|Different Stages in the Integration Process|
Interviewing IEHPs at different stages of the process of integration gave us a unique opportunity to assess the differences in the experiences of IEHPs being at these different stages.
IMGs: Issues varied, depending on what stage IMGs were at in the integration process. For example, it was often the case that newcomers to Canada were mostly concerned with passing the MCC examinations. Those who already passed the examinations were experiencing difficulty in deciding what to do next – to continue hoping for a residency placement, to try their chances in other provinces (as IMGs, clinical associates or as physician assistants), or to abandon medicine altogether.
IENs: Despite the fact that IENs reported their frustration with their regulatory bodies and had difficulties in navigating through the bureaucracy related to credential recognition, they had a clear sense of the process of integration. Those IENs who were still in the process of obtaining their license, were usually the IENs who were preparing for CRNE and attending language courses. At that time, passing CRNE was seen as the most difficult step on the process of integration. Once the exam was passed, those IENs who were not directly recruited to practice in Canada, encountered another barrier of which many of them had been unaware of, that of finding an employer who would be willing to hire an IEN. Many of these IENs, therefore, had to agree to work in jobs that were less than satisfying, where the full extent of their skills were not utilized. Although some of our respondents continue to work in these jobs due to personal reasons, many IENs were able over the years to adapt to the system and move up the professional ladder. We found, however, that their satisfaction with the job was mostly attributed to the facility in which they practice and to the quality of their personal relationships with other staff members.
ITMs: Unlike IENs, for the most part, ITMs were relatively satisfied with the efforts of their regulatory bodies. Attendance at the required bridging program prior to commencing practice helped them to feel better prepared to establish their practice in Canada than IENs. For the most part, once integrated, ITMs defined their work as rewarding yet very difficult – largely because of the model of practice – but this is not dissimilar from the experience of Canadian trained midwives. They also reported the least tension between the members of their health care team, but this may be more due to the somewhat more independent nature of their practice.
In sum, each step in professional integration was associated with specific difficulty or a barrier. When the process of integration was seen as clear, with defined step-by-step navigation, it helped IEHPs to integrate faster and better and to feel more satisfied with their job. Clearly, some of the differences we found by profession need to also be viewed with a lens sensitive to the level integration process.