Integration of International Health Professionals in India

Definition of Problem Statement and Introduction

Introduction:

Canada has a shortage of healthcare professionals, including nurses, doctors, and pharmacists. It burdens the workloads of existing health professionals, requiring more time for patients to get services and causing difficulties in assuring quality care. One way to ease this crisis is to retain internationally educated healthcare professionals (IEHPs), either those who have yet to come to Canada or already reside there. Unfortunately, the transition of IEHPs into the healthcare workforce is typically inefficient and unstandardized, resulting in delayed or- delayed employment, sub-optimum utilization of professional talents, as well as poor experiences with some IEHPs (Parsan, 2024).

Despite Canadas efforts to recruit skilled healthcare immigrants, this process remains riddled with barriers regarding credential recognition, professional licensing, and occupational entry. However, the recruitment of the regulatory regime to each of the provinces and lacking standard uniform integration policies compound this problem (Marchildon et al., 2020). Improved IEHPs are needed to transition the workforce from the dependent side to the productive side, and this cannot be achieved without tackling the many challenges; there is, therefore, a need to explore the strategies utilized by other countries that have been able to implement programs to improve IEHPs.

Defining the Problem Statement:

Integrating IEHPs into the Canadian healthcare system involves regulatory frameworks, health system structures, educational institutions, and workplace policies. Despite this increasing demand for healthcare professionals, IEHPs have high barriers that prevent them from playing an active role in the workforce. A primary challenge is the complicated credentialing and licensing requirements before IEHPs can practice in Canada. The rules and regulations vary across the provinces, leading to uneven licensing and assessment of foreign-trained professionals (Park, 2024). The lack of a coordinated national integration strategy further complicates the incorporation process. This creates a need for a more streamlined and comprehensive approach towards the integration of IEHPs into the Canadian healthcare system.

Apart from credentialing issues, few bridging programs and support services help IEHPs transition into the workforce. Some provinces provide structured pathways such as supervised practice programs and competency assessments, but these opportunities are not available to all. Limited information, financial restraints, and the lack of institutional support make navigating the system difficult for many IEHPs (Safari et al., 2022). Furthermore, workplace and cultural adaptation pose additional barriers. It is common for IEHPs to struggle to adapt to the expectations of the Canadian healthcare system, as well as the styles of communicating with patients and their work environments. In Canada, cultural competence training and mentorship programs, already in practice in other countries, are not readily available.

Another significant challenge facing IEHPs is the high rate of underemployment. Employer biases, strict hiring requirements, and a penchant for candidates with Canadian experience make it extremely difficult for many foreign-trained healthcare professionals to get jobs that match their qualifications and experience (Boroto., 2022). Therefore, most IEHPs occupy low-grade positions that are not an ideal fit for their expertise; they are thus professionally dissatisfied and financially deprived.

An environmental scan will be conducted to identify health system integration initiatives, diversity and inclusion measures, immigration policies, legislative frameworks, and research initiatives in Australia and New Zealand, which will be presented in the study. To understand what these successful processes are and how we might recommend them for use in Canada, this study seeks to examine these best practices through a comparative analysis of programs already implemented in Australia and New Zealand.

Approach to the Project:

This project will conduct an environmental scan of Australia and New Zealands initiatives to understand better how Canada might improve its approach to integrating IEHPs. Both countries have created programs that facilitate the transition of IEHPs into their healthcare systems. This study aims to find effective strategies that can be adopted in the Canadian context by systemically gathering information across various domains.

The environmental scan will cover key areas. The immigration initiatives of Australia and New Zealand will be investigated in terms of how they permit IEHPs to become part of their healthcare workforce via visa pathways and employment sponsorship programs. An analysis of the health system initiatives, orientation programs, residency requirements, and the supervised practice opportunities being provided to support the IEHPs will be carried out (Antonipillai, 2020). We will review how universities and training institutions provide bridging programs, credential recognition support, and continuing education for IEHPs.

Additionally, to help integrate IEHP, we will examine the effectiveness of diversity initiatives in workplace inclusion policies, cultural competence training, and mentorship programs. We will analyze legislative initiatives, such as licensing changes, professional mobility agreements, and government policies that mitigate systemic barriers, and uncover regulatory reforms that enable IEHP employment (Leslie et al., 2023). Finally, different integration models will be qualitatively evaluated regarding the challenges experienced, indicators used to evaluate the success of the initiatives, and reported outcomes.

Significance of the Study:

This study will systemically analyze these policies and programs in Australia and New Zealand and make evidence-based recommendations on how to incorporate these in Canada. This will help Canadian policymakers employ better strategies by knowing the evaluation metrics of the initiatives and which were successful. Furthermore, this study will add to ongoing debates around healthcare workforce planning by determining the most sustainable solutions to labour shortages and delivery of high-quality patient care.

