Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

Transcription

1 The National Alliance of Respiratory Therapy Regulatory Bodies Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada National Alliance of Respiratory Therapy Regulatory Bodies (NARTRB) Prepared for NARTRB by: Paulette Blais Blais Consulting Services February 10, 2008

2 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada Copyright 2008 by the National Alliance of Respiratory Therapy Regulatory Bodies (NARTRB). All rights reserved. NARTRB Head Office 1440, rue Ste-Catherine Ouest, bureau 320 Montréal (Québec) H3G 1R8

3 Contents Executive Summary I Introduction II Scope of the Research Methodology III Overview of the Respiratory Therapy Profession in Canada Respiratory Therapy Education in Canada Canadian Advisory Council for Education in Respiratory Therapy (CACERT) IV Regulatory Issues Regulated jurisdictions Alberta Manitoba Ontario Québec Role of the Canadian Society of Respiratory Therapists (CSRT) V Labour Market Issues Demographic composition of the RT workforce in Canada Respiratory Therapy Labour Supply Demand for Respiratory Therapy Services Labour Mobility VI Research Findings Overview Challenges for IEHPs applying to become RTs in Canada Challenges for Regulators Strengths and Opportunities VII Learning from Other Access Initiatives VIII Recommendations for Action IX APPENDICES Glossary NARTRB Research Steering Committee Respiratory Therapy Competencies National Occupational Classification (NOC) Respiratory Therapy Registration Process and Requirements: Alberta Registration Process and Requirements: Manitoba Registration Process and Requirements: Ontario Registration Process and Requirements: Quebec Voluntary Registration with the CSRT Employer Survey CRTO Survey of PLA Candidates Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 1

4 Acknowledgements The National Alliance of Respiratory Therapy Regulatory Bodies wishes to thank the Government of Canada s Foreign Credential Recognition Program for funding this valuable research. Thank you to the Steering Committee for their commitment in terms of time, guidance, information and expertise, and to the many individuals and organizations across Canada who provided data and other information and shared their knowledge to help shape this report. Special recognition must be accorded to the internationally educated respiratory therapists and other health professionals who provided insight into their experiences of becoming registered in the respiratory therapy profession in Canada. They have made a significant contribution to this research and to the profession. 2 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

5 Executive Summary Research and data gathered for this report have resulted in a number of findings. The number of applications from IERTs and IEHPs each year is quite small. Even the jurisdictions with the largest populations and number of registered respiratory therapists (RTs) (Ontario and Quebec) reported receiving fewer than 20 internationally educated applicants per year. Of the almost 8,000 registered respiratory therapists in Canada, there are currently only 19 RTs registered in Canada who completed their original education outside of Canada or the U.S. The research clearly indicates three common features of most internationally educated applicants to the RT profession in Canada: 1. the majority have completed education in a health profession other than respiratory therapy, often in medicine or anaesthesiology; 2. the majority have completed education in a country where English or French is not the primary language of clinical practice; 3. virtually all such applicants are required to complete additional theoretical and/or clinical education in Canada in order to meet the education requirement of registration. Regulators and internationally educated applicants reported a number of challenges in the registration process: difficulty performing credential assessment of international education programs, particularly in comparing non-rt programs to the education requirements for RT registration; the length of time and costs required to go through prior learning assessment (PLA) and/or additional education; and lack of educational programs designed to meet the specific learning needs of these applicants and help them to bridge to meeting the requirements of RT registration. A number of positive findings were also noted. There are several collaborative initiatives on-going and in development between regulators and educational institutions to assist internationally educated applicants meet provincial registration requirements. Applicants who had completed PLA and/or additional education in Canada and who are now registered respiratory therapists reported satisfaction with these processes, even if they were a bit challenging. They also all reported having no difficulty finding employment and being very satisfied in the profession. As a result of the research, a number of recommendations have been developed, under the following themes: Information for Applicants Common Credential Assessment Process Prior Learning Assessment Bridging programs Professional Supports Communication to International Medical Graduates These recommendations are elaborated at the end of this report. In 2008 the National Alliance of Respiratory Therapy Regulatory Bodies will consider all of them and set the priorities for moving forward on this important initiative. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 3

