Integration of International
Pharmacy Graduates into the
Canadian Pharmacy Workforce:
Barriers and Facilitators
FINAL REPORT
January 2008 Prepared for:
Moving Forward: Pharmacy Human Resources for the Future
Prepared by:
into the Canadian Pharmacy Workforce:
Barriers and Facilitators
FINAL REPORT
January 2008
Prepared for:
Moving Forward: Pharmacy Human Resources for the Future
Prepared by:
Management Committee, Moving Forward: Pharmacy Human Resources for the Future.
Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators. Ottawa (ON). Canadian Pharmacists Association; (2008)
Executive Summary...
Overview of Moving Forward: Pharmacy Human Resources for the Future ...1
Acknowledgements ...2
Acronyms Used in this Report ...4
Introduction ...5
Background to the Project...5
Purpose and Scope of Study...6
Overview of Report...7
Section 1: Research Approach and Methodology ...8
Research Design ...8
Specific Research Components ...8
Research Considerations ...12
Section 2: Findings ...13
Settling in Canada...13
Profile of IPGs Settling in Canada...13
Deciding to Settle in Canada ...16
Expectations of IPGs in Settling in Canada ...16
Sources of Information ...16
Information Lacking in the Country of Origin ...17
Licensing and Registration ...18
Information About the Licensure Process ...19
Number of IPGs Seeking Licensure ...19
Performance of IPGs in the PEBC National Pharmacy Examinations ...20
Number of Attempts at PEBC Examinations...21
Challenges Faced by IPGs in the Licensing and Registration Process ...22
Additional Programs or Services Needed to Support IPGs on the Path to Licensure ...24
Supports Being Offered by Employers ...26
Enablers of Success in the Licensing and Registration Process ...26
Perceived Effectiveness of Licensing Process ...27
Bridging Programs ...28
Current Bridging Programs Available for IPGs ...28
Awareness and Usage of Bridging Programs...28
Reasons IPGs Do or Do Not Participate in a Bridging Program ...32
Perceived Effectiveness of Bridging Programs ...34
Perceived Gaps in Program Delivery...35
Working in Canada ...36
Profile of Employment of IPGs ...36
Perceptions of Employers ...39
Benefits of Hiring IPGs ...43
Barriers or Challenges to IPG Success...44
Section 3: Key Findings...49
Settling In Canada ...49
Licensing/Registering to Practise as a Pharmacist in Canada ...49
Bridging Programs...50
Working in Canada ...51
Research Appendices...52
Appendix A: Bibliography ...54
Appendix B: Survey Questionnaires ...56
Appendix C: Interview Guides ...57
Appendix D: Focus Group Moderator Guides...58
EXECUTIVE SUMMARY
Introduction
The study of issues surrounding the Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce was designed to describe barriers and facilitators
surrounding the licensing and registration of international pharmacy graduates (IPGs) and their integration into Canadian pharmacy practice. The study was commissioned as part of
Moving Forward: Pharmacy Human Resources for the Future. This initiative is a
collaboration of eight national pharmacy stakeholders, including the Canadian
Pharmacists Association, and is examining the factors contributing to pharmacy human resources challenges in Canada.
The objectives of the research are to provide a profile of IPGs in Canada, an
understanding of the information, supports, and programs that are available to IPGs, the challenges they face in becoming licensed to practice and integrated into the Canadian pharmacy workforce, and what further supports may be needed to help alleviate these challenges. For the purpose of this study, IPGs are defined as individuals living in Canada who completed their undergraduate pharmacy education in a country other than Canada or the United States of America.
This research project collected data from many different sources in order to provide a comprehensive overview of IPG human resources issues. The research undertaken included the following:
• A national survey of IPGs (n=1067);
• A survey of pharmacy employers (owners, managers, and directors) (n=315); • In-person or telephone interviews with key informants from the provincial pharmacy
regulatory authorities, provincial associations, and large pharmacy chains (n=27); • Interviews with providers of bridging programs and courses (n=10);
• Four focus groups with IPGs;
• Two focus groups with employers, and • A literature and statistical review.
Settling in Canada
There is currently no comprehensive source of data on the number or proportion of IPGs in the Canadian pharmacy workforce. However, recent data from the Canadian Institute of Health Information report that the percentage of licensed practising pharmacists in
Ontario and Alberta who are IPGs is 27% and 8%, respectively.
According to information from Citizenship and Immigration Canada, approximately 500 new immigrants come to Canada each year stating that they intend to work as
pharmacists. This figure includes only “economic class” immigrants and does not include other populations of newcomers to the country. IPGs most often arrive in Canada from Southeast Asia (30%) or the Middle East (26%). Common countries of origin include India, Egypt, Pakistan, the Philippines, Iran and Jordan. The majority of IPGs settle in Ontario. Most IPGs come to Canada with undergraduate degrees in pharmacy. In addition, 14% of surveyed IPGs indicated that they had completed a master’s degree, 8% had completed a
PharmD degree, and 3% had completed a PhD. It is not known if these graduate degrees were entry-to-practice requirements in the IPG’s country of orgin. The majority (85%) of IPGs have practised as pharmacists in their country of origin before settling in Canada. IPGs generally appear to be making their own decision to settle and work in Canada. IPGs consult a variety of different sources in making these decisions. Often, they rely on the Internet, accessing information through the websites of the Pharmacy Examining Board of Canada (PEBC) and provincial pharmacy regulatory authorities (PRAs), among others. Family and friends already in Canada are also important sources of information for IPGs. Decisions on where to settle in Canada are often being made based on where family and friends are already living in Canada. IPGs generally choose to initially settle in large cities, where they feel they and their family members can more easily integrate into Canadian society, and where they believe that they are more likely to find pharmacy jobs. Some IPGs are making decisions based on incomplete information or incorrect assumptions. For example, while many IPGs feel that they should settle in the largest cities where there are likely to be more job opportunities, many key informants stated that most opportunities for pharmacist jobs are located in smaller cities or towns.
IPGs settling in Quebec are generally more proficient in French than English, and move to that province in order to be able to work and live in French.
Over three-quarters (78%) of IPGs who settle in Canada expect to eventually work as pharmacists. Some IPGs have no particular expectations related to their own career, and move primarily for reasons related to family.
Summary of Settling in Canada
• While IPGs come from many different areas and backgrounds, they are typically from Southeast Asia or the Middle East, possess an undergraduate pharmacy degree as their highest level of education, and have experience working as a pharmacist. • Before settling in Canada, IPGs most often find information about becoming a
pharmacist in Canada using the Internet, or through friends and family already living in Canada.
• Most IPGs settling in Canada expect they will eventually work as pharmacists in Canada, and most have already practised as pharmacists in their previous career.
Licensing/Registering to Practise as a Pharmacist in Canada
In order to practise as a pharmacist in a pharmacy, IPGs must become licensed (or
registered) to practise by the pharmacy regulatory authority of their chosen province. The steps involved in this process, and their order, vary by province, with Quebec’s licensing process being significantly different than that of the other provinces. Generally, however, IPGs must submit their documents for evaluation to the Pharmacy Examining Board of Canada (PEBC) for verification of identity and comparability of university credentials, undertake an Evaluating Examination, complete a two-part Qualifying Examination (which includes a multiple choice exam and a simulated practice component called the Objective Structured Clinical Examination, or OSCE), demonstrate English (or French) language fluency, undertake an apprenticeship period (known as structured practical training), and pass a provincial examination concerning issues of jurisprudence. The first two steps (Document Evaluation and the Evaluating Exam) can be completed outside of Canada,
whereas the other steps are usually completed within the country. The PEBC is responsible for the assessment of graduates in all provinces except Quebec.
