Part 2 of 2: Why internationally trained healthcare professionals can’t practice

As Canada faces a shortage of almost 25,000 doctors, foreign trained physicians are working as cashiers at McDonald’s and neurologists with decades of experience are working as massage therapists. Almost 30,000 Canadians died last year waiting for care, yet a lack of urgency to get internationally trained healthcare professionals (IEHPs) practicing means that number will likely continue to grow. 

In Part 1 of this series, we examined the pressing healthcare crisis affecting Canada from coast to coast to coast. A shortage of tens of thousands of doctors, nurses, and other healthcare staff means more and more patients are resorting to private, paid clinics to access care rather than waiting for years in pain. Canada has been underproducing domestic medical graduates for decades, and we cannot work our way out of this crisis without talent from abroad. 

Yet despite tens of thousands of trained IEHPs arriving in Canada, many are unable to practice due to high licensing fees (a convoluted process that differs in each province), mobility restrictions, and long wait times. Canada’s nursing industry in particular relies heavily on international talent; in 2023, 15% of all registered nurses in Ontario obtained their training abroad. But 79% of internationally educated nurses are employed in the healthcare sector in less-specialized roles, such as personal support workers. 

IEHPs face numerous obstacles to practicing in Canada. Many of these obstacles are profession-specific, but some exist across the board. Fragmented licensing systems across provinces are difficult for both immigrants and Canadian-trained professionals to navigate. The lack of a federal licensing system also limits immigrants’ mobility, forcing them to remain in the same province where they obtain their licensing. In a survey by the Canadian Medical Association, 73% of members believe a pan-Canadian licensure system would make Canada more attractive to internationally trained medical graduates (IMGs). 

Depending on their qualifications and country of education, IMGs can pursue licensing through several streams. Most pathways include mandatory return-of-service (ROS) agreements, which force IMGs to work in designated underserved or rural areas for a set period of time, further limiting their mobility. The utility of these agreements is debated. In Alberta, which does not use ROS agreements, the number of practicing family doctors in rural communities grew by 32% between 2005 and 2018. In Ontario, which mandates ROS agreements, practicing doctors in rural areas grew by only 20%.  

IMGs also face long wait times for the required exams, which typically only run a few times a year and can lead to months-long delays for doctors to get qualified. Furthermore, only 10% of annual residency spots – a requirement to licensing for most international doctors – are reserved for IMGs, leading to fierce competition. 

Nurses and allied health professionals like physiotherapists, pharmacists, and laboratory technicians, who make up the backbone of Canada’s healthcare system, are also in critically short supply. A recent LifeLabs closure in Thunder Bay and reports of medical technologists working 50 hours straight in Saskatchewan highlight the critical need for more of these professionals. 

An interview conducted for this article captured the experiences of Olukayode Jegede, a medical technologist, and his wife, a nurse, highlighting Canada’s complex and fragmented system. In 2016, the couple immigrated from Nigeria to Manitoba. In Nigeria, Olukayode worked as a medical laboratory technician testing a huge volume of samples daily in a major hospital. His wife, Esther*, was a practicing nurse and midwife. After immigrating, Olukayode went through the Canadian Society of Medical Laboratory Science (CSMLS) to re-qualify as a medical lab tech in Manitoba. The process included having all his documents sent from Nigeria to the CSMLS (they do not allow applicants to submit documents themselves), completing a bridging education program, writing two English exams (despite English being his native language), and writing the licensing exam. The costs added up to thousands of dollars. 

During the two years that Olukayode was getting re-licensed, Esther chose not to pursue qualifications as a nurse in Canada due to the fees associated with both Olukayode’s requalification and her own. Instead, she worked as an uncertified healthcare aide in a personal care home, simultaneously pursuing her healthcare aide certification. Through this time, Esther was the sole income earner for their family. Once Olukayode was licensed and working as a medical lab tech in Swan River, Manitoba, Esther applied to nursing school in Swan River. She decided to re-start her education from scratch because she’d been told by other foreign-trained nurses that the re-qualification process was too lengthy. After applying twice and being unable to secure a spot, Esther decided to get re-licensed based on her original qualifications. In 2020, she began the process of transmitting her documents from Nigeria to the National Nursing Assessment Service (NNAS), a coordinated program between the US and Canada. Despite being told the average wait time was 4 to 5 months, Esther waited 18 months to have her documents assessed.  

When foreign-trained nurses apply to the NNAS, they pay separately for each province and qualification (e.g. RN, LPN, etc.) they want assessed. Esther chose four assessments; two in Ontario, one in Saskatchewan, and one in Manitoba. She ultimately chose to relocate to Ontario, where she completed a bridging program and clinical placements in several hospitals in Ottawa before obtaining her qualifications as an RN and LPN in summer 2025. It took her nearly ten years to get re-licensed as a nurse in Canada due to financial and educational barriers. 

While these obstacles are frustrating to the talented immigrants who come here to support Canada’s healthcare system, the far-reaching consequences of these short-sighted policies will hit Canadians across the country, from elderly patients waiting for knee and hip replacements to families with young children seeking a general physician. 

When Olukayode and Esther decided to move back to Manitoba to be closer to family, Esther was not allowed to work as a nurse due to Canada’s provincially regulated healthcare system. Despite being a licensed RN and LPN in Ontario, the College of Registered Nurses of Manitoba and the College of Licensed Practical Nurses of Manitoba (CLPNM) requested documentation from Nigeria about her Nigerian nursing license.  

After several months, Esther is still waiting to hear back from the CLPNM. 

Olukayode, after working for years as a medical lab tech in Manitoba and remote communities in Northern Ontario, will complete his final contract this December. He finished the immigration law program at Queen’s University and now works as an immigration consultant supporting IEHPs. Olukayode doesn’t see this as an end to his healthcare career; he believes supporting other IEHPs is the biggest positive impact he can make in Canada’s healthcare system. 

The experience of Olukayode and Esther highlight several obstacles skilled immigrants face to making Canada their home. At the Institute for Canadian Citizenship, we recognized that economic immigrants are leaving Canada in worrying numbers. We cannot expect skilled immigrants to commit to Canada if the country stifles their contributions. 

Olukayode and Esther, like all immigrants, had options when they chose to leave their home country. They explored the US, the UK, and Canada. “I would still choose Canada every time,” Olukayode said. 

“I’m passionate about giving back to a country that has given me everything. How can I hand my voice to a discussion that’s going to affect all of us?” 

*A pseudonym has been used

Key words: healthcare, immigration, Canadian labour force, healthcare wait times, Canada’s healthcare crisis, nurses, skilled immigrants, IEHPs, internationally educated healthcare professionals, immigrant labour force