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Attract & Retain: Nova Scotia taps foreign healthcare workers to fill labour shortages

As part our presenting sponsorship of the Halifax Chamber of Commerce’s Annual Fall Dinner, we are pleased to present a series of thought leadership articles highlighting the dinner’s themes of immigration, recruitment, and labour market solutions.

Brendan Sheridan

The COVID-19 pandemic has exacerbated our country’s labour shortages in healthcare and put further strain on our healthcare systems. We must spotlight the importance of recruiting and retaining workers in this field now more than ever. In Nova Scotia, residents are desperate for primary health care. Many Nova Scotians are without a family physician and walk-in clinics seem to not have returned to pre-pandemic service levels. This has caused greater numbers of Nova Scotians to seek care from emergency departments, even in non-emergent scenarios. Higher patient levels and staffing shortages have resulted in significant emergency room wait times throughout the province and, in some cases, delayed care. There are also major surgical backlogs that must be addressed.

In particular, over 100,000 Nova Scotians are currently without a family doctor, and over 38,000 of these individuals are located in the Central Zone, which includes the Halifax Regional Municipality.[1] The shortage of healthcare workers is not only restricted to physicians, as Statistics Canada has confirmed there are significant job vacancies throughout the healthcare sector including for nurse aides, orderlies, and patient service associates; registered nurses and registered psychiatric nurses; and licensed practical nurses.[2]

The insufficient numbers of Canadians and permanent residents entering and remaining in the healthcare field has forced employers to explore alternative options, namely the hiring of foreign healthcare workers, to fill their vacant positions. Many employers are now faced with questions on how they can not only recruit, but also retain these vital foreign workers on a permanent basis. The Government of Nova Scotia and the Federal Government understand the urgent need to fill these labour gaps and have taken steps to allow foreign workers to more easily enter the healthcare field and remain in Canada on a long-term basis. Read on for an overview of options to facilitate the recruitment and retention of foreign workers in this field.

Streamlined Licensing Process for Healthcare Professionals

Many foreign healthcare workers who are interested in working in Nova Scotia will struggle with the lengthy and slow credential recognition and licensing process that can ultimately prevent foreign-trained doctors from starting work in Nova Scotia in a reasonable time period. The frustration involved could even dissuade prospective workers from moving to Nova Scotia at all. In light of the urgent need for more healthcare workers, the Government of Nova Scotia, Nova Scotia Health Authority, and the regulatory colleges have been working together to streamline the process to allow foreign workers to begin working in the field more quickly after receiving their immigration authorization to work in Canada, while still maintaining a diligent evaluation process.

In response to these efforts, a new streamlined pathway for licensing has recently been implemented for internationally educated physicians. The new pathway is expected to allow internationally trained physicians deemed to have “sufficient time and discipline training”[3] to receive their license more quickly, with less administrative burden and with shorter periods of assessment and supervision.[4] The Nova Scotia College of Nursing is also making efforts to expedite their process. Specifically, the College has already introduced measures to make their registration and licensing more efficient for internationally educated nurses, and are further exploring ways to streamline the licensing process as a whole.[5]

The efforts undertaken to streamline the licensing process should be welcome news to Nova Scotia employers seeking to recruit foreign workers in the healthcare field.

Provincial Nominee Program

A more efficient licensing process is only the first step to attracting foreign national healthcare workers, and immigration considerations related to recruitment and retention must also be accounted for. The Province of Nova Scotia recognizes the need to recruit healthcare workers from outside of Canada and has developed Nova Scotia Nominee Program (NSNP) streams that specifically target foreign workers in this industry.

Provincial Nominee Programs are primarily designed to support foreign nationals in obtaining permanent resident status in Canada and they generally involve a two-step process. The applicant must first apply to the Province of Nova Scotia for a Nomination through one of their established streams. Once approved, they must apply to the Federal Government for permanent resident status. While the ultimate goal of the Provincial Nomination Program streams is for foreign nationals to obtain permanent residence in Canada, many of these programs also offer the opportunity for foreign nationals to obtain a temporary work permit so that they may enter Canada to begin working while awaiting the processing of their permanent residence application. While each program has differing requirements and targets different occupations, they each support employers in facilitating the recruitment and retention of temporary foreign workers.

A brief overview of Nova Scotia’s Provincial Nomination Program streams targeting foreign national healthcare workers is provided below.

