Access to Licensure for Specialist ITPs: A Labyrinth of Barriers; Actionable Solutions

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Executive Summary

Specialist ITPs are physicians who have completed residency training in a country outside of Canada in a specialty other than Family Medicine. Canada currently faces a severe shortage of several specialties in areas of need, and Canadians wait longer than most high-income countries for consultations with specialists (2). 

This report shows that specialist ITPs are diverse, experienced and highly skilled. With training from 45 countries around the globe, almost 90% of the respondent ITPs have more than three years of specialist training, and over half have more than five years of independent clinical practice in their specialty area. Although skilled ITP specialists have various pathways available in Canada, a labyrinth of barriers prevent most of them from accessing licensure; these barriers however are not without actionable solutions. 

This report will showcase i) disjointed and non-uniform processes, ii) lack of transparency and adequate guidance from official resources, and iii) issues with eligibility criteria which prevent knowledgeable, qualified, specialist physicians from participating in Canada's clinical workforce. There is a lack of collaboration across health system stakeholders. The impact of this fragmentation has consequences for Specialist ITP licensure and ultimately healthcare access for Canadians.

Barriers include General Barriers and Pathway-Specific Barriers. 

The major General Barriers are:

1. Inequity and Discrimination

2. Navigation and Misinformation

3. Financial Burden

4. Recency of Practice

5. Access to documents, Redundancies and Inefficiencies

   
   

The major Pathway-Specific barriers are:

1. Mismatch between approved jurisdictions and countries that ITPs immigrate from

2. Rigidity in training assessment/eligibility/selection criteria that do not capture ITP strengths and competence

3. Lack of facilitation and support through licensure pathway

4. Limited opportunities/positions/spots

5. Cumbersome processes that lack transparency

   
   

Actionable solutions include: 

1. Expansion of available positions in all licensure pathways and facilitation through the process

2. Flexibility in assessment/eligibility/selection criteria in order to capture ITP strengths and competence and supplemental pathways used as adjuncts as necessary

3. Creation of a regulated Associate Physician role that ladders into an independent licensure pathway to support the regaining/maintenance of recency of practice

4. Mandated anti-bias and anti-discrimination training

5. A collaborative taskforce between immigration and licensure bodies

6. Financial grants for the licensure journey

Review our detailed recommendations in the Full Report.

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