Perhaps the real issue is not so much the clarity and accessibility of information itself, but the complexity of the system. The changes that the majority of the IEHCPs interviewed would most like to see in terms of the immigration and licensing processes are improvements to transparency and simplification:

"...transparency... Be honest 'cause it's not a transparent system at the moment." [British Columbia IMG #2, no longer pursuing integration]

Uh, you know, I just wish there was more organization. In a way this still was good, was okay, but I think if there was a little more centralized information involved for doctors, you know, the government could organize it province by province, you know, what's the process to come? [Manitoba IMG #1, practicing].

One of the gaps in the system that was identified by IEHPs is the lack of communication between individual provinces and between the provinces and federal ministries. For instance, one of the nurses decided to move to Ontario after five years of practice in Manitoba. Despite many years of Canadian practice and a nursing license from the Manitoba College of Nurses, she had to undergo the process of verification of her credentials once again. Since verification of credentials required communication with the nursing school in her home country, it significantly slowed down the process of accreditation.

Other IENs were not pleased with the work of the nursing Colleges/Ordres. We heard many accounts of documents being delayed or lost and it was perceived as almost impossible to receive any response to queries. The following excerpt explains the situation one IEN faced:

The College of Nurses would tell me that I needed verification from [my state], then I would call them and basically they would [put me] on hold on long distance, and they would say, you aren't registered here so we will not give you anything. You haven't written anything here, you're not registered here; we won't provide you with anything. Then I would go back to the College of Nurses and say, I can't get anything from them because I'm not registered there. So, I had a lot of trouble trying to figure out what paperwork I even needed... [The College was very] disorganized and I'm hoping that maybe... things are better now, but I know you still get that 1-800 Call Centre type of filter... It's very hard to get through to someone there... It's just such an aggravation and nobody knows what you need and you're going back and forth and you're wasting so much time and it's just frustrating, I guess, when you know that there's an employer that wants to hire you, they want you to work, they want you to start like yesterday, and you have to go through all this red tape. [Ontario IEN #1, practicing].

Similar problems were identified by ITMs. They were really looking forward to having one governing body which would assess midwives' qualifications:

Actually when you decide which province you want to go to you have to go through the PLEA, which is the Previous Learning Experience Assessment. You have to go through the governing body for that province. So each province has a College of Midwives, Registered Midwives. Sso mine was the College of Registered Midwives in Manitoba. And it was entirely on their stipulation that I went through the whole process. They set the exams. The problem in Canada I think, and this national exam is going to stop this, but each province can basically set up their own standard of exams without having to follow a national guideline. So every province is different, you know. And depends on which province you go to. It depends on how tough the process is. Well Manitoba is particularly tough for some reason. [Manitoba ITM #1, practicing]

Well you know, I think we've made a major step forward with this national exam being formulated because that was always my kind of grievance was you can't assess midwives at provincial level without there being a national guideline to follow because what one province might deem as appropriate, another one might not. And then that affects the reciprocity across the whole of Canada. So the fact that they've brought in this national exam now I think is good [Manitoba ITM #1, practicing]

ITMs in particular express frustration with changing standards and requirements, and many of these changes are attributable to a relatively young and evolving professional association in Canada. But even among professions like nursing and medicine, who have nationally standardized exams, there were another set of concerns, as discussed in Section 4 above.