6 I Introduction This project has been funded by the Canadian government s Foreign Credential Recognition (FCR) Program. The purpose of this project was to provide an overview diagnostic of the respiratory therapy profession in Canada and the issues associated with internationally educated health professions (IEHPs) seeking professional registration as respiratory therapists (RTs) in Canada. The research focused on providing an overview of the existing processes in Canada for recognition of respiratory therapy credentials and to identify the challenges faced by internationally educated applicants and regulators as IEHPs apply to enter the profession in Canada. The aim has been to identify the strengths and opportunities within the respiratory therapy profession to meet these challenges and, finally, to formulate recommendations regarding how access to the respiratory therapy profession can be facilitated for internationally educated health care professionals. Ordre professionnel des inhalothérapeutes du Québec (OPIQ) Canadian Society of Respiratory Therapists (CSRT) This work was also guided by a Steering Committee, which consisted of representation of all of the NARTRB partners, the Canadian Advisory Council for Education in Respiratory Therapy (CACERT), an internationally educated respiratory therapist currently registered and working in Canada and employer representatives. The list of Steering Committee members is included in the Appendix to this report. The project lead for this research is the National Alliance of Respiratory Therapy Regulatory Bodies (NARTRB). NARTRB is a partnership of the bodies that regulate the profession of respiratory therapy in the regulated provinces and the national professional association for respiratory therapy in Canada, which represents the unregulated provinces. The NARTRB Partners are: College and Association of Respiratory Therapists of Alberta (CARTA) Manitoba Association of Registered Respiratory Therapists (MARRT) College of Respiratory Therapists of Ontario (CRTO) 4 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

7 II Scope of the Research The Foreign Credential Recognition (FCR) Program was established to help professions look at the complicated issue of foreign credential recognition, as internationally educated health professionals (IEHPs) can make a significant contribution to helping us address health human resource shortages in Canada. The NARTRB project is consistent with the objectives of the first phase of the larger HRSDC FCR program, in that it consists of research and information gathering with respect to the various issues that IEHPs face as they seek to enter the profession of respiratory therapy in Canada. Activities included in this phase of the project also involve the collection of data on the current situation of respiratory therapy with respect to occupational demographics, education, regulatory standards, etc. receive a large number of immigrants and therefore receive requests for registration on a regular basis from internationally educated health professionals. Registered Respiratory Therapists (RRTs) are respiratory therapists who have met the requirements of professional registration in a regulated jurisdiction, or who reside/work in a non-regulated jurisdiction and have met the requirements of voluntary membership with the CSRT. Registered Respiratory Therapist (RRT) is a protected title that can only be used by professionals who are members in good standing of a provincial RT regulatory body or the CSRT. Throughout this report, the terms respiratory therapist and RT, which are the most commonly used descriptors for the profession, will be used to mean Registered Respiratory Therapists. Subsequent phases of the HRSDC FCR funding may involve the development and piloting of tools and resources such as bridging programs and curriculum, and the implementation of programs and products. These activities are outside of the scope of this project. The research for this project focused primarily on gathering information from the provinces where the profession is regulated. This was done for a number of reasons: These are the jurisdictions in which provincial statute has delegated authority to regulatory bodies to set the requirements for entry into and standards of practice of the profession; Data is more readily available, as all regulatory bodies collect data regarding applicants and members and supply this information to governments and research agencies; Two of these jurisdictions (Ontario and Quebec) The research also focused on access issues affecting internationally educated respiratory therapists (IERTs) and internationally educated health professionals (IEHPs) who completed their education outside of Canada or the United States. As respiratory therapy is a profession that is well-established in North America and the program standards are similar, most educational programs 1 completed by U.S. educated applicants are deemed equivalent to an approved Canadian program. Some jurisdictions also accept completion of the U.S. National Board for Respiratory Care (NBRC) examination as equivalent to completion of the Canadian national qualifying examination for meeting the examination requirement of registration. Given also the cultural and linguistic similarities, U.S.- educated applicants usually do not face the same challenges as applicants who have completed their education outside of the U.S. in obtaining professional registration as RTs in Canada. 1 U.S. programs accredited by the Committee on Accreditation for Respiratory Care (CoARC) at the 200 (therapist) level. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 5

8 Methodology During the course of this project, the researcher undertook to collect relevant data through a number of methods and sources. These included: key informant interviews with regulators, educators and other stakeholders in regulated provinces (Alberta, Manitoba, Ontario and Quebec); key informant interviews with CSRT staff; interviews with internationally educated health professionals (IEHPs) and respiratory therapists who are going through or have completed the registration process in BC, Alberta and Ontario; a focus group with IEHPs who have gone through the registration process in Quebec; an on-line survey of CRTO prior learning assessment (PLA) candidates; collection of demographic information from regulators regarding applicants; research and review of legislation and contacts in key non-regulated provinces; collection of graduate data from approved respiratory therapy educational programs across Canada; a review of labour market data available from the Canadian Institute of Health Information (CIHI); on-line employer surveys conducted in Alberta, Manitoba and Quebec; an employer focus group in Alberta; a review of successful initiatives in promoting access to professional registration for internationally educated health professionals in other fields. It should be noted that where web sites are referenced throughout the document, these pages were current as of January Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

