Health Committee on Oct. 23rd, 2025

[The Chair, Liberal, Hedy Fry]

Good morning, everyone. I apologize for being late.

I call this meeting to order.

Welcome to meeting number seven of the House of Commons Standing Committee on Health.

We recognize that we meet on the unceded territory of the Algonquin Anishinabe peoples.

Today's meeting is taking place in a hybrid format. Most of our witnesses are online. I will have to, for their sake, reread all of the instructions that you know by heart now.

I'd like to remind participants of the following points.

Please wait until I recognize you by name before speaking. For those participating by video conference, click on the microphone icon to activate your mic and please mute yourself when you are not speaking.

At the bottom of your screen, you can select the appropriate channel for interpretation: floor, English or French.

I'll remind you that all comments should be directed through the chair, not directly to the person you wish to speak to.

For members in the room, if you wish to speak, please raise your hand. On Zoom, please use the “raise hand” function.

The clerk and I will manage the speaking order as best we can, based on whose hand we see first. We appreciate your patience and understanding in this matter.

Pursuant to the motion adopted on Tuesday, September 23, 2025, the committee shall commence the study on the impact of immigration policy on health care and barriers to integrating internationally trained professionals.

I want to welcome our witnesses.

Please note that each witness has five minutes to present. That five minutes is for your organization, so if there are two of you who wish to speak, you're going to have to split your five minutes.

I will give you a one-minute and then a 30-second shout-out when you're coming close to time. People can ask you questions on some of the points you may not have been allowed to finish; you can elaborate then.

After you've presented, there will be a question and answer session. The questions and answers will be limited in terms of timing: it's not just the questions and then another set of time for answers. I will do the same thing and give you a one-minute and then a 30-second shout-out, so you know how you're doing.

In the first hour of this meeting, from the Canadian Anesthesiologists' Society, we have Vanessa Foran, chief executive officer, and Dr. Giuseppe Fuda, president.

We have the Canadian Association of Schools of Nursing and Dr. Rani Srivastava, president-elect.

We have the Royal College of Physicians and Surgeons of Canada and Dr. Christopher Watling, chief executive officer.

We will start with the Canadian Anesthesiologists' Society.

You have five minutes for your opening remarks.

[Vanessa Foran, Chief Executive Officer, Canadian Anesthesiologists' Society]

Good morning, Madam Chair and honourable members of the committee.

My name is Vanessa Foran. I am the chief executive officer of the Canadian Anesthesiologists' Society. Today I am joined by Dr. Giuseppe Fuda, president of CAS and a practising anesthesiologist in Montreal.

The Canadian Anesthesiologists' Society, CAS, is the national voice of anesthesiology in Canada and is a not-for-profit, volunteer-led organization focused on advocacy, education and research. We represent more than 2,500 health care professionals across the country. Our members include anesthesiologists, family physician anaesthetists, medical residents and anaesthesia assistants—all united by a commitment to delivering safe, high-quality perioperative care for patients across Canada.

Many people are not aware that post-operative mortality within 30 days is the third leading cause of death in the world, after cancer and cardiovascular disease. Your anesthesiologist is there to reduce the risk. They're your guardian angel at one of the most vulnerable times of your life. Our members are physicians who keep you safe before, during and after surgery. They are monitoring every heartbeat, every breath and every vital sign, and leading resuscitation when complications occur.

Anaesthesiologists also provide care beyond the operating room in critical care, labour and delivery, emergency medicine, and acute and chronic pain management. They are increasingly involved in procedures outside of the O.R., such as interventional radiology and procedural sedation.

We sincerely thank you for the opportunity to contribute to your study of the impact of immigration policy and barriers to integrating internationally trained professionals.

I will now hand this over to Dr. Fuda.

[Dr. Giuseppe Fuda, président, Société canadienne des anesthésiologistes]

Thank you, Madam Chair.

Canada is facing a serious anaesthesia workforce shortage at the moment, one that contributes to surgical backlogs and reduces access to care.

That worker shortage affects not only anesthesiologists, but also the nurses, respiratory therapists and anesthesia assistants who work in our operating rooms.

