Reports of low-skilled Canadian workers being replaced with those from other countries spurred changes earlier this year to the Temporary Foreign Worker Program. But they’ve made it harder for areas in need of physicians as well.

The system was overhauled this summer after reports that companies were misusing the program, with Canadian workers at RBC and at McDonald’s allegedly being pushed aside by international ones on the temporary program. A tip line to report such concerns got more than 1,000 calls, and the government subsequently announced a series of changes designed to make it harder for the program to be abused.

However, the new rules have affected the ability of highly skilled industries to recruit employees, including specialists in the tech and financial industries and internationally trained doctors. It’s an unintended effect many are saying is causing unnecessary stress and delays in communities that rely on foreign-trained doctors. The changes, including increased fees and more complicated paperwork,  have made it more expensive and time-consuming to recruit doctors into these positions.

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“I’ve talked to a number of recruiters who have said if the process does not change, they will give up,” says David Gravelle, physician recruiter for the Midland-Penetanguishene area and communications chair for the Canadian Association of Staff Physician Recruiters. “I think communities like ours will not proceed with the process; we’ll just continue to experience a physician shortage until we solve the process.”

It’s a larger issue in border towns, which use the visas to bring in part-time doctors who also work in the U.S., and in rural areas that use many foreign-trained doctors, like northern Alberta, which is heavily dependent on foreign trained physicians.

Rising fees

In 2013, 126,000 people were in Canada on the Temporary Foreign Worker Program. And in 2006, about 1% of full-time workers who weren’t permanent residents were family doctors. Joan Mavrinac, regional physician recruitment officer in the Windsor/Essex area, estimates about 8% of the physicians she recruits, or four a year, come through the program.

The process of bringing doctors over on the temporary program is usually stickhandled by physician recruiters, who are hired by hospitals, communities or governments. It involves posting the position, applying for a Labour Market Impact Assessment from the government, finding an international doctor to make an offer to, getting a temporary work permit, and having the doctor get a licence to practice, if necessary.

Physicians who come in through the Temporary Foreign Worker Program are required to have a medical licence to work in Canada. They apply through the provincial colleges, and proceed through steps such as the restricted registration, a practice assessment or a licensure assessment. They’re not international medical graduates who have to go through the residency process.

The fee for each position has risen substantially, from free before 2013 to $275 that year to $1,000 in the latest changes. And the charges now apply per place the doctor will work, rather than per applicant. Previously, recruiters could list one place as the primary position and the others as supplementary jobs, adding up to a full-time position. Now those can be seen as multiple part-time jobs instead. That can mean they’ll only get a labour market assessment for 12 months, rather than the three to five years that come with a full-time position.

For doctors, who may work at two or three different places, those per-employer charges add up. The costs, which cannot be paid by the physician, are falling to provinces and physician recruiters, some of which are paid for by smaller communities that may even fundraise to pay for the costs of bringing in a new doctor.

In Alberta, the charge for this component – not including other recruitment costs – is usually $2,000, because physicians often have to do a licensure assessment in one community before going on to practise in another. “It’s frustrating, since we’re all using public resources, to have to go through what look like hoops that don’t actually add value,” says Jamie Rice, executive director of provincial medical affairs integration at Alberta Health Services.

Pushing paperwork

In the new system, recruiters have to prove they’re not taking jobs away from Canadians. “You have to demonstrate to the program that you have been working very hard to recruit a Canadian before you’re even allowed to apply,” says John Soles, president of the Society of Rural Physicians of Canada.

Part of that involves more stringent Labour Market Impact Assessment criteria. Recruiters need an assessment for every place a doctor will work, even if they’re close by or in the same city. As part of that, they submit an Employer Transition Plan, a 10-page document that shows how recruiters will fill vacancies with Canadians. This, along with other requirements, like posting jobs in multiple places, adds up to an “inordinate amount” of paperwork, says Gravelle.

These changes slowed down the process in Alberta this summer, as Alberta Health Services worked to create uniform suggestions on what to say on the applications. “In the short term, it’s been a lot of angst,” says Rice. “We were very careful in figuring out what our answers [on the application] were going to be, going forward.”

Rice is also concerned about the new requirement to show progress towards having Canadians fill the job, which could happen as early as six months after a temporary hire. “Given the time frame, it’s unlikely that we’ll see much progress,” he says, pointing out that for physicians, Canadian recruitment is a more long-term challenge. “The staff involved are [especially anxious about] the expectation that the next application will show progress made,” he says.

Jason Kenney, Minister of Employment and Social Development, made it clear when the changes were announced in June that part of their focus was on finding Canadian workers. “These comprehensive and balanced reforms restore the Temporary Foreign Worker Program to its original purpose—as a last and limited resource for employers when there are no qualified Canadians to fill available jobs. Employers will be compelled to redouble their efforts to recruit and train Canadians,” he said in a release at the time. He has since defended the reforms.

But should that apply to areas that face regular doctor shortages? “Let’s get doctors to those communities as simply as we can, and not get hung up on rules that weren’t designed for them,” says Rice.

Ironically, low-skilled workers are a new addition to the Temporary Foreign Worker Program, which was originally created in the 1970s to fill vacancies in highly skilled roles. Low-skilled workers were only added in 2002. But a number of changes since then, culminating in the last round, have made it harder for physicians to be hired. “Even before these changes, doctors were a square peg into the round temporary foreign worker hole. It’s not designed for physicians,” says Rice.

Border cities & retention

For cities like Windsor, another key concern is the effect this will have on doctors who cross the border. They currently have 16 doctors working in the area who come from the U.S. under the temporary permits, and are worried about getting labour market assessments when those positions come up for renewal. “With these changes, if I have an American physician approach me, my first question is, are they going to apply for permanent residency in Canada [which requires moving here]. If the answer is no, I don’t move forward with that physician.”

The new changes may also end physicians working on temporary visas for an extended period of time. “We did have a number [of doctors who] would have temporary after temporary after temporary,” says Rice. “It seems in the new program that won’t be acceptable.”

And any issues with recruitment also make retention harder, as reducing the number of foreign doctors puts more pressure on those working in a community. “You get this crescendo effect where you had to slow attrition down and all the doctors are working harder,” says Soles. “That makes retention more difficult, and it also makes recruitment more challenging.”

Looking forward

The changes mean more work for recruiters, but all attempts to fill spots with foreign physicians in Alberta have worked, says Rice. “We’re still a little bit nervous, but we are still recruiting effectively… time will tell if we can’t continue to do that, but I’m optimistic.” Mavrinac is more pessimistic. She says many recruiters across the country have stopped recruiting temporary foreign workers, and in her community, there are fewer physicians coming in through the program as a result of the changes.

Long-term, training more Canadian doctors and encouraging them to work in rural areas would solve the problem. Short term, “the answer is that you have a different category,” says Soles. “If there’s a recognized need for these physicians to come in and fill positions, we should be providing a different process to enable that to happen more expeditiously.”