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

21 nurses with critical care or operating room experience. This program has recently received approval from the Ontario Ministry of Training, Colleges and Universities and is being undertaken in cooperation with Ottawa Hospital. This will be a full-time, 25 week program consisting of 15 weeks of theoretical education and 10 weeks of clinical placement. Polysomnography Certificate Program: This is a 190-hour certificate program available to internationally educated health professionals. This program is currently under revision so that graduates will be qualified to be certified as Cardiology Technologists Cardiac Diagnostics Certificate Program: 30 This is a part-time program program available to internationally educated health professionals. This program is currently under revision so that graduates will be qualified to be certified as Cardiology Technologists Algonquin College has applied for Ontario government approval to develop a bridging program for IEHPs to obtain an Ontario RT diploma that would be recognized by the CRTO. In addition, other community colleges in Ontario are discussing the feasibility of developing a respiratory therapy bridging program for IERTs/IEHPs. completed respiratory therapy programs, they require a significant amount of additional education to meet the requirements. PLA is quite lengthy; it may take 18 months 2 years to complete the process. There are specific challenges for PLA candidates as they are not integrated into the regular, fulltime RT program at community colleges. For example, PLA candidates may not have access to student financial assistance. As part of the PLA process, candidates must pass the didactic examination before they begin their clinical assessment. Full-time RT students complete this didactic examination after their clinical placement. PLA candidates and the schools have acknowledged that it is difficult for PLA candidates to be successful on the didactic assessment before they have had exposure to a clinical practice setting in Canada. Much of the study required for PLA is undertaken independently. This is more challenging and less supportive for the applicants than it would be if there were programs designed for them as a group, specifically to meet their needs. Stage 3 Clinical assessments for the PLA candidates must be arranged individually and it is quite difficult to find clinical placements. Some applicants have reported having to wait several months for a placement. Challenges Identified by CRTO and Educators: It may be quite complicated and difficult for applicants to provide all of the documentation required to do credential assessment. It is difficult and time-consuming for CRTO to do credential assessment of international education. As the majority of CRTO applicants have not 29 The CSRT has endorsed the development of anaesthesia assistant educational programs as specialized continuing education for RRTs. However, it is important to note that graduates of this pilot project who are not already RRTs will not be eligible for registration with RT provincial regulatory bodies or the CSRT. The Ontario regulatory body (the CRTO) does not support the inclusion of non-regulated health care providers in the Anaesthesia Assistant role. 30 This program is currently being revised and will probably comprise approximately 200 hours of instruction. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 19

22 Québec L Ordre professionnel des inhalothérapeutes du Québec (OPIQ) regulates the respiratory therapy profession in Quebec, and has the largest number of members of all of the provincial regulatory bodies OPIQ practising members Age Males Females Total < 25 Years Years Years > 60 Years Not reported Totals 500 2,787 3,287 Profile of OPIQ IEHP Applicants & Registrants Average # of IEHP applicants / year Primary source countries 2007 number of internationally educated registrants 2007 total number all OPIQ registrants 31 U.S. 32 Non-U.S. Total Morocco, Algeria, Columbia ,287 OPIQ has ten-full-time and one part-time staff to handle all regulatory activities. Prior to 2003 OPIQ did not have a formal mechanism for recognizing education completed outside of Canada. There is now one staff member of the Ordre who does equivalency assessments of programs and provides recommendations regarding applicant files to the Executive Committee. OPIQ uses an assessment process that compares international educational programs to Quebec RT programs and provides direction to applicants who are deemed to require additional theoretical or clinical education in order to meet equivalency. This may involve a clinical placement only, which can be arranged through OPIQ. Usually, though, this involves additional education that can be completed at a CEGEP in the province. OPIQ does not use the provincial credential assessment service, Service des évaluations comparatives d études to do credential assessment of applicant files. OPIQ is in the process of developing a free, selfdirected on-line assessment tool for applicants, to be launched in This tool is intended to provide applicants have a realistic idea of how their credentials may be evaluated by OPIQ, and to provide them with some idea of the additional studies they may be required to undertake to meet provincial registration requirements. OPIQ has developed collaborative relationships with the CEGEPs, with the largest number of applicants being referred to Collège Rosemont in Montreal to complete additional education. At Collège Rosemont, internationally educated applicants are integrated into the full-time respiratory therapy program, taking only the courses they have been directed to take by OPIQ. However, as they may need to complete courses in any of the years (first to third) of the program, it may take an individual the full three years, studying part- 31 Includes registrants with active, practising membership. 32 Refers to having completed RT education in the United States. 20 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

23 time, to complete the required courses. Such students receive and complete their clinical placements in the same manner as the full-time CEGEP students. If the internationally educated applicant is enrolled in 12 hours or more of classes per week (considered full-time), he/ she has to pay tuition fees of approximately $100 / semester; applicants enrolled in fewer hours per week must pay a higher fee of approximately $300 / semester. From PIQ has reviewed 55 applications from IERTs and IEHPs. The majority (37 applicants) had completed their education in North Africa: Morocco, Algeria or Tunisia. These applicants had completed education as anaesthesia or medical technicians or senior medical assistants 33. OPIQ has also received ten applications from Columbian-educated respiratory therapists and two applications from U.S. educated RTs. The remainder of applicants were doctors or other health professionals from Mexico, Syria, Russia, Vietnam and France. Collège Rosemont has received the majority of IEHPs and IERTs directed to complete additional education, with 43 individuals referred to the program since the beginning of the collaboration with OPIQ. Currently, 28 internationally educated candidates are registered in or have completed the educational program at this CEGEP: 13 have graduated, 13 are currently enrolled and two candidates are re-taking l épreuve synthèse, the comprehensive examination required for successful program completion. In all, 12 applicants have been successfully registered with OPIQ through this collaboration with Collège Rosemont. Looking at the applicants who have been referred to Collège Rosemont during the past few years provides an interesting snapshot of RT applicants in Quebec. A break-down of the countries where these applicants completed their education prior to applying for RT registration in Quebec is as follows: Country IERT & IEHPs Referred to Collège Rosemont to Complete Further RT Studies Number Algeria 18 Morocco 9 Columbia 8 Tunisia 2 France 1 El Salvador 1 Syria 1 Venezuela 1 Ivory Coast 1 Vietnam 1 Total 43 A break-down of the types of education applicants had completed before they applied to be registered as RTs in Quebec is as follows: IERT & IEHPs Referred to Collège Rosemont to Complete Further RT Studies Educational Background Advanced anaesthesia technicians (Techniciens supérieurs en anesthésie) Respiratory Therapy program, lacking anaesthesia curriculum required in Quebec (Équivalent à inhalothérapeute au Québec mais sans la portion anesthésie) Number 32 Kinesiology 1 Nursing 1 (Études supérieures spécialisées en soins infirmiers) Medicine 1 Total Technicien supérieur en anesthésie, Technicien supérieur de la santé, Auxiliaire médical et médecin. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 21

24 Currently OPIQ and Collège Rosemont are collaborating to design a bridging program (programme de formation d appoint) for IERTs and IEHPs that they hope will be funded by the Ministry of Immigration and Cultural Communities in The program is planned to be less than a year in length, will include theoretical and clinical education specifically designed to meet the needs of these applicants and will include completion of l épreuve synthèse. Program completion would not provide applicants with a diploma, but would be recognized as meeting the education requirement for OPIQ registration. Provincial Context: In recent years the Quebec government has undertaken a number of initiatives to encourage regulators to ensure that they have fair and accessible registration processes and that supports are made available to new immigrants seeking entry to regulated professions. In 1973 the Code des professions, the umbrella legislation which regulates all regulated professions in Quebec, was amended to allow regulators to recognize the equivalency of internationally acquired credentials. In 1994 it was made mandatory that regulators adopt policies to recognize the equivalence of education completed outside of Quebec in order to facilitate access by immigrants to regulated professions. In 2002, the Quebec Ministry of Immigration and Cultural Communities established a counselling and referral service to provide advice and guidance to immigrant seeking registration in a regulated profession. In addition, 45 profession-specific fact sheets have been developed to provide internationally educated applicants with information regarding the requirements for registration in each profession 34. In 2005, the Work Team on Recognition of the Credentials and Skills of Foreign Trained Individuals 35 released a report which made recommendations regarding the provision of information to applicants, improved integration services, the removal of barriers regarding PLAR and professional registration processes, recognition for work experience, the development of different types of temporary or limits permits to allow internationally educated applicants quicker access to the profession, the development of bridging education etc. Immigration-Quebec has developed a web site in French, English and Spanish which provides settlement information, including a guide for successful integration entitled Learning About Quebec 36 which includes information regarding credential assessment and the processes for becoming registered in a regulated profession. In addition, access and/or bridging initiatives have been developed (funded by the Ministry of Immigration and Cultural Communities) for a number of professions 37, including nursing, chemistry, speech pathology and audiology, medical technology, agrology etc. Challenges Identified: The majority of applicants have not completed respiratory therapy programs OPIQ handles applications from many anaesthesia technicians and the role of RT is very different from the role they had in their own country. Almost all applicants have to complete additional education and this may take them up to three years part-time. This is difficult for the applicants, and it would be better if a shorter bridging program designed specifically for them was available. 34 The Respiratory Therapy fact sheet (available in French only at this time) can be viewed at: professions-regies/inhalotherapeute.pdf Ministère de l Immigration et des Communautés culturelles, Projets visant à faciliter l accès aux professions et métiers réglementés mis en oeuvre par le ministère de l Immigration et des Communautés culturelles (MICC) et ses partenaires, 11 juillet Retrieved January 2008 at AccesProfessionsMetiers-ProjetsJuillet2007.pdf 22 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

