For those who were recruited directly by a recruitment agency, the process of immigration and professional integration was much easier and faster. The recruitment process could be what some have described as passive, that is, where positions are advertised; in other cases is could be active, through recruitment drives which seek out IEHPs in their country of origin (Labonte, Packer, & Klassen 2006; McIntosh, Torgerson, & Klassen 2007). In Quebec, for example, the government agency - Recrutement Santé Québec (RSQ), established in 2003, both recruits actively though sending delegations seeking nurses to French speaking countries in Europe, and passively through its website (RSQ 2010b).

Many IEHPs chose to come to Canada through a recruitment agency to address concerns about of the instability of being a newcomer in a new country. For these respondents, the prospect of having immediate employment seemed a good choice:

Brandon kind of found me. ... I'd seen the job in Brandon for the midwife...on the Internet. And I'd said to my husband 'That looks like that would be a good job'... [then] one of the guys from the recruitment agency actually lives in Winnipeg and he had contacts within the Brandon Regional Health Authority and had kind of said 'I've got a nurse coming but she's actually a midwife. Have you got any vacancies?' And they said 'Well we're looking for a midwife.' ... We were kind of moved along very quickly then. And we had got no intention of coming to Manitoba. We didn't even know where Manitoba was. But then when they said, you know, 'If you come, there's a job as a midwife'. I wasn't going to turn that down because I knew it would be so difficult to get here [Manitoba ITM #1, practicing].

Usually, an agency takes responsibility for contact with Canadian authorities, collection of all required documentation from the applicant and (in some cases) payment of travel expenses and accommodation. The RSQ, for example, takes care of the immigration paperwork for recruited IENs, puts these nurses in touch with various teaching hospitals, and in most cases, covers travel expenses, and organizes work visas and temporary work permits.

Recrutement Santé Québec chez moi qui en fait je suis rentré en contact avec elle, puis elle m'a aidé à faire les démarches, tout ce qui est au niveau immigration, immigration c'est elle qui m'a cherché aussi ma, pas qui m'a cherché mais qui a fait les démarches pour moi pour qu'au niveau de l'hôpital où je suis actuellement.

[Recrutement Santé Québec came where I lived and so I came in contact with her and she helped me take steps, get through all the immigration procedures. Immigration also came looking for me, not searching for me per se, but took steps on my behalf with the hospital where I currently work.] [Québec IEN #11, practicing]

A similarly smooth process was described by other IENs and ITMs who communicated directly with local health authorities or provincial program officers (e.g., BC Health Match), recruiters in their home country, or international bodies, such as the UN, for refugees. As one IEN told us, these kinds of arrangements help to ensure the maintenance of some of the job-related benefits for the IEN:

Donc j'ai commencé à creuser un petit peu tout ça, puis je me suis aperçue qu'il y avait quand même des accords entre la France et le Québec et qui permettaient de garder un peu, de ne pas tout perdre au niveau de la retraite, au niveau de plein de choses comme ça, que bon la façon de pratiquer était relativement similaire et il y avait aussi des accords avec le ministère de la Santé qui nous permettaient quand même, bien d'arriver et d'avoir [un poste] très, très rapidement quoi.

[I started looking into it a bit and I saw that there were agreements between France and Quebec that would let me hold on to a little, I mean, not lose everything as far as retirement goes, and lots of things like that, that professional practice was relatively similar, and that there were also agreements with the Department of Health that would allow us to come here and get a [position] very, very quickly.] [Québec IEN #7, practicing]

IMGs, on the other hand, generally do not experience the same formality of immigration assistance as their nursing counterparts. Indeed, in Quebec, before the establishment of the RSQ in 2003, it was almost impossible for IMGs to become integrated, since there was no formal process in place. Now, once a hospital agrees to hire the IMG, the institution becomes that physician's sponsor and assists with the temporary work visa and permit. Direct recruitment of physicians does occur in two of the provinces studied - BC and Manitoba – and many employment agencies are operating online (Health Match BC 2009). As a general rule, this path is open to physicians who received their training in United Kingdom, Switzerland, South Africa, Hong Kong, Singapore, Australia, New Zealand and the USA (CanAm 2008).

Up until relatively recently, the provinces under study were recruiting IMGs (primarily from South Africa) through a variety of means. A number of legal issues pertaining to discrimination of physicians made provincial Colleges cease the practice of direct recruitment and unify the process of integration, making it (at least on paper) relatively similar for physicians coming from different parts of the world. At the same time, as other provinces (Saskatchewan and Alberta) continued hiring South African physicians, many of the IMGs we interviewed who came from other countries complained about the preferential treatment given to these doctors.

Québec-based recruitment agencies are active in some French speaking countries (i.e., France, Belgium, Switzerland), and those representing other Canadian provinces are active in a number of English speaking countries (i.e., the Philippines, India, and,lately, Korea and China). Immigrants from Eastern European, South American, and many African countries, where the system and the language of education are considered to differ greatly from Canadian standards, often do not have the opportunity to come to Canada through recruitment agencies. Agencies do not often operate in those countries where the language skills and credentials of their residents cannot be defined as "ready to practice" in Canada.

While recruitment agencies often facilitate the process of obtaining necessary credentials to enter the country and start practicing, they often recruit IEHPs for practice in lower rank positions or offer them placement in rural or remote areas (Health Match BC 2009). This is especially true in the case of IENs. Recruitment agencies often offer employment in a lower nursing rank to potential immigrants coming to all provinces. In the following quote an IEN described how she and her fellow nurses were recruited to fulfill the positions of LPNs even though they would qualify to practice as RNs:

We are all graduates from a four year to a five year program and you finish with a degree in Bachelor of Science in Nursing. But ...when you come to Canada you have to go back to school because Canada's standards are really, really high... So we took the opportunity [offered by recruiters] and we signed in as licensed practical nurses. Before I came here I surfed through the internet if there is any association of registered nurses like we were introduced to the Manitoba Association of Licensed Practical Nurses. And then I wrote them an e-mail saying that if they could review our program ... So they did and then they said that 'Well your program is pretty much a university program so you can challenge the RN'. But because this agency ... did not allow us to challenge the RN exam. Instead they wanted us to come as LPNs. So when we got here to Canada we worked. We had job offers and we started right away full time as LPNs on a two year contract. So that's what happened [Manitoba IEN #2, practicing].

Very few IEHPs enter Canada through private recruitment agencies. Up until recently, Canada was recruiting physicians to come and practice, but in the past few years, the provinces of British Columbia, Manitoba, Ontario, and Québec standardized the process of integrating IMGs which made it impossible to come and immediately start practicing medicine. As a result of the revised and now more complicated procedures, private recruitment agencies seem to have lost interest in bringing IMGs into those provinces. Similar to some other provinces, the Québec government itself took over from the recruitment agencies and regulated the recruitment and integration process with the creation of the RSQ.

The process of immigration and integration can often be facilitated by recruitment agencies. As our respondents suggest, however, recruitment agencies would not often bother to actually find a tailored fit between the qualifications of an applicant and a particular position in Canada. On occasion they recruit IEHPs to fill positions where their skills would not be fully utilized. Furthermore, they sometimes mislead IEHPs as to the length of the process of obtaining permanent residency.