Evidence of meeting #8 for Health in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was programs.
A video is available from Parliament.
Conservative
The Vice-Chair Conservative Dan Mazier
Okay. I'm calling this meeting back to order.
Mr. Barnum, you have five minutes.
Geoffrey Barnum Senior Manager, Data, Canadian Post-M.D. Education Registry
Thank you.
My name is Geoffrey Barnum. I am the senior manager of data at the Association of Faculties of Medicine of Canada, of which the Canadian Post-M.D. Education Registry, CAPER, is an initiative. I have that oversight role of the CAPER initiative. The initiative was initially formed in 1986 to be the definitive source of national longitudinal information and analysis on trainees within the Canadian postgraduate medical education system.
I want to spend a minute or two talking about how we train doctors in Canada so that we're all on the same page.
The typical journey for a Canadian looking to become a doctor is that they complete a bachelor's degree, or sometimes a CEGEP degree in Quebec, and then apply to one of the 18 Canadian medical faculties. It was 17 until this year. Toronto Metropolitan University just opened up this year, making it 18. Once admitted, students spend three or four years, again, depending on which faculty they go to, developing their core medical competencies through a combination of lectures, labs and actual experiential learning out in the field, or what we call “selectives” and “electives”.
During the fourth year of their medical education—or third, for a shorter school time—the medical students apply to the R-1 match, which is administered by the Canadian resident matching service, CaRMS, and has been previously discussed. This is where medical students get attached to a specific specialty. That would be family medicine, psychiatry, general surgery and so on and so forth. They then spend two years, in the case of family medicine, and usually about five years for the other specialties, in completing their residency training—unless they go down the super subspecialty role route—and do their exams and go out to practise medicine here in Canada.
Together, the AFMC and the CAPER initiative collect, analyze and report data on the status of the medical education system throughout the individual's journey to become a physician. AFMC focuses on the undergraduate side, where they're earning their MD. CAPER focuses on the post-MD side when they're doing their residency or a fellowship.
Another area that sometimes gets a little confusing is the different types of postgraduate trainees who are in Canada.
We have residents. Those are individuals who are going for their initial certification with either the Royal College or The College of Family Physicians of Canada. Those are the ones that typically last two to five years.
There are also clinical fellows. These are fully trained physicians who are looking to specialize in a very specific area. Most fellowships last about a year. Some are a bit shorter. Some are a bit longer. Really, it's that super-duper specific training, right? Maybe you're a heart surgeon. This would be a fellowship on a very specific type of heart surgery.
The other topic that comes up often is the type of trainee. There are Canadian medical graduates and international medical graduates. That is how the system currently divides individuals. As the name would suggest, a Canadian medical graduate got their MD degree from a Canadian faculty, and an international medical graduate got their degree from outside Canada. This is mutually exclusive from their legal status in Canada. At CAPER, we recognize Canadian citizens and permanent residents as compared to visa trainees. Those are the individuals coming into Canada for training.
There's been a lot of discussions surrounding visa trainees in residency and fellowships. The majority of visa trainees are enrolled in clinical fellowships, doing that really specific training and actually administering that treatment to Canadians. For many of those, the salary and cost of training are paid for by foreign governments or institutions, and CAPER does collect that information. During their training, they provide complex tertiary and quaternary care to Canadians.
Senior Manager, Data, Canadian Post-M.D. Education Registry
Thank you.
There is a group, as has been mentioned, of visa trainees who do come to do residency training in Canada in those supernumerary positions, which was so well discussed earlier.
I want to note that any questions relating to the specific data I'm discussing is available in our international medical graduate report, which I would like to table for this committee. It's available on our website. I've included the links in my speaking notes for the English and French versions.
Liberal
Senior Manager, Data, Canadian Post-M.D. Education Registry
I think I'm good, thank you.
Liberal
The Chair Liberal Hedy Fry
Well done. Thank you very much.
I'll now go to the Internationally Educated Health Professionals in Canada, Ms. Slawecki.
Thank you.
Eva Slawecki Advisor, Canadian Medical Foundation, Internationally Educated Health Professionals in Canada
Thank you.
Honourable chair and members of the standing committee, thank you for the opportunity to speak today on behalf of the Canadian Medical Foundation.
About three years ago, we partnered with Pegasus on the internationally educated health professionals initiative. This includes support for refugee health professionals as well as IEHPs to continue their health careers in Canada.
In the last year alone, thousands of IEHPs—nurses, doctors, pharmacists, dentists and others—have accessed our resource hub, and hundreds have participated in our capacity-building activities, networking events and mentoring programs.
What we are doing is not enough, though. Let's look at the numbers. In 2021, an estimated 260,000 IEHPs resided in Canada. While 76% of them were employed, only 58% of those worked in health-related occupations. The rest were driving taxis, were working in retail or were sidelined entirely—their talents wasted while our health care system suffered severe staffing shortages.
