Ontario Health Human Resources Research Network | RORRHS-OHHRRN | University of Ottawa

About this Article:Canada has historically relied on internatonally educated health professionals (IEHPs) to address shortages in rural a nd remote locatons and hard to fll positons within its health care system. It contnues to do so and, while this has been true for medical and nursing labour in the past, this is now also true for midwives. At the same tme, we hear of numerous accounts of IEHPs who are not able to practce their profession in Canada. The barriers to practce for IEHPs – what some have labelled the 'brain waste' problem – have recently become a signifcant concern for Canadians.

Authors:  Ivy Lynn Bourgeault, Elena Neiterman, Jane LeBrun, Ken Viers & Judi Winkup

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Canada has historically relied on internatonally educated health professionals (IEHPs) to address shortages in rural a nd remote locatons and hard to fll positons within its health care system. It contnues to do so and, while this has been true for medical and nursing labour in the past, this is now also true for midwives. At the same tme, we hear of numerous accounts of IEHPs who are not able to practce their profession in Canada. The barriers to practce for IEHPs – what some have labelled the 'brain waste' problem – have recently become a signifcant concern for Canadians. The difcultes this causes are not limited to the Canadian context – in terms of lost labour, and possible solutons to its human resource crises – there are important implicatons for the countries from which health care providers migrate.

This study was designed to fll some of these gaps in our knowledge by examining:

• the experiences of internatonally educated physicians, nurses and midwives who were pursuing
  professional integraton, who have achieved it, and who have decided to redirect their eforts; and
• the barriers and facilitators they experienced along the way that they feel infuenced their
  relatve success at becoming integrated into provincial health care systems in Canada.

From the outset we decided to gather the perspectves of the IEHPs. This was intended to supplement the policy recommendatons that have been made through stakeholder consultatons, because the issues that have come to the atenton of Canadian stakeholders may or may not be a true refecton of IEHP experiences. The analysis took a comparatve approach between professions, as it allowed us to contrast the process and outcomes of various models of integraton across professions. We conducted interviews with 67 internatonal medical graduates (IMGs), 70 internatonally educated nurses (IENs) and 39 internatonally trained midwives (ITMs), recruited through a variety of means in four provinces – Britsh Columbia, Manitoba, Ontario and Quebec - and in two languages. Based on these conversatons, we traced their experiences, from their decision to come to Canada, through the process they undertook to get here, and then examined the barriers and facilitators to their professional and labour market integraton. We include some of their recommendatons for policy to improve the situaton for others who follow their path.

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