In Quebec, IPGs undergo a foreign credential recognition process through a provincial committee, which assesses their prior education and determines which courses they must complete at a Quebec university to achieve equivalency with Quebec pharmacy graduates. They must also demonstrate French language fluency and undertake structured practical training.
IPGs are generally reliant on the Internet for their information about the various steps of the licensure process, although some IPGs receive assistance directly from the PEBC, the PRAs, or from employers and peers.
During the time period of 2002-2006, an annual average of 876 unique, individual IPGs presented their documents for evaluation. During the same time period, an annual
average of 694 unique IPGs attempted the Evaluating Examination; an average of 524 IPGs attempted the Qualifying Examination Part I (the multiple choice questionnaire) and an average of 433 IPGs attempted the Qualifying Examination Part II (the OSCE). Candidates can have up to four attempts to pass each examination. During the years 2002 to 2006, combining all examination sittings, the IPG pass rate was 59% for the Evaluating Examination, 48% for the Qualifying Examination Part I, and 45% for the Qualifying Examination Part II. While only a quarter (26%) of unique IPGs made multiple attempts at the Evaluating Examination, almost one-half of unique IPGs made multiple attempts at both parts of the Qualifying Examination during that period (46% and 48% respectively). By comparison, less than 10% of domestic graduates generally make more than one attempt at the Qualifying Examination.
IPGs feel that the PEBC Qualifying Examination, particularly the OSCE, is the most difficult part of the licensing process. About three-quarters of surveyed IPGs feel that the Qualifying Examination Part I (74%) and Qualifying Examination Part II (77%) were “difficult” or “very difficult”, with 19% rating Qualifying Examination Part I and 28% rating Qualifying Examination Part II as “very difficult”, respectively. The Evaluating Examination was also rated as “difficult” or “very difficult” by a majority (58%) of IPGs. Finding a practical training position was rated as “very difficult” by 26% of IPGs, and “difficult” by 28% of IPGs.
IPGs often find the licensure process to be time-consuming and costly. The average amount of time for the licensure process was 26 months, with 58% of IPGs who had been licensed in Canada indicating that the process had taken two years or more. In Quebec IPGs are
required to attend courses at either of the province’s two university faculties of pharmacy. Consequently, there is a strong demand for these courses, and some IPGs report that the time required to achieve educational equivalency is often considerable. Costs accrued by IPGs as they undertake the necessary steps to achieve licensure may be considerably higher than those of Canadian graduates. They can include fees for evaluation processes, national examinations (often repeated), and bridging or support training.
Both IPGs and employers feel there is a need for more bridging programs and courses to help IPGs through the licensure process. IPGs generally felt that more opportunities for practical/work experience were needed, whereas employers generally suggested that
Summary of Licensing/Registering to Practice as a Pharmacist in Canada
• The pass rates of IPGs on the Qualifying Examination are low compared to those of Canadian graduates.
• A large percentage of IPGs make multiple attempts at the Evaluation and Qualifying Examinations.
• IPGs often take two years or more to become licensed to practise as a pharmacist. • IPGs identified the Qualifying Examination Part II (the OSCE) as the most difficult
step in the licensing process, but generally find all PEBC examinations to be difficult. • Both IPGs and employers feel that additional programs or supports are needed to
support IPGs on the path to licensure. IPGs are most often looking for programs and supports that provide practical experience, whereas employers feel
language/communication skills support are most critical.
Bridging Programs and Courses
Across Canada, there are a number of bridging programs and courses available to help IPGs become licensed to practise as pharmacists in Canada. These programs help internationally trained pharmacists adapt to the various aspects of practice in the
Canadian context. For the purposes of this study, bridging programs are defined as formal, post-degree programs of study designed to address gaps between an IPG’s education or experience and the standards of pharmacy practice in Canada. This research identifies and documents 9 such programs. These include programs for IPGs at the University of Toronto (U of T) and the University of British Columbia (UBC), as well as programs offered
through private trainers in Ontario, Alberta, Manitoba, and Nova Scotia.
Bridging programs are generally publicized through provincial pharmacy regulatory authorities, provincial pharmacy associations, the PEBC, employers, and immigrant settlement agencies. About one half of IPGs across Canada are aware of the programs, even though these programs are generally accessible only to those IPGs located in or around the selected cities where the courses are offered. No IPG bridging programs currently exist in the province of Quebec, although key informants reported a program was currently under development.
While 60% of IPGs said they had never taken a bridging program and had no plans to register in one in the future, interviews with the representatives from the programs indicate that the number of students enrolled in these programs is on the rise, and will likely continue to grow in the future. Although geographic accessibility is one explanation, most IPGs who are not taking bridging programs (51%) stated they did not take the
program because they simply did not feel a need to do so. Other reasons included not being aware of the programs (27%), or lacking the money required to take the program (17%). Many IPGs find the cost of the bridging programs, $10,000 or more for the most extensive courses, to be prohibitive.
Those IPGs who do take bridging programs feel the programs are effective in a variety of ways. Most IPGs who had taken the programs stated that the programs were “effective” or “very effective” in providing information on pharmaceutical care (83%), applied
therapeutics (80%), roles and responsibilities of pharmacists in Canada (79%), and on other topics. The programs also report considerable success rates among program completers in subsequently becoming licensed to practise.
Summary of Bridging Programs and Courses
• Nine bridging programs and courses specifically for IPGs from across Canada were identified and documented. These vary from intensive university-based programs to OSCE preparatory courses.
• Bridging programs and courses are generally seen as beneficial to the IPGs who participate in them.
• Not all IPGs have access to the existing bridging programs. The existing programs are not available in many areas of the country, and those that exist can be prohibitively expensive.
• A large proportion of IPGs feel they do not need to take bridging programs.
Working in Canada
The majority of IPGs (78%) expect that they will eventually work as pharmacists in Canada, and the majority have tried to work as either pharmacists (72%) or as pharmacy technicians (61%) since arriving in Canada. Despite the many challenges of settling in a new country and becoming licensed to practice as pharmacists, 70% of surveyed IPGs reported that they had worked as pharmacists in Canada at some point since settling in Canada.
Almost half (46%) of IPGs also indicated that they had at some point worked as pharmacy technicians since settling in Canada. This is sometimes an interim step on the path to becoming a pharmacist, or as a second choice if they have not been able to realize their goal of working as a pharmacist in Canada. Others have chosen to work in the
pharmaceutical industry where license/registration is not generally required.
Further, 44% of pharmacy employers indicated that they had hired at least one IPG during the past three years. Employers generally offer employment to IPGs who are permanent residents (landed immigrants), or to those who have become Canadian citizens.
