The majority of IEHPs in our sample came to Canada independently, that is, without the assistance of a recruitment or immigration aid organization. Citizenship and Immigration Canada (CIC) officials assess applicants using a point system. Points are awarded to prospective immigrants' applications according to a social capital model that includes the applicant's age, language ability, whether they have arranged employment in Canada, the type of work they intend to do here along with their skills, qualifications and experience in that area, and whether their occupation is in demand in the Canadian labour market (Brouwer 1999). This is, however, but one step in the integration process and one which can send mixed messages to applicants. For example, as Brouwer (1999) states,

Unless informed otherwise by a visa officer, many immigrants who are accepted as skilled workers understandably mistake the federal government's granting of 'points' for their occupation, education and training as recognition and approval of their qualifications. These immigrants assume that they then will be able to practise their profession or trade in Canada. In fact, however, the number of points granted by a visa officer and the Department of Citizenship and Immigration has no bearing on an individual's ability to practise an occupation in Canada.

Those that immigrated independently faced a range of policies and procedures which in turn reflect the variety of countries of origin, background and circumstances of the immigrating IEHP and their skills and language proficiency. There was great variability in the timing and costs associated with migration. For example, each country of origin necessitates different types of visas and this in turn, has associated costs. Each step of the process of independent immigration requires some amount of money. For some, it was not clear at the outset what the full cost would be:

You have to pay a processing fee first in order for them to be able to process your papers and then after that once you get interviewed and they will give you your visa you have to pay them a landing fee. I don't know what that's for. He said it's a landing fee for adults except children less than 18 years old. And then after that you have to show money that they require you. I think they required us... I don't know how much... Oh. I think it's 16 to 18 thousand Canadian dollars that you have to bring with you [British Columbia IEN #2, practicing].

It did cost more than I anticipated...because I'd applied for my work visa and then I suddenly realized the children needed student visas just to go to school here. So there's, you know, lots of little bits get added on and in the end it's sort of hundreds of pounds, ... Perhaps I just didn't research that enough to start with. I don't know." [British Columbia IEN #13, practicing]

The immigration process can take an unpredictable length of time. While some people received their status within a year, the process took much longer for others:

I had to wait like six months to get the HRDC letter that would say 'Yes, we do need nurses and she is welcome to come' because without this letter I wouldn't be able to get the work permit. So six months to wait. Waiting. Like every little thing, you would submit something, you had to wait at least a month. Now we need a criminal record [check]. Oh no, this one is the wrong one [British Columbia IEN #10, practicing]

Some of the respondents shared stories about their documents being lost in the application review process . Many applicants had to wait as long as five years to have their documents reviewed by the local embassy. Many IEHPs would continue living their lives throughout the application period:

And then we decided to immigrate. ... then, we applied to Canada but nothing happened. And I decided to do Nursing, because nursing is a degree with which you could go anywhere. So, I took the Nursing there and we're not even sure that we will come to Canada, we thought that maybe we should also apply to US and Australia. But then we received a paper. And we decided to go to Manitoba, because it was easier for us to go to Manitoba, and it was easier for me to become a doctor there. [Manitoba IMG #2, no longer pursuing integration]

I came back to Iran. I applied for immigration to Canada but it took much longer than my expectation. That was supposed to be done in 3 years. We heard nothing after three years. I felt it's a lost deal so I forgot it. For some reasons after about five years they called us and said they take us. We were supposed to participate in an interview but they even waived that. They said we did not have to participate in interview. They just said you can come. We'll give you visa. Just like this. [Ontario IMG #1, in progress]

Indeed, a frequently expressed frustration was with the level of bureaucracy in the immigration process, which seemed particularly unnecessary to the IEHPs we interviewed:

I can tell you that I am very surprised and very dissatisfied by how things are working in Canada regarding those administrative things. And I find it to be unbelievable how slow are the administrative and bureaucratic procedures in Canada. ...I am not talking about speed only. It's speed and efficiency and professionalism and accuracy. Many things. [Ontario IMG #3, no longer pursuing integration

Despite the differences in procedure, there were some remarkably similar experiences among our participants in that it took a long time to work through the immigration process, there were high costs involved, and both the length of time and amount of money required were unanticipated.