25 Applicants found it very financially difficult at first: most were only studying part-time and did not know how to find part-time work in Quebec while they were studying. It can be quite socially difficult for middle-aged professionals who previously held high-level jobs in their home countries to be in a program with very young (18 21 years old) students who have just graduated from secondary school. IEHPs who have gone through the education process and become members of the OPIQ have expressed that they had to go through significant cultural adjustment to Quebec society and the health-care system, and that they felt some isolation in the process of trying to integrate with their Quebec peers. Applicants from non-french-speaking countries have difficulty with French as the language of instruction and clinical practice. As many health care facilities in Montreal operate in both official languages, applicants may be faced with having to communicate in a second and a third language. Role of the Canadian Society of Respiratory Therapists (CSRT) The Canadian Society of Respiratory Therapists (CSRT) is the national professional association for respiratory therapy in Canada, and as such represents and advocates for the respiratory therapy profession at the national level. Voluntary membership in the CSRT provides members with a number of benefits 38, including access to professional liability insurance. RTs in both regulated and non-regulated jurisdictions may apply to become CSRT members. Professional membership with the CSRT allows respiratory therapists in non-regulated jurisdictions, who otherwise would not have access to the RRT designation, to use the title registered respiratory therapist (RRT). In addition, it provides them the opportunity to enjoy the benefit of labour mobility to regulated jurisdictions under the provisions of the Respiratory Therapy Mutual Recognition Recognition Agreement. CSRT membership also allows Canadian RRTs to benefit from the partial reciprocity agreement with the National Board for Respiratory Care (NBRC) in the USA. The CSRT does not do credential assessment for internationally educated applicants educated outside of the United States. In a non-regulated jurisdiction, the most likely way that an IEHP would eventually become a CSRT member would be to apply to complete additional education at an approved Canadian school, qualify to write the CBRC exam in this way, and then apply to CSRT as a Canadian educated graduate. In regulated jurisdictions he/she would apply to the regulator, go through a PLA process and/or complete additional education, and in this way qualify to write the CBRC. After successfully completing the CBRC and becoming registered, he/she could then apply for voluntary CSRT membership in the same way as any RT in Canada. CSRT Membership in 2007 was as follows: Province Number of RRT CSRT members 39 (2007) British Columbia 392 Alberta 307 Saskatchewan 122 Manitoba 89 Ontario 730 Quebec 89 New Brunswick 243 Prince Edward Island 17 Nova Scotia 219 Newfoundland 105 Northwest Territories/Nunavut 4 Yukon 1 Total 2, See for more detail. 39 Registered RTs category of registration only. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 23

26 V Labour Market Issues Demographic composition of the RT workforce in Canada Overall, there were approximately 7,886 RTs eligible to practice in Canada in The table below contains information regarding the numbers of RTs in Canada 40 from Please note that as this data has been drawn from CIHI, while the data provided in earlier sections of the report was collected directly from provincial regulators and the CSRT, there may be some small data differences. First year of regulation or nonregulated (NR) Respiratory Therapists in Canada % change Province as % of Canada total % female 2006 % male % unknowm Per 100,000 population Canada 6,356 6,572 7, N/A BC NR AB , SK NR MB ON ,721 1,923 2, QC ,457 2,651 3, NB NR NS PEI NR <1 10 NFLD NR Data not available Source: CIHI Health Personnel Provincial Profiles, November Data in this table includes both regulated (membership with a regulatory body is required as a condition of practice) and voluntary membership data (registration with the data provider, the CSRT, is not a condition of practice). These data are appropriate for some comparative purposes but should be interpreted with caution due to data-quality limitations. 41 Saskatchewan s Bill 42, of An Act respecting Respiratory Therapists received royal assent on May 19, 2006, but has not yet become effective as the accompanying regulations have not yet been approved. 42 An Act Respecting the Practice of Respiratory Therapists became effective in Nova Scotia on January 1, Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

27 There are a number of observations that can be drawn from the data above. Respiratory therapy is a growing profession: the number of practising RTs in Canada increased by 24% between Fully 70% of Canada s RTs live and work in Ontario and Quebec. The majority (almost three-quarters) of RTs in Canada are female. There is a wide variability in the number of RTs in the labour market from one province to another. There is great variability in change in the number of practising RTs in the labour market from , with Nova Scotia seeing a decline 43 in the number of RTs while other provinces, most notably Alberta, Ontario and Quebec, having seen marked increases. Information provided by CIHI and regulators indicates that the majority of RTs in Canada are female. This demographic characteristic of the RT labour force and other factors related to labour market patterns of younger workers makes forecasting of labour supply more complicated. Female labour market patterns differ generally from male workers in a number of ways: they are generally more likely to work part-time and to move into and out of active practice more frequently than their male counterparts, often due to maternity leaves and child- and elder-care obligations. Information from employers, particularly in Quebec, supports the contention that there is a great deal of voluntary part-time work in respiratory therapy. Employers have also indicated that both male and female younger workers entering the profession are more likely than earlier cohorts of graduates to want to work part-time. This trend makes health human resource planning challenging, as the number of new graduates in the profession each year in Canada likely may not translate into capacity to fill an equal number of full-time equivalent (FTE) positions. Data from CIHI indicates that the average age of health care providers in Canada in 2005 was 41.9 years. In respiratory therapy, the average of practising RTs was slightly younger, at 39 years. However, from the average age of Canadian RTs increased significantly, from 33.6 years to 39 years, an increase of 5.4 years 44. These data support information provided by regulators and anecdotal information from employers: that the RT population is aging and that the profession may be facing an exacerbation of the current shortage situation as older cohorts of baby-boomer RTs enter retirement age. Respiratory Therapy Labour Supply There are three potential sources of new labour supply in the field of respiratory therapy in Canada: 1. Newly graduated Canadian-educated respiratory therapists 2. U.S.-educated respiratory therapists 3. Internationally educated respiratory therapists or other IEHPs By far the major source of new labour supply is new graduates of approved respiratory therapy programs in Canada. The table below summarizes graduate numbers provided by approved Canadian schools and regulators. The most reliable data can be observed in years , as full data was able to be obtained for all schools during those years. 43 Note that due to the relatively small absolute numbers, this must be interpreted with caution. 44 CIHI, Canada s Health Care Providers, Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 25

28 Province Number of Graduates of Approved College and University Respiratory Therapy Programs British Columbia * Alberta Manitoba Ontario 98* 117* 97* Quebec * 96* New Brunswick Nova Scotia Hospital-based program data unavailable Newfoundland TOTAL 281* 362* 321* * 392* *Incomplete - data missing from one or more schools. Two reports, one from the Quebec government (Planification de la main-d oeuvre des techniciens des domaines de la médecine et des laboratoires, March 2003) and another published in the Canadian Journal of Respiratory Therapy (The Coming RT Shortage) 45 provide evidence of an existing and forecast shortage of respiratory therapists. These conclusions have been drawn from looking at such factors as graduate numbers and demographics of the current RT labour force such as age and gender. In all of Canada, only 68 U.S.-educated RTs are now registered in regulated jurisdictions, the majority of them (63) in Ontario. These 68 U.S. educated registrants represent less than 1% of all RTs in Canada. As has been shown in this paper, relatively few IERTs and IEHPs apply for registration in Canada. Only a handful of individuals complete PLA and/or additional education, successfully register and enter the Canadian labour market as RRTs each year. Current RT registrants who completed their original education outside of Canada or the U.S. (19 registrants) represent only about.24% of the Canadian RT workforce. Response to employer surveys 46 undertaken as part of this project reveals some regional differences: 70% of employer respondents in Quebec and the majority in Alberta indicated that they felt there was a current shortage of respiratory therapists. All Manitoba employers who responded to the survey 47 indicated that they were experiencing a shortage. Ontario employers generally did not indicate that they were experiencing RT shortages. Statistics Canada has indicated that immigration is a crucial source of new labour growth for Canada. As indicated in a recent report 48 : Immigration is becoming increasingly important to Canada s economic well-being. Roughly twothirds of Canada s population growth comes from net international migration. Population projections show that net immigration may become the only source of population growth by about 2030 and could account for virtually all net labour force growth by Planification de la main-d oeuvre des techniciens des domaines de la médecine et des laboratoires, March 2003, Ministère de la Santé et des Services sociaux, and The Coming RT Shortage by Miriam Sobel, Patrick Litwin, RRT, Cliff Seville, RRT, Cheryl Homuth, RRT Canadian Journal of Respiratory Therapy, Winter Please note that these were on-line surveys of a sample of employers in each jurisdiction. The responses should be considered anecdotal, as they are not statistically valid. 47 Five hospitals. 48 Statistics Canada, The Daily September 10, Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

29 The information provided indicates that, without further support and access initiatives for internationally educated individuals wanting to enter the profession, virtually all new all new RT labour supply will need to come from graduates of approved RT programs in Canada. This may present a challenge to meeting the labour supply needs for respiratory care services in Canada, particularly in regions experiencing shortages. It also represents a missed opportunity to capitalize on the skills of IERTs and IEHPs wishing to enter the practice of RT in Canada. Demand for Respiratory Therapy Services There are a number of factors that affect the demand for respiratory therapists in Canada. Some factors cited by respiratory therapy organizations include: Aging population with increased demand for rehabilitation in Chronic Obstructive Pulmonary Disease (COPD) Increased demand for home care therapists Increased role of RTs in public education regarding asthma, sleep disorder, COPD and environmental hazards Expanded role in critical care Increased awareness / diagnosis of sleep apnea Expanded role in sleep management Expanded role in public health Expansion of RT services in some rural communities Feedback from employers, indicated in the previous section, provides evidence that employers in some provinces are experiencing difficulty fully meeting their RT staffing needs. This was expressed with particular emphasis by Alberta employers, who are attempting to meet the needs of a client population which has increased dramatically in recent years due to inmigration to the province and an acute shortage of skilled labour overall. The report Respiratory Disease in Canada 49 states that Canada is facing a wave of chronic respiratory diseases. Since many of these diseases affect adults over the age of 65, the number of people with respiratory diseases will increase as the population ages. The corresponding increase in demand for services will pose a significant challenge for the health care system. Factors cited in the report include the increase in COPD and lung cancer in older women, related to social factors that encouraged women to smoke 30 to 40 years ago; an increase in bronchiolitis-associated hospitalizations in the past decade; the increasing longevity of clients with cystic fibrosis, who may now live into their 20s and 30s; and the decrease in mortality rates of clients with respiratory distress syndrome (RDS). Labour Mobility Labour mobility within the respiratory therapy profession in Canada is provided through two mechanisms: the Respiratory Therapy Mutual Recognition Agreement (MRA) and reciprocity agreements between provincial regulators and the CSRT and the U.S. National Board for Respiratory Care. Labour mobility agreements facilitate the movement of registered professionals from one regulated jurisdiction to another by reducing barriers to professional registration by allowing registered members in good standing to become registered in another jurisdiction through recognizing of their educational credentials and the examinations they have completed. This process streamlines the registration process and promotes labour mobility as registration in good standing in one regulated jurisdiction is recognized by another regulated jurisdiction and applicants do not have to go through the initial application process that would be required of a new applicant to the profession. 50 CIHI et al. September 2001, Respiratory Disease in Canada Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 27

