In summer 2011, the Office of the Fairness Commissioner conducted interviews with various authorities in the field.
When skilled immigrants migrate to the United States, they often face a problem of not being able to translate their work experience and education and training into a US context. So they end up working as baby sitters, or taxi drivers, whereas back at home, they worked as engineers and doctors and scientists and lawyers. Underemployment of skilled immigrants or what we call “brain waste” is a serious problem in the United States. In our research in the Migration Policy Institute, we found that one in five skilled immigrants are either unemployed or work in low skill, low paying jobs with little career prospects.
In the United States there are no similar acts like Ontario’s Fair Access to Regulated Professions. The policy context is very, very different. For the most part the American public opinion is not focused on highly skilled immigration. The elephant in the room is illegal immigration and what to do about it. Professional and licensing regulatory bodies guard their turf very severely. However, because immigrant professionals joined the ranks of these organizations such as the American Medical Association, the can and are initiating change from within.
At the Migration Policy Institute, we believe, there are a few things that can and should be done to alleviate the brain waste problem. Number one: is to continue doing analysis that would capture the cost of brain waste and once the magnitude of skills underutilization is known at the federal, state or local governments, this will serve as an impetus for policy change. Number two: there are a lot of promises and practices and great, really wonderful organizations that already today help immigrants to restart their careers in the United States, so a promising solution is to fund these organizations and spread the best practices so these practices can be transferred to other different states and different professions.Top ›
The Medical Council provides a qualification that the provincial regulatory authorities use in their licensing process and the Fairness Act, really in Ontario, is one of the national activities that have really I think improved access for international medical graduates across the country.
The regulatory authority is really interested in public safety, but the public also doesn’t necessarily see that a doctor is not a doctor is not a doctor. And our biggest need, at this moment in time in Canada, are people who can go into smaller communities and be general care providers. And if you happened to be someone who worked in a city as a cardiac specialist or ears, nose and throat specialist, you are not going to be able to go into that community and provide a broad care for that community.
Licensing of physicians in this country is a maze, and it’s incredibly complex because there are thirteen jurisdictions, not one country. The rules that apply in Ontario are not the rules for Quebec, and they’re not the rules for British Columbia. So doctors coming into the country as immigrants have a great difficulty trying to figure out what they need to do to fulfil the requirements of each regulatory authority.
We have been very complex in our instructions to individuals and when English may not be the first language it becomes even more confusing. The primary impact of the Fairness Act and the fairness commissioner has been on the College of Physicians and Surgeons of Ontario. But since they use our qualification as a third party the fairness commissioner has looked at us and the way we do our business, so it’s caused us to examine many of our processes
I am optimistic that over the next three to ten years things are going to get much better.Top ›
A core value of the Royal College of Dental Surgeons of Ontario is fairness and transparency. The process of evaluating applicants is done quickly and personally by staff. The other important thing is that the College takes into consideration the circumstances of professionals who come from countries where there are conflict and wars. So in this kind of situation professionals sometimes do not have access to documents. That means that the College, in this type of situation as in Bosnia, Iraq or Afghanistan, accepts a statutory declaration to make up for the lack of documentation. In handling applications, the only question is the protection of the public.
Governments, both federal and provincial, have pushed for greater labour mobility across the country. That means that, more and more, in all professions, doors are opening so we can all benefit from the expertise of professionals who can come and enrich our society and respond to specific professional needs, including dentistry.Even though I have been a proud Canadian citizen for almost thirty years, every day I see the contributions in many fields of professionals who arrive from elsewhere. Since 2007, the College has held a national forum to deal with the question of admissions and the recognition of qualifications of professionals educated overseas. The College takes this question very seriously and regards it as a question of justice and fairness.Top ›
The understanding of the regulatory system in Canada and Ontario in particular, is something that’s new to this profession and there needs to be education and upbringing in that part as well. As well, the health care system in Canada is also different compared to where the professional originates. So trying to get that into the practitioners for them to understand, whether they are already practising in Ontario or whether they are coming from another country, it is something that needs to be brought to the attention of the practitioner before the apply for registration.