9 III Overview of the Respiratory Therapy Profession in Canada The Early Years A Reflective History of the Canadian Society of Respiratory Therapists 2 provides an interesting overview of the history of the respiratory therapy profession and its professional association in Canada from the end of the Second World War to recent years. Those interested in learning the history of the profession from the unregulated role of oxygen orderly who learned through on-the-job training to the regulated, technically complex and skilled profession of respiratory therapy as it as it exists today, will find the publication very informative. In their current role 3, respiratory therapists are healthcare professionals who assist physicians with the diagnosis and treatment of lung disorders. Respiratory therapy, as all health care professions, is an evolving discipline, as technology, client populations, roles and scopes of practice and the delivery structure of health care changes over time. Respiratory therapists work in different roles in many different practice settings. The National Occupational Classification (NOC) for Respiratory Therapy 4, which describes in detail the job titles, duties and employment requirements of the profession is included as reference as an appendix to this report. The duties of respiratory therapists include: Maintaining an open airway for trauma, intensive care, and surgery patients Assisting in cardiopulmonary resuscitation and support of critically ill patients Providing life support for patients who can t breathe on their own Assisting in high risk births Stabilizing high risk patients being moved by air or ground ambulance Assisting anaesthesiologists in the operating room Administering inhaled drugs and medical gases such as asthma medication and oxygen Conducting tests to measure lung function Teaching people to manage their asthma or to quit smoking Providing in-home respiratory care to adults and children with chronic lung disease Most respiratory therapists work in hospitals, often in neonatal intensive care units, operating rooms, intensive care units, general wards, coronary care units and emergency departments. Respiratory therapists also work in the community in such settings as continuing care facilities and community health clinics. They bring their expertise to: Pulmonary function laboratories Diagnostic clinics Sleep disorder laboratories Asthma, emphysema, cystic fibrosis and other specialized respiratory clinics Home care Teaching Research Rehabilitation Hyperbaric oxygen treatment centres Medical equipment sales and service Beyond a high degree of health care knowledge and highly developed technical and clinical skills, respiratory therapists require critical thinking and decision-making skills, good judgement, excellent interpersonal skills, and the ability to maintain composure in critical medical situations. 2 The Early Years A Reflective History of the Canadian Society of Respiratory Therapists 2006 by the Canadian Society of Respiratory Therapists (CSRT). Publication available from the CSRT: Alta Vista Drive, Ottawa, ON K1G 3Y6. 3 See About RT at: 4 Please note that this NOC also describes the titles, duties and employment requirements of clinical perfusionists and cardiopulmonary technologists. This research paper focuses solely on the respiratory therapy profession. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 7

10 Respiratory Therapy Education in Canada Most respiratory therapists (RTs) in Canada graduate from three-year post-secondary programs offered by community colleges and institutes of technology. Some universities also offer four year respiratory therapy degrees. Programs receive approval and accreditation through the CSRT s Council on Accreditation for Respiratory Therapy Education (CoARTE) 5. CoARTE assesses entry level educational programs to determine whether they meet the CSRT s national accreditation requirements. Within the educational programs, students learn theoretical subjects, such as human anatomy, physiology and biology, pathophysiology, pharmacology and the physics and instrumentation involved in respiratory therapy care. Students also receive extensive clinical training in hospital and home care settings. Clinical education is essential in enabling the students to gain the competencies required to provide safe, ethical and effective care in the wide variety of practice setting in which RTs are employed. Therefore, schools require students to undertake clinical rotations in the following areas: Neonatal care; Paediatrics; Adult Critical Care; General Therapeutics; Cardiac, Pulmonary Diagnostics; Sleep Diagnostics; Anaesthesia; Community/Home Care; Chronic/Long Term Care and the Intensive Care Unit (ICU). Program content is based on provincial entry to practice competencies and the National Competency Profile 6 (NCP). Programs are currently in transition, as the NCP was introduced into the curricula in autumn 2006; therefore 2009 graduates will all be expected to have acquired these competencies by completion of their programs. Following graduation from CoARTE approved programs, students are eligible to write the national registration examinations as provided by the Canadian Board for Respiratory Care (CBRC). In three of the regulated jurisdictions profiled (Alberta, Manitoba and Ontario) successful completion of the CBRC examination enables Canadian graduates to meet the examination requirement for professional registration. In Quebec, successful completion of l épreuve synthèse, a comprehensive examination that tests similar competencies to the National Competency Profile, is required for graduation from approved RT programs. The CBRC National Respiratory Therapy Examination is a multiple choice examination consisting of two papers 7. Both papers are based on current entry to practice requirements based on a current job analysis, and future examinations will be based on the revised NCP. In non-regulated jurisdictions, almost all graduates of accredited programs complete the CBRC examination. Successful completion of the CBRC enables RT graduates to be eligible for membership in the Canadian Society of Respiratory Therapists and to use the Registered Respiratory Therapist (RRT) title. The RRT credential is required for employment in virtually all hospital settings, even in non-regulated jurisdictions, in Canada. There are currently 19 approved respiratory therapy programs in Canada. British Columbia: Thompson Rivers University Alberta: Northern Alberta Institute of Technology (NAIT) Southern Alberta Institute of Technology (SAIT) Manitoba: University of Manitoba - School of Medical Rehabilitation New Brunswick: New Brunswick Community College (NBCC) - Saint John Collège communautaire du Nouveau-Brunswick (C.C.N.B.), campus 5 For more information regarding the CoARTE approval and accreditation process, please see Paper 1 contains 150 questions and candidates are allotted 2 ½ hours for completion. Paper 2 is a Clinical Situation Exam of 90 to 110 questions with an allotted time of 2 ½ hours. 8 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