Developing a more coordinated and supportive integration of foreign-trained healthcare professionals will benefit the professionals themselves and contribute to the strength of Canadas healthcare system. By confronting systemic barriers using best practices in other nations, equitable employment opportunities, better relationships between IEHPs and the public, and enhanced delivery of healthcare services will be realized for the Canadian population.

Conclusion:

Canada faces a critical shortage of healthcare professionals, yet the potential of IEHPs is not being leveraged due to systemic barriers related to credentialing, employment, and workplace integration. With Australia and New Zealand initiatives reviewed comprehensively, an opportunity exists to learn from successful models and adapt relevant strategies to the Canadian context. This study will examine immigration policies, health system strategies, education and training programs, diversity and inclusion policies, legislative frameworks, and research initiatives for IEHP integration. Resolving these challenges will improve the efficiency of the Canadian healthcare workforce and provide sustainability in the future while allowing foreign-trained healthcare professionals to utilize their competencies in the healthcare system.Literature Review:

1.1 Introduction:

This literature review comprehensively analyses the integration of international health professionals (IEHP) in Canada, Australia, and New Zealand. It delves into the key areas of immigration policies, credential recognition, workplace integration, educational support, healthcare system adaptations, diversity initiatives, legislative frameworks, and community support mechanisms. The review also provides a comparative account of the approaches adopted by the three countries, best practices, and the existing literature on the subject.

1.2 Immigration Policies and Pathways for IEHPs:

As per the review from Ibragimova (2022), in Canada, IEHPs are primarily admitted under the Federal Skilled Worker Program (FSWP) or Provincial Nominee Programs (PNPs). However, these pathways often do not align with the licensure requirements, leading to challenges in credential recognition. The absence of a national strategy for IEHP integration in the provinces further exacerbates these issues, creating additional workload inconsistencies.

On the other hand, Australia and New Zealand have built more focused and streamlined migration structures for the holders of the healthcare profession. According to Clemens (2015), Australia's General Skilled Migration Program for healthcare occupations, including the Skilled Independent Visa and Employer-Sponsored Visas, includes skilled migrants with relevant qualifications and experience in high-demand healthcare roles. Just as New Zealand's Skilled Migrant Category too specifically deals with critical role shortage occupations, doctors, nurses, and allied health professionals (Istiko et al., 2022). This, in turn, also facilitates easier entry for IEHPs, and immigration policies are oriented towards the needs of the healthcare workforce. In addition, IEHPs are also supported in both countries by post-migration, pre-migration skill assessment, and orientation programs to integrate them into their respective healthcare systems. Immigration policy can address the shortage of the workforce by taking proactive measures to tailor immigration to support the integration of IEHPs, and these are lessons for developing Canada's country.

1.3 Credential Recognition and Licensing Processes:

The major challenge IEHPs must overcome in seeking employment is credential recognition. Based on the review from Alostaz et al. (2024), In Canada, there are various regulatory bodies, and even foreign credentials require attestation through institutions like the Medical Council of Canada (MCC) or the National Nursing Assessment Service (NNAS).

In Australia and New Zealand, there are centralized systems where professional healthcare authorities assess the skills of IEHPs. Australia's Australian Health Practitioner Regulation Agency (AHPRA) and New Zealand's Medical Council of New Zealand (MCNZ) (Cooper et al., 2020) provide standardized pathways for recognition.

In both countries, structured competency exams can help get you IAHP certified, with supervised practice in Canada, and you can become an IEHP and be readapted into the practice. As a result, integration of the Australian and New Zealand workforce is speedier in Canada's fragmented system

1.4 Workplace Integration and Employment Pathways:

IEHPs usually face the monumental challenges of securing employment that matches their qualifications and experience in Canada (Moser & Sadler, 2024). First, the lack of mentorship and systemic biases prevent them from integrating into the workforce (Huo et al., 2023). However, many IEHPs have years of experience and training at home, only to land roles that do not fully employ their skills; many say they are underemployed working as personal support workers or administrative staff. These underemployed IEHPs not only detract from IEHP's morale and professional satisfaction but also represent a lost potential chance for Canada to take its healthcare worker shortages seriously.

Australia and New Zealand have formed more structured and supportive workplace integration programs. For example, Australia's Transition to Practice programs sponsor IEHPs to do mentorship, clinical supervision, and cultural orientation to assist them in adapting to the local healthcare environment. They are usually specialized for the particular needs of IEHPs, providing programs to close gaps in knowledge and practice (Covell et al., 2016). On the other hand, New Zealand's Career Force initiative is similar in that they are engaged in workplace training and development so that IEHPs get the required meaning to fulfil local standards and expectations (Alkema, 2022). These initiatives help smooth transitions for the IEHPs, give these individuals the confidence and competence needed to do the job well, and result in better job satisfaction and retention rates.

