International migration and occupational integration of skilled health professionals

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Résumé (français)

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Résumé (anglais)

This thesis comprises three chapters (two are empirical) that focus on the international migration and occupational integration of foreign-trained health professionals and their labour market outcomes in host nations. Chapters 1, 2 and 3 are presented sequentially. In chapter 1, the objective is to survey and discuss the relatively small economic literature on the frontier interdisciplinary policy issue of international migration of health professionals taking both developed and developing country perspectives. Health workforce shortages in developed countries are perceived to be central drivers of health professionals’ international migration, one ramification being negative impacts on developing nations’ healthcare delivery. After a descriptive international overview, selected economic issues are discussed for developed and developing countries. Health labour markets’ unique characteristics imply great complexity in developed economies involving government intervention, licensure, regulation, and (quasi-)union activity. These features affect migrants’ decisions, economic integration, and impacts on the receiving nations’ health workforce and society. Developing countries sometimes educate citizens in expectation of emigration, while others pursue international treaties in attempts to manage migrant flows. Chapter 2 empirically investigates whether the possession of foreign credentials affects the integration of health professionals in the labour market. It examines eight selected regulated health occupations. We perform statistical multivariate analyses using the 2006 Canadian Census to investigate the effects of location of birth and highest education on the likelihood of employment as a healthcare professional and on labour market outcomes. The results show that immigrant, foreign-trained degree holders are less likely to work as licensed healthcare professionals after controlling for foreign experience, socio-demographic factors, and family compositions. A similar pattern emerges for labour market outcomes among those holding licensed health credentials; however, in some occupations we find mixed results. The results show earnings deficits associated with immigrants holding foreign credentials, not foreign birth exclusively (in some occupations), controlling for labour market activities, demographic and human capital factors. finally, in chapter 3 we find that foreign-trained dentists practicing in Canada earn approximately 30% less than their locally (Canada/US) trained counterparts. What explains such an earnings gap and what does it tell us about the content of services dentists provide? To address the issue, we apply a two-fold Oaxaca-Blinder decomposition to disentangle composition and market factors. We find that individual characteristics (such as gender, potential Canadian experience, visible minority status, geographic location and language) explain 61% of the gap, but 39% can be attributed to differences in rates of return for individual characteristics and unobservable characteristics. Possible causes of such differences in rates of return include differences in quality of training, dentists’ productivities, language skills, and duration of stay in Canada for foreign-trained persons. The foreign-trained dentists have positive rates of return for characteristics, but suffer training location effects (or penalties) for being trained abroad. Moreover, significant negative effects are associated with being a foreign-born, foreign-trained dentist in comparison to being a foreign-born Canada/US-trained dentist. We conclude that the location of a dentist’s highest training is the major factor influencing his/her labour market outcome, not immigration status exclusively.