Tightening of foreign worker rules affecting supply of doctors

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Ottawa's bid to crack down on abuse of the temporary foreign worker program is stymieing efforts to bring in a class of highly skilled labourers Canada badly needs: doctors.

Physician recruiters across the country say the red tape and fees now associated with the program are causing major headaches for international physicians who want to fill vacancies in Canada's hospitals and medical offices, especially in rural communities where doctor shortages are common.

A tightening of the rules in the last three years – including the most recent overhaul, announced last month – has convinced some recruiters to give up on the TFW program altogether.

(What is the Temporary Foreign Worker Program? Read The Globe's easy explanation)

"Many, many, many recruiters that were doing this work back in 2011 have dropped off," said Joan Mavrinac, head of the regional physician recruitment office for Essex County, which includes the border city of Windsor, Ont.

"Then, with the changes in 2013, we've become far fewer and now the changes in 2014, I think, are going to effectively kill the program [for doctors.]"The TFW program had been under fire for more than a year when Employment Minister Jason Kenney and Immigration Minister Chris Alexander announced sweeping reforms designed to prevent unscrupulous employers from importing low-wage foreign workers to displace Canadian employees.

The reforms include a 10-day turnaround time to process applications for highly skilled, high-wage workers, but they do not address any of the unique concerns of doctors, many of which stem from the fact MDs are generally self-employed.

"We are drifting further and further away from anything that makes sense for physicians," Ms. Mavrinac said. "These people aren't pouring coffee and flipping burgers, but basically, they are all caught up in the same thing."

For international physicians, the TFW program has functioned as both a bridge to permanent residency and a means to work in Canada temporarily or while continuing to live in the United States. But since most are independent contractors, there is no for-profit company ready and willing to pay the fees and plow through the paperwork as there would be in the case of other high-skilled professions.

That work is often left to health authorities or local physician recruitment offices, neither of which are flush with cash. The recruitment office in Southern Georgian Bay, for example, is funded partly by the Rotary Club and an annual charity golf tournament.

"Doctors are independent contractors. We're working in a grey area where the application process doesn't allow us to check that box," said David Gravelle, the family physician recruitment officer for Southern Georgian Bay and a spokesman for the Canadian Association of Staff Physician Recruiters (CASPR), which represents community and hospital-based recruiters. "It's really hard to get our ducks in a row in a way that makes sense."

To bring in a doctor under the TFW program, recruiters first have to secure a labour market impact assessment (LMIA), formerly known as a labour market opinion, from Ottawa, verifying there is a shortage of doctors in that location and that no qualified Canadians are available to fill it.

To get an LMIA, recruiters have to place national advertisements in at least three places, including the federal government's national job bank, for at least four weeks.

Recruiters can't declare a blanket shortage in one town. They have to secure an LMIA for every address, even if those addresses are near each other. If a new foreign doctor wants to work at three different locations – two emergency departments and a walk-in clinic, for example – the recruiter needs to obtain LMIAs for each location.

Prior to 2013, LMIAs were free. Last year, Ottawa introduced a $275 fee. Then last month, as part of the TFW overhaul, the federal government increased the fee to $1,000 per LMIA, money Ottawa is planning to spend on beefing up and expanding inspections.

"That is creating challenges for smaller jurisdictions that are operating within limited budgets," said Sheila MacLean, chair of CASPR and a physician recruiter on Prince Edward Island. "They haven't budgeted for that because the program changes were made throughout the fiscal year."

A spokesman for Employment and Social Development Canada, the ministry spearheading changes to the TFW program, said by e-mail that recruiters in Windsor contacted the department in 2013, and that officials have been working to sort out the difficulties there.

Mr. Kenney, the employment minister, was not available for an interview. His press secretary Alexandra Fortier said in a statement that the TFW program will now be administered based on wage, "because wage is a more objective and accurate reflection of skill level and labour need in a given area. This new process will allow physicians to be processed faster and will bring their applications on top of the pile."

Ms. Mavrinac, the Essex County recruiter, said there are 16 American doctors who currently cross the border to work in her area under the TFW program. She is in the midst of processing applications for two more American doctors who want to commute from the U.S., after which she will not be accepting any others, unless they plan to relocate to Canada.

"I can't say to these doctors with any kind of confidence that when their work permit expires they'll get another," she said. "Because the rules keep changing."