11 Nova Scotia: QEII/Dalhousie School of Health Sciences Newfoundland: College of the North Atlantic (CNA) Ontario: The Michener Institute for Applied Health Sciences Algonquin College of Applied Arts and Technology Canadore College of Applied Arts and Technology La Cité collégiale - Collège d arts appliqués et de technologie Fanshawe College of Applied Arts and Technology Conestoga College Institute of Technology and Advanced Learning Quebec 8 : Vanier College Le CEGEP 9 de Ste-Foy Le CEGEP de Sherbrooke Le Collège de Rosemont Le CEGEP de Chicoutimi Many of these schools field individual requests from IEHP applicants and/or regulators to provide credential or prior learning assessment of the educational programs these applicants have completed in an attempt to determine what additional education they may require or how they may be integrated into existing RT education programs. In British Columbia, Thompson Rivers University (TRU) reports receiving a few applications per year from internationally educated respiratory therapists wishing to enter their RT program. TRU s assessment process involves assessment of the applicant s credentials, knowledge, and skills in order to determine their learning needs and at what level of the program they can be placed. RTs from Columbia, for example, are usually placed into the second year of the full-time three-year program through a process referred to as the fast-track process. Several colleges in regulated jurisdictions have also developed formal collaborative relationships with regulators to perform PLA and/or integrate IEHPs into existing RT programs. These initiatives will be further elaborated in the province-specific sections for Ontario and Quebec. Canadian Advisory Council for Education in Respiratory Therapy (CACERT) In 2006, the Canadian Advisory Council for Education in Respiratory Therapy (CACERT) was formed with the mandate to represent the interests of the Respiratory Therapy academic community. CACERT members include representation from all CoARTE approved programs in Canada. The purpose of the CACERT includes to: Provide an opportunity for communication and collaboration across the RT academic community Foster sharing of information of best practices in education of respiratory therapy students Provide a forum for discussion of issues related to education of respiratory therapy students Participate in the advancement of the profession of respiratory therapy through advancement of best practices, improvement of respiratory therapy academic research capacity, and raising the profile of the profession. Support the development of specialty programming within the profession of respiratory therapy. Liaise with other like-minded groups, both international and inter-professional. Provide an opportunity to collectively raise awareness, provide feedback, address concerns, etc, on issues of interest to: Regulatory authorities for respiratory therapy National/Provincial professional associations of respiratory therapy Provincial/Federal governments Respiratory therapy practitioners Other health care disciplines The general public 8 One additional CEGEP, Collège Ellis, developed a new program in 2007, but it has not yet applied for or gone through the CoARTE approval process. 9 CEGEP is the acronym for Collège d enseignement général et professionnel, meaning College of General and Vocational Education. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 9