Employers also typically offer employment most often to IPGs who have successfully completed the PEBC Evaluating Exam, or have been practising in Canada for up to five years. Over one-third of employers however indicated that they were not aware of the immigration status (25%) or the stage in the licensure process (12%) of IPGs they have hired.
IPGs are finding employment in all types of pharmacies, including chain, banner, or franchise pharmacies (51% of IPGs who had been employed in Canada);
independent community pharmacies (34%); health care facilities (12%); or other types of pharmacies (2%).
While IPGs are often employed in larger cities, a significant proportion of IPGs find work in mid-size or smaller cities as well. Only 37% of IPGs who have worked as a pharmacist in Canada reported that their pharmacy was located in a city of more than 500,000 people, with the remainder being in smaller centres. Many IPGs are resettling within Canada to work as pharmacists: 31% of IPGs who had worked as pharmacists had to move from where they first settled in order to find employment as a pharmacist. While many IPGs who settle in smaller centres for work thrive in their new communities, some are more comfortable in larger centres, where they more often have the support of their cultural and/or religious communities.
Employers also do not generally appear to see particular benefits to hiring IPGs over domestic graduates. However, a somewhat higher proportion of employers agreed than disagreed (39% versus 17%) that IPGs are generally more experienced than new Canadian graduates. Employers do not generally agree that IPG employees provide access to new patients/clients (24% agreeing versus 27% disagreeing), and there appears to be limited awareness of the cultural benefits that IPGs can bring to pharmacies.
Employers do not generally appear to feel that IPGs require more time to supervise or train than domestic graduates. While key informants felt that this can be a concern for employers, and particularly for preceptors, this was not evident in the employer survey results. Most employers who reported that they had not hired any IPGs stated that this was largely the result of not having had any recent open positions or any IPG applicants. Still, most employers felt that barriers to success for IPGs did exist, particularly related to language and communication skills. The top barriers to IPGs’ success identified by employers were lack of proficiency in communicating effectively with patients and clients (67% of employers stated it was a barrier for IPGs), lack of proficiency in spoken English or French (66%), lack of proficiency in written English or French (60%), and lack of proficiency in communicating effectively with other pharmacy staff and other health care providers (55%).
The changing, and expanding, role of pharmacists in the Canadian health care system was also often cited as a challenge for IPGs. The current pharmaceutical care model in Canada requires a high level of patient consulting and advising, and many IPGs are typically not trained to practise according to this model.
Summary of Working in Canada
• Despite the challenges of licensure and settling in Canada, most IPGs appear to be finding work in pharmacy.
• Many IPGs are finding work as pharmacy technicians in Canada, often either as an interim step in the process of becoming pharmacists, or because of difficulties becoming licensed or finding employment as pharmacists.
• While IPGs face many challenges to success in the Canadian pharmacy workforce, communication skills are seen by employers as particularly severe barriers. • Differences in the culture of pharmacy practice are also perceived as significant
challenges to IPG success. The role of pharmacists in Canada is often different than in other countries, leading IPGs to have to adapt to new professional roles and
responsibilities.
Overview of Moving Forward: Pharmacy Human
Resources for the Future
One of the most urgent crises facing Canada’s health care system today is the appropriate management of health human resources. Pharmacists are a high-priority health human resource at many levels — involving patient care, drug supply management, health
institutions, the health system and population health needs. Pharmacists have a key role to play at all these levels in ensuring pharmaceuticals are used appropriately, safely and provide optimal benefits.
Serious challenges are facing the pharmacy sector’s efforts to optimize the management of its available human resources. These include the evolution of pharmacists’ and pharmacy technicians’ role in health care delivery, recruitment and retention difficulties and
complexities in integrating international pharmacy graduates. A failure to address pharmacy human resource challenges will compromise the ability of the profession to respond to these new demands and its ability to fully address the safe and appropriate use of drugs in Canada. There is, therefore, an urgent need to understand the factors
contributing to these human resources pressures and strategize potential solutions. A collaborative of eight national pharmacy stakeholders, including the Canadian
Pharmacists Association (secretariat for the project), the Association of Deans of Pharmacy of Canada, the Association of Faculties of Pharmacy of Canada, the Canadian Association of Chain Drug Stores, the Canadian Association of Pharmacy Technicians, the Canadian Society of Hospital Pharmacists, the National Association of Pharmacy Regulatory
Authorities and the Pharmacy Examining Board of Canada has partnered together to carry out Moving Forward: Pharmacy Human Resources for the Future. Funded by the
Government of Canada’s Foreign Credential Recognition Program, Moving Forward is an
in-depth examination of the factors contributing to pharmacy human resources challenges in Canada. It will offer recommendations to ensure a strong pharmacy workforce
prepared to meet the current and future health care needs of Canadians. Through a series of investigations and consultations, Moving Forward will:
• Develop a comprehensive understanding of the pharmacy workforce in Canada and the factors that influence its structure and the skills and competencies of its members; • Identify and analyze the short- and long-term human resource planning challenges
facing the pharmacy sector, including those specific to IPGs, and • Offer recommendations for these challenges.
The optimal management of pharmacy human resources requires more than just
information; it requires planning. The recommendations developed by Moving Forward
will be used by stakeholders at local, regional, provincial, territorial and national levels to develop their pharmacy human resources management plans. The findings contained in this report represent the results of Moving Forward’s research on the Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators.
Acknowledgements
The Moving Forward partners would like to express their appreciation to all the
individuals whose participation in this research contributed to its success. Moving Forward wishes to especially thank the many people who kindly took the time to
participate in surveys, focus groups, and interviews.