30 The Respiratory Therapy Mutual Recognition Agreement (MRA) The members of the National Alliance of Respiratory Therapy Regulatory Bodies (NARTRB) signed an RT Mutual Recognition Agreement (MRA) 50, in accordance with the Agreement on Internal Trade (AIT), in November The purpose of the Respiratory Therapy MRA is to reduce barriers to registration for registered respiratory therapists moving from one Canadian jurisdiction to another. The Respiratory Therapy MRA indicates that: 3.3 All parties acknowledge that there is a significant overlap in the practice of the profession in all provincial and territorial jurisdictions and that there is at least 80% overlap between the entry to practice competencies required to obtain a Licence with each of the regulatory bodies. Furthermore, it provides the following mobility provisions, which include labour mobility between unregulated and regulated jurisdictions, if the individual practising in an unregulated jurisdiction is a member of the CSRT. 4 Mobility Rights 4.1 A person licensed as a Registered Respiratory Therapist ; Registered Respiratory Care Practitioner ; inhalothérapeute ; technicien en inhalothérapie et anesthésie or a Technician in Inhalation Therapy and Anaesthesia on application, shall be licensed by the other regulatory body without restrictions other than those imposed on all members, subject to the conditions set out in this agreement. 4.2 Applicants must be registered with a regulatory body or be a registered member of the CSRT practising in an unregulated jurisdiction, and provide evidence of practising the profession within that jurisdiction for a minimum of 720 hours within the previous four years before being entitled to exercise the rights under this agreement. The labour mobility provisions of the RT MRA do not directly affect IERTs or IEHPs. However, the existence of the MRA demonstrates a willingness to cooperate and collaborate inter-jurisdictionally on agreements and processes of benefit to the profession across Canada. The agreement regarding the commonality of competencies required to practice RT across Canada also has the potential to be a good starting point for any future discussions, such as the development of harmonized credential assessment or PLA processes. It should also be noted that once any internationallyeducated applicant becomes registered in a regulated jurisdiction or with the CSRT and has worked for the requisite period of time, he/she is afforded the same labour mobility benefits as Canadian-educated RRTs. Reciprocity between Canada and the United States The Canadian Society of Respiratory Therapists has signed an International Reciprocity Agreement with the National Board for Respiratory Care (NBRC) in the United States that recognizes each country s RRT designation and facilitates the registration of RRTs between the two countries. This agreement will be in effect until at least the end of 2009, and will likely be extended. In Canada NBRC RRTs are required to complete only Paper 2 of the CBRC examination to meet the examination requirement of CSRT membership. In the U.S. the NBRC Registry Examination consists of two parts: the multiple-choice Written Registry Examination for Advanced Respiratory Therapists and the Clinical Simulation Examination (CSE), consisting of 10 separate simulated patient scenarios. CSRT members applying for registration as RRTs with the NBRC are exempt from taking the written portion of the registry examination and may meet the examination requirement upon successfully completing the Clinical Simulation Examination only Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

31 VI Research Findings Overview Respiratory therapy is a relatively small profession as compared to others in the Canadian healthcare system. Of the almost 8,000 RTs in Canada, there are currently only 19 RTs registered in Canada who completed their original education outside of Canada or the U.S. Outside of North America, respiratory therapy is offered as an educational program in only a few countries. Regulators have reported receiving applications from individuals who have completed respiratory therapy education programs in the Philippines, India, Columbia, Taiwan and Korea. The preparation, in terms of theoretical and clinical education is various and the scope of practice in other countries is not the same as in Canada. In most countries RT is not a regulated profession with the same role, autonomy of practice and scope as it is in Canada and the U.S. Regulators perform credential assessment on an individual program basis, and have found that while some of the programs contain comparable content to accredited Canadian programs, applicants generally must complete additional education to meet equivalency. For example, programs from the Philippines are generally considered to be delivered at a technician, rather than a therapist level; graduates may not be prepared for autonomous practice and may lack sufficient clinical education. OPIQ has reported that it considers the content of RT programs from Columbia to be 65% comparable to accredited Quebec programs. Other regulators have determined that Columbian RT programs are less comparable, and require applicants who have completed such programs to take two years or more of a Canadian RT program in their jurisdiction. Regulators generally do not use, or use in a selective or advisory capacity, the services of accredited credential assessment services. As there are so few applicants, such services may not have the experience to provide an in-depth (course-by-course) credential assessment of international RT programs. Also, as it is quite challenging to compare one type of program (e.g. degree in anaesthesia completed at a university in another country) to a different program (Canadian respiratory therapy diploma completed at a college), regulators feel more confident doing the assessment in-house. This also enables them, as part of the registration process, to be able to appropriately direct applicants to take additional education to meet the requirements. So far, no provincial regulator has deemed a respiratory therapy program completed outside of the United States to be equivalent to a Canadian program. It must be noted that 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 (Ontario and Quebec) reported receiving less than 20 applications from IERTS/IEHPs per year. Alberta and Manitoba each reported receiving even fewer applications from IERTS/ IEHPs annually. The source country and educational preparation of applicants, as reported by the regulators, varies by jurisdiction. In Alberta, CARTA reports having received applications from applicants who have completed respiratory therapy programs in Columbia, Taiwan and Korea and physician applicants from a number of other countries. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 29

32 MARRT reports that almost all of their applicants have completed respiratory therapy programs in the Philippines. In Ontario, the CRTO reports receiving the greatest number of applicants educated in the Philippines (RTs) and India (RTs and physicians). Other source countries of applicants in Ontario include: Colombia, Ukraine, Russia, China, Bangladesh, Belarus, Armenia, and Iran. CRTO indicates that most of these applicants have completed medical degrees, some with specialty education in anaesthesiology. There is usually no student or other financial assistance available for IERTs/IEHPs going through PLA in Ontario or the CEGEP education process in Quebec (if they are part-time students). There are difficulties with trying to integrate IERTs and IEHPs into regular full-time programs: there are currently no specific language or cultural supports, the demographic of the Canadian learners may be quite different from the new arrivals and the courses are not designed to build upon their existing knowledge and meet their specific needs. OPIQ reports that the greatest number of their applicants has completed anaesthesia technician programs in Morocco, Algeria or Egypt. OPIQ has also received applications from respiratory therapy graduates from Columbia and other health professionals from Vietnam, Russia and Syria. Research and data from the regulated jurisdictions 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. Challenges for IEHPs applying to become RTs in Canada Virtually all IERTs and IEHPS must complete additional RT education in Canada to meet registration requirements. This is costly and timeconsuming for them at a time when the majority are struggling to settle in Canada. As there are few IERT/IEHP applicants, many applicants must go through the process on an individual basis, which can be a very discouraging and isolating experience. There are no formalized mentor or peer supports to lessen applicants isolation in the process or to provide a sense of profession inclusion. Many applicants struggle with English or French as the language of assessment, instruction, client care and health-care team communication. There are no profession-specific language courses in French or English. In Ontario, applicants have expressed that it is difficult to obtain a clinical practicum to prepare for the clinical assessment and that it is very costly (clinical practicum may cost $800/month, and the placement may last several months). Challenges for Regulators Previous sections of this report outlined the challenges identified in each regulated jurisdiction. These included: difficulties in doing credential assessment, often of non-rt programs; lack of PLA or other competency-based assessments in some jurisdictions; limited opportunities for applicants to complete additional education; 30 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

33 length of time and costs to complete PLA and/or additional education; difficulty for applicants to access clinical placements in some jurisdictions; and concerns regarding lack of English or French language fluency of applicants. The number of members of the profession, the size of the regulatory body and the number of graduates per year varies widely from one regulated province to another. This has implications for how the issue of access can be handled. A smaller jurisdiction may have few resources upon which to draw to undertake any new initiatives aimed at facilitating access for the few applicants they receive per year. Conversely, a larger regulatory body may have greater numbers of applicants and capacity within the provincial post-secondary system to develop specific supportive initiatives such as PLA, bridging programs and/or language training. Even in Ontario and Quebec, which receive the largest numbers of applicants, there is concern that there may be insufficient numbers to make bridging programs cost effective. The profession may have to consider different types of appropriate strategies in different jurisdictions. Another possibility is to develop tools and resources that can be developed collaboratively and shared between all jurisdictions. As a large number of RT applicants completed their education in medicine or anaesthesia, there may be some benefit to making organizations that provide services to these immigrant professionals aware of any bridging options that are developed as access initiatives leading to registration in respiratory therapy. Quebec reports receiving applications from anaesthesia specialists who could potentially take on limited-practice roles in anaesthesia if there were provisions for restricted registration (permit restreint). However, there has not been enough research done to determine whether this is feasible. Strengths and Opportunities The existence of a national professional association (CSRT), the National Alliance of Respiratory Therapy Regulatory Bodies (NARTRB) partnership and the Canadian Advisory Council for Education in Respiratory Therapy (CACERT) provides established information networks and opportunities for inter-jurisdictional collaboration between key stakeholders on issues of concern to the profession in Canada. The existence of the Respiratory Therapy Mutual Recognition Agreement demonstrates a general agreement regarding common competencies required to practice RT in Canada and a willingness to cooperate between the jurisdictions for the benefit of the profession as a whole. Consensus on and the adoption of a National Competency Profile (NCP) provide the opportunity for building on a framework of competencies agreed upon by all approved schools. This may help in the development of harmonized credential assessment and/or prior learning assessment processes. Due to the relatively small size of the profession, even access initiatives that might facilitate the registration of a relatively small number of individuals will have a significant impact on the profession. As one employer representative indicated: If I have three vacancies and can recruit even one or two new RTS, this makes a big difference in the services we can provide. There is the potential to capitalize on a number of positive processes and initiatives already existing or in development in the profession. These include: the provision of plain-language information to applicants; PLA; on-line self- Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 31

34 assessment for applicants, competency-based assessment and bridging education. Employers have expressed a willingness to hire internationally educated respiratory therapists, as long as they are assured, through the regulatory process, that such applicants have the competencies to practice safely. Respiratory therapists who have gone through PLA / additional education and become registered in Canada have indicated that they did not have difficulty finding employment. Most expressed that they had found their current employment through Stage 3 of the PLA or clinical placements (l externat in Quebec). All such RTs indicated that they were very happy with their careers in respiratory therapy. As the majority of applicants have completed education in either medicine or anaesthesia, making community organizations that serve these applicants aware of any new initiatives (i.e. bridging education) that might provide an alternative option to regulated employment (in RT) might be beneficial. Such an initiative might also increase the number of applicants, ensuring sufficient enrolment to make the development of such a program viable. 32 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