Now the fairness access act is helping regulators, as well as everybody who is involved, to have a better sense, and it will help us to nurture and to keep on making sure that our registration practices in future and also currently retain transparency and making sure that it’s fair, impartial, and is objective.
The Office of the Fairness Commission is invaluable in the fact that it will definitely help facilitate the understanding that both professionals trained here and those from outside will cross fertilize and bring the profession to a different level.Top ›
I think the fair access law is effective in addressing the concerns of immigrant professionals. I think that there is more that still needs to be done, but it is certainly something to build on.
The value of the Office of the Fairness Commissioner is to ensure that legislation is implemented effectively, so that we can address issues that are of concern both to immigrant professionals but also to the broader population. The fact of the matter is that over the last 15 to 20 years a lot of our immigration has involved significant numbers of people who have prior learning and experience, and we need to optimize the skills that they bring into the country. So the value is to open up the labour market so that we have the ability to engage the skills and talents of many of the immigrant professionals that are coming into the country.
The first real look at the problem of the credentialisation and access to employment for immigrant professionals happened round about 1989 when we had the Cummings Report. Since then we’ve been struggling with this issue. We have had generations of immigrants coming into the country that are having a hard time getting attachment to the labour market in their areas of training and experience. And that is critical. We need to address that, especially because we are moving into a time period where a significant minority of members of the labour force are going to be racialized and immigrants.
I think in about five or 10 years if the work of the commission and other work that is being done, if the legislation is implemented in the way that it shows that it is effective, we will start to open significantly the doors to the various professions and trades, and make sure that those who are immigrating with the skills can utilize those skills both to their benefit as individuals, to their families but also to the economy.
I am always optimistic. I am naturally an optimist. I think that we have turned the corner somewhat with regard to this issue, and I think that we will start to see a difference in terms of access to professions and trades for many immigrants that are coming into the country.Top ›
Well, there’s a number of similarities between Canada and Australia which are very important. First, we’ve both got big, proactive, skilled migration programs. It’s about two-thirds of all our landed immigrants. Secondly, Australia has got 24 per cent of all its population first-generation migrants, compared with 19 per cent for Canada. So it is a big issue for us both. And third, our economies are in a very similar cycle.
But there are also important differences. The first is Australia has taken major proactive steps since the 1980s to facilitate credential recognition. I think we led the world in a number of those steps. Secondly, in the past decade, we have screened principal skilled applicants, as a condition of selection, their English ability and their credential recognition. If they have no likelihood of being recognized they can’t proceed with economic migration.
First, nothing is more important than English. All our research of the last two decades show if you are a migrant with high quality English you are four times likely to get work in your profession than if your English is poor.
So a basic problem we’ve got is that we’ve got 19th century regulatory systems trying to deal with 21st century people movement, in an age of globalization. Often the systems don’t match the purpose.
Australia has done a number of things to speed up recognition. And I would like to give an example first in terms of medicine. In an age of globalization, students choose where they study. And at the moment there are three and half thousand Canadian citizens who are medical students studying overseas. Ninety-nine percent of physicians who train in Australia pass the Canadian MCC [Medical Council of Canada] exams. And yet I understand there is no fast track to bring your citizens who’ve qualified overseas back to service in Canada. It would seem to me to make great sense to change the systems to facilitate their re-entry. And the majority, I understand, do come from Ontario.
