Why the health-care sector is hiring temporary foreign workers like never before
Industry represents small share of overall program, but interest is climbing
Persistent staffing shortages in the health-care sector across Canada in the wake of the pandemic have led some organizations, including some provincial government agencies, to increasingly call upon temporary foreign workers to fill positions in clinics, hospitals and senior care facilities across the country.
While health-care still represents a small fraction of the overall temporary foreign worker program, federal data analyzed by CBC News shows the government greenlighted the hiring of 4,336 health-care workers last year — up from 447 such positions in 2018. Health-care occupations represented roughly two per cent of the total temporary foreign worker positions that were approved in 2023.
A large share of that growth was driven by an uptick in approvals of nurse aides, orderlies and patient service associates. There were 2,514 such approvals last year, up from just 16 in 2018.
But employers have also turned to the program to fill other positions, such as nurses (612 positions approved, up from 65 in 2018) and family doctors (216 positions approved, up from 72 in 2018).
"I think this is another example of the overall health-care workforce crisis," said Ivy Bourgeault, who leads the Canadian Health Workforce Network, a network of researchers who study issues facing health workers. She said staffing shortages driven by burnout and attrition have employers turning to increasingly novel means to bring in new workers.
The uptick in health-care hiring is reflected in the number of positions approved through labour market impact assessments (LMIAs), which employers need to prove there's no one in Canada available to take a job before they can hire a temporary foreign worker.
There isn't an exact one-to-one ratio between the LMIA data and the number of temporary foreign workers in the country.
For example, the Vitalité Health Network, a regional health authority in New Brunswick, was cleared to hire 190 health care workers last year, but told CBC News in an email it expects to use fewer than 10 per cent of those permits in part because it's now leaning instead on another immigration program that more narrowly targets francophones.
But other organizations say the temporary foreign worker program has become a key part of their human resources strategy, at times as a stepping stone to bring a worker to Canada permanently.
Program fills staffing gaps, organizations say
Much of the hiring has been in Quebec, where health-care staffing shortages have been well-documented. Federal data shows just under half of the temporary foreign worker jobs approved last year were in that province, which represents just 22 per cent of the Canadian population.
The Centre hospitalier de l'Université de Montreal (CHUM), one of the largest hospitals in Canada, said it's used the program since 2007 and employs 141 nurses hired through the temporary foreign worker program.
"Due to a substantial health-care staff shortage, and while [we] prioritize hiring within the province of Quebec, this program helps fill positions that would otherwise remain vacant, despite our best recruiting efforts," said spokesperson Jessie-Kim Malo.
But employers in other provinces are using the program too.
Alberta Health Services (AHS) — cleared to hire 79 nurses and 74 doctors through the program last year — told CBC News in an email the TFW program is one of many it relies on to recruit local and internationally trained nurses.
As for doctors, spokesperson Kerry Williamson said AHS is focused on recruiting international medical graduates right now as a way to deal with doctor shortages, and that "many" apply for work permits under the temporary foreign worker program before seeking permanent residency.
Medicentres Canada, which runs walk-in clinics across Canada, started using the program about a year ago. Samantha Wilk, the company's senior manager of physician services, said they had hired a doctor from the U.K. who was struggling to get a work permit in a timely way and were advised by an immigration consultant that going through the temporary foreign worker program would be faster.
"We obviously still would love to give preference to permanent residents and Canadian citizens to fill the vacancies that we do have," said Wilk, who said they've filled jobs in Edmonton, Calgary, Winnipeg, Toronto and London, Ont., this way.
"However, if a physician is fully qualified and able to practise, our main goal is filling our vacancies and getting patients access to physicians."
Some employers, like CHUM and Medicentres, primarily recruit staff from countries, such as France or the UK, whose credentials can easily transfer to Canada.
But Spectrum Health Care, a home care company in the Greater Toronto Area, hires nurses from the Philippines who work for the company as personal support workers while they strive to meet the qualifications to work as nurses in Canada.
That company said it's so far hired 50 nurse aides, orderlies and patient services associates this way.
"While [internationally educated nurses] cannot single-handedly solve the country's staffing challenges, they play a critical role in building nursing capacity and providing care in communities where they are very much needed," said Sandra Ketchen, the company's president and CEO, in an email.
Not the 'highest return on investment'
While the temporary foreign worker program is one way to increase staffing levels and lighten the burden on health-care workers, Bourgeault said it's not necessarily the most effective.
"I wouldn't say that it is the highest return on investment," said Bourgeault, who is also a professor in the University of Ottawa school of sociology and anthropology.
Instead, Bourgeault thinks time and money would be better spent trying to retain workers who are already employed in the health-care system, encouraging those who've left to come back.
She also wondered about the fairness of hiring health-care workers away from other countries, when she said it isn't clear that any countries have excess workers to spare.
Still, University of Waterloo economics Prof. Mikal Skuterud, often a vocal critic of the temporary foreign worker program, said he has some sympathy for employers struggling to hire nurses, for example.
"The wages are largely paid by public funds and they're set by collective agreements through union-management negotiations," he said. "And so it's harder for employers to kind of increase wages [than it is in the private sector]."
CBC requested an interview with Immigration, Refugees and Citizenship Canada for this story, but the request was declined.
Via email, spokesperson Julie Lafortune told CBC that "immigration continues to play an important role in addressing labour shortages across the country, supporting social services and infrastructure by recruiting health-care and skilled trade workers."
Under pressure to shrink the number of temporary residents in Canada, the federal government has recently moved to tighten up some streams of the temporary foreign worker program. This spring, employers in sectors that had been given special permission to hire up to 30 per cent of their staff through the low-wage temporary foreign worker program were told they need to cut back.
But two sectors have been given exemptions — health-care and construction — which a spokesperson for Employment and Social Development Canada said was because those two sectors continue to deal with some of the country's most acute labour shortages.
For Wilk, with Medicentres Canada, the plan is to continue using the temporary foreign worker program as part of their broader hiring strategy. And while the program may have "temporary" in the title, the program is anything but — she said all the staff they've hired have applied for permanent residency.
"Patients love them, they're very qualified, trained doctors."
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