35 VII Learning from Other Access Initiatives During the past decade, there has been a marked increase in the awareness of the challenges affecting internationally educated professionals seeking registration in their profession in Canada. There have been a large number of reports 51, conferences and initiatives undertaken to highlight and suggest actions that should be taken to address these issues. The need to identify and eliminate barriers to access to regulated professions for qualified internationally educated candidates has been identified as an issue of fairness and social justice. It has also been seen as an economic imperative; as Canada s current and forecast skills shortages point to an urgent need to make maximum use of the skills of professionals immigrating to Canada. There has been a marked increased the skill level of immigrants and those seeking registration in regulated professions in recent years. Citizenship and Immigration Canada has noted that The trends... have led to a rapid increase in the yearly number of immigrants intending to enter a regulated profession (engineers, accountants, physicians, lawyers, etc.), from less than 10,000 in the 1980s to over 25,000 in Governments at the federal, provincial and in some cases the municipal levels have dedicated substantial funding to research and initiatives to support access initiatives for internationally educated professionals. Some jurisdictions, such as Ontario and Quebec have made legislative changes designed to decrease barriers to registration in the regulated professions. It is important to note that it is now widely acknowledged by regulators, governments and the public at large that the registration processes for entry into regulated professions may pose particular challenges for internationally educated professionals. There is also recognition that programs that provide supports, such as preparatory or bridging education, are effective in assisting individuals to attain the goal of registration/licensure in their profession. This paper will not elaborate on all of the developments related to access issues, though some are referenced throughout the paper. There are such a multitude of initiatives on-going at this time that it would be difficult to capture them all. However this paper will highlight initiatives under themes that could appropriately provide ideas and models for the profession of respiratory therapy. These themes are: Collaborative Initiatives Providing Information for Newcomers Credential Assessment and Prior Learning Assessment and Recognition Mentorship and Preceptorship Bridging Programs and Other Preparatory Education 51 Alboim, Naomi, Ross Finnie, and Ronald Meng. The Discounting of Immigrants Skills in Canada: Evidence and Policy Recommendations. IRPP Choices 11.2 (2005): Alboim, Naomi, and The Maytree Foundation. Fulfilling the Promise: Integrating Immigrant Skills into the Canadian Economy. Caledon Institute of Social Policy, April Bloom, Michael, and Michael Grant. Brain Gain: The Economic Benefits of Recognizing Learning and Learning Credentials in Canada. The Conference Board of Canada, Citizenship and Immigration Canada (2003): Immigrant Occupations, Recent Trends and Issues. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 33

36 Collaborative Initiatives In the last decade, with an increased awareness of this issue, there have been several collaborative initiatives undertaken by governments and agencies to work together on access initiatives for internationally educated professionals. The federal government has been supporting foreign credential recognition initiatives, language training and other settlement initiatives for many years. In 2004, the Government of Canada announced the development of a coordinated federal strategy to address key barriers to labour market participation faced by both newcomers and foreign-trained Canadians and to ensure they can contribute their full potential to the economy 53. The ORA has identified challenges and/or barriers faced by internationally educated professionals seeking professional registration/licensure and tools to alleviate these difficulties, including a Compendium of Promising Practices and a Regulators Guide for Promoting Access to Professions by International Candidates. 55 Providing Information to Newcomers As indicated in earlier sections of this paper, some jurisdictions have developed plain-language Fact Sheets regarding regulated professions, specifically designed to give clear information on the registration process for internationally educated applicants. Manitoba, Ontario and Quebec all have Fact Sheets regarding the profession of Respiratory Therapy. Enhanced in April 2005, this multidepartmental initiative is now known as the Internationally Trained Workers Initiative. The expanded strategy focuses on the following key areas: foreign credential assessment and recognition; enhanced language training; bridge-to-work initiatives; improved labour market information; research; and addressing issues of discrimination in the workplace. With CIC and HRSDC as the co-leads, an interdepartmental group of 14 federal departments and agencies is collaborating on the development and implementation of the strategy, including consultation and communications activities to engage the various stakeholders. In 2001 a group of Ontario regulators formed Ontario Regulators for Access (ORA) 54 to bring together professional regulatory bodies which shared a common goal of identifying barriers and challenges to professional registration / licensure faced by internationally educated professionals. In addition, the federal 56 and provincial government have developed web portals to provide information to newcomers. The governments of all of the regulated jurisdictions of focus in this paper (Alberta, Manitoba, Ontario and Quebec) have web pages specifically designed to provide labour market integration and settlement information to new immigrants. In Quebec, immigrants who intend to seek registration in a regulated profession must sign a declaration 57 indicating, among other statements that they understand that the profession is regulated and that I have been informed that I may encounter difficulties in meeting the requirements for obtaining a license to practice my profession in Québec, or that I may not meet these requirements. This was implemented to ensure that immigrants were made aware of the challenges they might encounter as they seek registration in their field. 53 Citizenship and Immigration Canada, Annual Report to Parliament on Immigration, Ontario Regulators for Access. Access to Ontario s Regulated Professions by International Candidates: Research Report and Compendium of Promising Practices. July 2003, Access Solutions Project: Final Report. September 2004, and Regulators Guide for Promoting Access to Professions by International Candidates. May Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

37 Credential assessment and Prior Learning Assessment and Recognition (PLAR) The Alliance of Credential Evaluation Services Canada (ACESC) represents accredited credential assessment agencies in Canada who have come together to set standards for fair, good practices and quality services in credential assessment services. These include the five provincially-mandated credential assessment agencies: International Qualifications Assessment Service (IQAS): serving Alberta, Saskatchewan, Northwest Territories International Credential Evaluation Services (ICES): British Columbia Academic Credentials Assessment Service (ACAS): Manitoba World Education Services (WES): Ontario Service des évaluations comparatives d études: Quebec In Quebec, the Conseil interprofessionel du Québec, which is an umbrella organization representing all 45 regulated professions in Quebec, produced a report in 2006 entitled Survey of Good Practice for the Recognition of the Equivalence of Credentials and Training Acquired Outside Quebec. This document included examples of equivalency grids that could be used for comparative purposes and recommended greater transparency by regulators in decision-making and communications to applicants regarding the assessment of their credentials. The Canadian Alliance of Physiotherapy Regulators (the Alliance): Opening Doors to Physiotherapy Practice in Canada (Best Practices initiatives) Since 1995, The Alliance has undertaken a number of initiatives aimed at identifying best practices in credential assessment and prior learning assessment to facilitate access to registration for qualified internationally educated physiotherapists. These initiatives have resulted have resulted in the development of a precedent file data base that captures previous credential assessment decisions and the development of The Alliance s Prior Learning Assessment and Remediation process, which began in The Alliance has developed in-depth knowledge of physiotherapy programs in other countries. Maintaining a database of previous credential assessment decisions makes the credential assessment process more consistent and more efficient, as programs that have previously been evaluated create a precedent file upon which later evaluations of the same program can be based. The fourth Best Practices project was undertaken and a revised credential assessment process has been implemented as of January In 2005 the College of Nurses of Ontario made a baccalaureate degree in Nursing the new entryto-practice requirement for registered nurses. In recognition of the fact that many internationally educated nurses had not completed a baccalaureate degree, but might have education and experience that could be deemed equivalent, CNO worked with educators to develop a model of PLAR to determine equivalency to an Ontario baccalaureate degree in Nursing 59. This model set eligibility criteria for PLAR and determined that the PLAR assessment should be based on the entry to practice competencies for registered nurses in Ontario. This model is currently being piloted by York University in Toronto. In 2007 the federal government created the Foreign Credentials Referral Office (FCRO). Through this initiative, all Service Canada Centres across Canada will have be offering in-person credentials referral services for newcomers trained internationally. FCRO services include: a dedicated toll-free phone service in Canada; an interactive website at gc.ca that helps internationally-trained individuals identify occupations in Canada for which they may be qualified, provide them with detailed labour market information, and refer them to the appropriate 58 College of Nurses of Ontario, PLAR Report and Recommendations: A Prior Learning Assessment and Recognition (PLAR) model for nursing baccalaureate equivalency, See for more information Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 35

38 regulatory body; overseas orientation programs where foreign credential and labour market information is provided to prospective immigrants outside of Canada early in the immigration process; expanded orientation sessions are being delivered in India, China and the Philippines; increased employer awareness of the processes for, and benefits of, hiring internationallytrained and educated professionals. Mentorship and Preceptorship In 2000 St. Michael s Hospital Inner City Health in Toronto introduced an innovative mentoring model for internationally trained health professionals. The project matched mentors with protégés of the same profession who, despite being highly skilled, had experienced difficulty finding employment in Canada. Their manual, Making Connections: A New Model of Mentoring for Internationally-Trained Professionals 59 is a valuable resource for other organizations interested in developing mentoring models. A number of other successful initiatives for internationally educated professionals include mentoring components. These include: The International Pharmacy Graduate (IPG) Program at the University of Toronto, the Toronto Region Immigrant Employment Council (TRIEC) Mentoring Partnership, e-mentoring for New Canadians through CanadaInfoNet.org (Canadian Information and Networking Services) and the Post-RN BScN Completion Program for Internationally Educated Nurses at York University. In 2007, the Ontario Ministry of Health and Long- Term Care funded a number of mentorship programs in health professions in Ontario. One of these was Supporting (Re) Entry to Professional Practice (SEPP) 61 for occupational therapists (OTs) and physiotherapists (PTs). This inter-disciplinary project sought to develop a supportive preceptorship (supervised clinical placement) / mentorship model for internationallyeducated OTs and PTs and Canadian-educated OTs and PTs who had been out of practice and were seeking re-entry to the profession. The project has developed a model that it hopes will become a full re-entry program at a university. Bridging and Other Preparatory Education CARE for Nurses 62, which began in 2001, is one of the more mature preparatory programs for internationally educated health professionals in Canada. It began as an exam preparation program and had great success in increasing the pass rate of internationally educated nurses on the national registration examinations. The CARE Centre now offers: individual and group support; a Nursing Readiness Assessment; individual counselling; financial guidance; help with career planning; resume writing and job search support; a Professional Partnership Program where CARE participants are partnered with a nurse in the workplace; and courses such as Nursing in Ontario, Professional Issues, Clinical Skills Assessment, Clinical Skills Review and Health Assessment. The International Optometric Bridging Program (IOBP) 63, offered at the University of Waterloo provides an interesting model. It offers two types of bridging education programs depending on the assessment of the individual learning needs of applicants, ascertained through academic credential, language and prior learning assessments. Bridging One is a one-month orientation program and Bridging Two is a year-long structured academic program. The IOBP is designed to prepare the applicants to take the Canadian Standard Assessment in Optometry; the examinations necessary for registration to practice optometry in Canada Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