With over 20% of Canadians being immigrants, we need a diverse health workforce that fosters cultural competence and that builds trust for improved health outcomes for our multicultural population. Integration of IEHPs will create a health workforce that truly reflects and serves Canadians.
Canadian immigration policies do actively attract skilled professionals, such as nurses; however, we hear repeatedly about IEHPs who arrive full of hope, only to then encounter a labyrinth that keeps them from practising and that squanders their training and expertise.
Today, I'll highlight some of the real human and systemic barriers they face.
The core issue lies in the barriers to licensing.
First, the pathways themselves are complex and fragmented. What seems straightforward on an immigration application becomes a maze of assessments, exams and bridging programs.
Second, IEHPs are faced with a glut of scattered online resources, many of which are inaccurate, outdated or not even legitimate. Recent IRCC cuts led to reductions in several newcomer programs that once provided basic guidance and system navigation. Without this, IEHPs can waste months, even years, chasing dead ends, all while their skills atrophy and their families struggle financially.
A doctor trained abroad might spend years navigating equivalency requirements, only to find their credentials outdated, which brings us to the third barrier. The longer the licensing process, the more likely they are to lose their recency of practice requirements.
Finally, IEHPs arrive without the social capital that Canadians take for granted. Newcomers have left their personal and professional relationships behind. They need mentors, connectors, networks and communities to better access opportunities for employment and integration, but our immigration system assumes IEHPs will figure all of this out alone. What is the impact of all of this? IEHPs face prolonged unemployment, deskilling and frustration while Canada misses out on a ready workforce.
However, there is hope. Many provinces are introducing practice-ready assessments for experienced physicians, and we've heard there are also plans to increase residency spaces for doctors. Several educational institutions have bridging programs for professionals to top up their skills, without starting their training from scratch.
Initiatives like ours have already helped hundreds by providing a first-stop shop for access to legitimate pathways and professional mentoring to support these IEHPs in understanding Canada's health system and to navigate the complexity of licensure and employment readiness.
In closing, our system excels at recruitment but falls short with true integration. We need to dismantle these barriers. This isn't just about policy tweaks but also about humanizing immigration's promise. By investing in navigation, coordination and wraparound supports, and by developing the social capital of IEHPs, we can boost integration, increase workforce entry and witness the success that our immigration policies promise.
On behalf of those we represent, thank you for your time and attention. I welcome your questions.
Liberal
The Chair Liberal Hedy Fry
Thank you very much.
We'll now go to the question and answer session. The first round is six minutes. I am going to be harsh with everybody to get them to stay on time.
I will begin with the Conservatives and Mr. Bailey for six minutes.
Conservative
Burton Bailey Conservative Red Deer, AB
Thank you, Chair.
Thank you, Dr. Anand, for your patience with our technology. I'm going to ask you to speak slowly and loudly for us, and I'll keep my questions brief.
Do you believe that national licensure recognition would be beneficial in Canada? Answer yes or no, please.
Conservative
Burton Bailey Conservative Red Deer, AB
Do you believe the recency of practice requirement should be reformed to streamline internationally trained grads to acquire licensure in Canada? Answer yes or no, please.
Conservative
Burton Bailey Conservative Red Deer, AB
Should the recency of practice and other recognitions be conducted before the individual comes to Canada?
Physician, As an Individual
I think that would streamline things and prevent many issues along the process.
Conservative
Burton Bailey Conservative Red Deer, AB
There are roughly 80,000 foreign-trained medical professionals in Canada who aren't working in health care. Do you believe the government should work on licensing and integrating the health care professionals already in Canada before thinking about bringing in more people?
Physician, As an Individual
I agree with that. I got cut off because of the technical issues, but I want to talk about our pilot program with clinical assistants in Red Deer.
We piloted a program for anaesthesia clinical assistants, where I personally supervised international medical graduates. Some needed a year or two of support and education. Some needed three weeks just to understand how to communicate more effectively with patients. The pilot ended, but at least two of those trainees are either practising anesthesiologists or working in residency programs.
There is a big opportunity, and Red Deer, your home constituency, has had great success with surgical assistants and clinical assistants. Those candidates eventually make it into residency programs and contribute to the Canadian health care system.
Conservative
Burton Bailey Conservative Red Deer, AB
Thank you for that.
Does population growth impact the demand on the health care system?
Conservative
Conservative
Burton Bailey Conservative Red Deer, AB
I'm going to ask you some basic questions about some of your medical licensing.
How much does it cost to get your medical licence in Alberta?
Conservative
Burton Bailey Conservative Red Deer, AB
You indicated that you have multiple licences because you work as a locum in underserved areas across Canada. Could you give us an idea of what the cost is for you, as an individual?
Physician, As an Individual
It is about $20,000 in total, because my CMPA to practise in Ontario is about $11,000, and there is not much reimbursement there. For each individual province, it's between $2,000 and $3,000.