To be successful, these programs depend on the involvement of healthcare organizations and regulatory bodies that will create inclusive work environments. Healthcare employers in Australia and New Zealand are green-lighted to adopt diversity and inclusion policies that avow equitable opportunities for IEHPs (Rees, 2019). This includes offering ongoing professional development, supporting diverse, welcoming workplace cultures, creating opportunities for professional growth, and dismantling any barriers that might block IEHP's progress.

1.5 Educational Support and Bridging Programs:

Such programs must support IEHPs in fulfilling the licensure requirements and adapting to the local healthcare system. However, the programs are generally restricted in scale and availability in Canada, especially in rural and remote areas. These aspects create significant barriers to the IEHP's seeking to improve their skills and qualifications. For instance, many IEHPs must attend costly and laborious bridging programs to remain in services, sometimes posing geographic or financial barriers. Second, there are inconsistencies between the quality and effectiveness of the bridging programs as they are implemented across provinces due to the lack of standardized bridging programs. Thus, many IEHPs are left unemployed or underemployed for extended periods beyond their ability to integrate into the Canadian healthcare workforce.

On the contrary, the educational support systems for IEHPs in Australia and New Zealand are more comprehensive and accessible than those in other countries. The Bridging Programs for overseas-trained professionals offered by Australia are geared towards assisting IEHPs in receiving targeted training to facilitate assessment and, as a result, to permit them to meet the Australian healthcare system (Austin & Gregory, 2024). Also, these programs are often delivered in collaboration with educational and healthcare organizations so that they are by local standards and meet regional workforce needs. Based on the review from Safari et al. (2022), New Zealand's Competence Assessment Program, IEHP has its structured pathway to enable IEHPs to prove their level of skills and knowledge while bridging any gaps in training. These programs also provide orientation courses on the local healthcare system, cultural norms, and professional expectations.

Accessibility and affordability are critical to their success. Many bridging programs within Australia and New Zealand are also subsidized by the government or offered at lower costs to IEHPs.

In addition, these programs are developed to meet the specific requirements of various healthcare professions so that IEHPs will get the IEPs as per their qualifications. The practical experience and networking aspect of the nursing bridging programs in Australia, including clinical placements and mentorship in Australia, are, for instance, the most important.

Canada and its counterpart countries experience differences in providing support, bridging programs and education, and the need to concede to more comprehensive and standardized standards (Covell et al., 2017). Australia and New Zealand can be the ideal models for designing suitable programs for IEHPs as they are qualified, confident, and capable of offering the best to the healthcare system. This would improve the experiences of IEHPs in association with the overall quality and resilience of Canada's healthcare workforce.

1.6 Healthcare System Adaptations for IEHP Inclusion:

Adapting to the healthcare system is essential for IEHPs to participate in the healthcare workforce. There is little evidence of a systemic adaptation in Canada to implement IEHP. For example, IEHPs may be unable to deliver culturally competent and supportive care to healthcare organizations.

Nevertheless, Australia and New Zealand have been more successful at the systemic level in adapting to IEHP inclusion. Australia's Cultural Competence Framework, under the Cultural Competence Framework, includes advice for healthcare organizations that provide cultural and social care. New Zealand's Health Workforce Strategic Framework emphasizes the importance of diversity and inclusion in the healthcare workforce (Neiterman & Bourgeault, 2015). These adaptations make IEHP environments more inclusive and improve patient outcomes.

1.7 Diversity, Equity, and Inclusion (DEI) Initiatives:

These initiatives serve to systemically bias and ensure full participation of IEHP in the healthcare system. DEI is increasingly recognized as necessary in Canada, but the efforts are usually sought-after, accompanying evaluation (Enders et al., 2021). Healthcare organizations have adopted DEI policies but are inconsistent in implementing them, and such barriers continue to be systematic. For instance, IEHPs are denied a seat at the table regarding hiring practices and career advancement and have no culturally competent support in the office. These challenges make it impossible to integrate IEHPs, which, in turn, are responsible for the underutilization of the skills and experience of the IEHPs and only contribute to healthcare workforce shortages.

Moreover, Australia and New Zealand have made more robust and systemic DEI initiatives to support IEHPs. Australia's Diversity and Inclusion Strategy for the Health Workforce also covers a full range of instructions for enforcing equity and inclusion. Targeted at this strategy are measures such as anti-discrimination training, mentorship programs, and efforts to increase representation of various groups in senior positions. Likewise, New Zealand's Health Equity Assessment Tool assists in identifying and resolving inequities in the access to health services and practice by the workforce of health organizations (Alegra et al., 2024). They are well supported by strong policy frameworks and ongoing evaluation so that associated initiatives effectively promote DEI.