This research study was conducted by R.A. Malatest & Associates Ltd. and Ms. Marie Rocchi. Invaluable assistance was provided by the Pharmacy Examining Board of Canada and the Ontario College of Pharmacists. The researchers were assisted by the Moving Forward Management Committee, National Advisory Committee, an IPG Working Group
and numerous expert advisors. These contributors include:
Management Committee
Kevin Hall (Moving Forward Co-Chair), Winnipeg Regional Health Authority
Fred Martin (Moving Forward Co-Chair), West Prince Pharmacy
Zubin Austin, Association of Faculties of Pharmacy of Canada Patty Brady, Human Resources and Social Development Canada Janet Cooper, Canadian Pharmacists Association
Tim Fleming, Canadian Association of Pharmacy Technicians Dennis Gorecki, Association of Deans of Pharmacy of Canada
Ray Joubert, National Association of Pharmacy Regulatory Authorities Paul Kuras, Canadian Pharmacists Association
Allan Malek, Canadian Association of Chain Drug Stores Linda Suveges, The Pharmacy Examining Board of Canada Ken Wou, Canadian Society of Hospital Pharmacists
National Advisory Committee
Sandra Aylward, Sobeys Pharmacy Group
Danuta Bertram, Winnipeg Regional Health Authority Paul Blanchard, New Brunswick Pharmacists Association Anne Marie Burns, Ottawa Hospital
Lynda Buske, Canadian Medical Association Jean-François Bussières, Hôpital Sainte Justine Nicolas Caprio, Shoppers Drug Mart
Deborah Cohen, Canadian Institute for Health Information
Omolayo Famuyide, Canadian Association of Pharmacy Students and Interns Rock Folkman, Canadian Pharmacy Technician Educators Association
Anne Marie Ford, Ford’s Apothecary
Michael Gaucher, Canadian Agency for Drugs and Technologies in Health Aline Johanns, New Brunswick Department of Health
Nadine Lacasse, Sebastien Aubin et Nadine Lacasse Pharmaciens Manon Lambert, Ordre des pharmaciens du Québec
Lisa Little, Canadian Nurses Association
Jonathan Mailman, Canadian Association of Pharmacy Students and Interns Ron McKerrow, British Columbia Provincial Health Services Authority Colleen Norris, Glebe Pharmasave
Acknowledgements
Bonnie Palmer, Shoppers Drug MartNoman Qureshi, International Pharmacy Graduate Alumni Association Michelle Rousel, New Brunswick Department of Health
Chris Schillemore, Ontario College of Pharmacists Brenda Schuster, Regina Qu’Appelle Health Region Jane Wong, Canadian Healthcare Association
IPG Working Group and Advisors
Josiah Akinde, International Pharmacy Graduate
Mohja Alia, Metropolitan Immigrant Settlement Association Nicky Corkum, IWK Health Centre
Catherine Ekeland, University of British Columbia Brian Hunjan, International Pharmacy Graduate Sandi Hutty, University of British Columbia Wendy Lack, Shoppers Drug Mart
Ruth MacKenzie, Yukon Government
Anik Minville, Ordre des pharmaciens du Québec Mustapha Olajuwon, International Pharmacy Graduate John Pugsley, The Pharmacy Examining Board of Canada Myrella Roy, Canadian Society of Hospital Pharmacists Shiva Justin Singh, International Pharmacy Graduate Julia Stanbridge, Bredin Institute
Farzhad Valankani, International Pharmacy Graduate Cibele Walsh, International Pharmacy Graduate
Project Staff
Heather Mohr, Project Manager Kelly Hogan, Research Coordinator
Acronyms Used in this Report
ACPE Accreditation Council for Pharmacy Education
CAP Comité d’admission à la pratique
CIC Citizenship and Immigration Canada
CIIP Canadian Immigration Integration Project
CP3 Canadian Pharmacy Practice Programme
CPhA Canadian Pharmacists Association
CPS Canadian Pharmacy Skills program
CSHP Canadian Society of Hospital Pharmacists
ELT Enhanced Language Training
IEHPI Internationally Educated Health Professionals Initiative
IELTS International English Language Testing System
IPG International Pharmacy Graduate
MISA Metropolitan Immigrant Settlement Association
NAPRA National Association of Pharmacy Regulatory Authorities
OCP Ontario College of Pharmacists
OSCE Objective Structured Clinical Examination
PEBC Pharmacy Examining Board of Canada
TOEFL Test of English as a Foreign Language
UBC University of British Columbia
Introduction
Background to the Project
Pharmacists are a major component of the Canadian health care system, making up the third-largest segment of health care professionals in Canada.1 There are approximately
30,250 licensed pharmacists in Canada.2Three-quarters (75%) of practising pharmacists
work in community practice, 15% work in health care facilities (including hospitals and health clinics), and the remaining 10% work in universities, pharmaceutical companies, government departments, associations, and other organizations.3
While the Canadian faculties of pharmacy produce approximately 900 graduates each year,4 Canada’s pharmacist workforce draws heavily on individuals who were educated
outside of Canada to meet pharmacy labour market demands. There is currently no comprehensive source of data on the number or proportion of internationally trained pharmacists in the Canadian pharmacy workforce. However, recent data from the
Canadian Institute of Health Information report that the percentage of practising, licensed pharmacists who obtained their pharmacy education outside of Canada (or the United States of America) is 27% in Ontario and 8% in Alberta.5 While these statistics are not yet
available for other provinces and territories, internationally trained pharmacists, commonly known as International Pharmacy Graduates (IPGs), represent a significant portion of the pharmacist workforce in Canada.
For the purposes of this study, IPGs are defined as individuals who completed their undergraduate pharmacy education, or obtained their licence to practice, outside of Canada or the United States of America. IPGs often face many challenges in integrating successfully into Canadian pharmacy practice. Evidence suggests that these challenges include a lack of fluency in English or French, a lack of understanding of disease states or treatments that they may not have encountered in their country of origin, and general difficulties in communicating with patients and other members of the health care team in settings where professional and cultural norms may be different from what they are accustomed to. A lack of clinical applied knowledge and of practical experience have also been noted as important challenge.6
Research suggests that Canada is experiencing a strong demand for pharmacists. One estimate suggests that there are vacancies for approximately 2000 pharmacists across Canada, with approximately half of these vacancies in Ontario. While anecdotal reports suggest that the demand for pharmacists has decreased in recent years, many pharmacies,
1. Poston, J. International Pharmacy Graduates: Briefing to the Standing Committee on Citizenship and Immigration. Canadian Pharmacists Association, March 10, 2005.
2. National Association of Pharmacy Regulatory Authorities. National Statistics. Available from: http://www.napra.org/docs/0/86/363.asp. Accessed September 19, 2007.
3. Poston, J. International Pharmacy Graduates: Briefing to the Standing Committee on Citizenship and Immigration. Canadian Pharmacists Association, March 10, 2005.
4. Austin, Z, Rocchi Dean, M. Bridging education for foreign-trained professionals: the International Pharmacy Graduate (IPG) Program in Canada. Teaching in Higher Education. Jan 2006;11(1):19-32.
5. Canadian Institute for Health Information, Pharmacist Database, 2006 data.
6. Austin, Z, Rocchi Dean, M. Bridging education for foreign-trained professionals: the International Pharmacy Graduate (IPG) Program in Canada. Teaching in Higher Education. Jan 2006;11(1):19-32.
particularly in smaller cities and towns outside of the major urban areas, struggle to fill their vacant positions. Demand for pharmacists is strong for a number of reasons,
including the high numbers of retiring pharmacists and the expansion of chain drug stores offering extended hours of service.7 Furthermore, the demand for pharmacists is likely to
remain strong in the future: the aging of he baby boomer generation, the introduction of new drug therapies, and the overall increased demand for health services are all likely to heighten the need for pharmacists.
This demand for pharmacists mirrors a nationwide shortage of health care workers. Shortages in health human resources are so prevalent that the federal government has initiated a Pan-Canadian Health Human Resources Strategy aimed at increasing the recruitment and retention of health professionals. An integral part of this strategy is the Internationally Educated Health Professionals Initiative (IEHPI), designed to reduce the barriers to practice for internationally educated health professionals to enable them to successfully integrate into the Canadian health workforce.
As Canadian health care evolves to support new roles and responsibilities for pharmacists, ensuring that IPGs are fully prepared for a career of pharmacy practice in Canada becomes more critical.
Purpose and Scope of Study
Anecdotal evidence has long suggested IPGs face challenges to successful integration in the Canadian pharmacy workforce. The results and findings of this study provide a body of work that will identify and describe the challenges faced by IPGs, and offer information that can be used to address these challenges.
Specifically, the research is intended to provides:
• A comprehensive picture of IPGs in Canada, including their demographic profile, countries of origin, and their employment status and goals;
• An understanding of the information, supports, and programs that are available to IPGs, and the perceived effectiveness of these resources;
• An understanding of the challenges facing IPGs in obtaining their license to practice, and practising, as pharmacists, and
• An understanding of what additional supports could help IPGs to successfully integrate into pharmacy practice.
