From Principles to Practice: Bridging the Gap for Internationally Trained Physicians in Canada

ITPC Directors
Dec 20, 2025
4 min read

By Dr. Chidinma Nnanna

ITPC Policy, Advocacy, Research Committee Volunteer INTRODUCTION

Canada’s Ethical Framework for the Recruitment and Retention of Internationally Educated Health Professionals (IEHPs) was developed to guide ethical and responsible practices in response to global health workforce shortages. Grounded in the WHO Global Code of Practice, the framework outlines principles and voluntary standards to support governments, regulators, employers, and partners in recruiting, integrating, and retaining IEHPs. Its aim is to promote fair treatment, ensure accurate and transparent processes, and uphold global responsibility while reinforcing the sustainability of Canada’s health system. The following is ITPC’s summary of highlights of the framework, followed by a discussion. The original framework document can be found here.

HIGHLIGHTS

Championing Fair Pathways for International Health Professionals

Internationally educated health professionals (IEHPs) are vital to Canada’s healthcare system, yet many encounter systemic barriers, including complex licensure processes and skills underutilization. Advocating for fair pathways (p.18) means pushing for transparency, consistent standards, and equal access to professional opportunities. Ensuring fairness upholds ethical principles while enabling IEHPs to contribute fully to patient care and health system resilience.

Prioritizing Equity and Justice in Global Health Recruitment

Ethical recruitment practices must consider the global impact of attracting health workers from countries experiencing critical shortages. Prioritizing equity (p.8–10) means ensuring that IEHP migration is voluntary, informed, and supported by transparent processes. Confronting racism, bias, and inequities within the Canadian system is essential to creating just, welcoming, and culturally safe work environments for all internationally trained professionals(p.20–21).

Empowering IEHPs: Ethical Action for a Stronger Health System

Empowerment involves supporting IEHPs through clear guidance, integrated information, bridging programs, and mentorship opportunities (p.15–17). Eliminating underemployment and enabling IEHPs to work at their full scope strengthens the entire health system. Ethical action requires collaboration among governments, regulators, employers, and settlement organizations to ensure that IEHPs are valued, supported, and positioned for success from recruitment to long-term retention (p.23–24).

DISCUSSION

Many internationally trained physicians (ITPs) come to Canada with years of experience and a genuine desire to continue serving communities. Although the Ethical Framework acknowledges the importance of supporting IEHPs throughout their journey, the lived reality for many ITPs often feels far removed from these intentions. It speaks about empowerment and enabling professionals to work at their full scope (p. 11), yet countless ITPs never have the chance to practice medicine again. Many arrive hopeful, only to discover that even after passing exams and completing observerships, the pathway to licensure remains uncertain. This is discouraging for them and represents a missed opportunity for the Canadian health system.

A central principle of the document is fairness, which calls for equitable access to opportunities (p. 18). However, the difference in residency availability between ITPs and CMGs illustrates a persistent imbalance. CMGs enter training predictably, while ITPs compete for a very small number of CaRMS positions that do not reflect their qualifications or the country’s workforce needs. Beyond residency access, many ITPs also face additional assessment requirements that are not applied equally to Canadian-trained graduates, such as repeated examinations and limited practice-ready assessment seats. This contradicts the spirit of fairness.

The document also emphasizes the importance of collaboration among governments, regulators, employers, and community partners (p. 23), yet the systems that oversee physician licensure remain fragmented. Provinces vary widely in available pathways, requirements, and timelines, leaving ITPs to navigate a maze of rules rather than a coordinated national strategy. This lack of alignment contributes to delays and missed opportunities for integration. The burden of this delay is then carried by the ITP, who is then barred from accessing licensure pathways because of a lack of “recency of practice”, although Canada provides few avenues to maintain/regain recency.

At the same time, Canada continues to welcome internationally trained physicians through immigration pathways without ensuring a realistic professional route once they arrive. Although the framework stresses responsible recruitment and workforce sustainability (p. 8), many ITPs find themselves admitted as skilled professionals but unable to practice due to the limited number of residencies and the absence of consistent bridging roles. This gap between immigration and licensure reinforces the disconnect between stated principles and lived outcomes.

The document highlights the value of bridging programs (p. 15), and this is crucial. Establishing a licensed Clinical Assistant role in every province, with a clear ladder to licensure, would give ITPs a viable point of reentry. It would allow them to rebuild confidence, regain clinical experience, and demonstrate their competence within the Canadian system. ITPs do not seek lowered standards. We simply need a fair opportunity to show what we can do. A structured pathway not only honours our training but also offers a practical response to the health workforce shortages.

CONCLUSION

Canada’s ethical responsibility in health workforce planning is not only global but also internal. While the Ethical Framework emphasizes responsible international recruitment, failing to meaningfully integrate internationally trained physicians who are already in Canada exposes a fundamental inconsistency between principle and practice. Recruiting physicians from abroad while large numbers of qualified ITPs remain unable to practice does not align with the framework’s commitment to fairness, sustainability, or responsible workforce planning.

Ethical recruitment must therefore be matched with fair and accelerated pathways to integration. Without equitable access to training positions, consistent assessment processes, and practical bridging roles that lead to licensure, the framework’s goals cannot be realized. Addressing workforce shortages by drawing from the existing pool of ITPs in Canada would also reduce concerns about brain drain from low resource countries, as it prioritizes the inclusion of physicians who have already chosen to build their lives and careers here.

In conclusion, this is not just about policy alignment but about people. It is about ensuring that physicians who are ready and willing to serve are not left watching from the sidelines while communities face shortages of care. By pairing ethical recruitment with genuine opportunities for integration, Canada can create a health system that is fairer, stronger, and more humane for everyone involved.

REFERENCES

ITPC

From Principles to Practice: Bridging the Gap for Internationally Trained Physicians in Canada

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