The number of graduating students entering the system is simply not able to keep pace with population growth or labour demand.
Competition for a spot in one of the country's master's programs is fierce. Some programs receive over 1,000 applicants for their 60 or 70 seats. This large applicant pool results in some Canadians leaving the country to pursue training abroad. By helping those Canadians return to practice in Canada, Canada can expand its workforce quickly and cost-effectively.
It takes at least six years to become a physiotherapist, including both undergraduate and graduate education. Students graduate with average debt loads of about $40,000. That debt discourages many from practising in rural and remote areas, where Canada faces persistent shortages.
We were pleased to see the Liberal government's commitment to expand the Canada student loan forgiveness program to include physiotherapists. I would strongly encourage the committee to ask for an update on the status of this program, which was supposed to come into force this month. Thousands of students are eagerly awaiting an update.
Over the next decade, 18,700 job openings are expected in physiotherapy, driven largely by growth in demand for services and an aging population.
What can the federal government do? In the short term, fund CAPR's efforts to streamline credential recognition; provide grants and bursaries for Canadians trained abroad to return home and practise here; fund bridging programs that accelerate licensure, using successful provincial models, such as B.C.'s internationally educated physiotherapist bursary program; and incentivize rural and remote practice, expanding student loan forgiveness and similar programs to include physiotherapists.
In the long term, increase training capacity in Canadian physiotherapy education programs and strengthen workforce data and mobility frameworks to allow physiotherapists to move more easily between the provinces and territories.
In short, physiotherapy represents one of Canada's most underutilized solutions to our health care challenges. By investing in training, recognition and integration, we can grow a resilient workforce, improve access to care and deliver better outcomes for Canadians at a lower cost.
Thank you again for the invitation to appear today. I'm excited to answer your questions.
Conservative
The Vice-Chair Conservative Dan Mazier
Well done. That was right down to the second. That's impressive.
World Education Services is next, with Shamira Madhany.
Shamira Madhany Managing Director, Canada and Deputy Executive Director, World Education Services
Thank you, Chair and members of the committee.
My name is Shamira Madhany. I'm the deputy executive director and managing director of World Education Services, or WES for short.
On behalf of WES, I'm pleased to contribute to this important study on the impact of immigration policy on health care and the barriers preventing internationally educated health professionals from fully contributing to the Canadian health system.
WES is a not-for-profit social enterprise that has worked for over 50 years to support the educational, economic and social inclusion of immigrants, refugees and international students. Since 2013, we've been one of five organizations designated by IRCC to provide educational credential assessments for applicants under express entry, in support of the verification of international credentials. In health care, we work closely with system stakeholders and groups representing internationally trained professionals in medicine and nursing to address systemic barriers that prevent qualified immigrant professionals from obtaining licensure and working in their professions.
Chair and participants, health care systems across Canada are in crisis, facing a predicted shortage of over 117,000 nurses by 2030 and more than 20,000 family physicians by 2031. At the same time, thousands of internationally educated health professionals, or IEHPs, living in Canada are ready and qualified to help. Many are Canadian citizens or permanent residents. However, despite their qualifications, training and experience, almost half are not working in their professions.
The systemic barriers preventing IEHPs from becoming licensed to practise are well documented. Their underutilization carries profound economic and social costs. However, rather than focusing on the barriers, I would like to focus on the solutions.
Successful solutions that have a positive impact are being implemented across the country and across health care professions. However, these initiatives are unaligned and contribute to an increasingly fragmented patchwork of licensure processes, criteria and supports for IEHPs. Licensure outcomes therefore can depend on where a person pursues licensure.
The complexity of systems and stakeholders involved in this issue demands pan-Canadian, cross-departmental and multi-sector approaches. The effort to find and align solutions must be guided by federal leadership and involve collaboration across federal departments and between levels of government, as well as with regulatory bodies, health education systems, health care employers, organizations representing IEHPs themselves and non-government partners.
In order to achieve this, WES recommends that the federal government take a leadership role in developing a pan-Canadian strategy and a coordinating body. While provinces regulate professions, the federal government has a critical role to play in ensuring coherence, consistency and fairness across the country. The federal government should establish a permanent, cross-department, cross-jurisdictional mechanism to guide strategy, planning and alignment across immigration, health and labour portfolios.
This coordinating body would accomplish three key outcomes.
First, it would streamline and harmonize licensing pathways for IEHPs by developing national standards based on evidence and competencies.
Second, it would facilitate the establishment of federal frameworks to implement and expand proven best practices, including modernized registration processes, supervised clinical experience and assessment models, and career navigation supports tailored to specific occupations. It would also align immigration selection and licensing, ensuring that individuals invited through category-based selection in health occupations have viable pathways to licensure and practice in Canada.
Third, it would support advancing a comprehensive health workforce data strategy that includes information about IEHPs, enabling evidence-based health workforce planning, decision-making and evaluation.
Our written submission contains additional details, which I'd be happy to speak to during the question period.
In conclusion, the talent we need to solve many of our health care challenges is already in Canada and ready to contribute. The question is whether we can align our systems to recognize and mobilize it.
Thank you.
Conservative
The Vice-Chair Conservative Dan Mazier
Thank you.
Our last testimony will be from the Catholic Community Services of York Region.
I believe you're splitting your time. You have two and a half minutes each.
Ali Amiri International Medical Doctor, Catholic Community Services of York Region
Yes, we are.
