Catherine Sas, K.C.It comes as no surprise to most Canadians that we are facing an extreme shortage of doctors across Canada. Many people have been lacking a family doctor for years. With a view to alleviating this problem, this past Friday, September 23, 2022, Canada’s Minister of Immigration, Refugees and Citizenship, the Honourable Sean Fraser, announced significant changes to the way that doctors are assessed for permanent residence to Canada under the Express Entry selection program.
The path to permanent residence to Canada for the medical profession has been historically challenging. 30+ years ago when I began practicing immigration law, many medical professionals, including doctors, were precluded from applying for permanent residence. At the time, there was a negative occupations list where such occupations as doctors, nurses, dentists, teachers, lawyers and many other such professionals were specifically listed as being ineligible to apply for permanent residence through Canada’s independent application category (a precursor to the current Federal Skilled Worker (FSW) program). On June 28, 2002 with the introduction of the Immigration and Refugee Protection Act (IRPA) this was changed and the negative occupations list was eliminated. However, this did not open the door for medical and other professionals to apply directly for permanent residence – they still had to demonstrate that they could obtain licensing from their respective provincial or territorial licensing bodies. This requirement remains to this day.
Many doctors have come to Canada on work permits to work in the more remote regions of Canada. They first need to apply for and obtain a provisional licence from their regulatory licensing body which allows them to work, generally under the supervision of other doctors. Concurrently they are able to go through the standard licensing process which includes studying for and writing Canadian exams. This process is both necessary and appropriate to ensure that foreign professionals are able to demonstrate that they have the education and ability to perform their profession in accordance with Canadian standards. Similar requirements apply to most foreign professionals seeking to work in Canada. The process of coming to Canada to work and then progressing to permanent residence is longstanding.
The challenge for doctors is the manner in which they are paid in accordance with the “fee for service” remuneration model. Most doctors are not employed in a traditional “employer-employee” relationship. Doctors frequently work in clinics, whether self-employed or in association with other doctors, and payment for their service comes from the provincial or territorial governments in the province or territory that they work in and are paid based upon the service that they provide to each individual patient. This “fee for service” model is characterized as self-employment by Immigration, Refugees and Citizenship Canada.
There lies the conundrum for foreign medical doctors working in Canada seeking to obtain permanent residence to Canada. As of January 1, 2015, Canada’s primary economic immigration stream is the Express Entry selection program.
Express Entry only recognizes Canadian work experience as an “employee”. Self-employed work experience is not counted towards the Comprehensive Ranking Score (CRS) points system such that many doctors, if not most, are not able to qualify for permanent residence to Canada under the Express Entry selection system.
Friday’s announcement by Minister Fraser both recognizes and corrects this hindrance to foreign doctors in obtaining Canadian permanent residence and being able to provide their skills to the benefit of Canadians desperately needing medical services (see link). Modifying the evaluation of Canadian work experience for foreign trained doctors working in Canada is a positive step in order to enhance the ability of retaining such much-needed medical talent from doctors who have both established themselves in and contributed to the Canadian health care system.
