Dear Federal and Provincial Ministers of Health, Canada, as well as the CEOs and HR Directors of public healthcare organizations in Canada,
We have a dominant public healthcare system in Canada, and most of the healthcare jobs are in the public sector, not the private sector. The jobs are controlled by policies set by you or people working under you. I wish to share some candid thoughts and opinions of mine.
This post is a request for a review of Human Resources policies and practices in the publicly funded hospitals and administrative organizations related to healthcare in the provinces of Canada. There is a need for equal employment opportunity rights for all Canadians, and especially the under-represented segments like, younger Canadians, new graduates, and IEPs (Internationally Educated Professionals) in the administrative, technical, clerical and support jobs in the healthcare sector in Canada. Right now, the recruiting is not completely fair, and does not represent all Canadians. Clinical jobs, of course need appropriate qualifications and licensing requirements, though there can be pathways established to make the journey easier.
The youth (age group 15 to 25) unemployment rate is double that of total unemployment rate in Canada. Ontario has the worst rate of all provinces, and Toronto has the worst rate among all cities of Ontario. I believe that in the future elections (at every level), the youth, new graduates and immigrants should vote only for those political parties and leaders who promise them jobs and make the efforts to follow up on their promises.
There are eight topics that I wish to draw your attention to:
(1) Stronghold of Unions: Unions do a great job providing a framework of security for the workers, lobbying for them, and protecting their rights. However, they have become like gated communities unwilling to let outsiders in. There is an oft-repeated term called as "Old Boys' Club". Guess what? We have an "Old Workers' Club" in existence in the Canadian healthcare system, where the existing workers deprive opportunities for new workers. When I wrote an email to Alberta Health Services, the reply I received was that they have about 90,000 workers in AHS, and most of the job openings get filled internally, and that the applicants should keep on trying. Similar is the reply from hospitals in Ontario. Another suggestion was that one should apply for lower level positions to gain entry into the unions -- but then, you get rejected for being overqualified. This is not fair to new and non-union applicants. Not all 100% of the jobs should have preferential treatment for the unions where they have the first pick or first consideration, and where there is a process of internal postings, and only the left-over jobs are posted to external applicants. This is unfair to other applicants. Every Canadian pays taxes (utilized in publicly funded hospitals), not just the union members. The union members already have jobs, as it is. Why should they have the privilege to cherry pick on new opportunities and send the left-overs to the general public? I used to be liberal minded, pro-worker, and pro-union, but I am not so sure anymore.
(2) Recommendations and Favoritism: Healthcare jobs pay comparatively better than many other sectors. A security guard working for a private company makes $11 an hour. An in-house security guard of hospital makes $26 an hour. A porter or an attendant in a hospital makes more than $20 an hour, while a similar worker makes $10 an hour outside. Clerks, Project Managers, IT professionals and Research Assistants are paid well too, if not better than other sectors. Therefore, healthcare jobs are in high demand, and there is plenty of competition. When applicants send their resumes, the HR staff screen the resumes and forward them to the hiring managers -- usually the heads of the departments which are hiring. Is there a potential for a bias here? Yes. I have heard people say that you need connections or recommendations to get hired, and the selection is not made purely on the basis of merit. Again, internal applicants get a preference over external ones. Agreed, people like people they know, but is it fair for the rest?
(3) Stronghold of Nurses: The sunshine lists of provinces include many nurses making over $100,000 a year. Sure, they work hard, do a great job, and work overtime to make it to the lists. However, there are many healthcare administrative jobs that specifically need valid nursing registration. Why are these opportunities denied for others with degrees in allied healthcare or international healthcare degrees, along with master's degrees?
(4) Stronghold of Select Universities: There are some universities which have exclusive partnerships with hospitals. They are usually universities with medical schools which have their medical residents training in partner hospitals. Similarly, there are nursing students, allied health students as well as health administration students and graduates working in collaboration. An example is UofT with partnerships in the GTA. While this is not a bad thing, quality-wise, there is a bias in hiring, and other applicants are at a disadvantage.
(5) Stronghold of Professional Organizations: Medical Associations, Dental Associations, Nursing Associations, and other professional associations lobby on behalf of their members for greater pay, opportunities and control. That affects professionals who do not have strong lobby groups, like internationally educated healthcare professionals.
(6) Support for IEHPs, Especially, IMGs: Many hospitals are actively supporting IEHPs (Internationally Educated Health Professionals), and that is great! However, while IENs (Internationally Educated Nurses) are welcome with open arms and have bridging programs, there is not much support for IMGs (International Medical Graduates). There are no broad sweeping, open-for-all bridging programs for IMGs to enter the workforce in Canada. There is no plan for IMGs. Canada's Physician / Population ratio remains near the bottom among the 34 nations belonging to the OECD. Canada is the second largest country in the world, but its population ranking is 38th worldwide. This means that ideally, we should at the least match the OECD average, if not slightly exceed it. Agreed, there are not enough residency spots for all IMGs in Canada. However, there is no official plan, roadmap or bridging for all IMGs, either. IMGs are left helpless by governments, to find their own ways of survival. Nurses from abroad are given credits to fast-track into Practical Nursing programs. However, doctors from abroad are not given credits to fast-track into Physician Assistant programs, Medical programs, or even Nursing programs. Finally, the application fees for MCC exams are quite high for the average IMG in Canada (with total medical licensure cost reaching almost $10,000), and the government should reduce the fees.
(7) Internships and Observerships: We talk a lot about our aging population and current or future shortage of healthcare workers in Canada. Let us introduce our youth to the healthcare sector at an early age, and get them interested in working as LPNs, RNs, BSc.Ns, NPs, PAs, MDs, clerks, transcribers, and so on. Healthcare is a serious business, and one has to have a diploma, bachelor's degree or master's degree to fit into certain roles, but the youth are smart and creative. Exposing them to healthcare sector early would be great, and not just as volunteers. There can be paid summer internships for the youth (16 to 25) interested in the hospital environment where they work under supervision in nonclinical roles. We can introduce paid observerships and clerkships for IEHPs who are legal Canadian permanent residents or citizens, where they not only refresh skills under supervision, but also contribute to work under supervision.
(8) Canadians First: Legal immigrants to Canada have gone through the grind of applications and long waits to make Canada home. However, there have been job postings for Canadian healthcare admin. positions (and not just nurses) abroad. My argument is that instead of obsessing with a perfect readymade match, there is local workforce with transferable skills that can be trained within Canada, and scarcity may be a myth, as supported nicely by an excellent article recently.
Ministries of Health of all provinces should publish online HR reports every year, apart from their annual financial reports, to increase transparency. Apart from new employment data, they should present analyses on new hires and the break-down of job appointments by types (male / female, union / non-union, Canadian / Non-Canadian, executive / non-executive, and so on), including the efforts made for the youth, new graduates, and the under-represented demographics. A lot of people will be interested in reading these reports. In addition, you may also consider publishing annual social responsibility and sustainability reports, as I had mentioned in my MBA Healthcare Consulting report about Ontario MOHLTC last year -- you can download it below.
It is not possible for the Canadian public healthcare system to provide jobs for every qualified professional. However, we can reduce barriers to entry and provide a meritocracy based level playing field for all Canadians. I hope that happens.