This project resulted in three major deliverables:
• This integrated research report, detailing the findings and conclusions from all research activities;
• A detailed inventory of the bridging programs and courses available to IPGs, and • A Road Map, detailing the steps IPGs take in the process of becoming licensed to
practice as pharmacists in Canada, and the resources available at each step.
7. Austin, Z, Rocchi Dean, M. Bridging education for foreign-trained professionals: the International Pharmacy Graduate (IPG) Program in Canada. Teaching in Higher Education. Jan 2006;11(1):19-32.
Overview of Report
This report outlines the detailed results and key findings based on the available research. Following a short overview of the research approach and methodology, the report is structured to follow the major stages in the process of integrating into the Canadian pharmacy workforce.
The first section of findings, Settling in Canada, provides a profile of IPGs settling in Canada, details the expectations of IPGs in coming to Canada, and discusses what sources of information they use when deciding to come to Canada.
Licensing and Registration presents findings related to the process of IPGs becoming
licensed or registered to practice as pharmacists in Canada.
The third section, Bridging Programs, summarizes the programs available for IPGs, discusses their perceived effectiveness, and looks at gaps in supports for IPGs.
Finally, Working in Canada provides findings on the extent to which IPGs are finding employment in Canada, on employer perceptions of working with IPGs, and on what is helping or hindering the successful integration of IPGs into pharmacy practice.
The report then presents a summary of Key Findings based on the research. The report also includes, as Appendices, a bibliography as well as data collection instruments for the project.
Section 1: Research Approach and Methodology
Research Design
The Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators is a comprehensive study involving multiple research
components. The study examines the issues facing IPGs from a variety of sources, and includes both primary and secondary data.
The information in this report represents a synthesis of information obtained through mixed-mode surveys of IPGs and pharmacy employers, interviews with key stakeholders, focus groups with IPGs and employers, as well as a literature and statistical review. Where possible, triangulation of sources is used to demonstrate the extent to which findings are consistent or different across data sources.
Specific Research Components
Surveys
Survey of International Pharmacy Graduates
Surveys were undertaken with IPGs from across Canada in order to gather data on their experiences since deciding to settle in Canada, and their perspectives on Canadian pharmacy workforce integration. A total of 1067 IPGs completed survey questionnaires for the study.
IPGs were contacted about the survey using a variety of methods. Over 2100 postage-paid postcards and survey information letters were mailed from the Pharmacy Examining Board of Canada (PEBC) to international pharmacy graduates currently active within the PEBC
Province Number % of Total Surveys
Ontario 887 83% Alberta 64 6% British Columbia 45 4% Quebec 43 4% Manitoba 12 1% Saskatchewan 6 1% Nova Scotia 5 1% New Brunswick 4 0.4%
Newfoundland and Labrador 1 0.1%
Prince Edward Island 0 0%
Territories 0 0%
Total 1,067 100%
Figure 1—1
certification process. IPGs interested in participating in the survey were asked to provide their name and contact information on the postcard provided and place it in the mail. These postcards were returned to the consultant, and IPGs who had responded were contacted by telephone to participate in the study.
The study was also publicized by the Canadian Pharmacists Association (CPhA), the
Canadian Society of Hospital Pharmacists (CSHP), the Canadian Association of Chain Drug Stores (CACDS), and the provincial pharmacy regulatory authorities using email notices, posting of information about the survey on their websites, and advertisements in
newsletters. As a result, many IPGs contacted the consultant directly in order to participate in the surveys and focus groups. Finally, the Ontario College of Pharmacists (OCP) provided the consultant with contact names of approximately 2700 provincially licensed IPGs in Ontario.
The survey questionnaire was available in English and French versions, and the questionnaire underwent a plain language review prior to distribution.
All IPGs interested in participating in the study were given multiple methods of
completing the survey questionnaire. IPGs had the option of completing the survey by mail, fax, online, or over the telephone. In all 1067 surveys were completed.
Employer Survey
Surveys were undertaken with pharmacy managers/owners, directors, and human resources managers from across Canada. The survey addressed the extent to which pharmacies have employed IPGs, and their perspectives on what challenges IPGs face.
Province Number % of Total Surveys
Ontario 106 34% Alberta 44 14% British Columbia 31 10% Quebec 47 15% Manitoba 18 6% Saskatchewan 15 5% Nova Scotia 12 4% New Brunswick 12 4%
Newfoundland and Labrador 13 4%
Prince Edward Island 10 3%
Territories 7 2%
Total 315 100%
Figure 1—2
In May 2007, 1014 survey packages containing a cover letter, frequently asked questions, and a copy of the survey were mailed out to a sample of pharmacy employers across Canada. The names and addresses of these employers were obtained from a mailing list provided by Dendrite. Dendrite, (formerly Synavant), has compiled a list of all pharmacists in Canada practicing in hospital or retail. This list was cross-referenced against a database obtained from CSHP and, where there were differences, the contact names and addresses of the CSHP database were used. As a result of the relatively low number of Quebec hospital pharmacies in the Dendrite sample, additional hospital pharmacy directors from Quebec were added, using the list provided by CSHP. As with the survey of IPGs,
respondents had the option of completing the survey in French or English, and by mail, fax, online, or by telephone, and the surveys were publicized through CPhA, CSHP, CACDS and the provincial pharmacy regulatory authorities.
A total of 315 surveys were completed by employers. Among those respondents, 51% were employed in chain, banner or franchise drug stores, 29% in independent pharmacies, 19% in health care facilities, and 1% in other types of organizations.
Based on the overall population of 8053 pharmacies reported by the National Association of Pharmacy Regulatory Authorities (NAPRA), the survey has a margin of error of ±5.4%, 19 times out of 20.
Qualitative Research Components
Key Informant Interviews
Semi-structured key informant interviews were undertaken with a wide range of
stakeholders involved in pharmacy across Canada. A total of 37 in-person and telephone key informant interviews were conducted, with representatives from 10 bridging programs
Figure 1—3
Percentages of Employer Survey Respondents by Type of Pharmacy
Source: Employer Survey Q9 n=315 51% 19% 29% 1% other Independent pharmacy
Chain, banner or franchise drug store
Health care facility
Source: Employment survey Q9 n=315
and courses, and with 27 representatives from provincial pharmacy regulatory authorities, national and provincial pharmacy associations, large pharmacy chains, and settlement and support agencies. Questionnaires for these key informant interviews were developed by the consultant, were reviewed by the working group, and contained both quantitative (close-ended) and qualitative (open-ended) questions looking at a variety of topics, including licensing, bridging programs and courses, and working in Canada.
Following the completion of interviews with the providers of bridging programs and courses, nine fact sheets were developed that detailed bridging programs and courses, currently offered in Canada for IPGs.8 These fact sheets represent a current inventory of
bridging programs and courses available to IPGs in Canada. To ensure accuracy, these fact sheets were verified by the program/service managers.
