National Reporting Instrument 2021

Canada

Tracey

Tracey Jones Cameron

Senior Policy Advisor

1 343 571 7924

tracey.jones-cameron@canada.ca,hrhinfo@who.int

Primary responsibility for the provision and delivery of health care services, including the training and management of health care professionals, falls under the purview of the provinces and territories (PTs). As part of their responsibility to administer and deliver health care services, the PTs establish training curricula and manage, license, and regulate health care professionals through arms-length regulatory bodies, such as professional colleges and professional associations. The federal role with respect to health professionals is primarily one of bringing together PTs to discuss pan-Canadian health workforce issues, to help ensure a workforce capable of addressing the health care needs of Canadians. a) The Department of Immigration, Refugees and Citizenship Canada (IRCC) provided the following: o No steps specific to the Code, as the Federal Government of Canada does not regulate labour recruitment. However, different measures have been and continue to be taken with regard to protections for foreign workers in Canada, as explained below. o The federal government does not regulate labour recruitment in Canada. Jurisdiction over regulating workplaces and businesses, except for a small number of industries that fall under federal jurisdiction, rests with the provinces at the sub-national level. Most matters of employment (labour standards, occupational health and safety, etc.) and the business of employment agencies and private labour recruiters are regulated by the province in which those actors operate. As such, provincial regulatory schemes vary widely across the country; notable examples of provincial labour legislation include British Columbia’s Temporary Foreign Worker Protection Act and associated regulations, as well as Quebec’s Act respecting labour standards, and the Regulation respecting personnel placement agencies and recruitment agencies for temporary foreign workers. o With respect to foreign worker protections at the federal level, the government has authority to inspect employers under Canada’s temporary foreign worker programs to ensure compliance with the offer of employment provided to a foreign national on an employer-specific work permit with respect to wages, working conditions and occupation. To this end, the federal government recently allocated new additional funds to increase employer inspections under Canada’s temporary foreign worker programs. o The Government of Canada is currently proposing amendments to the Immigration and Refugee Protection Regulations with an aim to enhance the protection of temporary foreign workers by setting new employer requirements and conditions. This includes a requirement for employers to provide workers with the most recent information about their rights in Canada and a requirement to have a signed employment agreement with their workers. The proposal would also expand the definition of “abuse” to include reprisal against a temporary foreign worker. Finally, the proposal would prohibit employers, and recruiters operating on their behalf, from charging or recovering recruitment fees from the worker. These proposed amendments are currently being presented to employers and stakeholders in Canada for comment and are subject to changes prior to their coming into force. b) The Province of Alberta provided the following information as of 2021: o Alberta Health staff reached out to several areas in the Department of Labour and Immigration and with the health authority, Alberta Health Services (AHS). Neither organization has any agreements nor policies to report at this time. o AHS does not have a record of receiving direction to implement this code; it did not find any policies related to this Code. Additionally, AHS reports it has not done any recruiting of international professionals (by that they mean actually searching out international candidates) other than physicians since 2014, and those that they have hired are international students, post-graduates, or those with open work permits.

The Province of Ontario provided the following information (2018): Ontario is participating in pan-Canadian health workforce planning efforts. These include discussion of all variables affecting such planning, including the entry and cross-Canada migration of internationally educated health professionals.

The Province of Saskatchewan provided the following information (2021): In the Province of Saskatchewan, Saskdocs (Physician Recruitment Agency of Saskatchewan) used the Code to adopt its own ethical recruitment framework that it uses while recruiting internationally trained physicians. The framework is posted publicly on the saskdocs.ca website.

See Saskatchewan’s response to 1.4.1 above.

Please refer to the information provided by the IRCC in 1.1 above.