We have only about nine physician anaesthesia providers per 100,000 Canadians, which is well below countries such as Germany, Australia and the U.S. This shortfall is compounded by an aging workforce, burnout and extended responsibilities outside the operating room.

To ensure that patients continue to receive timely surgical care, both short- and long-term solutions are needed. These were outlined in our 2023 HR resources position statement, and they include a significant increase in anesthesiology residency positions, recognition of health care workers' credentials between hospitals, regions and provinces to allow flexible redeployment where needed, redirection of select surgeries to underutilized centres, expansion of anaesthesia training programs to better support anesthesiologists, support for physician well-being, and retention and analysis of institution-specific efficiencies.

One key opportunity directly relevant to your study is simplifying and accelerating the licensing of internationally trained anesthesiologists while maintaining an unwavering commitment to patient safety. Currently, pathways for internationally trained physicians are fragmented and inconsistent across provinces. For example, the Royal College approved jurisdictions route recognizes training from only four international certifying bodies, leaving most qualified anesthesiologists to navigate complex, lengthy and costly equivalency assessments.

It's important to take into account that the quality and duration of medical training varies significantly from country to country, which complicates skills assessment.

A particularly restrictive barrier is the recency-of-practice requirement. Physicians who immigrate to Canada often lose licensure eligibility because they cannot maintain an active practice abroad while waiting for accreditation here. In some provinces, they must even return overseas for a month at a time to preserve their eligibility.

That's an unrealistic requirement for newcomers and their families.

We believe that Canada can do better. The European Union provides a useful model. Physicians trained in approved jurisdictions with harmonized standards are recognized automatically within four months. When training gaps exist, it provides an adaptation period or targeted assessments to ensure safety and fairness. Language proficiency, professional conduct and continuous quality assurance are all verified.

To sum up, the Canadian Anesthesiologists' Society recommends establishing a transparent, time-limited process for foreign-trained anesthesiologists; modernizing recency of practice rules to reflect the realities of immigration; and enabling a harmonized process for medical science licensure recognition for all provinces and territories.

Thank you.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

I will now go to the Canadian Association of Schools of Nursing.

Dr. Srivastava, president-elect, you have five minutes.

[Rani Srivastava, President-Elect, Canadian Association of Schools of Nursing]

Good morning.

My name is Dr. Rani Srivastava. I am the president-elect of the board of directors of the Canadian Association of Schools of Nursing, CASN. I also currently serve as dean of nursing at Thompson Rivers University in British Columbia. I have previously worked in roles in practice as vice-president and chief nursing executive. I am not an internationally educated nurse, IEN, but I have worked closely with IENs in practice and education.

The Canadian Association of Schools of Nursing is the national voice for nursing education in Canada, representing 93 member institutions across the country. CASN supports the education of registered nurses, registered psychiatric nurses and nurse practitioners. We commend the House of Commons Standing Committee on Health for undertaking this important study on the integration of IENs. The motion introduced by MP Dan Mazier addresses a critical issue: Canada is facing a nursing workforce crisis. Over the past five years, nursing vacancies have tripled. We have significant challenges in both recruitment and retention. Data from a pan-Canadian survey indicates that four in 10 nurses report that they intend to leave their job—or the profession—or retire within the next year. The impact is significant on the professionals, the quality of care and patient safety.

Internationally educated nurses who choose to migrate to Canada are an invaluable and grossly underutilized resource. We must remove unnecessary bureaucratic barriers for licensure. Internationally educated nurses emigrate to Canada from all over the world. There are variations in education, professional nursing culture and expectations. They have different health care system experience.

The two main barriers faced by IENs are regulatory complexity and workplace integration challenges. Regulatory bodies work to ensure public safety through a rigorous process of credentials recognition. For IENs to be part of a sustained solution, CASN recommends focused attention in three areas: streamlining the registration process, pairing that with quality bridging education, and workplace integration support for both short-term and long-term success. Collectively, we must adopt a coordinated, evidence-informed and ethical approach. Streamlining and harmonizing the registration is already happening. In response to the pandemic and the exacerbation of long-standing nursing shortages, nursing regulatory bodies have collaborated with governments, employers and professional associations.