International Medical Doctor, Catholic Community Services of York Region
Thank you.
Mr. Chair and honourable members, thank you for the opportunity to speak.
My name is Ali Amiri. I was born and raised in Iran. I ranked 12th out of 150,000 candidates on the Iranian national university entrance exam, trained as a physician and worked for over four years before completing a clinical Ph.D. in Europe. Eventually, I came to Canada as a post-doctoral fellow at the University Health Network, working in cancer research.
When I arrived, I faced a system that I didn't fully understand. The journey as an IMG is long, demanding and uncertain. Catholic Community Services of York Region, CCSYR, helped change that for me. In their free IMG support groups, I prepared for my exams. Today, I volunteer to support others.
CCSYR is a non-profit settlement and counselling agency that has been serving newcomer communities in York region since 1980. Since 2010, it has supported internationally educated health care professionals through study groups and mentorship, helping them to integrate and contribute to Canada's health care system.
Like many other IMGs, I've made Canada my home, and I am deeply committed to serving its people, yet despite our qualifications and dedication, IMGs still face barriers that prevent us from contributing to the system we care about so deeply.
Out of nearly 4,000 residency positions across Canada, only about 180 are open to IMGs in the first iteration this year. Today, 6.5 million Canadians lack access to a family doctor. Our emergency rooms are overcrowded because people can't access timely primary care. It's straining hospitals, providers and patients, a gap we could ease by licensing more IMGs.
In conclusion, I respectfully urge this committee to recognize the value IMGs bring, to promote fairness and transparency in policy and to expand opportunities for supervised training and residency across Canada. All I'm saying is that we are not outsiders: We are Canadians by choice.
Thank you for your time and consideration.
Antanina Hulko International Medical Doctor, Catholic Community Services of York Region
Thank you, Mr. Chair and honourable members.
I am Dr. Antanina Hulko. Before coming to Canada, I worked as a general surgeon at the Minsk Regional Hospital, performing hundreds of operations and training young doctors. For me, surgery has never been just about skill. It's about saving lives at the most fragile moments.
In 2020, I arrived in Toronto with the dream of continuing my medical career and giving back to the country that welcomed me. When the pandemic struck, I knocked on every possible door to help. Today, five years later, I still serve Ontarians, now at the Downsview Long Term Care Centre, caring for residents with dedication and compassion, but of course not as a physician.
Along the way, I have worked tirelessly to meet every Canadian medical standard, completing the MCCQE1 and the NAC OSCE and earning my LMCC certification. I was preparing to apply for residency in Ontario when, only weeks ago, the province announced a new policy restricting eligibility for the first round of the 2025 CaRMS match to internationally trained physicians who did not attend high school in Ontario. This decision has placed many of us in an impossible position.
Despite being a Canadian citizen living, working and paying taxes here for five years, I am now not eligible to apply for residency in the very province I call home. The rules changed midway through the process, after years of effort, investment and hope. Beyond personal loss, this policy also limits Canada's ability to respond to growing health care shortages. There are hundreds of qualified physicians already here, ready to serve, if only given the chance.
I stand before you not only as a surgeon but as a new Canadian who believes deeply in this country's values of fairness, opportunity and service. My journey from the operating rooms of Belarus to the long-term care homes of Toronto reflects both my gratitude and my determination to give back.
We internationally trained physicians are not asking for special treatment, only for a fair opportunity to contribute, to return to the operating room, to care for the patients who need us and to strengthen the health care system that has become our own.
Canada gave me a home. I am ready to give it my hands, my skill and my heart.
Thank you very much.
Conservative
The Vice-Chair Conservative Dan Mazier
Thank you.
We'll start with our first round of questioning.
We have Dr. Strauss from the Conservatives for six minutes.
Conservative
Matt Strauss Conservative Kitchener South—Hespeler, ON
Thank you, Chair.
Thank you, witnesses.
My questions today are for Dr. Amiri and Dr. Hulko. It was very moving testimony from both of you.
It sounds to me like you were both involved in specialist care in your home countries, or specialty training.
International Medical Doctor, Catholic Community Services of York Region
I was a general practitioner.
Conservative
Matt Strauss Conservative Kitchener South—Hespeler, ON
Oh, I see. Okay, in either case, I also gather that you both wrote the MCCQE.
Conservative
Matt Strauss Conservative Kitchener South—Hespeler, ON
It is the case, and this may be news to you, that the president of the Federation of Medical Regulatory Authorities came and spoke to us and said that, if an IMG had FRCPC from the Royal College, for specialists, or if the CFPC—I always struggle with that acronym—the College of Family Physicians of Canada gave them credentials, they would have no problem achieving provincial licensure.
Are you both allowed to write those exams right now?
International Medical Doctor, Catholic Community Services of York Region
I don't think so. To my knowledge, we are not allowed.
The journey I'm taking is through the CaRMS application to apply for residency, because I was not specialized in my home country.
International Medical Doctor, Catholic Community Services of York Region
I'm applying through CaRMS, and I think that the CaRMS journey is completely different.
Conservative
Matt Strauss Conservative Kitchener South—Hespeler, ON
Dr. Hulko, is that also the case for you, that you're not allowed to write the fellowship exam for general surgery in Canada?
International Medical Doctor, Catholic Community Services of York Region
Not really. I was a specialist back in my country. Potentially I would be eligible for this exam; however, unfortunately, we have a difference in the postgraduate education system that doesn't fit with the Canadian one, so residency is also my pathway.