Focus groups
Once preliminary analysis of the surveys and interviews had been conducted, six focus groups were held with employers (two groups), and with IPGs (four groups), to further explore the research issues. Focus groups were conducted in Toronto, Montreal and Edmonton. Participants were recruited from among those survey respondents who indicated an interest in taking part in a focus group. To supplement this group, additional pharmacies in Toronto and Edmonton were contacted to identify and invite further employer or IPG participants. Potential focus group participants were also identified through the project’s IPG Working Group and the project team’s Expert Advisor Marie Rocchi.
The Consultant recruited a mixture of participants for the focus groups. Eligible IPG participants included individuals who had completed their undergraduate pharmacy education outside of Canada and who were working as pharmacists in Canada, currently pursuing licensure in Canada, or were no longer pursuing their licence. Eligible
employers included managers and owners who had hired and/or who currently employed an IPG, as well as those who had not.
Literature and Statistical Review
Reports and academic literature of relevance to the study were reviewed to obtain an
understanding of the issues surrounding the integration of IPGs into the Canadian pharmacy workforce and in order to inform the development of survey instruments for this study. A listing of the articles/publications reviewed as part of this study is provided in Appendix A. In addition, the Consultant reviewed statistical data of relevance to the study. For example, data was obtained from Citizenship and Immigration Canada (CIC) on the number of individuals coming to Canada as permanent residents declaring their intention to work as pharmacists.
The Consultant also obtained detailed statistics from PEBC’s exam management system database on both the number of unique IPGs and domestic graduates attempting and successfully completing the PEBC Document Evaluation and Evaluating and Qualifying
8. Although the Consultant conducted 10 interviews with bridging and support program providers, nine fact sheets were prepared for programs specifically relevant to IPGs.
Examinations for the years 2002 to 2006. These statistics were obtained based on the final attempt recorded by the PEBC of any IPG for each certification step; therefore each attempt represents one unique individual. However, as statistics were not captured beyond 2006, it is expected that a certain number of IPGs who were unsuccessful at their exam attempts may have gone on to make further attempts beyond the end of the data tracking period. This is especially true of those IPGs making their recorded attempts in the later years of the studied time period. The number of IPGs who have indeed gone on to make later attempts is not known.
In addition to statistics on individual IPG candidates, the PEBC also provided statistics illustrating the “pass rates” of IPGs for each examination sitting. According to the PEBC, pass rate is calculated per exam sitting by dividing the total number of exams written per sitting by the number of exams which were successfully passed. These statistics do not distinguish between individual IPGs over sittings, and care must be taken when using these statistics to illustrate performance by pass rates over multiple years.
Research Considerations
The Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators used a variety of data sources and types of
information in order to assure that its findings were based on defensible and
comprehensive information. However, some limitations of the research should be noted. A large proportion of IPGs were identified through the PEBC and the provincial pharmacy regulatory authorities. As a result, most IPGs surveyed for the project had either attempted to obtain certification for licensure through the PEBC or were licensed to practise as a pharmacist. While some IPGs were informed through word of mouth and through referrals from settlement services and other venues, those IPGs in Canada who have not attempted to become licensed as pharmacists are likely under-represented in the survey responses. The extent to which the survey respondents are representative of all IPGs in Canada is not known.
While the surveys were publicized across Canada through the national and provincial pharmacy associations and the provincial pharmacy regulatory authorities, the ability to undertake a direct mail-out of the surveys to IPGs licensed through OCP and the inability to do so in other provinces has likely resulted in IPGs in Ontario being over-represented among survey respondents. Further, those IPGs in Quebec, where pharmacists are not required to be certified to practice through the PEBC, are likely somewhat under-represented.
Only a small number (1%) of American-educated IPGs responded to this survey. This percentage should not be seen as necessarily representative of the number of American-educated pharmacists in Canada. While the definition of IPG used for this study was inclusive of American-educated pharmacy graduates, the study was not marketed to this group. Similarly, IPGs from the United States are exempt from the Evaluating Exam and, as such, they are not included in the PEBC statistics on these examinations displayed in the report.
Finally, findings from the six focus groups represent the views of a limited number of IPGs and employers. While illuminating, the views of focus group participants should not be seen as necessarily representative of all IPGs and employers.
Section 2: Findings
Settling in Canada
Profile of IPGs Settling in Canada
In 2006, 426 permanent resident immigrants came to Canada with the declared intention of working as a pharmacist.9This figure includes only those immigrants coming to Canada
under the economic class and excludes those coming under family class (including being sponsored by a family member) who are not required by CIC to declare their intended occupation.10 This number also does not include temporary workers or those economic
class immigrants intending to work as pharmacy technicians or assistants.
The majority (60%) of these individuals were destined for Ontario, with British Columbia (15%) and Quebec (14%) being the next two most common provinces of destination in 2006. Over the period 1996 to 2006, British Columbia, Quebec and Alberta alternate as the second and third most popular destination provinces. The number of permanent resident immigrants with the intention to work as pharmacists showed overall growth in the years from 1996 to 2006.
Province/Territory of
Destination 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Newfoundland and Labrador — — — — — — — 0 0 — —
Prince Edward Island 0 0 0 0 0 0 0 — 0 0 —
Nova Scotia 5 9 — — — — — — — — — New Brunswick 0 0 — 0 — — — 0 0 — — Quebec 19 16 17 14 16 21 41 66 77 67 58 Ontario 220 260 197 204 314 340 421 313 310 364 257 Manitoba 6 9 5 6 10 5 6 8 — 10 — Saskatchewan — — — — — 0 — 0 0 — — Alberta 14 14 21 15 16 17 22 14 33 31 36 British Columbia 47 52 41 38 43 60 52 45 56 68 63 Yukon — 0 0 0 0 0 0 0 0 — 0 Province or territory not stated 0 0 0 0 0 0 0 0 0 0 0 Total 316 364 291 281 405 452 548 451 489 534 426
Figure 2—1
Number and Province/Territory of Immigrants to Canada — Permanent Residents,
Economic Class, with Intention to Work As Pharmacists in Canada (1996-2006)
Source: Citizenship and Immigration Canada, Facts & Figures 2006.
Note: Due to privacy considerations, some cells have been suppressed and replaced with the notation "—".
As a result, components may not sum to the total indicated. In general, suppressed cells contain less than five cases.
9. This number represents those indicating to CIC that they intended to work as pharmacists after immigrating; the extent to which this reflects their actual goals is not known.
According to the survey of IPGs undertaken for this study, IPGs immigrating to Canada commonly received their undergraduate pharmacy education in Southeast Asia (30%) or the Middle East (26%). Other common areas of education were Europe (excluding the United Kingdom) (12%), Africa (11%), and the United Kingdom (11%).
While most IPGs come to Canada with undergraduate degrees, a significant proportion of IPGs also have postgraduate pharmacy degrees. 14% of surveyed IPGs indicated that they had completed a master’s degree, 8% had completed a PharmD degree, and 3% had completed a PhD. It is not known if these reported graduate degrees were entry-to-practice requirements in the IPG’s country of origin.
Generally, IPGs appear to have experience working as pharmacists in their countries of origin. The majority (85%) of surveyed IPGs indicated that they had practised as
pharmacists before settling in Canada. About one-half (49%) of IPGs had primarily practised as pharmacists in community pharmacies, while 18% had practised in the pharmaceutical industry, and 16% had practised in a hospital. Eleven per cent of IPGs had experience in more than one area of practise before coming to Canada. The remainder indicated that they had primarily practised in government, academic institutions, the military, or in fields of practice.
