Mobility restrictions imposed on internationally trained physicians in Canada could be aggravating the health-care crisis intensifying an ongoing doctor shortage.
Canada’s Temporary Foreign Worker Program has recently come under intense scrutiny, with a new United Nations report by a Special Rapporteur characterizing it as a systemic “breeding ground for contemporary slavery.”
The report criticizes the Temporary Foreign Worker Program for limiting workers’ freedom of movement by tying their immigration status to a single employer.
In contrast, regional or sectoral contracts could offer workers more flexibility in the labour market, reduce existing power imbalances, and enable them to push for better working conditions without fearing deportation.
Canada’s doctor shortage
The UN report overlooked how similar mobility restrictions imposed on internationally trained physicians (ITPs) could be aggravating Canada’s health-care crisis, tarnishing our international standing and intensifying our ongoing doctor shortage.
These mobility restrictions largely stem from what are known as practice-ready assessment programs that evaluate the clinical competence of ITPs to ensure they meet the standards required to practice independently in a specific province.
Compounding this issue, return-of-service contracts — often tied to the assessment programs — further limit ITPs’ mobility by mandating that they work in designated, often under-served, areas for a set period of time.
These policies aim to address regional health-care shortages but create significant mobility barriers for ITPs. This deters many from entering the workforce through these pathways. It also intensifies competition for limited residency positions, which Canadian-born medical graduates clamour for.
This restrictive environment worsens Canada’s health-care crisis by preventing the effective distribution of medical expertise. The physician shortage is severe, with only 2.5 doctors per 1,000 people in 2021. As a result, patient wait times are dangerously long, averaging 21.2 weeks for specialized treatment.
Integrating ITPs into the workforce poses no threat to Canadian medical graduates when supported by appropriate labour protections, including enforceable standards for equal opportunity in hiring, transparent and standardized credential recognition processes and measures to prevent discriminatory practices in job placements.
Additionally, integrating ITPs through practice-ready assessment programs has been demonstrated to yield only a nine to 13 per cent return on investment, and a 2019 report by the Royal Bank of Canada estimates that the under-utilization of skills among foreign-trained immigrants costs the Canadian economy up to $50 billion annually.
Creating bottlenecks
The health-care crisis and under-utilization of ITPs highlight a significant barrier to their integration into Canada’s health-care system. This issue, similar to the UN’s critique of the Temporary Foreign Worker Program, stems from mobility restrictions imposed on ITPs.
Practice-ready assessment programs require ITPs to practise in the province where they completed their assessment. Additionally, return-of-service contracts tied to these programs mandate practice in designated areas, often restricting ITPs to specific health-care facilities or small communities.
As a result, despite 72 per cent of ITPs having more than three years of clinical experience abroad — 20 per cent have more than 10 years under their belts — these restrictive return-of-service contracts lead many to opt for the already overloaded residency stream to procure their licences.
This exacerbates competition with Canadian medical graduates for residency positions, creating bottlenecks and forcing ITPs into unnecessary retraining. It also raises concerns about potential violations of mobility rights, akin to those closed work permits recently maligned by the UN and described by one physician as a form of “indentured servitude.”
A different path forward
To address this, the National Assessment Collaboration Practice-Ready Assessment, which oversees these programs at the federal level, should consider offering financial bonuses or loan forgiveness to attract doctors to under-served areas without restricting ITPs’ mobility.
Financial bonuses have demonstrated immediate rewards for physicians who choose to work in under-served areas, while loan forgiveness programs offer long-term financial relief. In Australia, the Rural General Practice Incentives Program significantly increased the number of rural practitioners, resulting in a 25 per cent increase in rural general practitioner placements between 2015 and 2018.
Additionally, a 2022 survey found that 86 per cent of Canadian ITPs were willing to work in rural areas of Canada if they received appropriate support and incentives.
Promoting economic growth
For temporary foreign workers and ITPs alike, the introduction of work permits would encourage healthier competition among employers to offer better working conditions, wages and benefits to attract and retain both migrant and domestic workers.
By dismantling the structural inequalities inherent in the closed work-permit system, sectoral work permits could reduce the exploitation of migrant workers, which often indirectly impacts Canadian workers by undermining hard-fought labour standards.
A fairer, more transparent labour market would benefit all workers by ensuring that employment standards are upheld across the board, leading to a more just and equitable work environment throughout Canada.
Eliminating return-of-service contracts could also free up residency spots for Canadian medical graduates, as ITPs would no longer bypass the practice-ready assessment pathway to avoid current mobility restrictions.
Canada’s systemic mobility restrictions on both low-skilled foreign workers and ITPs reflect a broader pattern of exploitation. The UN Special Rapporteur’s critique of the Temporary Foreign Worker Program has troubling parallels in the health-care sector. ITPs face restrictive return-of-service contracts that, like closed work permits, limit their freedom and perpetuate power imbalances favouring employers over workers.
Eliminating these constraints, whether through sectoral work permits or reformed return-of-service contracts, is essential. Such changes would protect worker dignity and rights while enhancing Canada’s labour market health and productivity. Ultimately, these reforms would foster a more equitable and dynamic economy, benefiting both migrant and domestic workers and contributing to Canadian society.
