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Oecd Health Working Papers International Mobility Of DELSA/ELSA/WP2/HEA(2008)6 INTERNATIONAL MOBILITY OF HEALTH PROFESSIONALS AND HEALTH WORKFORCE MANAGEMENT IN CANADA: MYTHS AND REALITIES Jean-Christophe Dumont, Pascal Zurn, Jody Church and Christine Le Thi 40 OECD HEALTH WORKING PAPERS For Official Use DELSA/ELSA/WP2/HEA(2008)6 Organisation de Coopération et de Développement Économiques Organisation for Economic Co-operation and Development 16-Oct-2008 ___________________________________________________________________________________________ English - Or. English DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS Employment, Labour and Social Affairs Committee For Official Use DELSA/ELSA/W Health Committee P2/HEA(2008)6 P2/HEA(2008)6 OECD HEALTH WORKING PAPER NO. 40 International Mobility of Health Professionals and Health Workforce Management in Canada: Myths and Realities Jean-Christophe Dumont, Pascal Zurn, Jody Church and Christine Le Thi English - Or. English JT03253133 Document complet disponible sur OLIS dans son format d'origine Complete document available on OLIS in its original format DELSA/ELSA/WP2/HEA(2008)6 DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS OECD HEALTH WORKING PAPERS This series is designed to make available to a wider readership health studies prepared for use within the OECD. Authorship is usually collective, but principal writers are named. The papers are generally available only in their original language – English or French – with a summary in the other. Comment on the series is welcome, and should be sent to the Directorate for Employment, Labour and Social Affairs, 2, rue André-Pascal, 75775 PARIS CEDEX 16, France. The opinions expressed and arguments employed here are the responsibility of the author(s) and do not necessarily reflect those of the OECD. Applications for permission to reproduce or translate all or part of this material should be made to: Head of Publications Service OECD 2, rue André-Pascal 75775 Paris, CEDEX 16 France Copyright OECD 2008 2 DELSA/ELSA/WP2/HEA(2008)6 ACKNOWLEDGEMENTS The authors would like to express their gratitude to John Martin, Martine Durand, Peter Scherer, Jean- Pierre Garson, Elizabeth Docteur and Francesca Colombo for their valuable comments. The authors are also grateful to the Representatives of Health and Migration Ministries and all the experts who kindly accepted to meet with the authors during the OECD secretariat mission in Canada and provided very valuable information and data. The OECD Secretariat thanks the Health Canada for their support in organising and assisting the OECD secretariat mission in Canada. This paper is one in a series of case studies undertaken as part of a project on Health Workforce and International Migration. The project was jointly undertaken by the OECD and the World Health Organization: one of the co-authors, Pascal Zurn is a WHO official who was seconded to work at the OECD on the project and also worked on the study on Canada upon his return to WHO. We are grateful to the Swiss authorities for the financial support which supported this secondment. The case study has also benefited from the Canadian Society for International Health Young Professionals Placement Program, through which Jody Church joined the OECD team for a six-month period. The Health Workforce and International Migration project has received direct financial support from Australia and Canada, and has benefitted from voluntary contributions in support of the Health Systems Performance work programme from other member countries. The Health Workforce and International Migration project has been co-financed by a grant provided by the Directorate General for Health and Consumer Protection of the European Commission. Nonetheless, the views expressed in this report should not be taken to reflect the official position of the European Union. 3 DELSA/ELSA/WP2/HEA(2008)6 TABLE OF CONTENTS OECD HEALTH WORKING PAPERS ......................................................................................................... 2 ACKNOWLEDGEMENTS ............................................................................................................................ 3 SUMMARY .................................................................................................................................................... 7 RESUME ......................................................................................................................................................... 8 INTRODUCTION ........................................................................................................................................... 9 Main findings ............................................................................................................................................... 9 I. HEALTH WORKFORCE DEVELOPMENTS AND POLICY RESPONSES ......................................... 13 Canadian health workforce: context and some basic facts ........................................................................ 13 Public health expenditure and cost containment issues in the early 1990s ............................................ 16 Trends affecting the Canadian health workforce ....................................................................................... 19 Balancing work and family life .............................................................................................................. 19 Feminization of the medical workforce .................................................................................................. 20 Ageing of the health workforce .............................................................................................................. 20 Main developments in health human resources management since the late 1990s: rebuilding the health workforce ................................................................................................................................................... 22 Increasing medical and nursing school enrolment ................................................................................. 22 Improving health workforce management ............................................................................................. 24 Developing new models of care ............................................................................................................. 27 Improving Pan-Canadian collaboration on health workforce issues ...................................................... 29 Inter-provincial migration of health professionals ..................................................................................... 30 Inter provincial mobility is limited but not insignificant........................................................................ 30 Inter provincial migration is dominated by East-West flows ................................................................. 31 II. INTERNATIONAL MIGRATION OF HEALTH PROFESSIONALS ................................................... 34 Immigrant health professionals represent an important share of the health workforce … ........................ 34 … as this is also observed in other occupations......................................................................................... 35 Long-term changes in the share of foreign-trained doctors in Canada ...................................................... 37 Recent trends show increasing migration of health professionals to Canada … ....................................... 40 … partly as a response of policy changes .................................................................................................. 42 Main countries of origin for migrant doctors and nurses ........................................................................... 45 Emigration of Canadian doctors and nurses .............................................................................................. 50 Emigration of immigrant health professionals ........................................................................................... 53 III. RECOGNITION OF FOREIGN QUALIFICATIONS OF HEALTH PROFESSIONALS .................... 55 Pathways to full licensure for International Medical Graduates ................................................................ 55 Provisional and other types of restricted licenses for IMGs ...................................................................... 57 Becoming a licensed registered nurse in Canada ....................................................................................... 59 IV. Labour market integration of foreign-trained health professionals ..................................................... 60 4 DELSA/ELSA/WP2/HEA(2008)6 Integration of foreign-trained health professionals in the Canadian labour market ................................... 60 Federal programmes to facilitate the recognition of foreign credentials of health professionals .............. 65 V. Health workforce in rural areas: solving the unsolvable? ..................................................................... 68 A persistent issue characterized by marked differences between rural and urban health workforces…. .. 68 … and a strong presence of international medical graduates in rural areas. .............................................. 69 A large range of policies and initiatives have been developed, especially for doctors… .......................... 71 Education/training .................................................................................................................................. 72 Regulatory/administrative
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