Yes, I can absolutely touch on that as well.
What we found in preparing the research—and this is specific to immigrant physicians working in Canada but can be generalized to many other health care workers, including nurses, lab technologists, other front-line workers and workers involved in testing—is that it is taking an exorbitantly long time for a newcomer to recertify. When I say “newcomer”, it might sound odd. Maybe the more appropriate term I should be using is “international medical graduate”, which would include those who may be Canadian citizens or permanent residents but who studied abroad for their medical degree.
We found that it is taking upwards of five to 10 years for a newcomer or an international medical graduate to recertify within Canada. It is also costing a considerable amount, upwards of 42% of an IMG's or newcomer's median income during the period. This doesn't just involve the costs of recertification itself, which include things like fees and licensing requirements. This also includes the foregone benefits, like the income they could be earning during that time, the costs of buying textbooks to recertify, and the costs of transportation associated with travelling to various interviews. For some, especially those in more vulnerable parts of the population, this might mean that it's simply impossible to practise in Canada.
I will use a real-life example. I was speaking with an immigration lawyer who recently helped a refugee gain protected person status in Canada. The refugee was a very well-regarded heart surgeon from Colombia who was fluent in both official languages, English and French. However, because of the manner in which this refugee came to Canada, the individual came without a lot of assets and income and was working for Uber. This means that even with the knowledge the person has, he or she is very unlikely to recertify due to the financial barriers.
Some of this is due to a limitation on the residency seats available for IMGs, international medical graduates, at the provincial level, but it's not exclusively that. Immigrants often arrive in Canada with the unfounded expectation that because they qualified under the federal immigration streams, they are qualified to work. They are sadly disappointed when they're unable to help.
I noticed that recently the Province of Quebec decided it wanted to increase the number of what it calls essential workers coming to Quebec. However, I noted that many of them would need access to a licence in order to practise. Even if they arrived next month, it's likely that they would not be able to actually help out in the COVID-19 pandemic until much further down the road.
I know there are plenty of questions for the other panellists here, who can provide valuable insight as well, so I'll finish by saying that this pandemic is helping us to consider what barriers to entry are actually necessary. I can understand our concerns about public health and safety with regard to licensure of newcomers, but others, such as Ireland, France, the U.K., New York, New Jersey and several other states in the U.S. have decided to arrange everything to allow immigrants to practise under an associate model, meaning they practise under the supervision of a fully licensed medical professional.
New York, for example, will be completely waiving the requirement that they have a licence in order to practise. I wouldn't necessarily suggest that, but I do think that this pandemic is an opportunity to reassess how exactly we license newcomers and how we can work with the provinces and the federal government to ensure that part of their immigration streams involve a licensing stream as well.