The Province of Ontario provided the information below (2018):  Ontario is committed to ensuring self-sufficiency in health human resource capacity in order to meet the health needs of the people of Ontario, now and in the future. As such, the Ministry of Health and Long-Term Care (the ministry) does not promote or actively recruit internationally-educated health professionals.  With respect to physicians, Ontario has introduced a number of initiatives to increase physician supply, improve retention and enhance the distribution of physicians in the province. The ministry’s evidence suggests that the province has moved to an overall sufficient number of physicians; therefore, Ontario is shifting the focus away from “increasing supply” toward effective management of the expanded system in order to deliver the right mix and distribution of physician services across Ontario. This includes: o Maintaining a balanced and predictable supply of new physicians; o Managing the mix of specialties and new physicians to address population growth and changing healthcare needs (e.g. aging population) and services (e.g. addition of new roles such as Physician Assistant, Nurse Practitioner, etc.); o Ensuring newly educated providers go where they are most needed across Ontario and avoiding clustering of services in communities that are relatively well-served (e.g. downtown Toronto); o Making strategic new investments and targeted approaches (or strategic realignment of existing approaches) as needed to build capacity in areas of high need (e.g. psychiatry, rural and north); and o Working closely with medical schools to monitor the flow-through trainees through the medical education system, gather and assess evidence to support planning and management of the size and mix of Ontario’s training system.  Ontario has increased its evidence base to inform health workforce planning to meet the needs of the Ontario population. The ministry uses its data and physician forecasting tools in conjunction with other evidence, to support planning in collaboration with other key system stakeholders in Ontario. This includes working with medical schools on the allocation of physician residency positions.  Additionally, through a federal/provincial/territorial Committee on Health Workforce, a pan-Canadian physician forecasting tool https://www.hhr-rhs.ca/index.php?option=com_content&view=article&id=564%3Atools-from-the-chwc&Itemid=61&lang=fr was developed in order to provide jurisdictions and medical educators with pan-Canadian projections of physician supply and population needs to help identify potential physician imbalances across specialties.  This information is intended to facilitate greater collaboration between the ministry and medical schools in residency planning and promote improved alignment between physician supply and the health care needs of the population.  Ontario will continue to closely monitor its physician supply and the number of postgraduate training positions available and with the schools, through a collaborative process, will use the best available evidence to plan for any changes to the postgraduate medical education training system.  The ministry also worked on a nursing model to allow estimation of: o the supply of nurses available to care for the people of Ontario; o the number of nurses required to meet the health care requirements of the Ontario population; o the number of nurses the health care system will be able to employ; and o “gaps” between each measure.  Ontario worked on creating an even more strategic focus in planning the province’s health workforce. Too often health workforce planning in Ontario has involved a series of disparate strategies and initiatives focused on short-term goals.  The ministry has been working with sector partners to build a comprehensive framework to guide provincial and local planning that would shift the planning paradigm from a focus on physician supply and demand to a much greater emphasis on skills mix, distribution and other providers in the system.

To promote, strengthen and create efficiencies in human resource deployment.

The MOU is a labour mobility agreement for all occupations (Doctors; Nurses; Midwives; all categories of the health workforce).

L'Entente conclue entre la France et le Québec vise à faciliter la reconnaissance mutuelle des qualifications professionnelles des personnes y exerçant une profession ou un métier réglementés. Elle vise les professions et les métiers qui sont réglementés en France et au Québec, mais exclut les officiers publics et ministériels tels les notaires. De portée générale, l'Entente établit une procédure commune de reconnaissance des qualifications professionnelles en vue de la signature d'arrangements de reconnaissance mutuelle (ARM). Ces ARM visent à accélérer et à simplifier le processus de reconnaissance des qualifications menant à l'obtention d'une aptitude légale d'exercer une profession ou un métier réglementés. On y précise les conditions d'obtention d'une aptitude légale d'exercice ainsi que les mesures compensatoires (stage, épreuve d'aptitude, formation d'appoint) qui peuvent être exigées.

Shared ethical recruitment practices; Recruitment of internationally trained physicians; Co-sponsor and cost share for career fair attendance in the United States and United Kingdom

Human Resources

Many other health professions - see Entente - Annexe III

Family physicians and specialists.

