Want more health care news? There’s no full-time health care reporter west of Hampton Roads. We’d like to change that. You can help us fund this position.
In January, the government of the Canadian province of Newfoundland and Labrador announced that one of its cabinet ministers would embark on a recruitment mission overseas.
This does not immediately sound like a big deal. It’s become commonplace for American governors, and sometimes the mayors of major U.S. cities, to lead trade missions overseas to woo companies to do business here at home.
What made the trip by Newfoundland’s Minister of Health and Community Services unusual is that he wasn’t traveling to talk up investment opportunities. Instead, he was going to Ireland to recruit doctors and nurses.
Newfoundland, like lots of places, finds itself short of health care workers and has allocated $30 million in Canadian dollars — about $22.38 million in our greenbacks — toward recruiting more of them to the mostly rural province on the Atlantic coast.
The health minister didn’t go alone. He took a team of 11 recruiters to visit four Irish cities — Dublin, Limerick, Cork and Galway — to talk up the advantages of health care workers moving to Newfoundland. Ireland was not particularly keen on this; the Irish Medical Organization called the recruiting trip an “absolute threat” to that country’s health care system.
This overseas recruitment trip was not unusual for a Canadian province, either. Last fall the province of Nova Scotia sent a team to visit three refugee camps in Kenya, which are a temporary home to people fleeing violence in the Democratic Republic of Congo, Ethiopia, Somalia and South Sudan. The recruiters came back with 65 people qualified to be continuing care assistants.
There are two takeaways from this, both of which are relevant to those of us in Virginia.
First, the competition for health care workers is both intense and global. Cardinal’s Megan Schnabel wrote last year about the shortage of nurses, and how it’s difficult to train more because it’s hard to find enough instructors. More recently, I’ve written about how most nursing graduates in Virginia wind up out of state within five years of graduation, so we end up training other states’ workers. State officials are certainly not unaware of this. Gov. Glenn Youngkin earlier this year proposed $30 million — that’s 30 million of our dollars — to accelerate the training of nurses. That’s one of many things hung up in the stalemated negotiations over the state budget.
The other takeaway is that this is yet another illustration of how Canada takes a very different view of immigration than the United States. I’ve written about that before but will revisit it today because now we have some new information.
Both the United States and Canada face the same demographic challenges: an aging population that is increasing the number of retirees, a declining birth rate that has reduced the number of young adults, plus a pandemic that has accelerated retirements and created a labor shortage and a situation where fewer and fewer workers are paying into a system to support more and more retirees. One obvious solution to that labor shortage is to increase immigration, particularly of young adults, but the two countries have responded quite differently. In the United States, immigration is a political hot button and Congress has been deadlocked for decades over immigration policy; the Trump administration took steps to reduce immigration. By contrast, in Canada, both major political parties — the Liberals and the Conservatives — are in broad agreement that the country needs more immigration to make up for labor shortages and increase the number of young adults so there are more people paying taxes to support the benefits paid to senior citizens. In 2022, the United States saw 96,000 immigrants lawfully enter the country. Canada, a country with a population one-tenth our size, accepted 431,645 immigrants and wants to increase that to 500,000 a year by 2025.
“If we don’t continue to increase our immigration ambition and bring more working-age population and young families into this country, our questions will not be about labor shortages, generations from now,” Immigration Minister Sean Fraser told The Canadian Press. “They’re going to be about whether we can afford schools and hospitals.”
Granted, Canada has one advantage that the United States doesn’t: It doesn’t have to deal with an uncontrolled influx of people walking across its southern border (although it does have some, mostly along the border between New York and Quebec). How to deal with that migration — build a wall or do something else — has essentially taken over the American immigration debate and squeezed out discussion of the demographic challenges we face. Border security is important but it’s not the entirety of the immigration issue, just the one that paralyzes everything else.
Canada has the geographic luxury to focus on one thing: not just attracting more people, but attracting more people with in-demand work skills. Newfoundland and Nova Scotia show just how far some Canadian provinces are willing to go to attract immigrants — literally. For what it’s worth, Newfoundland, which went recruiting in Ireland, presently has a Liberal provincial government, while Nova Scotia, which went recruiting in Kenya, has a Conservative one. Can we envision the Republican governor of a rural American state sending a delegation to Africa to recruit immigrants? For that matter, can we envision a Democratic one? For the Conservative government in Nova Scotia, this recruiting trip to Kenyan refugee camps was a talking point about how it’s getting things done. “One of the biggest challenges we face is finding the right health care professionals to fill the vacancies we have across Nova Scotia,” said Health and Wellness Minister Michelle Thompson. “There are talented and skilled people around the world who would love to come here, and we would love to have them.”
Canada is targeting skilled immigrants in other ways. The country actively encourages foreign students to study at its colleges, on the theory that a certain percentage of them will stick around after graduation and become new Canadians. The United States has seen the number of foreign students decline, from almost 1.1 million in 2018-19 to 914,095 in 2020-21 before rebounding slightly to 948,519. Trump-era restrictions probably had something to do with some of that decline, but the pandemic appears to have had a lot more. Canada, meanwhile, had 638,300 foreign students in 2019. The pandemic dropped that to 528,200 in 2020 before the number came back up to 621,600. Again, here’s a country one-tenth our population with an international student population two-thirds of ours. If the United States pursued international students with the same fervor that Canada does, we wouldn’t have about 1 million international students, we’d have more than 9 million (assuming there were that many to go around). Thought experiment: Most Virginia colleges are seeing enrollments decline for demographic reasons; there simply aren’t enough college-age students to go around. What would the impact be if they had Canadian-level numbers of international students?
We all know that there’s often a difference between goals and reality. Canada’s goal is to use immigration to beef up its talent pool. Is that working? Here’s some evidence that the answer is “yes.” The New York Times reported last year that the tech workforce in Toronto — technically the larger Toronto-Waterloo region — was growing faster than in any other metro in North America. Not only that, but the number of tech workers in the Toronto area is projected to surpass the number of tech workers in Silicon Valley sometime this year. How can this be?
When we think of tech hubs that aren’t in Silicon Valley, we think of Seattle or Austin or Boston. How did Toronto — cold, snowy Toronto — sneak up on all of them? Here’s one way: immigrants with tech skills. Half of those 400,000-plus immigrants Canada accepts have STEM-related degrees (science, technology, engineering, mathematics). While we’re busy arguing over our southern border, an economic rival north of the border is building a tech hub bigger than Silicon Valley. True, Toronto isn’t a rival to Silicon Valley in one way: Silicon Valley still attracts far more investment, $132 billion vs. $5.4 billion. Still, the raw employment numbers are an indication of how the world is changing, whether we want it to or not.
Youngkin is rightly focused on how Virginia is seeing more people move out than move in; he wants more emphasis on creating jobs in the state and creating a talent pipeline to fill them. That’s what’s behind his nursing education initiative, that’s what’s behind his proposal to accelerate the number of high school students earning dual-enrollment credits, that’s what’s behind his proposal to revamp the state’s workforce development programs. What, though, if that isn’t enough? At some point, talent recruitment is a zero-sum game and numerically speaking, somebody somewhere is going to wind up short. At what point will we see some American governors emulating Newfoundland and Nova Scotia and dispatching recruiters to Ireland and Africa?