Daphne Bramham: Canada’s broken system punishes high-skilled immigrants [credential recognition of dentists]

Dentist case study and related recognition data:
Early last Friday, Mariam Tariq, a couple of friends in Toronto and her mother in Pakistan were ready at their computers waiting for the moment that registration opened to get her seat to write the first of three National Dental Examining Board of Canada exams in August.
Tariq managed to get a place on the waiting list. So, she’ll have to keep studying hard … just in case.By August, the 32-year-old will have been in Vancouver for more than two years and has moved only a tiny step closer to becoming a licensed dentist.

It took 14 months before her academic credentials were accepted, although the NDEB says the average processing time once all the documents are received is 20 weeks.

Then, Tariq joined the throng of close to 1,700 who each year sign up for the “equivalency process,” which entails a total of three exams, including a clinical one. Currently, there are over 10,000 people at various stages of the process.

It’s anathema to how Canada’s immigration system should work.

Canada promises high-skilled professionals and tradespeople from around the world a fast-track to a bright future here. But on arrival, they’re ensnared in a web of national and regional accreditation and licensing bodies.

It can take up to five years or more to qualify and some simply give up and move on to something or somewhere else.Tariq had been a lecturer in pediatric dentistry at the government-run Ayub College in Abbottabad and presented papers at international dental conventions including in the U.S.

She came here on the fast-track-to-permanent-residency under Canada’s Express Entry program that favours people whose skills are badly needed.

In January 2020, she sent credentials from Pakistan to the NDEB for verification and signed up for online coaching for the first exam — the assessment of fundamental knowledge or AFK.

“I thought it would take a year or a year-and-a-half (to get licensed),” Tariq told me. “But I’ve found out that it usually takes more like three-to-five years.”

She arrived here in July 2020. It wasn’t until March 2021 that her credentials were accepted. But the AFK exam is given only twice a year in August and February. And Tariq had missed the window to register for the August sitting.In November 2021, she wasn’t fast enough to grab a precious seat for February 2022.

COVID-19 restrictions are partly to blame for the bottleneck. The NDEB expects to be able to increase testing capacity later this year.

Aside from the scarcity of seats, the full-day exams are gruelling as they must be to protect patient safety. Over the past five years, the pass rate for the multiple-choice AFK has ranged from 32 to 49 per cent. For the other two exams, the pass rate runs from the mid-30s to the mid-60s.

And if that’s not pressure enough, NDEB has a three-strikes’ rule. Fail three times and you’re banned from ever trying again.With such high stakes, many foreign-trained dentists pay fees of up to $5,000 to what Tariq described as “coaching academies” in addition to the NDEB fees that start at $1,000 for the AFK and go up from there.

There are thousands currently in this unenviable cycle of what Tariq described as “work, earn money to study, study and pay for the next exam.”

Having run through the money she had saved to come to Canada, she has at least found work at dental clinics, albeit as an accounts receivable clerk, a receptionist and now as a chair-side assistant — “I have a lot of friends who are working at Tim Hortons, Walmart.”

Tariq is pragmatically taking courses to qualify as a dental assistant. The pay will be better than what she’s earning now, which means Tariq will be less reliant on her dentist/mother for help paying for the NDEB examsShe’s also fortunate to be in the first cohort of a free coaching program offered by the immigrant settlement society, SUCCESS.

Its CEO, Queenie Choo, has first-hand experience with the credentialing hoops. Trained as a nurse in Britain and having worked on a transplant team and in acute care, she said it was humiliating to have to prove her ability to do injections by sticking a needle in an orange.

“We want to attract talent through immigration, but we have not created an environment where they are able to practise,” she said. “We definitely need a system that is seamless with less barriers including financial help for the required exams.”

Among the many criticisms of Canada’s accreditation system is that only credentials from institutions in the white, English-speaking world are deemed good enough.

“I don’t know if it’s a subtle form of racism,” Choo said. “But we need to look at systemic racism that it may be creating.”

What might that look like? A lot like what’s happening now

By neglect or design, the expensive and fragmented credentialing system is creating an underclass. Instead of working dentists, doctors and nurses, foreign-trained professionals end up as assistants, associates and aides.

In the past 20 years, Statistics Canada found that the number of immigrants who become Canadian citizens has dropped by more than 20 percentage points.

There are multiple reasons why. But this is surely one of them.

Source: Daphne Bramham: Canada’s broken system punishes high-skilled immigrants

About Andrew
Andrew blogs and tweets public policy issues, particularly the relationship between the political and bureaucratic levels, citizenship and multiculturalism. His latest book, Policy Arrogance or Innocent Bias, recounts his experience as a senior public servant in this area.

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