Canada: Paging All International Doctors: 5 Practical Tips For Recruiting International Staff Physicians

Last Updated: April 18 2018
Article by David Nurse

There's no shortage of media coverage about a doctor shortage in Canada and the resulting impact on Canada's healthcare system. Most non-Canadian clinical physicians enter Canada for work based, at least initially, on a work permit issued pursuant to a Labour Market Impact Assessment (a.k.a. LMIA). This means Canadian staff physician recruiters considering foreign candidates must understand the LMIA process and how to obtain an LMIA to hire a non-Canadian physician.

Here's a look at the LMIA requirements for foreign physicians to enter Canada, and five practical tips for obtaining an LMIA to recruit international staff physicians.

LMIA Recruitment Requirements

A "Labour Market Impact Assessment" is the document the federal department of Employment and Social Development Canada (ESDC, the responsible federal government department) issues to a Canadian employer authorizing it to hire a foreign worker through the federal temporary foreign worker program. Most employers consider obtaining a LMIA to be a long, arduous and costly process.

LMIA Exceptions. There are some exceptions to the requirement to obtain an LMIA, some of which apply to foreign physicians. For example, NAFTA (at least for now) allows qualified U.S. and Mexican citizens in certain "designated professions", which includes physicians, to temporarily enter Canada for work under the "NAFTA professional work permit" without an LMIA – but this exemption is limited to teaching and research positions, and doesn't apply to physicians whose primary activity is direct patient care. In addition, a physician nominated for permanent residence in Canada through certain provincial nominee programs (PNP) won't require an LMIA to obtain a work permit; for example, Nova Scotia recently introduced a Physician Stream under its PNP. However, most foreign clinical physicians still enter Canada for work on a LMIA-based work permit, at least initially.

Specific Requirements. The ESDC's website describes the purpose of an LMIA as, "verif[ying] that there is a need for a temporary worker and that no Canadians are available to do the job." Therefore, to obtain an LMIA the employer must demonstrate it has conducted exhaustive recruitment. ESDC has very specific recruitment requirements, so it's critical that recruiters review all of ESDC's requirements on its website before applying for an LMIA.

Advertising. One of those specific recruitment requirements pertains to advertising for the job vacancy. The advertising requirements vary depending on whether the position falls into the "high-wage" or the "low-wage" category; all physicians are in the high-wage LMIA category. Before applying for a high-wage LMIA, ESDC requires employers to advertise in a minimum of three locations and, in most cases, on the government of Canada's Job Bank. ESDC also expects the advertisements will contain detailed information about the vacancy, and run for a minimum of four weeks within the three months immediately before the LMIA application, with at least one maintained on an ongoing basis until ESDC makes a decision. All advertising must contain this information:

  • Company operating name.
  • Business address.
  • Title of the position.
  • Job duties (for each position, if advertising is for more than one vacancy).
  • Terms of employment (for example, project based, permanent position).
  • Language of work.
  • Wage (including any incremental raises, performance pay or bonuses); the employer can use a wage range for the purposes of complying with the advertising requirements, but the minimum wage in the range must meet prevailing wage).
  • Benefits package offered (if applicable).
  • Location(s) of work (local area, city or town).
  • Contact information, including telephone number, cell phone number, email address, fax number, or mailing address.
  • Skills requirements (includes education and work experience).

5 Practical Tips for Effective International Physician Recruitment

Here are five practical tips to help effectively recruit international physicians in compliance with the LMIA recruitment requirements.

1. Detailed wage disclosure

Physician compensation arrangements can be complex, making it difficult to know how to comply with ESDC's wage disclosure requirements. In our experience, ESDC prefers the employer include in the advertisement as much information as possible on the compensation arrangement. Therefore, applicants are wise to provide as much detail as possible in the advertising campaign on the compensation arrangement, including whether the physician will receive a mix of fee-for-service payments and salary, a signing bonus, and other incentive payments.

