How are we providing a strong and sustainable workforce of healthcare professionals?
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“Ontario is concerned about having an appropriate supply of health professionals in all heath care fields across all parts of the province and is implementing high-quality long-term planning,” says McMaster University health and labour market economist Arthur Sweetman.

Sweetman is the Ontario Research Chair in Health Human Resources, funded in part by an endowment from the government of Ontario. His research into our health workforce is aimed at giving government and stakeholders the data they need to make informed decisions.

One aspect of his work looks at the integration of internationally trained health professionals into Ontario’s workforce. This is a very complex process involving many stakeholders. Among other aspects, it requires an understanding of Ontario’s labour market needs, international and national migrant flows, the training of new members of the health workforce in Ontario, and occupational regulatory processes.

Sweetman points out that Ontario is concerned about the fair treatment of migrants in regulated health (and non-health) occupations: “To this end the province established the Office of the Fairness Commissioner,” he says.

Recent research co-organized by Sweetman looking at this issue involved a cluster of researchers and policymakers. It focusses on occupational regulation and foreign qualification recognition from a variety of perspectives. The approach recognizes that collaboration is a keystone to sustained improvements.

The (now former) Fairness Commissioner, the Honourable Jean Augustine, made serious ethical, policy and empirical contributions to this research project by tracking changes in Ontario’s occupational regulation environment for internationally trained workers. While change is a slow process, she points to measureable improvements in both process and outcomes.

Sweetman and his co-author, McMaster health policy PhD student Yaw Owusu, examined those who do, and do not, work in their trained health occupation as a function of place of birth and training.

The researchers used data to contrast labour market outcomes of the eight largest health occupations. They found evidence pointing to important differences in working in a regulated health profession based on place of training for those with relevant educational degrees, but not by place of birth.

Sweetman and Owusu came to this conclusion after crunching numbers on eight different types of health professionals in Ontario: dentists, medical laboratory technologists, medical radiation technologists, pharmacists, physiotherapists, psychologists, physicians, and registered nurses.

Also, Sweetman and Owusu found that for foreign-trained health professionals whose training is recognized as up to Canadian standards, there is no evidence they earn less than others in their field.

In related work with Casey Warman and Gustave Goldmann, Sweetman examined the portability of new immigrants’ human capital, focussing on language, education and occupation-specific skills. They found that the Canadian trained (whether migrant or Canadian born) received a premium that increases with their Canadian labour market experience.

However, perhaps oddly, the Canadian labour market (on average) appears not to reward pre-migration labour market experience. Migrants who work in the same occupation both before and after migrating receive markedly higher earnings in Canada than those who switch occupations, but how long they worked in that occupation before migration appears not to influence their earnings.

“This is not what we expected at the start of this study, and it has important implications for those who immigrate later in their careers” says Sweetman.

Fortunately, the post-migration earnings premium for Canadian labour market experience is larger for immigrants than is the premium for the Canadian trained. This allows immigrants’ wages to accelerate.

Sweetman says “the elements of package of skills that immigrants have interact with each other.” Immigration points systems and the like treat various skills – language and education for example – in isolation but the labour market values useful combinations of skills. “When it comes to immigrant selection and settlement services, we have only begun to think about how to translate into policy our ever improving understanding of which bundles of skills are valuable in the labour market.”

“It’s like sailing a big boat,” he says. “It takes a long time to turn a big boat around.”

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