39 The Internationally-Educated Engineers Qualification Bridging Program (IEEQB) 64 is offered by the Faculty of Engineering, Architecture and Science at Ryerson University, in cooperation with the Professional Engineers Ontario (PEO). This program also offers candidates two customized streams of study, depending on their need for additional education to meet the PEO registration requirements and to qualify to write the registration examinations. In Ontario, other bridging programs are available in a wide variety of professions, including midwifery, social services, dietetics, veterinary medicine, and pharmacy. The International Pharmacy Graduate (IPG) Program has developed an English language training program for internationally trained pharmacists and other internationally educated health professionals entitled Orientation to Canadian Health Care Systems, Culture and Context 65. This five-week course is being offered at several sites across Canada (Regina, Edmonton, Toronto and Vancouver) and will help develop the language skills necessary to communicate within a health profession in Canada and to prepare (pharmacy participants) for entry to the IPG Program. This program is offered free of charge to qualified individuals. In Manitoba, Prescription for Learning: Communication Skills for the Practice of Pharmacy was developed as a 50-hour program designed to be delivered over seven, seven-hour sessions and integrated communication techniques and knowledge of the workplace with topics and issues facing Canadian pharmacists. During the pilot session, participants were supported by a travelling mentor/coach throughout the program. This was developed in and while it is no longer being offered in Manitoba, the curriculum was shared with B.C. and Alberta for use in those provinces Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 37

40 VIII Recommendations for Action Based on the research, the Steering Committee has a developed a number of recommendations to facilitate the successful integration of internationally educated respiratory therapists and other internationally educated health professionals into the profession of respiratory therapy in Canada. Information for Applicants 1. Where not already available, develop plain language information regarding registration requirements specifically aimed at internationally educated applicants. Such information should be made available on each jurisdiction s web site and on the new NARTRB web site. b. explore the replication of processes and resources for use in other provinces; and c. explore development of new common PLA processes such as the expanded use of simulation laboratories to assess skills and competencies. Bridging programs 5. Build upon the existing PLA process in Ontario and the education integration initiatives provided by Quebec CEGEPs to develop bridging program(s) for internationally educated IEHPs to bridge from their health education background to respiratory therapy. 2. Develop hard-copy and web resource lists of contact information (regulators, schools) and all available courses and programs available for IERTs/IEHPs across Canada. This information should be made available on request and posted and kept up to date on the NARTRB web site, and provincial regulators sites may link to it. Common Credential Assessment Process 3. Collaborate within NARTRB to develop: a. Common credential assessment criteria; b. A common credential assessment model; and c. A shared a database of credentialing decisions that could be shared by regulated jurisdictions. Prior Learning Assessment 4. Collaborate within NARTRB and with RT educators to: a. share experiences and practices in PLA and competency-based assessment; Based on feed-back from internationally educated applicants, such programs should ideally: build upon the existing skills of IERTs/IEHPs; include profession- or healthcare-specific language and communications; include specific orientation to Canadian culture/heath-care practice; include integrated clinical education; be offered full-time, ideally for a year or less; be structured program so that learners are eligible for student or other financial assistance; allow learners to receive a certificate or diploma of completion; Professional Supports 6. Consider the development of peer support mechanisms such as opportunities for IERTs/ IEHPs going through the registration process to meet (in-person or as part of an on-line community) to exchange information, form informal study partnerships etc. 38 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

41 7. Develop a mentorship model (which would include defining roles, orientation, training support for mentors) to match practising registered RTs with IERT/IEHP applicants in order to provide guidance, support and professional inclusion. Where possible, it would be particularly pertinent to recruit IEHPs who have become successfully registered to take on the mentorship roles. Communication to International Medical Graduates 8. Consider communicating to organizations that provide services to internationally educated physicians or anaesthetists, to make them aware of the potential to bridge to the respiratory therapy profession. In 2008 the National Alliance of Respiratory Therapy Regulatory Bodies will consider all of the recommendations and set the priorities for moving forward on this important initiative. The Steering Committee acknowledges that some of these recommendations, such as provision of information to applicants, are actions that may be undertaken in the short-term as collaborative initiatives within the existing NARTRB partnership. Other recommendations will have to be considered in cooperation with educators and other stakeholders. They may also require longer-term planning and additional resources. Subsequent phases of the HRSDC FCR funding, which are made available to assist with the development and piloting of tools and resources such as bridging programs and curriculum, and the implementation of programs and products, may be requested to implement some recommended initiatives. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 39

42 IX Appendices Appendix 1: Glossary Frequently Used Acronyms ACAS: Academic Credentials Assessment Service CACERT: Canadian Advisory Council for Education in Respiratory Therapy CARTA: College and Association of Respiratory Therapists of Alberta CBRC: Canadian Board for Respiratory Care CEGEP: Collège d enseignement général et professionnel CIC: Citizenship and Immigration Canada CIHI: Canadian Institute of Health Information CoARC: Committee on Accreditation for Respiratory Care CoARTE: Council on Accreditation for Respiratory Therapy Education COPD: Chronic Obstructive Pulmonary Disease CRTO: College of Respiratory Therapists of Ontario CSRT: Canadian Society of Respiratory Therapists FCR: Foreign Credential Recognition FCRO: Foreign Credentials Referral Office HRSDC: Human Resources and Social Development Canada ICES: International Credential Evaluation Services IEHPs: internationally educated health professionals IERTs: internationally educated respiratory therapists IQAS: International Qualifications Assessment Service MARRT: Manitoba Association of Registered Respiratory Therapists MRA: Mutual Recognition Agreement NARTRB: National Alliance of Respiratory Therapy Regulatory Bodies NBRC: National Board for Respiratory Care NCP: National Competency Profile OPIQ: Ordre professionnel des inhalothérapeutes du Québec PLA: Prior Learning Assessment PLAR: Prior Learning Assessment and Recognition RT: respiratory therapy or respiratory therapist WES: World Education Services (WES) 40 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

43 Appendix 2: NARTRB Research Steering Committee Mary Bayliss, Manager, Policy and Investigations College of Respiratory Therapists of Ontario (CRTO) Paulette Blais, Research Consultant Blais Consulting Services Bryan Buell, Registrar College and Association of Respiratory Therapists of Alberta (CARTA) Richard Di Lallo, Coordinator Respiratory Services (adult sites) McGill University Health Centre (Montreal) Mr. Eugene Leshchyshyn, Internationally Educated Respiratory Therapist Douglas Maynard, Executive Director Canadian Society of Respiratory Therapists (CSRT) Shane McDonald, Registrar Manitoba Association of Registered Respiratory Therapists (MARRT) Andrea Nelson, Project Manager National Alliance of Respiratory Therapy Regulatory Bodies Ian Pappin, Vice-Chair Canadian Advisory Council on Education in Respiratory Therapy (CACERT) (Northern Alberta Institute of Technology) Josée Prud homme, Directrice générale et secrétaire Ordre professionnel des inhalothérapeutes du Québec (OPIQ) Dr. Kenneth Tin, Regional Director Respiratory Health Services/Co-chair Dept of Respiratory Medicine, David Thompson Health Region/Wetaskiwin Hospital and Care Centre Ted Yachemetz, Chair Canadian Advisory Council on Education in Respiratory Therapy (CACERT) (University of Manitoba) Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 41

44 Appendix 3: Respiratory Therapy Competencies The complete National Competency Profile (NCP) is available as a PDF document on the CSRT web site at NCP.pdf. The table below indicates the categories of competencies included in the NCP. Category Respiratory Therapy Competencies A Professionalism B Communications C Analysis and Problem-Solving D Health and Safety E Research F Administration G Health Education, Prevention and Promotion H Patient/Client Assessment I Consultations/Collaborations J Blood Analysis K Pulmonary Diagnostic Testing L Cardiac Diagnostic Testing M Hemodynamic Testing N Basic Respiratory Care O Airway Management P Ventilation Management Q Medical Gas Therapy R Anaesthesia Assistance S Cardio-Pulmonary Stabilization T Pharmacology U Patient Transportation 42 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

45 Appendix 4: National Occupational Classification (NOC) Respiratory Therapy 3214 Respiratory Therapists, Clinical Perfusionists and Cardiopulmonary Technologists Respiratory therapists assist physicians in the diagnosis, treatment and care of patients with respiratory and cardiopulmonary disorders. They are employed in hospitals, medical clinics, health units, extended care facilities, public health centres and respiratory home care companies. Clinical perfusionists provide technical support to patients undergoing cardiac surgery and patients requiring cardio-respiratory support. Cardiopulmonary technologists assist physicians in the technical aspects of diagnosis and treatment of cardiovascular and pulmonary disease. Clinical perfusionists and cardiopulmonary technologists are primarily employed in hospitals. Supervisors and instructors of respiratory therapists, clinical perfusionists and cardiopulmonary technologists are included in this unit group. Example Titles 66 cardiopulmonary technologist cardiovascular perfusionist cardiovascular perfusion supervisor certified clinical perfusionist (CCP) chief respiratory technologist clinical perfusionist perfusionist registered respiratory therapist (RRT) respiratory therapist respiratory therapy clinical instructor Main duties Respiratory therapists perform some or all of the following duties: Perform diagnostic tests, such as arterial blood gas analysis and cardiopulmonary functions tests Operate and monitor respiratory equipment to administer treatments such as oxygen, oxygen-air mixtures, humidified air or medications Operate, monitor, maintain and test a variety of diagnostic and therapeutic equipment Assess patients and perform or assist with interventions such as airway maintenance, line insertions, inductions and intubations Perform artificial respiration and external cardiac massage Assist with transport of high-risk patients Supervise and train students and other respiratory therapists Participate in home care programs for chronic respiratory patients and provide patient and family education Participate in research related to cardiac and pulmonary disorders. Respiratory therapists may specialize in areas such as anaesthesia, critical care, pediatrics, cardiopulmonary diagnostics and respiratory home care. 66 More example job titles are provided in the NOC 2314 reference document at: Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 43