2. Use the advertising variation for fee-for-service physicians.

There's an important variation to the advertising requirements for fee-for-service positions. Generally, an employer must advertise the wages (or at least the wage range) it's offering, and those wages must be consistent with the prevailing wage rate for the occupation. But ESDC has issued an advertising variation for fee-for-service physicians: "Compensation paid to Physicians (NOC codes 3111 and 3112) based on a fee-for-service remuneration model is generally considered to be consistent with the prevailing wage rate for the occupation." Simply put, this means an employer advertising a fee-for-service position isn't required to advertise a specific wage or wage range, but in all advertising should state the position is fee-for-service. However, where an employer will pay a physician a combination of fee-for-service and salary, in our view the employer should specify in the advertising the amount of the salaried portion (or the salary range).

3. Skip the Job Bank

Another complex issue for physician employers is whether – or not – to advertise vacant positions on the government's Job Bank. In our experience, the Job Bank isn't an appropriate nor an effective method of physician recruitment.

Terms of Use. Our experience indicates that ESDC considers any fee-for-service position in which the physician will be remitting their own taxes, etc., to be outside the Job Bank Terms of Use. Those Terms of Use state: "Job Bank will not post jobs: if the employer expects the employee to remit his/her own tax deductions; if the employer expects the worker to arrange other employment coverage for programs such as income tax, the Canada Pension Plan (CPP), employment insurance (EI), and workers' compensation;" In our experience, this is precisely what is expected of fee-for-service physicians; they are generally paid directly by the provincial health insurer, pay their own staff and remit their own tax (including income tax) deductions. Therefore, it may not be appropriate to use the Job Bank for fee-for-service positions.

Election. Arguably, the Job Bank still isn't an appropriate nor an effective method of recruitment for either fee-for-service or for salaried physician positions: clinical physicians simply don't search the Job Bank for employment opportunities. While ESDC states it considers using the Job Bank mandatory, individual employers can elect not to use the Job Bank and instead use an alternative third method of advertising, such as a national occupation-specific method like the Canadian Medical Association's (CMA) Dr. Careers site. In such a case, the employer must submit to ESDC a written rationale and explanation for using the alternative method. In my experience, ESDC has been receptive to the argument the Job Bank isn't an appropriate or effective method of physician recruitment. But recruiters that do elect to use the Job Bank should be aware that ESDC now requires employers to use the Job Match function, obligating the employer to invite eligible candidates to apply for the position.

4. Use occupation-specific advertisers

ESDC requires employers to use recruitment methods that are consistent with the occupation. It's therefore generally wise to use occupation-specific advertisers, such as the CMA or the provincial Colleges of Physicians and Surgeons, or private occupation-specific sites or recruiters. ESDC recently amended its requirements to state it may consider multiple online ads that don't have unique value and target unique audiences as only one method of advertising. It's therefore wise for employers to consider using both online and print ads, and to consider the unique value each method brings. In any campaign, ESDC requires that at least one method of recruitment be "national", by which ESDC means "Canadians and permanent residents must have the capacity to search advertisements for work locations across Canada in a single site, as opposed to referring to individual or regional sub-sites".

5. First-timer Tips

Here are a few additional tips for staff physician recruiters applying for their first LMIA.

LMIA Fees. The fee to apply for an LMIA is $1,000.00 – per position. This can really add up: if you're seeking approval to hire five physicians, the fee to obtain the LMIA will be $5,000.00. And this doesn't include any legal fees or other recruiting-related costs you'll incur in the recruitment process.

Processing. A special Service Canada Centre of Specialization in Saint John, New Brunswick – not the processing centre for other LMIAs for your region – processes all LMIA application for physicians. This is advantageous for employers: the Centre of Specialization staff are very knowledgeable and understand the unique issues related to LMIAs for physicians.

Expiry. Be sure to note the expiry date of the LMIA. An LMIA is normally good for six months, meaning the foreign worker should apply for their work permit within six months of ESDC's approval of the LMIA.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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