
Canada’s Temporary Foreign Worker Program (TFWP) has come under fire from a new United Nations report, which calls it a “breeding ground for modern slavery.” The report points out that the TFWP limits workers’ freedom by tying their immigration status to just one employer. This not only stops workers from finding better conditions but also creates power imbalances, making it hard for them to fight for their rights without fearing deportation.
However, while this criticism is important, it misses another issue that worsens Canada’s health-care crisis. The same mobility restrictions affecting temporary foreign workers also apply to internationally trained physicians (ITPs) and worsen our serious doctor shortage.
Canada’s health-care system is struggling, with only 2.5 doctors for every 1,000 people in 2023 and unconscionably long wait times for specialized treatment. A key factor in this crisis is the strict assessment programs for ITPs that ensure they meet provincial standards before practicing. These programs come with return-of-service contracts, requiring ITPs to work in specific, often underserved areas for set times. While intended to help regional health shortages, these policies create major mobility barriers for ITPs.
These restrictive contracts discourage many ITPs from joining the workforce and increase competition for limited residency spots, which Canadian medical graduates also seek. This leads to an uneven distribution of medical professionals and worsens the doctor shortage. Despite 72% of ITPs having over three years of clinical experience abroad, and 20% having over a decade, these restrictions push many to chase residency programs, causing unnecessary delays and deepening the crisis.
The UN’s criticism of closed work permits for temporary foreign workers is similar to the situation for ITPs. Both groups deal with limits on their mobility that lead to exploitation. For ITPs, the practice-ready assessments and return-of-service rules create obstacles like those criticized in the TFWP.

To tackle these issues, Canada should consider reforms in two main areas. First, it could introduce sectoral work permits for temporary foreign workers, allowing them to move freely between employers in their field. This would create healthier competition among employers, improving working conditions, wages, and benefits. Such a change could lead to a fairer labor market, benefiting both migrant and local workers.
Second, integrating ITPs into Canada’s health-care system needs a review of current policies. The National Assessment Collaboration Practice-Ready Assessment could look into options like financial bonuses or loan forgiveness to attract doctors to underserved areas without imposing strict mobility rules. Evidence from Australia’s Rural General Practice Incentives Program shows that such incentives increased rural placements by 25% from 2015 to 2018. A 2022 survey found that 86% of Canadian ITPs would consider rural work if offered proper support.
Removing strict return-of-service contracts could also ease the pressure on residency programs, freeing up spots for Canadian medical graduates and simplifying paths for ITPs.
Ultimately, reforming both the TFWP and policies affecting ITPs is vital for building a fairer, more dynamic economy. By breaking down mobility restrictions and addressing inequalities, Canada can improve the labor market, protect worker rights, and tackle crucial shortages in areas like health care. These changes would foster a more equitable environment for all workers, benefiting Canadian society overall.