  1. Nova Scotia Labour Market Priorities for Physicians Stream:

The Labour Market Priorities for Physicians Stream targets general practitioners, family physicians, and specialist physicians. Qualifying physicians must have an approved opportunity from the Nova Scotia Health Authority or the IWK Health Centre, sign a Return for Service Agreement committing to live and work in Nova Scotia for at least two years, and have a valid Express Entry profile. Qualifying applicants with a valid Express Entry profile will receive an invitation to apply for a Nomination from Nova Scotia and must submit their complete application. Once approved, the physicians will apply to the Federal Government for Permanent Residence and have the opportunity to apply for a temporary work permit so that they may begin working in the Province prior to obtaining their permanent residency status. As this program operates through the Express Entry system, applicants may have their federal permanent residence application processed in as little as six months.

  1. Nova Scotia Physician Stream:

Similar to the Labour Market Priorities for Physicians Stream, the Nova Scotia Physician Stream targets general practitioners, family physicians, and specialist physicians. This program is designed to help the Nova Scotia Health Authority and the IWK recruit and retain physicians with the required skills to fill positions that could not be filled by Canadians or permanent residents. This stream requires that the physician has a job offer from the Nova Scotia Health Authority or IWK. Once the applicant has secured a job offer, they can prepare and apply to the Nova Scotia Office of Immigration for a Provincial Nomination. Once nominated, the applicant will apply to the Federal Government for permanent residence and will have the opportunity to apply for a temporary work permit that will authorize them to work in Canada while waiting for their permanent residence application to be processed.

While this stream is similar to the Nova Scotia Labour Market Priorities for Physicians Stream, the Physician Stream has significantly longer processing times for the federal permanent residence application process. The service standard for the federal permanent residence application is currently 18 to 24 months in length.

  1. Nova Scotia Labour Market Priorities Stream:

While this stream is not geared solely to recruiting and retaining healthcare workers, it does allow the province to select candidates who are already in the federal Express Entry system pool who meet provincial labour market needs. The identified labour market needs currently include both registered and psychiatric nurses, and the last draw for invitations to apply was solely for qualifying applicants in these occupations. Applicants who are invited to apply for a Nova Scotia Provincial Nomination must demonstrate that they meet the criteria for their draw and submit complete applications. After receiving their Provincial Nomination, applicants must then apply for permanent residence through the Express Entry system. As noted above, the applications submitted through the Express Entry system can be processed in as little as six months.

While this stream offers significant opportunity to facilitate the retention of healthcare workers, its most recent applicant draws occurred on February 8, 2022. Further use of this stream by the province would be a welcome occurrence to fill ongoing gaps in the healthcare market.

  1. Nova Scotia Occupations in Demand:

The Nova Scotia Occupations in Demand is a stream that targets certain semi and low-skilled occupations that are deemed to be in high demand in Nova Scotia’s labour market. While occupations deemed to be in “high demand” can change from time-to-time, this stream is currently targeting foreign nationals who have full-time permanent job offers in certain occupations including nurse aides, orderlies, and patient service associates. Similar to the Nova Scotia Physician Stream discussed above, this stream operates outside of the Express Entry system. Qualifying applicants must apply directly to the Province of Nova Scotia for a Nomination. Once approved, applicants can apply to the Federal Government for permanent resident status and a temporary work permit.

Federal Express Entry Changes for Physicians

In September 2022, the Federal Government announced changes to the Express Entry System to make it easier for foreign national physicians to obtain permanent residence without relying on a Provincial Nomination. In particular, Sean Fraser, Minister of Immigration, Refugees and Citizenship Canada, announced that physicians can now count their Canadian work experience as a physician towards their “Canadian experience” for Express Entry System purposes. Prior to this announcement, physicians working under a fee for service model were considered to be self-employed for Express Entry purposes. They therefore did not receive points for their work experience in Canada and would not be eligible for the Canadian Experience Program. This limited their permanent residence options and forced many foreign national physicians to first obtain a Provincial Nomination before moving forward with a permanent residence application. This change should provide a more streamlined process for many physicians as they may be able to skip the Provincial Nomination step.

This is a long overdo change that should make a significant impact allowing Canada and the Province of Nova Scotia to attract and retain more foreign national physicians.


Nova Scotia’s healthcare system is in urgent need of additional employees. Ultimately, streamlining and simplifying the recruitment of foreign healthcare workers is one important step in addressing these shortages. Employers can take solace in the fact that the Province of Nova Scotia and the respective regulatory colleges are taking immediate steps to facilitate the recruitment and retention of foreign workers in various positions throughout this sector.

This update is intended for general information only. If you have further questions about these programs or are an employer seeking to support your workers, please contact a member of our Immigration Group.

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