Those who had the opportunity to start the process of obtaining their license even before receiving their permanent residency status here in Canada reported fewer difficulties than those who didn't take this route. Many IENs, for example, described travelling to Canada prior to making the final decision to move here; they sat the CRNE exam - one of the biggest barriers to obtaining their license – or they found a prospective employer before moving here:

When I was in UA I went through the paperwork and applied to [the College of Nurses here in Canada] and they said you need to pass the exam [CRNE]. So I came to Winnipeg in 2004 June to appear for the exam. I came as a visitor to appear for the exam only and then when I went back... I got the pass and then I started paperwork... Then in one or two couple of months I got everything cleared to come to [Canada]. [Manitoba IEN #12, practicing]

That was one reason I started working with the College almost a year before I had my permanent residency because I did not want to take the exams ever again. [Ontario, IEN #3, practicing]

In Quebec, on the other hand, nurses are allowed to practice their profession for two years before being taking the OIIQ nursing exam. Depending on their country of origin and the evaluation of their credentials, they are required to take either a twenty-day orientation period or a six- to eight-month updating course (i.e., bridging program), which includes both a theoretical and practical component. Once this obligatory exposure to the Quebec health care system is successfully completed, they are awarded a one year temporary permit to practice, renewable once, allowing them two years of practice before being obliged to pass the equivalency exam.

La première année je pouvais travailler comme infirmière sans qu'il y ait de problème, ils se sont rétractés par la suite, pas avec moi mais pour d'autres. Au début les premières infirmières qui sont arrivées elles avaient le droit de travailler deux ans et au bout de deux ans si elles voulaient rester fallait qu'elles passent l'examen.

[The first year I could work as a nurse without a problem, and then they retracted, not for me, but for others. At the start, the first nurses who arrived were allowed to work for two years and after two years, if they wanted to stay, they had to pass the exam.] [Quebec IEN #1, practicing]

Physicians who migrated to Québec generally had a much easier time obtaining their license if they began the equivalency process before leaving their home country. In fact, RSQ strongly encourages IMGs to go as far as they can in the process of obtaining their license while still in their home country before even starting the immigration process. There are a number of countries in which IMGs may take the Canadian equivalency exams for medical practice in Québec.

Dans le monde aussi c'est très organisé, sur le Collège ils vous marquent les endroits où vous pouvez passer, c'est sûr que pour l'Europe il y avait Londres, il y avait Paris, il y avait l'Italie, je crois qu'il y en avait en Espagne aussi, un peu partout.

[In the world, too, it's very well organized. At College they show the locations where you can go. Sure, in Europe, there was London, there was Paris, there was Italy, and I think there was Spain too, almost everywhere]. [Quebec IMG #4, practicing.]

There are also ongoing discussions between the Collège des médecins du Québec and the Ordre national des médecins de France with a view to reaching an agreement on mutual recognition of physicians. (CMQ 2009b). Similarly, MCC provides a list of 73 countries where physicians wishing to practice in Canada can write the evaluating exam – the first step for obtaining their license (MCC 2010)

Although physicians are allowed to take the evaluating exam without permanent residency status, this exam is but one small step on the way to professional integration. Residency positions, however, cannot be obtained without having permanent residency status in Canada. Similarly, the option of doing as much as one can prior to immigrating is limited in the case of ITMs, because to be eligible to attend an assessment process where their skills will be evaluated, they usually have to have permanent residency status. Therefore, while nurses do get a chance to find employment in Canada prior to the actual migration, IMGs outside of Quebec and ITMs across Canada have to be physically present in Canada to go through the process. As a result, many IMGs and ITMs postpone their preparations for professional integration until they enter the country.