Canada – the Province of British Columbia; the Phillipines

Canada; United States; Australia; Ireland; United Kingdom

Canada - Province of Manitoba and the Philippines

Canada - Quebec; France

Canada - the Provinces of Saskatchewan;Alberta; British Columbia and Manitoba

The Province of British Columbia

Canada

Department of Labour and Immigration of the Government of Manitoba, Canada

Le gouvernement du Québec

The Provinces of Saskatchewan; Alberta; British Columbia and Manitoba

The Philippines

The United States; Australia; Ireland; United Kingdom

Department of Labour and Employment of the Government of the Republic of the Philippines

La République française

The Provinces of Saskatchewan; Alberta; British Columbia; Manitoba

For Alberta: Please see information provided at 1 A. above. The following information was provided by the IRCC: no federal (IRCC) policies or laws specific to immigration of health workers; however, health screening examinations are generally required for temporary residents arriving to work in certain specific fields, including health sector jobs where public health is of concern. Provinces and territories have their own regulations for employment/work in health sector jobs.

British Columbia (BC) provided the following information: In BC, the Temporary Foreign Worker Protection Act (which is now fully in force as of December 15, 2020) has established a provincial role that did not previously exist for protecting foreign nationals from abuse and ensuring that they receive all protections under BC’s employment and labour laws: https://www.bclaws.gov.bc.ca/civix/document/id/complete/statreg/18045 . Specifically, the legislation establishes a licensing requirement for foreign worker recruiters and a registration requirement for employers seeking to hire foreign nationals and sets out some prohibited practices.

 An employer or recruiter who has been found to have committed a prohibited practice could be subject to penalties and fines under BC law.

Canada’s laws, policies and enabling programs uphold equality for citizens and immigrants alike. Canada’s inclusive laws are embedded in the 1981 Canadian Charter of Rights and Freedoms, with its provisions related to equality and freedom from discrimination. Canada’s 1977 Citizenship Act, 1977 Canadian Human Rights Act, 1988 Canadian Multiculturalism Act and 2001 Immigration and Refugee Protection Act also uphold these principles.The Temporary Foreign Workers (TFW) Program has a comprehensive compliance framework in place to protect TFWs and the Canadian labour market. The cornerstone of the compliance regime is employer inspections, which serve to protect TFWs from abuse and exploitation and to protect the integrity of the Canadian labour market, by encouraging employers to comply with Program conditions. If an employer fails to meet these conditions or does not cooperate during an inspection, a range of consequences can be imposed, such as administrative monetary penalties, bans from accessing the Program, or revocation of Labour Market Impact Assessments. In addition, integrity tools such as the on-line fraud reporting tool (www.canada.ca/en/employment-social-development/services/foreign-workers/fraud.html ) and the confidential tip line (1-866-602-9448) encourage disclosure of possible wrong-doing. Matters of a criminal nature are referred to the Canadian Border Services Agency or the Royal Canadian Mounted Police for further investigation.

British Columbia (BC) provided the following response: Health Match BC is a free health professional recruitment service funded by the government of BC. https://www.heabc.bc.ca/page49.aspx#.YRvh6YhKhPY Health Match BC actively recruits from the US, UK, Canada, Australia, and Ireland. o Health Match BC does accept and support applications from anyone who wishes to access their services.

In order to better inform TFWs about their rights, the TFW Program is doing three things. First, the Program updated its pamphlet “Temporary Foreign Workers: Your Rights are Protected” (https://www.canada.ca/en/employment-social-development/services/foreign-workers/protected-rights.html ) which informs TFWs about their rights and protection. It also provides contact numbers should they be in need of help. When conducting an inspection, departmental officers provide the foreign worker with a copy of a pamphlet (Temporary Foreign Workers: Your rights are protected) that outlines their rights and responsibilities as workers under the program while working in Canada. Service Canada also provides key information directly to TFWs about their rights in Canada when they apply for their social insurance number. This information, which includes contact information for health and safety offices and employment standards offices, a list of ineligible employers to the Program, and some valuable information on how to report abuse or misuse, is provided orally, and in print. Employment and Social Development Canada also has a webpage which facilitates access to information on temporary foreign worker rights and protections, found at: https://www.canada.ca/en/employment-social-development/campaigns/foreign-worker-rights.html

Province of Alberta: Regulated professions’ mobility is governed by the Health Professions Act and Regulations; Alberta’s regulatory colleges all have processes in place.