However, a considerable strength of the DEI initiatives in Australia and New Zealand is their work on cultural competence and anti-racism. Therefore, Australia's Cultural Competence Framework can be helpful for healthcare organizations when delivering culturally safe care, including acknowledging and addressing the unique needs of IEHPs. These are the Te Tiriti o Waitangi (Treaty of Waitangi) principles that guide the healthcare policies in New Zealand, including equity and inclusion in all segments of its healthcare system (Came et al., 2019). In addition to the IEHPs benefiting from better experience, patient outcomes benefit from more inclusive and equitable healthcare environments to support them.

This is particularly so for Canada since it involves immense disparities in DEI initiatives between one another and concerning their counterparts. Learning from Australia and New Zealand, Canada can create targeted DEI strategies focused on systemic biases, cultural competence, and equitable opportunities for IEHPs. This would enhance the integration of IEHPs and reinforce Canada's healthcare system's resilience and inclusivity.

1.8 Legislative and Policy Frameworks:

Legislative and policy frameworks provide support for IEHP integration. However, there is no national comprehensive strategy for IEHP integration in Canada, and there are significant differences between provinces. This has generated inconsistencies in the level of support available to IEHPs, which has impeded the effectiveness of integration.

Australia and New Zealand have better-developed legislative and policy frameworks that support the integration of IEHP. As per the review from Heale and Rieck Buckley (2015), Australia's Health Practitioner Regulation National Law establishes a uniform base between which to register and regulate healthcare professionals in Australia, while New Zealand's Health Practitioners Competence Assurance Act makes it compulsory for IEHPs to satisfy local standards of practice. Policy development and evaluation supporting these frameworks continue to occur, allowing these frameworks to stay responsive to the needs of IEHPs

1.9 Community and Peer Support Mechanisms:

Community and peer support mechanisms will assist IEHPs in addressing the integration cases. Such mechanisms are usually limited in scope in Canada, especially in rural and remote areas. This restricts what is available to and supports IEHPs and generates feelings of isolation.

Community and peer support mechanisms in Australia and New Zealand are more widespread. Indeed, Australia's Overseas Trained Doctors Association offers networking and mentorship, while New Zealand's International Medical Graduates Association offers the same support (Suphanchaimat et al., 2019). These mechanisms enable IEHPs to establish local networks, gain access to resources, and mobilize their strength to meet their needs.

1.10 Theoretical approach:

Systems Theory:

This study examines how IEHPs are integrated into the Systems Theory, where the outcome of the system is described as the product of interactions of many of its parts, and high interdependence occurs between various parts of the system (Berry et al., 2018). According to this theory, the integration of a healthcare system is highly dependent upon an ensemble of linked stakeholders, including education institutions, healthcare organizations, government regulators, and policymakers. However, Systems Theory highlights that these markets cannot be removed from barriers without all stakeholders' coordinated efforts, especially credential recognition, workplace integration, and systemic biases. Regarding immigration policy, educational, and workplace dimensions, Canada can make the IEHPs part of our current system through systems based on holistic approaches and give them value.

Figure 1: System theory:

Social Capital Theory:

The social capital theory prescribes that integrating IEHPs depends on the networks, relationships, and trust among IEHPs. This theory explains that social capital is required to access the healthcare system and employment, such as professional networks and mentorship (Pham et al., 2019). Although the IEHPs are located in Canada, they are usually isolated due to the absence of strong social capital mechanisms and, therefore, disadvantaged. Thus, social capital can be leveraged by Australia and New Zealand to take on mentorship programs, professional associations, and peer support networks. Canada should use social capital to advance Canada's interests and foster the integration of IEHPs by building connections, giving them access to resources, and helping IEHPs meet the needs of a healthy healthcare workforce.

Figure 2: Social Capital Theory:

1.11 Research gap:

This study analytically and critically focuses on research regarding the integration of IEHP; however, much is missing in terms of literature. One example is that little direct comparison has been made between approaches in Canada, Australia, and New Zealand. Additionally, most of the results of the integration initiatives are not systematically evaluated overall, with special attention on Canada. To fill these gaps, this study should be a comparative analysis of how IEHP has integrated into the three countries and what the best practices can do to improve the outcome of integration.

1.12 Chapter Summary:

This literature review examines IEHP integration in Canada, Australia, and New Zealand through the debates on immigration policy, credential recognition, workplace integration, educational support, healthcare system adaptations, DEI, and legislative and community support frameworks. The review discusses the issues manifested by IEHPs across Canada and presents best practices that Australian and New Zealand IEHPs have implemented as possibilities in the Canadian context. The next chapter will provide the details of the analysis of the findings and recommendations for improving IEHP integration in Canada.?