Thank you, Madam Chair and members of the committee.
My name is Amber McPherson. I'm a U.S.-trained, board-certified emergency medicine physician with 12 years of experience prior to moving to Ontario earlier this year.
I came to Canada because I was increasingly frustrated by practising in a system where patients are routinely bankrupted by life-saving or even routine medical care. I wanted to work in a country where access to basic health care is a right, not a privilege.
I'm not alone. Many U.S.-trained physicians feel this way, especially recently. A growing number of American physicians are seeking to leave a system where evidence-based medicine is becoming increasingly politicized. We want to practise in countries where science, equity and public health are supported not only by professional organizations, but by government policy. Canada, as our nearest neighbour, is a natural first choice.
Unfortunately, Canada's licensing and immigration processes are so burdensome, disorganized and inconsistent that many physicians give up before even arriving. In my own case, I spent months in back-and-forth communications with British Columbia's licensing bodies, trying to determine whether I qualified for a licence. I had connections on Vancouver Island and a likely job offer, but the answers I received were inconsistent and ultimately inconclusive. I eventually shifted my attention to Ontario, where I was finally able to obtain my certificate to practise.
Once licensed, I was able to secure a job almost immediately, and I chose to join the Waterloo Regional Health Network, where I am happy practising today.
Like any immigrant, I hope to obtain permanent residency to reduce long-term uncertainty and build a stable future in Canada, but the pathway is far from straightforward. For example, Ontario has a provincial nominee program with a specific stream for physicians, yet the program currently excludes most U.S.-trained specialists.
The issue is a terminology mismatch. The College of Physicians and Surgeons of Ontario issues what is called a “restricted certificate” even though it allows full independent unsupervised practise with no time limit. The only restriction is that we must practise within our specialty—in my case, emergency medicine.
Why would the provincial nominee program create a pathway for physicians that is effectively inaccessible to nearly all immigrant physicians? It's almost certainly unintentional, but it represents a significant and unnecessary barrier for physicians who simply want to live, work and contribute permanently in Canada.
This reflects a broader pattern across the country. Regulatory bodies, immigration programs, provincial ministries and federal frameworks operate in silos. Their requirements do not align and internationally trained physicians get stuck in the gaps.
Until I obtain permanent residency, my legal status is tied to a single work site, preventing me from providing locum coverage elsewhere. Locums are an effective way to support rural and remote communities. Many physicians, including me, enjoy providing part-time coverage in high-need areas, but delays in immigration status limit our flexibility, as does the lack of reciprocity between provincial licensing bodies.
It's important to emphasize that the clinical differences between the U.S. and Canada are minimal. We follow the same science and evidence and similar standards of care, yet licensure pathways vary dramatically between provinces, and the process can be opaque even within a single province. Several of my colleagues in the U.S. are interested in practising in Canada but cannot obtain a clear answer about eligibility.
In contrast, in the U.S., while licensing is state-based, the criteria are transparent. If you meet objective requirements and have no history of misconduct, you know you will qualify before you invest extensive time and money in the process of applying. Given the rigorous standards of U.S. medical training and board certification, there's no reason why Canadian provinces should not implement reciprocal or streamlined licensing for most specialties.
For all of these reasons, I strongly support national licensure standards and a more coherent, streamlined pathway to permanent residency for internationally trained physicians, particularly those from equivalent training systems like the United States.