Internationally Educated Health Professionals in Canada: Navigating Three Policy Subsystems Along the Pathway to Practice

The integration of internationally educated health professionals (IEHPs) into the health workforces of their adopted countries is an issue that has challenged policy makers and policy scholars for decades. In this article, the authors explore the implications of the ideological underpinnings of the policy subsystems that IEHPs must navigate in seeking employment in Canada, with a focus on Ontario. Using a policy subsystem approach, in 2015 the authors analyzed a large preexisting data set composed of articles, governmental reports, Web sites, and transcripts of interviews and focus groups conducted in Ontario with IEHPs, health care executives, human resource managers, and job counselors to IEHPs. Through this analysis, they identified three policy subsystems—the immigration system, the educational and licensure/regulatory system, and the health human resources system—that conflict ideologically and, as a result, create barriers to IEHP integration. To make substantive progress on IEHP integration in Canada, four questions should be considered. First, how can researchers bring new research methods to bear to explore why no jurisdiction has been able to create an integrated pathway to practice for IEHPs? Second, how and to what end are the institutions within the three policy subsystems regulating the IEHP pathway to practice? Third, how might the educational and licensure/regulatory policy subsystem create alternative health care employment options for IEHPs? Finally, how might health professions educators pursue a leadership role in the creation of an overarching institution to manage the pathway to practice for IEHPs?