Human Resources Committee on Nov. 1st, 2011

[The Chair, Conservative, Ed Komarnicki]

I call this meeting to order.

I should mention that we expect you to present for five to seven minutes. I may give you a five-minute warning. We have three groups presenting, so we'll need to be fairly close to the time. But at the same time, we don't want you to be reading too quickly because it's difficult for the interpreters to keep up. We want to have the right balance, if we could.

We'll start first with the presentation from the Canadian Physiotherapy Association.

Michael Brennan, if you wish to proceed, go ahead.

[Michael Brennan, Chief Executive Officer, Canadian Physiotherapy Association]

Thank you. Bonjour, tout le monde. Good afternoon.

Thank you for the opportunity to present to the committee. The title of this presentation is a somewhat intimidating one—about practical solutions for what is historically an intractable problem—but we'll give it our best shot.

Four years ago, the Canadian Physiotherapy Association and the Alliance of Physiotherapy Regulators co-published a document on foreign credential recognition in Canada for physiotherapists. The research for that document was funded by the foreign credential recognition program at HRSDC. We're grateful for the assistance the government has provided us to examine this problem. We were very keen at the time to tackle those issues, and we continue to be keen to tackle those issues.

Approximately 13% of all physiotherapists currently practising in Canada were trained in another country. Also, 13% of our membership has trained in another country. And we see that trend continuing as the demand for physiotherapy grows.

The study we undertook identified a number of structural barriers I'm sure you're all familiar with—poor pass rates for qualifying exams, the length of time it takes for applicants to be declared eligible for the exam and subsequently to be licensed. Language skills were considered a significant barrier, as well as cultural differences, in understanding the context of Canadian health care vis-à-vis the candidates' countries of origin. The information provided during the immigration process was identified as being a key area or a key shortcoming. Finding employment during and after the integration process was a problem four years ago. And finally, the cost of running the system was prohibitive.

So the physiotherapy community came together and undertook a notable and significant effort to address these issues, which resulted in a physiotherapy language benchmark established in 2009. It helps people identify what the goals or objectives are for their language. We developed an online language test that's available to examine candidates. We developed an online pre-assessment tool to determine how one compared to the Canadian equivalent.

In 2009, only two years after the publication of the study, we ran the first comprehensive bridging program at Ryerson for internationally trained physiotherapists. That program is now at the University of Toronto. Two new programs will be starting up in 2012, and we have profession-specific language training within those three programs.

So we've done a substantial amount of work to address the findings from the 2007 study. However, frankly, we have seen absolutely no impact on the time it takes for a physiotherapist with an overseas credential to be recognized and licensed—mostly because these programs are new. From 2009 to today, we don't really have enough data and enough experience to be able to optimize the programs.

Our problems now are more about running the program and developing an understanding and a reasonable set of expectations, versus the issues of its implementation that we faced a few years ago. Perhaps most substantially, physiotherapy in Canada is significantly different from physiotherapy in most other non-Commonwealth countries, even compared with the competencies of our American counterparts. More often than not, the Canadian standard is significantly above the expectations of overseas-trained candidates. So that continues to be a significant issue. We don't wish to compromise the success story of Canadian physiotherapy, but at the same time we recognize that we must do more to accommodate those candidates.

We're looking at practical solutions now. We recognize that the time it takes for candidates to get through this process is too long. We need more administrative capacity—there's a backlog right now, and we have well-intentioned folks working on credential recognition—but we currently have a nine-month backlog before we even look at a candidate's profile. And by “we”, I'm talking about the physiotherapy community. It's not our association that does it; it's contractors for the Alliance of Physiotherapy Regulators. So the backlog is significant.

Concerning access to practicums, we recognize that it's very important for these candidates to have an opportunity to work in the rehabilitation community. But access to those practicums is extremely difficult.

It's difficult for students in physiotherapy programs. Physiotherapy is delivered 50% in the private sector, so we're asking small business owners to find opportunities to provide these practicums. That's proving to be challenging, as it is for physiotherapy students.

We want better credentials data. We want to get a much better sense of what the equivalents are in other jurisdictions, and we are making some progress with the World Confederation for Physical Therapy. We just launched a program in June, a new database that will allow us to develop a much better understanding of these credentials before the candidates enter the system.

We heard there was a Deloitte study released today about the importance of getting this right. We're keen on doing our part to get it right. We see the most practical solution as doing our homework on behalf of the physiotherapy community and working with Immigration Canada and the various stakeholders.