In terms of pecking order, I would say Australia is doing relatively well, but we are in the grip of major transitions at this stage. Canada is doing less well, but is far ahead of many other immigrant receiving states. And in countries, such as Europe, who are only just becoming dependant on introducing proactive immigrant programs, Canada would be well ahead. Countries such as Germany have had catastrophic outcomes for many overseas qualified professions. So there is a momentum building in the world to develop better systems to recruit, but also to utilize, health professionals and other professionals in every field.Top ›
The values of the bridging program are in three key areas as I see them. One is guidance. Very often, when these people come, they need guidance. They need some very basic advice about what would work for them. Number two: the value of the bridging program is in making an assessment of what they need. How can we help these people? Number three: is providing the support, the components which can vary from credit courses, so in cases of university generally but it also includes mentoring, it also includes language support. Without these key elements, the path for them could be longer, could be more difficult. I would say the system of education and training as it exists has some basic inadequacies. I mean, there are things that do not exist and the bridging programs provide those services and support. As we have seen in the bridging program over the last four years, the licensing system has become more open. And by openness I mean that people often have an answer as to what their assessment is and why their assessment is like what it is. Number two: the appeal process has also improved. In the earlier licensing process people often did not have a very clear and transparent appeal process and now they have a very clear process of appeal. Number three: the requirement for Canadian experience has either been waived by most licensing bodies, which is a huge shift from the earlier procedure where their experience in their countries where they came from where not recognized. Right now, all the three accounting bodies have either waived this requirement or are in the process of waiving it, or they have considerably reduced it, or the offer alternatives to this experience. So I think that’s a huge shift.
In terms of education, also the number of institutions that they now accept and evaluate as equivalent to Canadian education—that list has grown and their process has also improved.
The fair access law is important in Ontario because it’s really the first step we have seen in regulating and legislating transparency and accountability of the regulatory bodies, and it has done so in a way that has set a framework for what the expectations are, what the benchmarks should be. They are developing an audit format and accountability structure, and these are first steps and we haven’t had this before and we are seeing this replicated in other provinces, other jurisdictions across Canada. It’s important because it’s setting the foundation. But there are still more steps, challenges and places for it to go.
It’s still a relatively new law and commission. In the future I think it needs to explore and consider what powers it needs, what authority it has to implement change with some of the regulatory bodies. I think it’s been able to instil a collaborative and collegial relationship with many of the regulatory bodies, but it needs to also ensure that it continues to raise the bar on how well they are serving Ontario’s newest residents and ensuring that those who are qualified to be licensed do get licensure. We still need, I think, an avenue for individual immigrants to be able to have recourse for their individual applications. The fairness commissioner and the Office of the Fairness Commission is a very systemic approach to transforming the regulatory environment, and that’s important, but I think we also need access to individual recourse.
I think we have seen a growth in response by these very important institutions, the regulatory bodies. And so we see transparency, accountability and recognition of international credentials as a priority in institutions where it wasn’t talked about before. And so I think that’s a really important first step and contribution of the office.
And so, I think we are seeing progress. We’re seeing employers who are becoming much more open to changing and learning how to do this better. And we’re seeing regulatory bodies becoming better partners in doing that. And so I’m optimistic in thinking change can happen, but I think we have to stay on it. I think we need to continue to be vigilant, to watch what’s happening, and to encourage better practice.
I think the Fair Access to Regulated Professions Act has really helped internationally educated professionals in particular, but all applicants, to understand better the requirements certification in a regulatory profession, to have greater access, more information. And I think we as regulators have responded by making the pathway clearer and removing some challenges and some barriers for those individuals. The college responded to the act by passing our own legislation in 2009 and even prior to that, to the existence of the Office of the Fairness Commissioner, we had started a review of our own practices in 2007. We interviewed internationally educated applicants, held focus groups, and had already made some changes to our process in response to some of the challenges they were facing.
We’ve made a number of changes to our process and to our requirements, and I think one of the most significant changes is that we removed the requirements for all applicants who completed their program outside of Ontario to accumulate a year of teaching experience in Ontario before holding or before having the right to have a permanent certificate and that represented a significant change. It is very challenging right now in this current job climate for teaching to find employment and to accumulate that year of teaching experience, and so removing that means that those internationally educated applicants receive the same certificate as those who complete the same program in Ontario. A second change is that we’ve moved all of our applications onto an online application which means that internationally educated applicants can start the process, they would know what the requirements are and the greatest benefit is that they can track their application online do that once they’ve applied they can see in their own personal password protected area, which documents we already have, which documents are outstanding, what more information we need from them. That’s been a great benefit.