11. Although a small portion of American graduates responded to the IPG survey, they were not part of the target sample. This percentage is not intended to reflect the percentage of American pharmacy graduates in the Canadian pharmacy workforce.
Area %
Southeast Asia (e.g., the Philippines, India, Pakistan, Bangladesh) 30% Middle East (e.g., Egypt, Israel, Iran) 26%
Europe (Not including the UK) 12%
Africa 11%
United Kingdom 11%
Other Asia (e.g., Japan, Korea) 3%
China 2%
Russia and Commonwealth of Independent States 2%
United States of America11 1%
Australia 1%
Caribbean (e.g., Trinidad and Tobago, Jamaica, West Indies) 1%
South America 1%
Figure 2—2
Areas of the World Where IPGs Completed their Undergraduate
Pharmacy Education
n=1,067
Source: IPG Survey Q2
The PEBC Evaluating Examination is a necessary step in the process of licensure for all provinces except Quebec, and the available statistics on its candidates provide a profile of many IPGs in Canada. In 2006, one-half (50%) of IPG PEBC Evaluating Exam candidates were 31 to 40 years of age. Those 20 to 30 years of age were the second most common group (26%), followed by those 41 to 50 years of age (20%).
IPGs attempting the Evaluating Exam were almost evenly split between men and women, with 52% of candidates being female and 48% being male.
Primary Area of Practice %
Community 49%
Pharmaceutical industry 18%
Hospital 16%
Multiple areas of practice 11%
Government 3%
Academic institution 3%
Military 1%
Other 1%
Figure 2—3
Primary Area of Practice of IPGs Before Settling in Canada
n=902
Source: IPG Survey Q4b.
Figure 2—4
IPG Evaluating Exam Candidates by Age (2006)
Source: PEBC Exam Management System Database
50% 26% 20% 4% 20-30 31-40 41-50 51-60
Deciding to Settle in Canada
Decisions on where to initially settle in Canada are being made by IPGs based on a number of factors. IPGs in the focus groups in Toronto and Edmonton stated that
decisions were based on where family and friends were located, and on their perception of where job opportunities may be. In many cases, the fact that friends and family from their countries of origin were already residing in a particular city was felt to make
integration into that community easier. In other cases, IPGs settled in communities where they already had opportunities to work, or where their spouses had found a job.
For the majority of the focus group participants in Montreal, fluency in the French language was the major deciding factor in their decision to settle in the province of Quebec. As francophones, they felt it was logical to settle in Montreal. As one IPG stated, “On se réalise mieux dans un endroit où on peut communiquer aver les gens” [you can better reach your potential in a place where you can communicate with others]. Not only did IPGs in Montreal feel that their ability to communicate in French would help their own personal and
professional integration, but that it would ease the integration of their spouses and children. Many IPGs felt that settling in a large city was a natural choice. One IPG stated that they felt that bigger cities would have more employment opportunities for them. Another stated that, as a member of an ethnic community, it is easier to find acceptance in a big city.
Expectations of IPGs in Settling in Canada
Over three-quarters (78%) of IPG survey respondents indicated that, when they first settled in Canada, they expected that they would, at some point, work as a pharmacist. The majority of IPGs in the focus groups in Edmonton and Toronto had planned to work as pharmacists, or, as a second-best option, as pharmacy technicians. A few participants had no specific expectations related to their own employment, as they were moving as a result of their spouse’s employment opportunities or plans. IPGs in the focus group in Montreal had somewhat different expectations than those in the focus groups in Ontario and Alberta; they generally did not expect to work as pharmacists immediately after settling in Canada. Many had been told that they would have to return to university in order to obtain equivalency with Quebec pharmacists.
Sources of Information
IPG respondents consult a variety of sources of information to help them make their decision to practice as a licensed/registered pharmacist in Canada. IPGs most commonly consult the PEBC (73%), friends or peers living in Canada (67%), provincial pharmacy regulatory authorities (55%), or family living in Canada (48%).
The three most common sources of information that IPGs found effective or very effective were the PEBC (44%), friends or peer living in Canada (43%), and the provincial pharmacy regulatory authority (30%).12 Of those IPGs who indicated another type of information consulted, most
stated they consulted the Internet (no particular site specified) or Canadian universities. IPGs in the focus groups identified the Internet as the most frequently used, and most useful, source of information for the purposes of deciding to settle in Canada. Like the IPG survey respondents, IPG focus group participants got information through the PEBC website, which was said to be useful. Others noted that they had also found useful information through the provincial pharmacy regulatory authorities’ websites.
Information Lacking in the Country of Origin
Many IPGs feel they did not have all the information they would have liked before settling in Canada. IPGs in the focus groups noted several information gaps, including the following: • A comprehensive, step-by-step overview of the process of becoming a pharmacist in
Canada, including what can be done to begin this process prior to coming to Canada. Some IPGs noted that they were not clear what documentation from their country of origin would be needed in Canada, and that this caused difficulties or delays later in obtaining university transcripts and other documents.
• Methods of connecting with other IPGs (such as through an online chat room or other web-based forum). This was felt to be critical in order to create realistic expectations of the licensing process.
• More information pertaining to the costs involved in licensure, the actual length of time required to become licensed, the degree of difficulty of the process, and details on particular requirements in different provinces.
% IPGs Who Consulted Effectiveness of Source (according to IPGs) Not Very Effective / Somewhat Effective Effective / Very Effective Don’t Know Pharmacy Examining Board of Canada
(PEBC) 73% 32% 60% 8%
Friends or peers living in Canada 67% 28% 64% 9% Provincial pharmacy regulatory authority 55% 32% 54% 54%
Family living in Canada 48% 31% 48% 20%
Pharmacy employer 41% 36% 43% 21%
Friends or peers living outside of Canada 41% 52% 30% 19%
Canadian embassy or consulate 39% 56% 26% 17%
Federal government of Canada 37% 52% 25% 23%
Family living outside of Canada 34% 43% 31% 26%
Pharmacy recruiter 31% 37% 30% 32%
Canadian Pharmacists Association (CPhA) 28% 44% 24% 32% Provincial government of Canada 26% 50% 19% 31% Other (e.g., Internet, Canadian
Universities) 97% 3% 9% 88%
Figure 2—5
Usage and Effectiveness of Available Sources of Information in Helping IPGs
Make their Decision to Practice as a Licensed/Registered Pharmacist
in Canada
n=1067
One key informant noted that the federal government has recently supported the provision of more comprehensive information at the country of origin through the Canadian Immigration Integration Project (CIIP). This federal program, managed through the Association of Canadian Community Colleges, has provided workshops and one-on-one counselling sessions in countries of origin for those coming to Canada through the federal Skilled Worker Program to help to create realistic expectations of the process of personal and professional integration in Canada. According to the project’s website, the CIIP is operated in sites in Guangzhou, China; New Delhi, India; and Manila, the Philippines.13
Licensing and Registration
In order to practise as a pharmacist, IPGs must become licensed (or registered, as the process is known in some provinces) to practise by the pharmacy regulatory body of their province.14 In all provinces except Quebec, the process of licensure for IPGs involves the
following activities (the order of which can vary by province):
• Successful completion of the PEBC Document Evaluation process, which verifies that the applicant has acquired a legitimate university degree from a program that is acceptable to PEBC, and includes a verification of the identity of the applicant; • Successful completion of the PEBC Evaluating Examination, which demonstrates
comparability of academic preparation in pharmacy;
• Demonstration of sufficient levels of English or French language fluency as defined by standardized tests such as the Test of English as a Foreign Language (TOEFL) or others;
• Successful completion of an in-service apprenticeship period, known as structured
practical training, under the supervision of a qualified pharmacist;
• Successful completion of the PEBC Qualifying Examination Part I, which involves a written test of clinical knowledge;
• Successful completion of the PEBC Qualifying Examination Part II, the Objective
Structured Clinical Examination (OSCE). The OSCE (introduced in 2001) involves
candidates undertaking 16 seven-minute simulated patient interviews, or
non-interactive stations, in order to test communication skills, clinical judgement and problem solving and ethical decision making, and
• Successful completion of a provincial examination related to pharmacy jurisprudence. Domestic pharmacy graduates are also required to complete a structured practical training period, the PEBC Qualifying Examination Parts I and II, and a provincial jurisprudence examination. Graduates of American pharmacy programs are exempted from undergoing the PEBC Evaluating Examination.