12 IV Regulatory Issues Regulated jurisdictions Manitoba was the first jurisdiction in Canada to regulate the profession of respiratory therapy, in Currently respiratory therapy is regulated in only five Canadian jurisdictions: Alberta, Manitoba, Ontario, Quebec and Nova Scotia. Legislation to regulate the profession of respiratory therapy in Nova Scotia became effective during the course of this research, in January Therefore data regarding respiratory therapy as a regulated profession in that jurisdiction was not available and is not included in this report. Legislation to regulate respiratory therapy is currently pending in Saskatchewan. Regulatory bodies have been delegated authority through provincial statute to regulate the profession to ensure public protection. This involves setting the entry requirements for registration in the profession, setting and enforcing the practice standards and continuing competency requirements for the profession, and undertaking remediative or disciplinary action if members do not maintain the standards of practice. Regulatory bodies are non-profit organizations funded primarily or completely through membership fees to perform their regulatory activities. All of these regulated jurisdictions have similar registration requirements. However, these requirements are described slightly different from one jurisdiction to another and the evidence required to meet these requirements may differ. In their publications and on their web sites, some provincial regulators provide information specifically aimed at internationally educated applicants, while others provide only registration information generally relevant to all applicants. Overall, the requirements for provincial registration as a registered respiratory therapist are as follows, with some variation between jurisdictions: 1. Education: having completed an approved RT program, an equivalent or comparable RT program or demonstrating competencies equivalent to those acquired in such a program; 2. Examination: having completed an approved RT licensure/registration examination; 3. Eligibility for registration: being registered in good standing or eligible for registration as an RT in another Canadian jurisdiction or country; 4. Language proficiency: Providing evidence of language fluency in English and/or French; 5. Currency: Having recently graduated from an approved RT program or worked as a registered respiratory therapist recently (e.g. practised as an RT a required number of hours within a set number of years preceding the application); 6. Eligibility to work in Canada: Having legal authorization to work in Canada; 7. Good conduct/suitability to practice: Providing evidence that he/she has good conduct and is suitable to practice to practice the profession. The requirement response by all regulators to be the most difficult for applicants to meet is the education requirement. Regulators also reported that many applicants had challenges with fluency in English and French. Tables outlining the detailed requirements for each regulated jurisdiction and for membership in the CSRT are provided in attachments at the end of this report. The following sections provide a brief overview of the profession and its membership in each regulated jurisdiction, and a brief overview of the role of the CSRT. 10 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

13 Alberta The regulatory body for the respiratory therapy profession in Alberta is the College and Association of Respiratory Therapists of Alberta (CARTA). A profile of CARTA membership is provided in the two following tables CARTA practising members Age Males Females Total < 25 Years Years Years > 60 Years Not reported Totals ,145 Profile of CARTA IEHP Applicants & Registrants Average # of IEHP applicants / year Primary source countries 2007 number of internationally educated registrants 2007 total all CARTA registrants 10 U.S. 11 Non-U.S. Total 14 U.S. Philippines, Columbia, Syria, Iran ,145 CARTA has two full-time and one half-time staff to handle inquiries and assessment of applicant files. CARTA reports receiving approximately 14 applications from IEHPs each year, though it may receive up to 50 inquiries per year, mostly from physicians who have completed their education in developing countries. The majority of IEHPs inquiring about registration have not completed respiratory therapy programs, though CARTA does report receiving applications from individuals who have completed respiratory therapy programs in Columbia and Taiwan. CARTA may use the services of the provincial credential assessment service International Qualifications Assessment Service (IQAS) to provide language interpretation/ verification of applicant documents, but not credential assessment. CARTA is considering recognizing Taiwan Medical University Respiratory Therapy graduates as substantially equivalent. Respiratory therapy education is delivered by two post-secondary institutions in Alberta: Northern Alberta Institute of Technology (NAIT) and Southern Alberta Institute of Technology (SAIT). IEHP applicants to CARTA who do not meet the education requirement may be referred to NAIT or SAIT to complete additional education. While NAIT and SAIT do not have a formal prior learning assessment (PLA) process, they have endeavoured to assess and integrate IEHPs into existing RT programs. This is usually done by giving the applicant advanced credit standing for relevant courses they have completed and integrating the individual into the program. Both NAIT and SAIT have reported limited success with this process. Applicants require a great deal of individualized support, and the programs are not structured or funded to provide this; additionally, applicants tend to struggle with English 10 Includes registrants with active, practising membership. 11 Refers to having completed RT education in the United States. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 11