46 Clinical perfusionists perform some or all of the following duties: Assemble, maintain and operate extracorporeal circulation equipment, intra-aortic balloon pumps and other heart assist devices to support or temporarily replace patients cardiopulmonary functions during open-heart surgery Administer blood products, drugs and other substances through heart-lung machines and other devices as directed by cardiac surgeons and anaesthetists Monitor vital signs to maintain patients physiological functions during cardiopulmonary surgery Supervise and train student clinical perfusionists and other clinical perfusionists. Cardiopulmonary technologists perform some or all of the following duties: Perform diagnostic tests, such as pulmonary function and asthma stress, or assist physicians with cardiac and cardiopulmonary stress tests and bronchoscopies Determine patients blood characteristics such as activated clotting time and oxygen saturation Operate, monitor, maintain, calibrate and test diagnostic and therapeutic equipment Monitor patients and advise physician of any changes in patients condition Prepare medications and administer inhaler and other treatments under supervision of cardiologist Provide information and care for patients during tests Assist with the preparation of cardiac catheterization room, prepare specialized catheters and assist cardiologists during catheterization Perform analysis, programming and monitoring of implanted devices such as pacemakers and defibrillators during surgery Supervise and train students and other cardiopulmonary technologists Provide technical support for research. Employment requirements Respiratory therapists require the completion of a two- to three-year college, hospital or university degree program in respiratory therapy, including clinical training. Clinical perfusionists require the completion of a respiratory therapy or registered nursing program with a minimum of one year of work experience as a respiratory therapist or registered nurse and Completion of a college or university program in clinical perfusion, including clinical training. Cardiopulmonary technologists require a minimum of a diploma in an allied health discipline such as respiratory therapy, nursing diploma or degree, or a degree in a related science and training through a post-diploma program or supervised on-the-job clinical training. Licensing is required for respiratory therapists in Quebec, Ontario, Manitoba and Alberta. Registration with the Canadian Association of Cardiopulmonary Technologists (CACPT) may be required. Additional information Supervisory and instructor positions in this unit group require experience in their respective fields as a respiratory therapist, clinical perfusionist or cardiopulmonary technologist. Classified elsewhere Other Medical Technologists and Technicians (Except Dental Health) (3219) Other Technical Occupations in Therapy and Assessment (3235) 44 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

47 Appendix 5: Registration Processes and Requirements ALBERTA College and Association of Respiratory Therapists of Alberta (CARTA) Application process General information regarding the documents required to apply to CARTA may be obtained by contacting CARTA or visiting the CARTA web site at No specific information regarding internationally educated applicants is provided. Step 1: Applicant must submit: 1. Two Character Declarations (see this section) signed and dated by someone who is not related to you. 2. Completed, signed and dated Application Form 3. A copy of Respiratory Therapy program (school) diploma or certified true transcript. 4. A copy of Certificate of Registration (CSRT or NBRC) if applicable. Step 2: CARTA s Registrar does does credential assessment in conjunction with Registration committee. Credential assessment of each applicant s file on a case-by-case basis. This includes a review of education curriculum/ transcripts, course outlines, diplomas, degrees, certifications work experience, practice areas and continuing competency activities. CARTA also uses a structured interview to help with assessment of the applicant s RT preparation and level of language fluency. 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 provides each applicant with an individual assessment regarding what he/she needs to do to obtain a registration. If an applicant s education program is deemed not equivalent, he/she is referred to NAIT or SAIT for individual assessments and integration, if possible, into a full-time RT program. Step 3: Once an applicant has met all requirements, he/she is deemed eligible to attempt the CRBC examination. The fee for this exam is $ payable to the CBRC. Step 4: Upon successful completion of the CRBC, an applicant would be eligible for CARTA registration of $333. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 45

48 Requirement 1. Education requirement 2. Examination requirement 3. Eligibility for registration 4. Language proficiency 5. Legal authorization to work in Canada 6. Currency requirement 7. Good Conduct Evidence required Applicant has graduated from a program in Respiratory Therapy that has been approved or considered equivalent by the College. In 2007 this included: Canadian programs approved by CoARTE; and U.S. programs approved by the Committee on Accreditation for Respiratory Care (COARC) at the 200 (therapist) level. or Program completed outside of Canada or the U.S. that has been assessed by CARTA as being equivalent. In 2007, CARTA accepts completion of: The Canadian Board of Respiratory Care (CBRC) National Certification Examination. or National Board for Respiratory Care (NBRC) registry examinations. Applicants registered in other Canadian or U.S. jurisdictions are required to provide: a copy of certificate of registration in another Canadian jurisdiction; a copy of their CSRT membership; or certificate of registration with the National Board for Respiratory Care (NBRC). There is currently no language fluency requirement, but this is anticipated to be included in new legislation. Not required. Applicant may meet this requirement by: graduating within the last 4 years from an approved Respiratory Therapy program; or Providing verification by his/her previous employer of having worked 640 practice hours of work within the last 4 years. Two Character Declarations signed and dated by someone not related to the applicant. Mandatory self-declaration regarding whether he/she has ever been disciplined or is currently being investigated by any body responsible for the regulation of respiratory therapy or any other profession. 46 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

49 MANITOBA Manitoba Association of Registered Respiratory Therapists (MARRT) Application process Step 1: Applicants must submit the following documentation to MARRT: 1. Completed Application for Registration Form 2. $25.00 application fee Step 2: MARRT s Registrar initially performs credential assessment of each applicant s file on a case-by-case basis. After MARRT determines that an applicant has completed a program deemed equivalent, MARRT will then proceed to assessing whether the applicant has completed the other requirements of registration. MARRT does not use the services of the provincial credential assessment service Academic Credentials Assessment Services (ACAS). If an applicant s program is deemed not equivalent, he/she is referred to the PLA process available at the Michener Institute (in Ontario) as there is no RT PLA process available in Manitoba. The fee for an active practising license in Manitoba is $130. Requirement 1. Education requirement Evidence required Applicant has graduated from a program in Respiratory Therapy that has been approved or considered equivalent by the College. In 2007 this included: or Canadian programs approved by CoARTE; and U.S. programs approved by the Committee on Accreditation for Respiratory Care (COARC) at the 200 (therapist) level. Program completed outside of Canada or the U.S. that has been assessed by MARRT as being equivalent. 2. Examination requirement In 2007, CRTO accepts completion of: The Canadian Board of Respiratory Care (CBRC) National Certification Examination. or National Board for Respiratory Care (NBRC) registry examinations. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 47

50 3. Eligibility for registration 4. Language proficiency 5. Legal authorization to work in Canada 6. Currency requirement Applicants registered in other Canadian or U.S. jurisdictions are required to provide: a copy of certificate of registration in another Canadian jurisdiction; a copy of their CSRT membership; or certificate of registration with the National Board for Respiratory Care (NBRC). Not required. Not required. Applicant must provide evidence he/she has: 1. met the education requirement ; 2. practised in the profession 720 hours; or 3. passed the approved exam within the four years preceding the application 7. Good Conduct An applicant: must not have been found guilty of a criminal offence or an offence under the Controlled Drugs and Substances Act (Canada) or the Food and Drugs Act (Canada). must also satisfy the College that he or she has not been found guilty of professional misconduct, incompetence, incapacity or other similar proceeding in another profession or in another jurisdiction in Respiratory Therapy. Evidence regarding these requirements is provided through a signed selfdisclosure statement on MARRT License/Membership Application form. Verification of good standing with the regulator (other Canadian jurisdiction or state board) is also done if the applicant has been previously registered. 48 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

51 ONTARIO - College of Respiratory Therapists of Ontario (CRTO) Application process Step 1: Applicants must submit the following documentation to CRTO: 1. Completed Application for Registration Form 2. $75.00 application fee 3. Registration Verification Form (if registered outside Ontario or in another health profession): section A completed by the applicant; section B completed and submitted directly from the regulatory/licensing body to CRTO; 4. Educational Records: official transcripts to be sent directly from the Registrar s/ transcript office to CRTO. If the applicant has not completed an approved RT program and is requesting a review of the program for equivalency status, he/she must submit additional documentation required for assessment: transcripts / mark sheets / grade lists; a description of the program; date program began; list of affiliations with other organizations (e.g., clinical sites, hospitals and other educational institutions; program admission criteria; program curriculum (didactic and clinical components); detailed course outlines that include how students are evaluated; information on the clinical rotations of the program including location annumber of hours/weeks; faculty lists and credentials; and accreditation status if any. 5. Documentation (original or photocopy) verifying Canadian citizenship, permanent residency status or employment authorization to work as an RT. 6. If the applicant s first language is neither English nor French and his/her RT training was not in English or French, he/she will need to provide a copy of the score report for one of the acceptable language fluency tests. The applicant is responsible for the cost of the language proficiency test. 7. If the applicant has practised as an RT or in a related field, he/she must provide a detailed employment history, including names and addresses of employers, dates of employment or volunteering and a list of job titles and duties performed. Note: If any of the application documents are under a different name than the one the applicant is currently using, he/she must provide proof of change of name (e.g. copy of marriage certificate). Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 49

52 Step 2: CRTO considers and evaluates all documentation provided and determines whether an applicant has met the requirements of registration or not. RT programs completed outside of Canada and the U.S. are compared to Ontario approved programs to determine equivalency. If the CRTO Registration Committee determines that the RT program the applicant has completed is equivalent it will make a recommendation to Council for approved program status. This process may take up to 6 months. Once this approval is granted, graduates of the program will be eligible to register with the College in the Graduate Class, and will be deemed eligible to write the CBRC examination. If the Registration Committee is not able to determine that the educational program is equivalent to an approved Canadian RT program the applicant will not be eligible for registration with CRTO. However he/she may be referred to undergo the Prior Learning Assessment (PLA) process or consider enrolling in one of the approved RT programs. The PLA process includes the following phases and relevant fees: Stage 1: Interview and Feedback $ Stage 2: Didactic Assessment $ Stage 3: Clinical Assessment $ per day Fees are payable to the educational institution conducting the assessment. Step 3: Once the candidate has demonstrated equivalency through PLA, (and met all other registration requirements) but prior to completing the approved examination, any applicant (Canadian- or internationally-educated) may be granted a Graduate Certificate of Registration. This is a temporary class of registration and is automatically revoked after 18 months. It allows the Graduate Member to perform the functions of a Respiratory Therapist under the supervision of a fully qualified RT or another regulated health professional until he/ she has fulfilled the examination requirement and can be granted full membership. Step 4: Candidate must successfully complete approved examination (CBRC). Step 5: Candidate is eligible for full registration. The fee is $500. for a full year, pro-rated depending on when the applicant registers throughout the year. 50 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

