Common approaches often focus primarily on attraction, but do not address the reasons why they tend to leave.
This article from Natalya Brown, Nipissing University; Melissa Kelly, Metropolitan University of Torontoand Victoria Esses, Western University originally appeared on Conversation and is published here with permission.
Smaller communities in Canada, especially those located in rural areas, have difficulty attracting and especially retaining health professionals, leading to poorer health outcomes.
For example, in March 2022, a shortage of doctors in Northern Ontario forced the emergency department in Red Lake to close for 24 hours, and people with medical emergencies had to travel more than 200 kilometers to reach to the nearest hospital. In the same region, shortages of nurses and personal support workers are exacerbated by recruitment and retention issues. Similar situations exist in many small communities across Canada.
It’s no surprise, then, that the five northern Ontario cities participating in the Rural and Northern Immigration Pilot, designed to attract more immigrants to smaller communities, are prioritizing health professionals. But can they keep them?
The recruitment of internationally educated health professionals (EFHPs) to work in underserved communities is not new. However, challenges to keeping them in these communities persist. As immigration researchers, we have documented the challenges of newcomer retention in small communities across Canada, with a recent focus on IEHPs.
Why Popular Approaches Don’t Work
Common approaches used to encourage TCSPs to work in smaller communities often include “return of service” contracts requiring TCSPs to work in underserved areas for several years as a pathway to licensure in the province or territory. For example, the National Assessment Collaboration’s fitness-to-practice programs for international physicians, offered in seven provinces, require a commitment to return from service in a rural area of the province.
These somewhat coercive strategies tend to be ineffective in the long term because they focus primarily on attracting IEHPs to smaller communities and do not address the reasons why they tend to leave. These reasons include social and professional isolation.
Factors that contribute to the social isolation of IEHPs in small communities include estrangement from family members and social connections, limited access to settlement services that can facilitate community connections, lack of a large immigrant population and access to cultural and religious supports, limited employment and educational opportunities for family members, and experiences of racism and discrimination.
Factors driving professional isolation in small communities include long work hours and limited time off due to the small size of the health care team, as well as limited opportunities for professional development and learning. advancement within a cohort of peers. IEHPs may also find that they lack the generalist skills required to practice in small communities, which may differ significantly from urban health care.
While many of these factors apply to all healthcare professionals, whether Canadian-born or foreign-trained, others tend to be unique to THPs, compounding their sense of isolation and motivation to move to a large urban centre.
Reasons to stay
Several strategies can be used to support the retention of FCSPs, including training and experience in health care in small communities. As an example of the importance of training and experience, the Northern Ontario School of Medicine (NOSM) has increased the number of physicians and dietitians practicing in small northern communities Ontario.
NOSM graduates know the needs of these communities and, with their specialized training, are prepared to serve them for the long term. Once established in a community, professional networks and professional development opportunities can also help IEHPs overcome professional isolation.
Additionally, IEHPs will be more likely to stay in small communities if their families are well established in the community and if they feel socially connected. Addressing racism and discrimination in the community is a first step. In addition, spouses of IEHPs may need special assistance in finding employment related to their field of study. Children of IEHPs can benefit from links to educational and extracurricular activities.
The right fit
Efforts should also be made to attract IEHPs with characteristics that make them more likely to stay. IEHPs who come from small or rural communities may find it easier to adapt to living and working in smaller Canadian communities, making them much more likely to stay.
Communities should also communicate what kind of lifestyle they can offer IEHPs, and IEHPs should know what to expect, improving their physical fitness. IEHPs may be attracted to smaller communities because of the housing, education, and outdoor recreation opportunities they offer, or because of the sense of safety and community that some smaller centers can provide. Importantly, these location attributes may be more attractive to IEHPs who are at a certain point in their life. Those who prioritize home ownership or are raising children may be more likely to have their needs met in a smaller community.
For the upcoming Municipal Nominee Program, in which communities will have a greater say in the selection of new immigrants, a key measure of success will be how well the program responds to labor shortages and retention in key sectors such as healthcare. The capacity of small communities to make the right matches and to combat the professional and social isolation of IEHPs will be essential.
Natalya Brownassociate professor of economics, Nipissing University; Melissa KellyResearcher, Canada Excellence Research Chair (CERC) in Migration and Integration, Metropolitan University of Torontoand Victoria EssesProfessor, Department of Psychology, Western University