We in Ontario, in the teaching profession, we want to welcome diversity, we want students to see themselves in their teachers and so having a law that allows greater access and allows more internationally educated applicants into the profession is good for all of us.I think the law has allowed us to have greater self reflection, greater analysis of our own processes, to develop quality assurance processes and to take more time to think about on going changes that we can make and to have dialogues with our partner regulators—its brought us together in some collaborative projects; to ask each other how are you implementing alternatives when documents aren’t available and learning from each other. Top ›
The objective process involves five examinations, both written and clinical skills. Three of these examinations are the exact same exams that the Canadian medical graduates sit after they finish their medical school to get their MD. We have to sit for an extra two exams which means that objectively we have all the necessary knowledge and have demonstrated the skills necessary for independent practice in Canada. However, for international medical doctors, there’s also the subjective component which is where we have to work with the preceptor who will work with us for a few months to make sure that its safe practice, and I think that’s fair. The problem is: the people who are in charge of arranging this “preceptor-ship” or assessment have not been helpful. Number one, the process is not transparent in the sense that usually only one person who makes that decision. This person is the program director of the university faculties of medicine, and this person (he or she) has sole power to decide whether to take someone into the position or not. Secondly, that same person has the power to determine how many positions are available, and that’s where the subjective part of it is failing. The college has not been able to help us to hold these people accountable.
Let’s talk about a forty-two year old doctor who has worked as a surgeon for fifteen years in her country of origin. She has come to Canada and passed the five exams, the objective exams. All she needs now is a preceptor for six months and she has applied for the last three years with no success. So how has the system failed? Because the college has this policy that says, “Ok, you pass all these exams and then you get a preceptor”. And they say, we’ve done all this and there’s no preceptor.
The Office of the Fairness Commissioner has no power to ask, Is that policy fair in the first place, because if you have no ability to provide a preceptor, then that whole process is itself unfair.
International medical doctors are competent are qualified--those who have passed all the Canadian exams. No one is advocating for anyone who is unqualified or come from dubious universities. They will greatly benefit the health care system in Ontario so, if I were to look forward five to ten years, if we could get these doctors into practice there will be a real benefit to the communities of Ontario. If things stay the same it be best to be actually very honest and tell the world that if international medical doctors ever come here, would probably ninety-five percent unlikely to ever practice medicine again—unless things change.Top ›
Well, I think the primary benefit of the law is that it establishes what are the basic requirements of the process regardless of the profession one is seeking entry into. It’s important that the professions are independently regulated but it’s also important that the professions follow these basic requirements, and I think the law establishes them, establishes them pretty clearly and sets up a mechanism by which the professions can show they’re meeting them or be helped to meet them.
An easy example where major progress has been made is the profession I come from, the legal profession. If I compare where we are now compared to a decade ago on access to the profession by not just lawyers trained in other countries, but even lawyers trained in other provinces, it’s come a huge distance. There’s been much greater recognition of foreign credentials, much more willingness to fill in the gaps so people can make the move into the practice in Ontario, even the development of a bridging program at one of the law schools to help people to do that.
I think the importance of having an Office of the Fairness Commissioner, at least the intent of the legislation, was to really accomplish two things, both really important. One, to ensure that these principles of fairness are in place to help ensure that and secondly, to help support the professions as they implement innovative procedures, to learn from one another, to be teachers themselves and I see the office as a place to be both an accountability device but also a supportive, consultative agency.
I think the commission has gone through the inevitable growing pains of trying to establish its role and that has occasionally gotten them into an excessively adversarial relationship with some of the regulatory bodies. It has obviously required them to gather a lot of information and file a lot of reports and so on so that it required a lot of work of the bodies. I think they are learning to be supportive and not to expect massive change overnight and they are also learning, I think, to provide better guidance on what is good practice and what ways you can achieve it. Top ›