One of the sources of a great deal of frustration among IEHPs who participated in our study was the apparent disconnect between their difficulties in obtaining a license in Canada and the perceived (and indeed, in some cases, conveyed) feeling that Canada is in need of health professionals:

Voilà mais j'avoue que ce qui ne m'a pas plu c'est que, je me dis mais on a besoin de former des agents de santé, le Québec ça crie partout oui il y a manque d'agents de santé, il y a manque d'infirmières, il y a manque de médecins...

[Okay, so here, I admit that what I didn't like, I tell myself, but we need to train healthcare professionals; in Quebec, everybody's complaining that there's a lack of healthcare professionals. That there is a shortage of nurses, a shortage of doctors.] [Québec IEN #4, in progress].

For instance, since I came here I can find out from all indications, interaction whatever, there are a shortage of doctors here. As I said earlier the most important thing about the whole thing is to ... make the system a little easier for foreign trained doctors to get into the system ...because if some of these measures are relaxed there are certain fundamental objective ways you could assess a foreign trained doctor to really find out if he is competent. I think that the ...measures are so rigorous and difficult. [Manitoba IMG #1, in progress].

One source of disillusionment among IEHPs is an inconsistency in the message being given regarding licensing opportunities between immigration representatives at the Canadian embassy or national level, and licensing bodies at the provincial level. Many have experienced both inter- and intra-institutional inconsistencies in terms of requirements, costs, labour market realities, and even lifestyle.

This issue of the misleading belief that IEHPs are indeed in great demand in Canada and would thus have no trouble finding a job, resonates with many policy stakeholders (Bourgeault 2006). Many argue further that this is a result of the disconnect between the immigration policy and health professional regulatory policy – which is exacerbated by being a federal and a provincial jurisdiction, respectively. Thus, IEHPs fare well in our points-based immigration policy system but then face the seemingly paradoxical situation of the professional regulatory world.

If Canada doesn't need us, why it opens so many centers for assessment? Somehow Canada sells illusion. So I don't know, this is my... you know, when you see okay, there are so many centers around the world for those exams, that means they really need physicians, they are really looking so much to hiring us which is not true. ...Who opens those centers? Medical Council of Canada, yeah? Those centers for assessment are under Medical Council of Canada. But if Medical Council of Canada doesn't want physician why they open so many centers for assessment? This is my biggest question. [Ontario IMG #2, no longer pursuing integration]

Moreover, the belief among some stakeholders that Canada will likely always rely (at least partially) on the supply of IEHPs and that effective HHR planning should also include the accommodation of incoming health professionals (Bourgeault 2006), is shared by many of the IEHPs we interviewed:

Well what I said to you there has to be a regulatory body as World Health Organization or something like that that would penalize this country because this country is doing two kinds of damage. Like is draining the poor countries of doctors. How many dollars that country has spent in training that physician for that physician to come here for example to Canada? The second damage is to the person. They are not allowing that person to practice medicine. ...We are bringing physicians here to deliver pizzas. This is nonsense. So somebody has to penalize Canada and say well, for example, we poor countries [want] some compensation. [Ontario IMG #5, no longer pursuing integration].

In terms of recruitment, the consensus is that IMGs should not be actively recruited from developing countries. If they are, they should be given access to their profession in Canada.