A recent scan of 20 nursing regulatory bodies across Canada found that while licensure requirements are broadly consistent across jurisdictions, notable differences exist in the pathways, particularly in recency of practice requirements and expedited pathways for internationally educated nurses, leading to inconsistencies and inequities in licensure pathways and creating unnecessary complexity. There is a need to further explore the harmonization and consistency of pathways. This requires commitment. We know that competency assessment is important, but it often becomes the bottleneck. Partnerships between regulators and post-secondary educators can be hugely beneficial.

CASN also asks for an establishment of a joint commission between the Canadian council of nurse regulators, CASN, CNA and employers to ensure alignment between the needs and strengths of all the stakeholders.

Lastly, we ask for the exploration of international partnerships, including Canadian accreditation of international schools and IEN residency structures to reduce this redundancy and accelerate licensure.

Ensuring quality bridging education is the second piece. These are important tools that can support not just entry to practice but also successful integration in both the long term and the short term. These programs require the ability to accommodate the unique needs and experiences of IEN learners through responsive pedagogy and flexible learning-centred programming that is practice-oriented. The ability to provide responsive and effective bridging education hinges on increased sustainable funding of public educational institutions. National standards for bridging education and an accreditation program will ensure the quality of bridging education.

The third prong is to provide practice support for both short-term and long-term integration. This requires commitment and partnership between the IENs entering the workforce and the existing professionals in the system. Employers need to support both, recognizing the needs of both parties.

[The Chair, Liberal, Hedy Fry]

Please wrap up.

[Rani Srivastava]

CASN's internationally educated nurses mentorship program provides examples of where such support can be provided.

To summarize, the world is facing a global nursing shortage. Canada must act now to support the IEN integration that should be seen as a key pillar of a broader HR strategy for nursing. That includes strengthening Canadian nursing education and the integration of IENs.

Thank you.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

Now I go to the final witness from the Royal College of Physicians and Surgeons of Canada, Dr. Christopher Watling.

You have five minutes.

[Dr. Christopher Watling, Chief Executive Officer, Royal College of Physicians and Surgeons of Canada]

Thank you very much.

Good morning, everybody.

My name is Chris Watling. I'm a neurologist, and I am the chief executive officer of the Royal College of Physicians and Surgeons of Canada. I'm speaking to you today from the ancestral territory of the Anishinabe, Haudenosaunee, Lūnaapéewak and Chonnonton Nations, from London, Ontario.

I will share a little bit about the Royal College. We are a national, not-for-profit organization that represents over 50,000 specialist physicians and surgeons across over 100 different disciplines in Canada and around the world. We're the voice of specialty medicine in Canada, and we set the standards for specialty medical education, assessment and lifelong learning. We also do what we can to promote sound health policy.

In that vein, I'm very grateful for this opportunity today to highlight some of the challenges that internationally trained specialist physicians face when they move to Canada and try to integrate into our health care workforce. Estimates vary, but we think there may be as many as 13,000 internationally trained physicians in Canada who are not in practice. Internationally trained physicians have identified that the process to becoming a practising physician in Canada is challenging, time-consuming and often confusing.

The government has, thus far, very appropriately focused on getting internationally trained primary care physicians and family doctors into practice. We agree with that at the Royal College, but we also want to point out that optimizing the Canadian health care workforce requires attention to both primary and specialty care, because they are interdependent.

I'm just going to identify, first, some of the various routes to getting to be a certified specialist physician in Canada, and some of the specific areas that we might be able to improve, or have already improved. Internationally trained physicians who have not yet completed residency or postgraduate training or who are willing to retrain in Canada have the option of matching into a Canadian residency training program through the Canadian residency matching service. Related to this route, the Royal College encourages the government to ensure there remains equitable access for all eligible international medical graduates, IMGs, to that match process, to best meet the needs of the system.

Second, internationally trained physicians who already completed residency training and practised abroad in their specialty may complete a practice-ready assessment. This pathway consists of a clinical workplace-based assessment usually lasting around 12 weeks. There are currently nine provinces that offer these, but only three offer them for specialist physicians. Those are Alberta, Manitoba and Quebec.