53 Requirement Education requirement Examination requirement Eligibility for registration Language proficiency Evidence required Applicant has graduated from a program in Respiratory Therapy that has been approved or considered equivalent by the College. In 2007 this included: Canadian programs approved by CoARTE; and U.S. programs approved by the Committee on Accreditation for Respiratory Care (CoARC) at the 200 (therapist) level. or Has demonstrated through a prior learning assessment (PLA) that he or she has knowledge, skills and judgment equivalent to those of a person who has successfully completed an approved program. In 2007, CRTO accepts completion of: The Canadian Board of Respiratory Care (CBRC) National Certification Examination. Not a separate requirement. If the applicant s first language is neither English nor French and his or her Respiratory Therapy (or related) training was not in English or French, the applicant will need to submit documentation, in the form of one of the following, as evidence of language fluency: English: CanTEST Reading: 4 Writing: 4 Listening: 4 Speaking: 4.5 International English Language Testing System (IELTS) Overall band score: 7 Michener English Language Assessment (MELA) Reading: 8 Writing: 8 Listening: 9 Speaking: 9 Michigan English Language Assessment Battery (MELAB) Total score at least 85, plus an oral rating of at least 3 Test of English as Foreign Language TOEFL Internet based Total: 92 Reading: 21 Writing: 21 Listening: 21 Speaking: 24 TOEFL Paper based 580 plus Test of Spoken English (TSE) 50 TOEFL Computer based 237 plus Test of Spoken English (TSE) 50 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 51

54 French: Legal authorization to work in Canada Test pour étudiants et stagiaires au Canada (TEStCan) A minimum score of 5 in each category. The applicant must be a Canadian citizen or a permanent resident of Canada or be authorized under the Immigration and Refugee Protection Act (Canada) to engage in the practice of Respiratory Therapy. Currency requirement Good Conduct An applicant for a Graduate Certificate of Registration must have: met the education requirement within the two years immediately preceding the application for registration; or practised respiratory therapy in a jurisdiction outside Ontario within the two years before the date of the application. An applicant: must not have been found guilty of a criminal offence or an offence under the Controlled Drugs and Substances Act (Canada) or the Food and Drugs Act (Canada). must also satisfy the College that he or she has not been found guilty of professional misconduct, incompetence, incapacity or other similar proceeding in another profession or in another jurisdiction in Respiratory Therapy. This evidence is provided through a signed self-declaration. 52 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

55 Québec - Ordre professionnel des inhalothérapeutes du (OPIQ) Application process Step 1: Applicants must submit the following documentation to OPIQ: 1. Completed OPIQ application form 2. Complete transcripts and course descriptions 3. Certified copy of college or university diploma 4. Proof of successful completion of respiratory therapy clinical placement 5. Description and proof of relevant work experience 6. Proof of participation in continuing education or advanced studies in respiratory therapy since graduation 7. $ application fee Step 2: OPIQ reviews the applicant s file to determine equivalency, using the criteria indicated under Education Requirement below. OPIQ does not use Service des évaluations comparatives d études. Step 3: The candidate is informed of the assessment and is advised what, if any, additional education he/ she must complete. Usually he/she is referred to a CEGEP to complete additional theoretical education and complete a supervised clinical placement. Step 4: Once the candidate has completed required additional education, he /she is required to complete a 10-day anaesthesia assistant clinical placement supervised by OPIQ and l épreuve synthèse. Step 5: Once the candidate has met all requirements, he/she may obtain a permit by filling out an application for a permit, providing a passport-style photo and paying the annual fee of $470. Evidence required Requirement 1. Education requirement Applicant must have graduated from an approved Quebec RT program or equivalent. In order for a program to be considered equivalent, it must have been completed minimally at the college level and include 2,775 hours of study, or equivalent learning activities including 2,115 hours as follows: 240 hours of study of human anatomy and biology, chemistry, biochemistry and physiology; Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 53

56 795 hours of study directly related to respiratory therapy, including: 244 hours of respiratory therapy care: instrumentation, pharmacology, pathology and respiratory therapy; 271 hours in critical and urgent care, including instrumentation, mechanical ventilation, hemodyanics, gas exchanges, pharmacology and pathology; 90 hours in anaesthesia assistance. Including instrumentation, pharmacology, modalities and interventions in anaesthesia; 126 hours in diagnostic testing, including cardiology and pulmonary functioning; Supervised clinical placement in respiratory therapy, including a minimum of 250 hours in anaesthesia assistance. The candidates must also provide evidence that the program includes a comprehensive examination that tests the respiratory therapy competencies acquired during the course of the program. 2. Examination requirement 3. Eligibility for registration 4. Language proficiency 5. Legal authorization to work in Canada 6. Currency requirement There is no separate examination requirement for an applicant who completes his/her education 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 Quebec RT programs. Canadian educated graduates moving to Quebec under the auspices of the RT MRA do not have to complete l épreuve synthèse. Candidates applying from another Canadian jurisdiction must provide evidence that they are registered of good standing. French language fluency is required for full registration. Applicants may obtain temporary registration with OPIQ prior to meeting this requirement. L Office québécois de la langue française (OQLF) administers the required four-part exam at no fee. The exam evaluates French language fluency in the following areas: 1. verbal comprehension; 2. written comprehension; 3. verbal language skills; 4. written language skills. Not required. Internationally educated candidates who graduated more than three years before applying to OPIQ and have not practised in respiratory therapy within that period will not have their education recognized as equivalent. However, equivalency may be granted if subsequent work experience and education can be demonstrated to fill any competency gaps. 54 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

57 Candidates applying from another Canadian province must provide evidence that they have worked as a respiratory therapist for at least 720 hours within the past four years. 7. Good Conduct An applicant: must not have been found guilty of a criminal offence or an offence under the Controlled Drugs and Substances Act (Canada) or the Food and Drugs Act (Canada). must also satisfy the College that he or she has not been found guilty of professional misconduct, incompetence, incapacity or other similar proceeding in another profession or in another jurisdiction in Respiratory Therapy. This evidence is provided through a signed self-declaration. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 55

58 Voluntary Registration with the Canadian Society of Respiratory Therapists (CSRT) Application process General information regarding the documents required to apply to CSRT may be obtained by contacting the CSRT or visiting the CSRT web site at No specific information regarding internationally educated applicants is provided. While there are a number of classes of CSRT registration (student, corporate etc.), this section only includes the process related to the most relevant class of registration: Registered Member. Such applicants must provide: MRA Applicants verification directly from their Canadian regulatory body of membership in good standing with no restrictions evidence of practicing the profession of respiratory therapy within that jurisdiction, as a fully registered/licensed member, for a minimum of 720 hours within the previous four years Other Registry Applicants proof of graduation from a CoARTE-approved program of respiratory Therapy evidence of successful completion of a CSRT-approved examination Requirement 1. Education requirement 2. Examination requirement 3. Eligibility for registration 4. Language proficiency Evidence required Proof of graduation from a CoARTE-approved program of respiratory Therapy. This requirement can be waived if the applicant is an NBRC registered respiratory therapist in good standing. Evidence of successful completion of the CBRC examination. NOTE: A candidate who has obtained his/her RRT credential from the National Board for Respiratory Care (NBRC) in the U.S. may meet the examination requirement by successfully passing only the clinical portion (Paper Two) of the CBRC Certification Examination. Applicants applying under the labour mobility provisions of the MRA must provide verification directly from their Canadian regulatory body of membership in good standing with no restrictions. NBRC members must provide verification of good standing directly from NBRC to the CSRT. Not required. 56 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

59 5. Legal authorization to work in Canada 6. Currency requirement 7. Good Conduct The applicant must be a Canadian citizen or a permanent resident of Canada or be authorized under the Immigration and Refugee Protection Act (Canada) to engage in the practice of Respiratory Therapy. No explicit requirement. Applicant must provide a mandatory self-declaration regarding: 1. Criminal or other offenses; 2. Revocation, suspension or modification of any certificate, license, registration professional or other designation; 3. Rejection of any application for a certificate, license or registration in a professional or semi-professional society or body; 4. Whether, to the applicant s knowledge or belief, any event, circumstance, condition or matter not disclosed in his/her replies to the preceding questions that touches upon or may concern his/her conduct, character and/or reputation, and that he/she knows or believes might be thought to be an impediment to his/her admission to membership in the Society or a matter warranting further inquiry by the Society. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 57

60 Appendix 6: Employer Survey 1. Introduction This employer survey is being distributed on behalf of the National Alliance of Respiratory Therapy Regulatory Bodies (NARTRB). NARTRB is an alliance of respiratory therapy regulators representing jurisdictions where the profession is regulated in Canada (Alberta, Manitoba, Ontario and Quebec) and the Canadian Society of Respiratory Therapists (CSRT). The Alliance is currently conducting research regarding the integration of internationally educated respiratory therapists into the Canadian health care system. This project has been funded by the Canadian government s Foreign Credential Recognition (FCR) Program. As part of this project, the Alliance is seeking to understand employer opinions and experiences regarding internationally educated respiratory therapists. The questionnaire should take no more than 20 minutes to complete. All responses to this survey are kept confidential and no respondents will be identified. You have the right not to answer any questions or to opt out of the survey at any time. You may also resume the survey if you need to opt out temporarily. If you would be willing to be contacted for a follow-up telephone interview, you will have an opportunity to provide your contact information at the end of the survey. It is anticipated that the final report of this project will be completed in early 2008, and that the report will be made public through NARTRB member organizations. 2. Demand 1. What type of organization do you represent? Hospital Long-term care facility Home care Asthma, emphysema, cystic fibrosis and other clinics Teaching Research Rehabilitation Diagnostic clinics and sleep disorder labs Hyperbaric Oxygen Treatment facility Medical equipment sales and service 2. Approximately how many (full-time equivalent - FTE) respiratory therapist positions are there at your organization? 58 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

61 3. Approximately how many respiratory therapists are employed full-time? 4. Approximately how many respiratory therapists are employed part-time? 5. Approximately how many vacant respiratory therapy positions (FTEs) are there currently at your organization? 6. Does your organization fill any jobs on an underfill capacity? Yes No (Skip to Question 7) 7. If yes, what is your organization s definition of underfill? (For example, is this where an individual has been hired in a more junior role as they do not have the training/competencies/experience to work to the full scope of the position?) 8. How many underfilled respiratory therapy positions are there at your organization? 9. How many respiratory therapy vacancies (FTEs) do you anticipate will be created at your organization in the next 5-10 years? 10. In your opinion, is there a shortage of respiratory therapists to meet your organization s needs? Yes No 11. If yes, what factors are likely responsible for this shortage in respiratory therapy human resources? Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 59

