Description: Canada has both historically and more recently relied on internationally trained health care providers to help solve shortages in rural and remote underserviced areas and in urban subspecialties. At the same time, we hear of numerous accounts of internationally trained providers not being able to practice their profession. The difficulties this cause are not limited to the Canadian context – in terms of lost labour, and possible solutions to its human resource crises – there are important implications for the countries from which health care providers migrate to Canada. In this study, we will examine:
For each of these three case studies, we will collect data through: 1) the acquisition of key public domain policy documents from the various provider/stakeholder groups; 2) interviews to be conducted with key informants involved in the policy decision-making process and 3) experiential interviews with internationally trained physicians, nurses and midwives who have either successfully integrated into the Canadian health care system and those who have not.
Description: Although research has been conducted on the medical and social consequences of aging and on changing needs for and shortage of care providers, surprisingly little reference is made to the foreign born workers who often provide this care. Knowledge is also limited on the contributions that foreign workers make in institutional or home settings, and equally on the client-provider relationship and quality of care, in which the carer's immigration status, linguistic skills and cultural differences may have an influence. Indeed, the full extent of the roles immigrant care workers play in health care is relatively unknown, especially from a comparative perspective. These issues also need to be situated in the larger debate on the impact of the emigration of skilled health workers from developing countries, and in the policy levers for managing skilled and low skilled migration. Of particular interest are the unintended consequences of current policies and practices.
The aim of this study is to address some of these gaps by adding a Canadian component to an ongoing international comparative study examining the following issues in the U.K., Ireland and the U.S:
Description: Provisions for rural and remote health care have garnered increasing attention by Canadian policy makers and health care planners not the least of which has included provisions in the recently released Royal Commission on the Future of Health Canada in Canada. As policy makers and planners grapple with the effects of restructuring and providing equitable access to care to people in rural and remote communities, the consideration of gender and women's health is necessary to complete the picture of health needs, service provision and utilization. To begin to respond to this critically important issue a National Research Steering Committee on Rural and Remote Women's Health (NRSC) was created from the network of researchers affiliated with the National Centres of Excellent in Women's Health (CEWH). Members of the NRSC has undertaken this research to address the following questions:
This research project involved three modes of data collection to address these research questions:
Description: This study is headed by Rebecca Sutherns a Postdoctoral Fellow who works with me in the Health Studies Programme at McMaster University [ This e-mail address is being protected from spambots. You need JavaScript enabled to view it ]. Based on Rebecca's doctoral research on rural maternity care in Ontario, we extended our data collection to include an analysis of the maternity care experiences of women in rural Alberta. We have interviews with over 50 women specifically examining the availability of a range of services; what women and their communities are doing where there is a shortage of services and what social and structural factors help women mediate these shortages.
Description: This research extends from my doctoral research on the midwifery integration project and involves an analysis of the impact of recently implemented midwifery policy on midwives and their clients in Ontario and in another Canadian province that has integrated midwifery: British Columbia. I am specifically examining three aspects of midwifery's continued integration: 1) midwifery education policy and the reorientation of midwifery education from an apprenticeship-based approach to a baccalaureate program and the impact of this shift; 2) midwifery hospital policy and the integration of midwives into the hospital setting and their interaction with physicians and nurses in this setting; and 3) midwifery economic policy and the evolution of government funding for midwifery services from a centralized, consumer-run bureaucracy to local transfer payment agencies in the community.
Description: In response to the rapidly rising rates of the public's use of Complementary and Alternative Medicine (CAM), Health Canada has commissioned a group of discussion papers that have highlighted the existence of significant gaps in our knowledge. One of these gaps is regarding the knowledge, attitudes and practice patterns of various Canadian health care providers regarding CAM. Much of the research that is available on this topic relates to physicians' views with very little focusing on other professions. Overall, there is a paucity of research looking at health care providers' views from a comparative perspective, as well as little research on the views of health care educators. Thus, the purpose of this research is to examine the knowledge, attitudes and behaviour of both educators and providers regarding CAM comparatively across the professions of medicine, nursing and midwifery. Ontario and British Columbia have been chosen as the research sites as all three provider groups practice in both provinces and both have education programs for the three provider groups. Semi structured interviews will be conducted with approximately 40 providers and educators in the two research settings. This research is conducted in collaboration with Kristine Hirschkorn, a doctoral student working with me at McMaster University Department of Sociology.
Description: This is a five year research program undertaken as part of my Canadian Institutes of Health Research (CIHR) New Investigator Award. It addresses two key factors that are noticeably absent from the burgeoning literature on the rationalization of the health care division of labour: gender and location. The examination focuses on the influence of gender and geographic location on the rationalization of maternity care, primary care and mental health care - in Canada and the U.S. The data include key policy documents and position statements from the various provider groups [i.e., the grey literature] and secondary source documents [i.e., the published literature] and key informant interviews conducted in the Province of Ontario and in New York State.
Description: I was involved in a multi-year project, with a group of sociologists who specialize in health care work, on the comparative experience of health care providers and managers of managing vs. managed care in Canada and the United States. [Pat Armstrong, Hugh Armstrong, Jacquelyne Choiniere, Joel Lexchin, Eric Mykhalovskiy & Jerry White]. We specifically evaluated the claims of managed care against the day-to-day work experiences of providers (nurses & physicians) and managers. For more information about the first book to come out of this project please visit the following website: http://www.garamond.ca/ArmstrongHEAL.html