The PEBC is the certification body for the pharmacy profession in all provinces except Quebec, and is responsible for the assessment of graduates on behalf of participating provincial pharmacy regulatory authorities. Candidates (both IPGs and domestic graduates) can make three attempts at the PEBC examinations, and the Board will consider a request to attempt examinations a fourth time if the candidates are able to present acceptable evidence of continuing education units, course work (for the Qualifying Exam Part I) or practical experience in pharmacy (for the Qualifying Exam
13. Canadian Immigration Integration Project. Available from: http://ciip.accc.ca/default.aspx?DN=782,32,Documents. Accessed September 29, 2007.
Part II). If candidates are unsuccessful in their fourth attempt, the PEBC Board does not permit any additional attempts and the candidate cannot proceed further in the PEBC certification process.
The licensing process for IPGs15 in Quebec is significantly different than in other
provinces. In Quebec, academic qualifications are assessed on a case-by-case basis by a practice admissions committee (Comité d’admission à la pratique [CAP]) of the Ordre des pharmaciens du Québec. On the basis of the CAP assessment, IPGs are required to
complete university pharmacy courses in Quebec at one of the province’s two university pharmacy faculties, University of Montreal or Laval University in order to be considered equivalent in their education to Quebec pharmacy graduates. The licensure process requires the successful completion of these courses as well as demonstration of French language fluency and the completion of the required number of structured practical training (600 hours).
The pharmacy regulatory authority in Ontario also requires the completion of an IPG bridging program (available through U of T) as a requirement for licensure. It is currently the only province to include this requirement in addition to PEBC certification. This will be discussed in greater detail in the section discussing pharmacy bridging programs for IPGs. Information About the Licensure Process
IPGs generally become informed about the various steps in the licensure process through the Internet and/or through the PEBC. Additionally, some areas of the country have developed specific resources to help IPGs to understand and manoeuvre through the licensing and registration process. For example, the Ontario College of Pharmacists (OCP) and the province of Ontario host a website designed for new pharmacists
(www.newontariopharmacist.com). The site provides relevant information on the licensing process in that province, including a fact sheet and frequently asked questions section. In Nova Scotia, the Metropolitan Immigrant Settlement Association (MISA)
produces a “welcome package” for new IPGs that provides step-by-step information on the licensing process in that province.
Number of IPGs Seeking Licensure
In 2006, 801 IPGs (excluding US graduates) successfully completed the PEBC Document Evaluation, the first step in the licensing process in all provinces except Quebec.16As seen
in Figure 2-6, among those IPGs successful in their Document Evaluation, most were from Southeast Asia (43%) (most commonly India, the Philippines, Pakistan), or the Middle East (30%) (most commonly Egypt, Iran, Jordan).
The number of IPGs undertaking each of the steps of the PEBC certification from 2002 to 2006 is shown in Figure 2-7. Variations in annual totals of individuals attempting exams is likely due to several factors, including difficulties on the part of IPGs in immigration procedures,
immigration fluctuations due to external factors, or IPGs choosing careers not requiring a pharmacy license. In particular, it should be noted that the Qualifying Examination Part II did not exist prior to 2001, thus affecting the number of individuals attempting this exam for the first time.
15. Including those trained in the United States of America
An annual average of the number of unique IPGs attempting each step during the time period studied is also provided. Annually, an average of 876 unique IPGs submit documents for Evalua -tion, 694 unique IPGs attempt the Evaluating Examination, 524 unique IPGs attempt the
Qualifying Examin ation Part I and 433 attempt the Qualifying
Examination Part II.
The majority of IPG survey respondents (72%) indicated that they had their licence/ registration to practise as a pharmacist in a Canadian province. Licensed IPGs in the survey indicated a wide range of estimated amounts of time required for them to complete the licensing/registration process. As shown in Figure 2-8, while about one-quarter (24%) of IPGs completed their licensure in one year or less, 58% required two years or more. The average amount of time to complete licensure was 26 months, and the median time was 24 months. (The average length of time did not vary significantly when analyzing responses from IPGs in different areas of the country, although the number of responses was limited from many provinces.)
Year 2002 2003 2004 2005 2006 Total
(2002–06)
Annual Average Submitting Documents Evaluation 994 783 952 854 801 4,384 876 Attempting Evaluating Exam 531 657 787 753 754 3,482 694 Attempting Qualifying Exam Part I 323 449 518 626 704 2,620 524 Attempting Qualifying Exam Part II 254 382 446 459 626 2,167 433
Figure 2—7
Number of Unique IPG Attempting Each of the PEBC Certification Steps (2002-2006)
Source: Pharmacy Examining Board of Canada
“Unique IPGs” refers to the number of single individuals attempting any of the PEBC examination or document evaluation process. Numbers of unique IPGs are obtained by tracking only the final attempt made by an IPG on any exam, whether it be pass or fail, during the years 2002 to 2006. Final attempt includes both the single, non repeated attempts of each unique indi-vidual, as well as the final attempt of multiple attempts by each unique indiindi-vidual, whether it be that individuals 2nd, 3rd or 4th attempt) Any attempts beyond 2006 are not captured, therefore there is likely a certain number of IPGs who have gone on to make a later attempt at any of the examinations post 2006 and are therefore captured in the wrong category in this table.
Area # %
Southeast Asia (e.g., the Phillippines,
India, Pakistan, Bangladesh) 348 43.4% Middle East (e.g., Egypt, Israel, Iran) 244 30.5% Europe (Not including the UK) 27 3.3%
Africa 70 8.7%
United Kingdom 21 2.6%
Other Asia (e.g., Japan, Korea etc.) 27 3.4%
China/Taiwan 22 2.7%
Commonwealth of Independent States 20 2.5%
Australia/New Zealand 3 0.4%
Caribbean/Central America 11 1.4%
South America 8 1.0%
Total 801 100%
