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ABSTRACT
This article looks at recent efforts to better coordinate and integrate health care providers trained abroad. The findings are based on a pilot study of physicians, nurses, midwives and psychologists who have immigrated into Canada. The article traces some of the demographic and policy contexts related to health labour migration.
Although it was common to lament the health care "brain drain" from Canada throughout the 1990s (Hickey 1995, Williams 1997), it is important to note that we are by far a greater importer than exporter of health labour. Indeed, Canada has relied heavily on internationally trained providers in part to help solve shortages in rural and remote under-serviced areas and in urban subspecialties (Barer and Stoddard 1991, CIHI 2001, OHRC 2002). At the same time, we hear of numerous accounts of internationally trained providers not being able to practice their profession. One of the staples of recent Canadian news writing has become the story of highly educated professionals driving taxis or performing other type of deskilled labour. The deskilling of immigrants is also a recurring trend in the scholarly and policy literatures. This contradicts immigration policies that strive to seek the "best and the brightest."
Where does this disconnect arise? One commentator has argued that there are "[c]omplex and interdependent actors in multiple jurisdictions with unaligned accountabilities. Governments do one thing, educational institutions do another, and regulatory authorities do a third," (Fooks 2003). As a result, we have had no nationally coordinated policy for health labour immigration. Efforts have been recently made to address these issues. New specifically targeted efforts have highlighted the importance of the associated problems of lost labour and potential solutions to the current or projected shortages of several kinds of health care providers.
In this article, I discuss some of the recent efforts undertaken to better coordinate and integrate health care providers who have been trained abroad.' The cases I present are based on a pilot study of the migration of physicians, nurses, midwives and psychologists into Canada. The purpose of this pilot study was to: 1 ) examine the demographic and policy contexts surrounding the migration of physicians, nurses, and midwives; and 2) begin to identify the gaps that exist between the policies of various institutions and...