A good example is a recent negotiation between the Quebec regulators and the French government, which recognizes their equivalent to physiotherapists as what we call a thérapeute en réadaptation de physiothérapie in Canada. Perhaps the simplest but least satisfactory solution is a reasonable expectation that somewhere between three to four years is how long it should take to have these credentials recognized and have these workers integrated into our system. It doesn't necessarily solve the problem, but we're not sure we can do better than that. We'd love to talk about how we could do this, but when we look at the difference between Canadian physiotherapists and those who are operating in many of these other countries, we're not sure we can beat that.

Thank you.

[The Chair, Conservative, Ed Komarnicki]

Thank you.

We'll move to the Health Action Lobby, with Christine Nielsen and Mr. Shields.

[Charles Shields, Member, Health Action Lobby]

I was here a couple of weeks ago in another capacity. I am Chuck Shields. With me today are Christine Nielsen and Michael Brennan, who has already presented. We are all three members of the Health Action Lobby, and the leadership asked us to present to you on our experience with the issue.

I am CEO of the Canadian Association of Medical Radiation Technologists, Christine is from the Canadian Society of Laboratory Science, and Michael you have met already.

I'd like to thank the committee for the opportunity to talk on behalf of HEAL, which is a coalition of 35 national organizations. We represent a broad cross-section of associations, institutions, and facilities. Our memberships include about a half a million individuals, providers, and consumers of health care in Canada.

Over the past 20 years, HEAL has had the opportunity to present briefs to standing committees and has released a series of policy papers on a number of issues, including the role of the federal government in funding health care, health human resources, entry to practice, and the Canada Health Act.

Last July, HEAL met with officials at HRSDC to review issues, challenges, and solutions regarding internationally educated health professionals or IEHPs. The concerns that were addressed then continue to be concerns for IEHPs. These include upgrading in techniques and knowledge to meet Canadian practice requirements; preparing to pass licensure exams; obtaining relevant work experience; developing professional contacts or networks; becoming socialized into the Canadian workplace, culture, and context, which requires business information, collegial support, and the soft skills necessary to obtain and manage successful employment; developing or improving communication and language skills; and developing, managing, and meeting career goals.

At this point, I'd like to turn the table over to Christine, who will continue with some other points we want to make.

Thank you.

[Christine Nielsen, Member, Health Action Lobby]

The challenges for internationally educated health professionals in the integration and credentialling process include the time and personal resources needed to meet the demands. Quite often, internationally educated health professionals are older than our domestic graduates, and many times they have resource shortages and more responsibilities. The challenge of working and upgrading at the same time can lead to some challenges, with the internationally educated holding survival jobs.

Accessibility and availability of information and supports are necessary for people to understand what courses are available and where they might find colleagues. And relevant work experience is always important. When support and information is available through bridging programs, often an internationally educated health professional might not be aware that a program exists.

There's general consensus among HEAL members that the following supports, which Michael and Charles referred to already, would assist in the assessment and integration component: language training; mentorship; peer support networks; quicker credentialling assessments; preparation for licensure exams; and bridging programs, which in many cases can solve all of these issues.

Many of the barriers have begun to be addressed on a profession by profession basis, and many of the HEAL members have received contribution agreements and grants under HRSDC's FQR programs.

We know from the research we have conducted that bridging programs are a great solution for the internationally educated. Some professions already have these programs in place. They operate on different funding models. Some are fee for service, whereby the tuition is paid by the individual. Some are integrated into the full-time education system, whereby they're eligible for financial support or grants. Others sometimes have low- or no-cost alternatives and can often be subsidized by a return-to-service agreement. We know that the most cost-effective process is to add bridging programs to already existing education programs rather than to create stand-alone programs, because they already have the faculty, curriculum, and equipment.

There are significant challenges finding clinical placements or internships, as Michael mentioned, for the internationally educated. This challenge is not simply for the internationally educated. Our domestic students also face it. The biggest challenge we have is trying to figure out how to add this additional training responsibility to an overburdened health care system and how to compensate the individual and the facility they're training at.

Funding individual internationally educated health professionals through programs such as the Canada student grants program would give them access to bridging programs and would, in turn, help them contribute significantly to the sustainability of these programs.

We understand that a federal loan program for IEHPs has been proposed, and we encourage the government to proceed with this initiative.

Bridging programs solve many of the challenges internationally educated health professionals face and they allow them to integrate into the workforce in their chosen professions much faster. Earlier entrance into the workforce at a high-skill capacity is of financial benefit to the government, as taxation rates are higher with higher wages. Everyone benefits from earlier integration.

We thank HRSDC and the government for their interest and action in the assessment and integration of immigrants to Canada. Investment must continue to be made in this area, as the financial burden for the internationally educated professional, the associations, and the regulators would be insurmountable were it not for the commitment of the Government of Canada.

We thank you for your time today, and we'd be happy to take questions later.