62 3. Hiring Internationally Educated Respiratory Therapists 12. To the best of your knowledge has the organization that you are working for now ever hired an internationally educated respiratory therapist? Yes No (Skip to Question 14) Don t Know (Skip to Question 14) 13. Are there any internationally educated respiratory therapists working in your organization now? Yes No Don t Know 14. Thinking of your entire career in respiratory therapy, have you ever worked with an internationally educated respiratory therapist? Yes No Don t Know 15. Regardless of your previous experience, how likely are you to hire an internationally educated respiratory therapist for a respiratory therapist position (assuming that education, experience and skill requirements are met)? Very likely Somewhat likfely 16. Why do you say that? Not very likely Not liekly at all 17. If you interviewed an internationally educated candidate who was not licensed but who you thought would be a good fit as a respiratory therapist in your organization once they became licensed, would you be very likely, somewhat likely, not very likely or not likely at all to hire this person in another role? Very likely Not very likely (Skip to Question 18) Somewhat likfely Not likely at all (Skip to Question 18) 18. If very likely or somewhat likely, in what role? Please indicate job title: 60 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

63 19. Have you personally ever hired an internationally educated respiratory therapist in any of the roles indicated in your previous response? Yes No 20. If you were hiring an internationally educated respiratory therapist to work as a full respiratory therapist, would you look for qualifications and qualities that may be different from Canadian educated respiratory therapists? Yes No (Skip to Question 22) 21. If yes, please indicate what they would be. 22. Would your organization consider supporting a program that would provide internship, mentorship or clinical skills programs to those internationally educated in respiratory therapy before they were licensed, so that they can keep their skills current and so that they can learn about the Canadian system? Yes, willing (Skip to Question 24) No, not willing (Skip to Question 24) I already support one 23. If you already support one, please provide additional comments on the program (s) you support (i.e., title and brief description) 24. If you are NOT currently supporting a program that would provide internship, mentorship or clinical skills programs to those internationally educated in respiratory therapy before they were licensed, are you aware of any such programs like this? Yes No (Skip to next section) 25. If yes, please indicate name of the program(s). Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 61

64 4. Attitudes Towards Internationally Educated Respiratory Therapists 26. Given everything you know, what would you say are some of the advantages, if any, of hiring an internationally educated respiratory therapist? List as many as you feel apply. 27. What would you say are some of the disadvantages, if any, of hiring an internationally educated respiratory therapist? List as many as you feel apply. 28. What would you say are some of the biggest barriers that internationally educated respiratory therapists face when becoming integrated into the Canadian system? 29. What would you say are some of the biggest barriers that institutions face regarding the hiring of internationally educated respiratory therapists? 30. Are there any countries that you feel provide a respiratory therapy education that is superior to Canadian respiratory therapy education? Yes No (Skip to Question 32) 31. If yes, which countries? 32. Are there any countries whose respiratory therapy education program gives you cause for concern? Yes No (Skip to Question 34) 62 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

65 33. If yes, which countries? 34. The following are some statements about internationally educated respiratory therapists. Please indicate whether you agree strongly, agree somewhat, neither agree nor disagree, disagree somewhat or disagree strongly with each of the following. 1. Official language proficiency is an issue for many individuals who are internationally educated in respiratory therapy. 2. I have to provide more supervision of internationally educated respiratory therapists. 3. I find internationally educated respiratory therapists to be more experienced than those educated in Canada. 4. When I ask about salary expectations for internationally educated respiratory therapists, their expectations are somewhat lower than Canadian trained respiratory therapists. 5. There is a shortage of respiratory therapists in Canada and internationally educated respiratory therapists fill that gap. 6. My patients would feel as comfortable receiving treatment from an internationally educated respiratory therapist as from a Canadian educated respiratory therapist. 7. Internationally educated respiratory therapists can give us access to new ideas, approaches and ways of thinking. 8. I think that I would have to spend too much time re-educating an internationally educated respiratory therapist to make it worthwhile. 9. There should be some sort of practical education component that internationally educated respiratory therapists should go through in Canada before they can work. 10. The ability of those internationally educated in respiratory therapy to speak a different language may be beneficial to my clients who also speak that language. 11. I know that it is difficult for internationally educated respiratory therapists in Canada, so I am willing to give them opportunities to ensure they get the help they need. Agree Agree Neither agree Disagree Disagree Strongly Somewhat nor disagree Somewhat Strongly Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 63

66 5. Provincial Regulators 35. The regulatory body in your province is responsible for setting entry to practice standards and registering respiratory therapists to practice. Knowing this, do you think the provincial body is doing an excellent, good, fair or poor job at ensuring the quality of internationally educated respiratory therapists that enter the Canadian marketplace? Excellent Good Fair Poor Don t Know 36. What else would you suggest that your provincial regulatory body do to ensure the quality of internationally educated respiratory therapists that come into the profession? 37. What else can be done generally to encourage you / your organization to consider hiring internationally educated respiratory therapists? 64 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

67 6. The survey is now complete. Thank you! 38. We will not make public who participated in the study and what the individual s answers are. All responses are reported in aggregate. If you provide your contact information, one of the researchers may contact you for a follow-up interview. Please be assured that all information is kept confidential. Your contact information will not be used for any other purpose than this research study. Knowing this information, please indicate your consent by providing your contact information so that you may be considered for a follow-up interview: Yes, I consent (please provide contact information below) No, I do not consent (the NARTRB thanks you for your time) 39. Please provide your contact information (name, title, organization, telephone number and address) below: Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 65

68 Appendix 7: CRTO Survey of PLA Candidates 1. Introduction Background: In Spring 2007 the National Alliance of Respiratory Therapy Regulatory Bodies (NARTRB) received funding from the federal government s Foreign Credential Recognition program to conduct research regarding issues affecting internationally educated health professionals seeking to become registered respiratory therapists in Canada. NARTRB is a partnership of the bodies that regulate the profession of respiratory therapy in the four 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) Ordre professionnel des inhalothérapeutes du Québec (OPIQ) Canadian Society of Respiratory Therapists (CSRT) Purpose: The purpose of this survey is to gather information from internationally educated health professionals (IEHPs) who are currently going through the CRTO PLA process to meet the program requirement for registration as a respiratory therapist in Ontario. The information gathered from IEHPs will serve to inform and guide the recommendation of this project. Time to complete survey: It will take approximately minutes to complete this survey. It would be greatly appreciated if you could complete the survey by December 10, Privacy: Please be assured that your participation in this survey is not related in any way to the CRTO registration process. It is your choice to complete the survey or not. Responses to this survey will be kept strictly confidential and will not be identified with any individual. 66 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

69 2. Applicant Data 1. Your age 2. Sex Male Female 3. Before applying for registration as a respiratory therapist in Ontario: 1. In what country/countries did you complete your post-secondary education? 2. What program(s) of study did you complete? 3. In what year did you complete your post-secondary studies? 4. Were these studies completed at a community college-level educational institute or a university? College-level (total number of years of study) University-level (total number of years of study) Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 67

70 5. If the program you completed was not in respiratory therapy, did it include any specific focus on respiratory therapy care? Yes No Comments 6. For how many years did you work in the health care field before coming to Canada? 7. Did you work in respiratory therapy care? Yes No ( skip to question 9) 8. If yes, please provide more information regarding your role/type of care. 9. Have you ever applied for registration with any other health regulatory college in Canada? Yes No 10. Which regulatory body/profession? 11. Why did you choose to apply to become a registered respiratory therapist in Ontario? 68 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

71 4. The CRTO Process 1. How did you learn about the CRTO registration process? CRTO Ontario Government Government of Canada The Michener Institute Algonquin College A registered respiratory therapist Friends/family Immigrant-serving agency Other (please specify) 2. When did you apply to the CRTO? 3. How long did it take for your to qualify for the PLA process? Years Months 4. Were there any challenges related to qualifying for the PLA process? Yes No If yes, please describe 5. What do you think is the purpose of the CRTO PLA Process? 6. Have you begun the PLA process yet? Yes No 7. If not, why not? Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 69

72 8. If you have begun, where are you going through the PLA process? The Michener Institute for Applied Health Sciences Algonquin College 9. Please indicate what steps of the PLA process you have completed: Completed the CRTO application process and have been referred for PLA Stage 1: Interview and feedback Stage 2: Didactic assessment first attempt Stage 2: Didactic assessment second attempt Stage 3: Clinical assessment 10. If you have completed the Stage 1 interview, what do you think about the feedback and recommendations you received? 11. If you have completed the PLA Stage 2 (didactic) assessment, how difficult did you find this experience? 12. If you are completing or have completed the Stage 3 (clinical) assessment, can you briefly describe your experience? 13. Before participating in the PLA process, had you taken any additional respiratory therapy or health care education since arriving in Canada? Yes No (skip to question 15) 14. If yes, please indicate what courses and where you have taken them. 70 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

73 15. From your experience, do you agree or disagree that the following factors have been or are a challenge to you as you go through the PLA process in Ontario? Strongly Agree Agree Neutral Disagree Strongly Not Applicable Disagree Accessing information about the PLA process Understanding what I need to do to complete the PLA process Arranging meetings/getting information from the educational institution Accessing courses at times when I can take them Having to do independent study to fulfill some learning needs Accessing a clinical placement Having time to complete the PLA process Costs/income lost while completing PLA process Filling educational/knowledge gaps related to respiratory therapy because the RT program I completed was different from Ontario requirements Completing further education because the program I completed was in a different field Learning terminology related to Ontario respiratory therapy practice 16. Please provide any additional comments regarding challenges you have identified. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada 71

74 17. Please provide any recommendations you have regarding the CRTO PLA process. 18. Please provide any recommendations you have regarding other issues related to IEHPs becoming a registered as a respiratory therapist in Canada Thank you for your time and effort. Your experience and input are valuable to CRTO and the National Alliance of Respiratory Regulatory Bodies as we work to enhance access to the respiratory therapy profession for internationally-educated health professionals. 72 Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada

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76 Funded by the Government of Canada s Foreign Credential Recognition Program. The opinions and interpretations in this publication are those of the author and do not necessarily reflect those of the Government of Canada.