14 as the language of instruction and clinical experience. Only two applicants have successfully met the education requirement of CARTA registration through this process. Provincial Context Due to a high level of economic activity and labour demand in the province, Alberta is experiencing severe labour shortage issues. The population of Alberta has been increasing at a very fast pace: In mid-2006 the population of Alberta increased at the rate of 29.5 per 1,000 population - the fastest in the country and almost three times the national average 12. During this period, Alberta posted a record high net interprovincial migration of 57,100 persons, which was 22,700 more than in the previous year. This migration accounted for 58.2% of Alberta s population growth. Moreover, the Alberta natural growth rate (births) remains the highest amongst Canadian provinces. This migration, mainly of workers and their families drawn to the employment opportunities in the oil sector, has put a significant strain on all provincial services, including health care. Alberta employers who took part in a focus group and/or responded to an on-line survey reported: actual and anticipated shortages of respiratory therapists; a willingness to recruit and hire qualified internationally educated RTs; and a great deal of frustration with immigration processes that might allow them to recruit RTs (for example, from the U.S.). Alberta s Health Workforce Action Plan indicates that a Proposed Action for the province to attract health human resources is: 16 Attracting Health Professional Working Abroad to Alberta: Government and health employers should partner on international marketing and recruitment campaigns to attract health professional working in other countries, including the repatriation of Albertans now working abroad. In 2006 the governments of Alberta and British Columbia signed the Trade Investment Labour Mobility Agreement (TILMA) to remove barriers to trade, investment and labour mobility between the two provinces. The agreement creates creates a market of 7.8 million people - Canada s second largest economy. A major aim of TILMA is to facilitate the movement of skilled workers between the two provinces. Challenges identified by CARTA: Difficulty ascertaining the authenticity of applicants credentials, particularly if the applicant is a refugee and has difficulty providing original documents; some applicants may not accurately represent their qualifications on application. Difficulty ascertaining whether applicants have had professional conduct issues or criminal convictions in other jurisdictions. Difficulty communicating with professionals who are not proficient in English. Processing IEHP applications is very resource intensive and applicants may request assistance with other concerns not related to professional registration (settlement, employment and immigration issues). Immigration issues: applicants may not have received accurate information regarding registration and employment in the profession, may be confused regarding legal authorization to work in Canada. Canadian RT education programs not designed 12 Statistics Canada, The Daily, September 27, See 12 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

15 for or having expertise and resources to work with IEHPs; internationally educated applicant may have to take entire 3-year program as there is little opportunity to integrate them otherwise. IEHPs often experience a very high level of frustration due to government bureaucracy, difficulty in having credentials recognized and lack of supports for them. Doubts (despite the mutual recognition agreement) that IERTs originating from other provincial jurisdictions possess comparable knowledge, skills and abilities required for practice in Alberta. Lack of support, communication from federal or provincial governments on matters pertaining to immigration of professionals from other countries. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 13

16 Manitoba The Manitoba Association of Registered Respiratory Therapists (MARRT) regulates the profession in Manitoba. A profile of MARRT membership is provided in the two following tables MARRT practising members Age Males Females Total < 25 Years Years Years > 60 Years Not reported Totals Profile of MARRT IEHP Applicants & Registrants Average # of IEHP applicants / year Primary source countries 2007 number of internationally educated registrants 2007 total number all MARRT registrants 13 U.S. 14 Non-U.S. Total 5-8 Philippines MARRT has no paid staff, so all of the regulatory responsibilities of the Association are undertaken by dedicated volunteers within the profession. MARRT reports receiving a small number of internationally educated applicants per year. Almost all of these applicants have completed respiratory therapy programs in the Philippines. The Registrar has primary responsibility for performing the assessment of applications on a case by case basis, in consultation with the Registration Committee as required. MARRT does not use the services of the provincial credential assessment service Academic Credentials Assessment Services (ACAS). The first step involves determining whether or not the applicant has graduated from a recognized accredited program. If the individual has not graduated from an approved program, he/she is referred to the prior learning assessment (PLA) process program offered at the Michener Institute in Ontario, as no similar process is available in Manitoba. If he/she is deemed to have graduated from a recognized program MARRT would proceed to the next steps in the licensure approval process. To date, no IERT applications to MARRT have reached this stage. There is one respiratory therapy education program in Manitoba, offered at the University of Manitoba as a four-year program leading to a Bachelor s degree in Medical Rehabilitation: B.M.R. (R.T.). There is relatively small enrolment in the program, with no more than 13 graduates annually in any year within the past decade. There are specific challenges related to trying to integrate IEHPs into such a relatively small program with limited resources, and university entry and residency requirements may make such integration 13 Includes registrants with active, practising membership. 14 Refers to having completed RT education in the United States. 14 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