Third, internationally trained physicians who have completed residency training abroad in a recognized specialty and whose residency training is quite similar to that which would occur in Canada may also use what we call the practice eligibility route. That requires them to take an examination and to complete two years of observed practice in Canada. We've had great support from a grant from the federal government and have had some success in simplifying and streamlining this pathway. We've seen applications increase 400% and processing times drop from several months to several weeks.

Then, finally, we have specific routes for U.S. trainees and those from other approved jurisdictions where training is recognized as a substantial equivalent to Royal College training. These trainees can apply directly to take a Royal College exam. Once they pass that exam, they would be certified without requiring observed practice time in Canada.

What more can be done? First, we think that the practice-ready assessment route is underused and has the potential to expand. It is a quicker and more cost-efficient way of licensing internationally trained physicians compared to a typical residency program, which can last two to six years. We'd encourage the government to consider developing a federal program that supports an expansion of practice-ready assessments for both family doctors and specialist physicians.

Second, we think more can be done to address the challenge of internationally trained physicians in Canada who are just missing a handful of competencies that would be required to meet the full scope of a Canadian credential. We'd encourage the government to consider a funding pool that could help medical schools to provide top-up training to those physicians, which would allow them to more quickly transition—

[The Chair, Liberal, Hedy Fry]

You have 45 seconds.

[Dr. Christopher Watling]

—into practice.

Third, we think we can do more to support the additional learning that internationally trained physicians require to bridge cultural competency and learning gaps. For example, regardless of where you've trained, if it's outside Canada, you likely lack information about indigenous health and indigenous cultural competency. We would encourage making that training a requirement for all physicians trained internationally, and we're happy to work on that with the government.

Finally, I'll just point out that we've done a lot of consulting with internationally trained physicians this summer, and many of them pointed out that labour market assessments are a major pain point in their process of getting into Canada.

Now is the time, we think, for everyone in the health care system to consider alternative solutions to streamline the immigration and licensing processes for internationally trained physicians so that they can enter the system more efficiently and provide necessary care.

Thank you very much.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

I'll begin the question and answer round. Just to remind everyone, this is a six-minute round. Six minutes are for questions and answers. I'm going to give a one minute and thirty second count to those who are questioning and to those who are answering. You will always have an opportunity in another round to finish off what you were saying.

I'll begin with Mr. Mazier for six minutes, please.

[Dan Mazier, Conservative, Riding Mountain, MB]

Thank you, Chair, and thank you to the witnesses for coming here this morning.

Dr. Watling, does the Royal College of Physicians and Surgeons of Canada support national or pan-Canadian licensure so that doctors can work across provinces and territories without barriers?

[Dr. Christopher Watling]

We do.

[Dan Mazier, Conservative, Riding Mountain, MB]

Dr. Fuda, does the Canadian Anesthesiologists' Society support national or pan-Canadian licensure so that doctors can work across provinces and territories without barriers?

[Dr. Giuseppe Fuda]

We do support it, and it's already part of our physician statements. I will go further and say that the Atlantic provinces actually already have the licensure for Atlantic Canada. One thing that's particular to anesthesiologists—

[Dan Mazier, Conservative, Riding Mountain, MB]

Thank you. You do support it, and that's great.

Dr. Watling, does the College of Physicians and Surgeons of Canada agree that population growth is one of the factors impacting Canada's health care system, yes or no?

[Dr. Christopher Watling]

Yes.

[Dan Mazier, Conservative, Riding Mountain, MB]

Immigration is a form of population growth, then. Is that correct?

[Dr. Christopher Watling]

Population grows in a variety of ways, including immigration, yes.

[Dan Mazier, Conservative, Riding Mountain, MB]

Dr. Watling, how many members are there in the Royal College of Physicians and Surgeons of Canada?

[Dr. Christopher Watling]

There are roughly 50,000.

[Dan Mazier, Conservative, Riding Mountain, MB]

Did the federal immigration department consult with the Royal College of Physicians and Surgeons of Canada on this year's federal immigration levels plan, yes or no?

[Dr. Christopher Watling]

No.

[Dan Mazier, Conservative, Riding Mountain, MB]

According to this year's immigration levels plan, the federal government is planning to allow 395,000 permanent residents and 673,000 non-permanent residents into Canada this year. Will all these individuals be able to get a family doctor this year, if they want one?