[The Chair, Conservative, Ed Komarnicki]

Thank you very much for that.

We'll turn to Sandra Murphy, from Centennial College, for the final five to seven minutes.

[Dr. Sandra Murphy, Dean, School of Community and Health Studies, Centennial College]

The problem with going third is that I'm going to be repeating a lot of information. The one good thing is that we're very consistent in our findings.

One of the reasons I'm here is that in 2008 I finished my doctoral work, and my thesis was on the experiences of internationally educated nurses when they come to work in Canada for the first time, looking at the barriers they face.

As dean of the school at Centennial College, I took on a pilot project in 2009 to 2011 for two bridging programs, which underwent extensive program evaluation. We looked at two bridging programs, one for nursing and one for pharmacists who would complete their diploma as a pharmacy technician. It wasn't a surprise to us that language, by far, is the biggest barrier facing internationally educated professionals. The issue we found is that many of the bridging programs that exist do not have an occupation-specific need, and hence there is a gap there.

There really does need to be pre-arrival language training that should be encouraged and perhaps required. In some professions, like nursing, as an example, internationally educated nurses must demonstrate specific levels in English fluency that relate specifically to meet the needs of the occupation in which they will be practising. Those requirements are very high.

In addition, we found there needs to be improved marketing. Internationally educated health professionals need to have information available about relevant programming for them to initiate the licensing process before they even come to Canada and step off the plane. We need to actually ramp up our current marketing methods above and beyond participating in job fairs for immigrants and disseminating application information at settlement houses or community centres.

Financial assistance for learners remains a barrier, especially for a lot of the bridging programs that are non-diploma bridging programs. What happens there is that students are not eligible for OSAP or for assistance programs. Many of the educated learners, as we have talked about, are mature learners, have families, and are trying to make ends meet while undertaking demanding studies.

What we found is that if you compare it with Canadian stats, 80% of the internationally educated professionals are married and 62% have children, compared to only 54% who are married that are Canadian-born and 47% having children. One of our students in our program stated to us:

So I think the government should help [students] for funding [beyond OSAP] for those kind of people who are willing to go back because I know a lot of professionals move here and they work in the kitchen because they need money.

Another thing I have found is that there needs to be accurate information regarding professional registration and integration into the Canadian workforce. They are very surprised that we have prerequisites to employment in their professions, and they find this added information very discouraging. They also find that the information is available in a very scattered number of resources and sources, through colleges, regulatory bodies, immigration officials, etc. That information really does need to be consolidated. The lack of a centralized national online information portal that helps these individuals access abroad really does create a significant informational barrier. They need to have this information so that they are able to expedite the licensure process.

The other problem is that with some regulatory bodies there's a very narrow window where they have to prove and demonstrate safe practice. This length of time is decreasing from five to three years, particularly in the nursing area. So when immigrants come over and they have to be landed immigrants, it almost becomes impossible for them to continue on in their profession within that very narrow window of opportunity.

Cultural competence is something that has become very important. A lot of immigrants come from a unique cultural society, and they find that Canadian norms and values, in a very culturally diverse country, are very difficult for them to understand and to be able to practise in their chosen profession. The fact that we have interprofessional teams and a client-centred approach to care is very foreign to them. It's a concept they do not recognize, and they need to have bridging programs to do that.

Examination, preparation, and job searching skills are very important as well.

I will just let you know that the normal pass rate for internationally educated nurses is 70%, compared to 90% for Canadian-educated, first-time writers. In our bridging program the pass rate has been 90%, which is close to 20% higher than for those who do not partake in bridging programs. That shows you the importance of a bridging program to prepare for a profession.

I'm at five minutes, right?

[The Chair, Conservative, Ed Komarnicki]

You're at five minutes and 40 seconds, but carry on.

[Dr. Sandra Murphy]

Bridging programs really do provide these individuals with the ability to prepare for exam writing, because they're not used to multiple-choice exams. Once our students leave, they historically have difficulty obtaining jobs because of the barriers they face in the profession. There's a lot of negativity in terms of internationally educated professionals. We find that we need to help them with job search training, preparation of resumés, interview techniques, etc., for them to be able to get positions.

In closing, bridging programs are absolutely instrumental and critical for any health care professional. I cannot imagine how anyone would be able to integrate into the profession without having experience in a bridging program, to get that practical connection and workplace experience.

My suggestion is to continue the funding, and look at funding for students beyond just the bridging program development. Tuition reimbursement would be a great help.

Thank you.

[The Chair, Conservative, Ed Komarnicki]

Thank you very much for that presentation. We have certainly heard about the need for bridging programs, how well they work, and their success rate.

We'll move on to Ms. Crowder.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Thank you.

I want to thank the presenters, and I want to thank Mr. Brennan for highlighting the Deloitte study. I haven't had time to read the whole study because I just got it, but it certainly identifies some continuing challenges with the immigration system. It recommends a number of action items, and I'm going to ask the committee members to address them.

We've been hearing fairly consistently about a couple of things, and I think all of you have touched on one in some way or another.

First of all, there's a real challenge overseas with people having accurate information. I think Ms. Murphy referenced having some language training before people come into the country. There could be some process that starts credential recognition overseas, although other witnesses have identified some challenges with that because of security issues around whether you're actually assessing the person who's coming.

The other three areas appear to be: assessment once they come to Canada; a bridging program that addresses education, work experience, or practicum placement; and finally, the time to an actual job in the profession.

Do I sort of have it in a nutshell there? Okay.

So there are a couple of questions. In your experience, do the regulators, colleges and universities, and associations work closely together to develop a comprehensive action plan? Can I have each of the three groups address that?

[Michael Brennan]

The quick answer is yes. Perhaps it's the single best example of collaborative approaches in physiotherapy in the last 30 years. I listed a number of achievements from 2007 to today in the development of those bridging programs: language testing, opportunities for placements, and so on.

The frustration today is that because we have these mechanisms in place, we are more acutely aware than ever of just how much extra work is needed. We have capacity that may improve the problem by 10%, but for every person who gets into a bridging program, six don't. For every person who gets a placement opportunity, 12 don't. So now it's a question of volume. It's been a success for us in the sense that the collaboration is there, but we're more acutely aware than ever of just how big a hill we're trying to climb.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Do those three bodies get some sort of funding to help them work together to develop an action plan, an implementation plan?

[Michael Brennan]

We received funding to do the study, but so far everything else has been funded either through our own pockets or through the provincial government. The bridging program at Ryerson, which has now transferred to the University of Toronto, was funded by the Government of Ontario. One of the limitations we've recognized is that they were pretty insistent that the candidates be residents of Ontario, which of course makes sense, and the demand is so much greater than that.

But we've been fortunate in that the Government of British Columbia, the Government of Nova Scotia, and the Government of Ontario are continuing to fund these bridging programs now.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

But it's a piecemeal approach, depending on the provincial interest.

[Michael Brennan]

That's right.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Mr. Shields and Ms. Nielsen, in your experience do the regulators, the colleges and universities, and the associations work together collaboratively?

[Charles Shields]

Again, yes. I can't speak for all of the HEAL members, but I can certainly speak for our own association. We have done that traditionally, but we had been assisted in doing that through the support we had for some of the grants from HRSDC. When we developed guidelines for bridging programs, that included education programs around the country.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

I'm sorry, Mr. Shields, may I interrupt? Is that on a project-by-project basis? You don't have an ongoing pot of funding that allows you...? You have to address specific projects?

[Charles Shields]

That's right.

Other projects that we've had on creating a national standard for assessment involved regulators and educators and other stakeholders as well. So we've pulled people together. That has been, again, through HRSDC funding.

There are some mechanisms we have so that we pull some of the players together ourselves, just in the course of our own work. But when you get into talking particularly about the internationally educated group, that's been assisted, particularly by the help we've had from HRSDC.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

When you're responding to things on a project-by-project basis, how does that help in terms of a long-term plan and strategy? I know other organizations have done it on their own. But a long-term human resource strategy, which requires not dealing with things on a project-by-project basis but actually having the mechanism in place to develop that strategy, looking at labour market information, looking at all the demographic information and trends, and developing that strategy around recruitment, retention, all of those kinds of things that are in an HR strategy....

[The Chair, Conservative, Ed Komarnicki]

There's a lot in that question. Could you maybe shorten the answer?

[Charles Shields]

Let me try to take a short go at it and say that when we started, it was really just a project. As we began having our experiences.... The last time I was here with the committee I mentioned that we conceptualize things now in a way that there's a spectrum of activity. We're looking at starting with the internationally educated person back in their home country before they even decide to come to Canada, and carrying all the way through successful completion of the certification exam and beginning to practise. We're aiming our efforts at trying to get at the different areas along that.

So although we're addressing things project by project, we're aware of how they fit together.

[The Chair, Conservative, Ed Komarnicki]

Thank you.

We'll move to Mr. Daniel.

[Joe Daniel, Conservative, Don Valley East, ON]

Thank you very much.

Thank you, folks, for coming and allowing us to quiz you.

My first question is to Mr. Brennan. How big is the gap? Why do we need all these foreign-trained people here?

And pushing on the long-term theme, is this gap getting bigger as we go down the years?