17 very complex. So far, there have been no opportunities or initiatives to integrate IEHPs into this program. The only MARRT members who have completed their educational preparation outside of Canada were educated in the United States. Provincial Context: Manitoba has also been experiencing significant labour shortages. The majority of employers who responded to an employer survey as part of this research expressed that their organizations are experiencing or forecast a shortage of RTs and expressed a willingness to hire qualified internationally educated health professionals to meet their staffing needs. The major concern expressed by employers was that IERTs or IEHPs might have difficulty with English as the language of client care. Manitoba has recently outlined its Manitoba Settlement Strategy 15 to improve social services and expand programs to assist immigrants in settling and succeeding in the province. The province plans to double immigration over the next 10 years and the plan highlights the need for a wider range of effective supports for refugees and skilled workers after they have arrived in Manitoba. The Strategy outlines the key service areas as well as the systemic supports to be provides, such as: pre-arrival Information; centralized initial information and orientation; centralized assessment and referral; employment supports; and recognition of foreign professional and academic qualifications. In 2004 an in-depth study of the scope of respiratory therapy practice through the Winnipeg Regional Health Authority (WRHA) recommended implementing a new model to enhance the ability for RTs to work to their full scope of practice in order to maximize the use of limited RT health human resources and improve patient outcomes 17. Challenges Identified by MARRT: Difficulty validating credential certificates and the credentialing information provided by applicants. Inability to assess equivalency of programs completed in other countries. Logistically, financially and in terms of time commitment, credential assessment is a costly undertaking for MARRT as all regulatory activities are carried out by volunteers. There is no PLA process for respiratory therapy available in Manitoba. As the university program has a relatively small enrolment and limited resources, it would be very difficult to integrate IERTs or IEHPs who needed to complete only a portion of the program; the program is not designed or funded to facilitate this type of program integration. Plain language information regarding regulated professions is available on the government s web site, including a Fact Sheet regarding the respiratory therapy profession See for more information. 16 See 17 Winnipeg Regional Health Authority, Initiative 6 Allied Health, Project 6.3 Scope of Respiratory Therapy Practice, Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 15

18 Ontario In Ontario, the College of Respiratory Therapists of Ontario (CRTO) regulates the profession. A profile of CRTO membership is provided in the two following tables CRTO practising members Age Males Females Total < 25 Years Years Years > 60 Years Not reported Totals 714 1,669 2,383 Profile of CRTO IEHP Applicants & Registrants Average # of IEHP applicants / year Primary source countries 2007 number of internationally educated registrants 2007 total number all CRTO 18 U.S. 19 Non-U.S. Total 19 U.S., India, Philippines ,383 CRTO has eight full-time staff, including a Coordinator of Registration who processes applications for registration, provides direction to applicants referred to the PLA process 20 and handles all membership data. The approval of credentialing/pla decisions resides within the Registration Committee, which has the statutory authority regarding all registration issues. CRTO does not use the services of World Education Services (WES) to do credential assessment. The CRTO includes a great deal of plainlanguage information on their web site specifically aimed at helping IERT/IEHPs understand the requirements and process of registration. CRTO is the only jurisdiction that reported receiving a number of U.S.-educated applicants each year. Virtually all other internationally-educated applicants go through first credential assessment, then a prior learning assessment (PLA) process in order to determine equivalency to an approved Ontario RT program. Currently there are approximately 34 applicants eligible to go through the PLA process. The majority of applicants who have begun the PLA process are at the Michener Institute for Applied Health Sciences, in Toronto. The remainder are going through PLA at Algonquin College in Ottawa. The Michener Institute now has 19 CRTO applicants enrolled in courses and/or going through the stages of PLA: three U.S.-educated RTs preparing for the CBRC exam; 12 internationally-educated candidates past stage 1: (Interview and Feedback) and eligible for stage 2: (Didactic Assessment) of the PLA; 18 Includes registrants with active, practising membership. 19 Refers to having completed RT education in the United States. 20 For more information regarding the CRTO PLA process please see the attached overview of the of Ontario RT registration process. 16 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

19 Two internationally-educated candidates having completed Stage 2 and now eligible for and stage 3 (Clinical Assessment) of the PLA; and Two internationally-educated candidates part-way through a clinical practicum to prepare for Stage 3 of the PLA. Two CRTO applicants are currently going through PLA at Algonquin College. During the course of this research, a survey of CRTO applicants eligible for the PLA was undertaken. The survey revealed that the respondents had a good understanding of the purpose of PLA and generally felt that it was a fair process. Also, the majority of PLA candidates who responded to the survey agreed or strongly agreed that the biggest challenges they faced in going through the PLA were: Having time to complete the PLA process Costs/income lost while completing PLA process Costs associated with a clinical practicum to prepare for the Stage 3 Assessment Learning terminology related to Ontario respiratory therapy practice Accessing a clinical placement Many respondents indicated that having to do independent study and/or enrolling in individual courses was challenging and requested that a specialized RT bridging program be designed for IEHPs. An internationally educated physician who had successfully completed the PLA expressed general satisfaction with the process. It took him 20 months to complete the process and cost approximately $12,000. A large part of the cost was associated with a clinical practicum that lasted several months and cost $800/ month and the Stage 3 Clinical Assessment, which cost $200/day. He is currently employed as a respiratory therapist and reports being very fulfilled in the profession. Provincial Context: In the last decade, the Ontario government has been very focused on issues of access to professions and trades for skilled immigrants. The Ontario Access to Professions and Trades office has now become the Labour Market Integration Unit of the Ministry of Citizenship and Immigration (MCI). In the last few years, the Ontario government has invested over $53 million in more than 90 orientation, upgrading and bridging programs to help internationally educated professionals and tradespeople gain the skills and knowledge they need to work in Ontario 21. Specific Ontario government initiatives have directly targeted regulators, seeking to assess whether registration practices play any part in creating barriers to access. The progress report Opening doors: an Investment in Prosperity regarding access to regulated professions 22 and its follow-up report 23, which focused on the top ten regulated professions in Ontario have scrutinized the registration processes of Ontario regulatory bodies. The Thomson Report 24, which reviewed the appeal mechanisms of regulated professions, has been followed by the enactment of the Fair Access to Regulated Professions Act, which was proclaimed by the Ontario legislature in March This legislation establishes a Fairness Commissioner and requires regulatory bodies to do audits of their registration practices and provide regular reports to government. In 2006, the Ontario government announced the creation of HealthForceOntario (HFO) 25 which 21 See for more information. 22 Ontario Ministry of Citizenship and Immigration, Opening doors: an Investment in Prosperity. January Ontario Ministry of Citizenship and Immigration, Opening doors: Investing in Prosperity, An update on the Integration of the Internationally Trained into Ontario s Workforce September George M. Thomson, Review of Appeal Processes from Registration Decisions in Ontario s Regulated Professions November Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 17

20 is a collaborative multi-year health resource planning and service strategy to give Ontario the right number and mix of health care providers, now and in the future. HFO is a collaborative initiative that involves the Ministry of Health and Long-Term Care (MOHLTC), Ministry of Training, Colleges and Universities (MTCU) and Ministry of Citizenship and Immigration (MCI). Among many other initiatives, HFO includes an Access Centre for Internationally Educated Health Professionals to provide information, guidance and referral to IEHPs seeking professional registration in Ontario. Respiratory-therapy related initiatives The Michener Institute for Applied health Sciences, in Toronto, performs the 3-step Prior Learning Assessment (PLA) for IERT/IEHP applicants referred by CRTO as part of its Access and Options 26 program. Colleges Integrating Immigrants to Employment (CIITE) Competency Assessment Project 27 CIITE, launched in 2003, is a multi-phased strategy for modifying and refining systems, programs and structures of the Ontario college network. One of the Phase 2 projects involves a competency assessment project for the profession of respiratory therapy. The aim is to develop outlines of a prototype model that will assess the knowledge and skills of internationally trained individuals by program rather than on a course-by-course basis. The three key activities are to: 1. Develop guiding principles that colleges can use to recognize an applicant s prior skills and knowledge. 2. Compile an inventory of assessment processes, other than PLAR, that can be used to recognize knowledge and skills that exceed, complement, or are not reflected in formal credentials. 3. Develop outlines of prototype models in two professions (one for RT) that will assess the knowledge and skills of ITIs by program rather than on a course-by-course basis. The report of this phase of the project is anticipated to be released in early Algonquin College, Algonquin Connecting Expertise of the Internationally Trained Project (ACEIT) 28 : included in ACEIT are a number of programs to assist internationally educated health professional integrate into respiratory therapy and RT-related professions. These include: Prior Learning Assessment and Recognition (PLAR) and Preparation for Regulated Employment Program (PREP): The PLA component of this program is undertaken in cooperation with the CRTO. The applicant must first apply to the CRTO and have their application assessed to determine if he/she is eligible to undertake for PLA. The applicant may then complete the 3-step PLA process at Algonquin. Any required additional theoretical and clinical education the candidate needs to take is considered part of their PREP. Respiratory Therapy Program Integration: Algonquin College is planning to launch this program in It will allow IEHPs to apply directly to Algonquin College to complete the Respiratory Therapy full time program in a modified format. Candidates will be provided PLAR opportunities and be assessed on an individual basis. Then they will be advised of the program possibilities he/she will have to study either full-time or part-time to meet the program requirements and complete the RT diploma program. Anaesthesia Assistant Program: In 2008 Algonquin College will be piloting an Anaesthesia Assistant program for internationally educated physicians, anaesthetists and advanced practice nurses and Canadian-educated RTs and registered Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada