As I outlined recently in my “e-Literate’s Changing Themes for Changing Times” post, I am shifting my coverage somewhat. I’ll be developing and calling out tags I use for these themes so that you can go to an archive page on each one. This one will be listed under the “changing enrollment” tag.
Just before Christmas, The New York Times published an ostensibly feel-good story about a Syrian refugee who built a massively successful chocolate business in Canada. But the story buries the lede. The company’s CEO could have—and should have—been a doctor. He couldn’t get credit for his prior education in Syria. Canada is facing an acute healthcare crisis because of a shortage of skilled workers. Canada has figured out half the problem with the labor shortages that plague many industries there and here. They are welcoming immigrants willing to work hard and do the jobs. But they are missing the other half, enabling those immigrants, many of whom arrive with skills, to employ those skills where they are needed. This denial of economic opportunity causes a well-intentioned policy to fail to live up to its economic and humanitarian aspirations.
Canada’s labor shortages are hardly unique, as anyone who has been paying attention to the US economy knows. We are suffering real economic pain from our inability to attract, train, and retain skilled workers in various industries. Worse, in this new era of economic, geopolitical, rapid technological advancement (e.g., ChatGPT) and climate volatility, we can expect the shifts in job markets to accelerate as supply chains get rewired, industries get disrupted, and reconfigured,
Until recently, I have been a skeptic regarding Competency-Based Education (CBE) and Prior Learning Assessment (PLA) because I did not believe the economic drivers were present to force the massive reconfiguration of the higher education system. But situations change. Long-term economic forces will increasingly drive demand for more rapid reskilling than our current system can support. Meanwhile, a significant and growing percentage of U.S. colleges and universities face enrollment crises. While this problem is often framed by academia as a decrease in the supply of students—the so-called “enrollment cliff,” the hot job market, and so on—I think it is better understood as a failure to respond to changing demand and new opportunities. EdTech and venture investors have been arguing this for decades. I continue to believe that they were wrong. But, like I said, situations change.
In this post, I will argue that now is the time for CBE and PLA at scale, using the Canadian healthcare labor market as the primary example. I will also make the case by focusing on skills mainly as an additive to the degree—the degree-plus-“skills” formula promoted by Coursera, boot camps and the like—institutions are missing opportunities. We will see that well-defined paths for pre-degree career credentials exist in critical industries. By neglecting these paths and leaving them to others, traditional higher education leaves itself vulnerable while failing to serve its mission to students and the public good.
Willy Wonka could have invented the everlasting artificial heart
Let’s return to our story about the Syrian refugee and his Canadian chocolate empire:
Back in Syria, [Refugee Tareq] Hadhad’s father, Isam, had founded a confectioners in Damascus that eventually employed hundreds of people and shipped its chocolates throughout the Middle East. Bombing during the civil war leveled it.
The Hadhads became privately sponsored refugees in Antigonish, Nova Scotia. While the town is the home of St. Francis Xavier University, it is generally known for having an aging population rather than being economically vibrant.
Mr. Hadhad was midway through medical school when he fled Syria. But once in Canada, and with considerable help from the people of Antigonish, he vowed to re-establish his father’s business under the name Peace by Chocolate….
This month, Mr. Hadhad opened a new, bigger shop and expanded the factory that produces the company’s chocolate. In all, Mr. Hadhad told me, Peace by Chocolate now employs about 75 people and could hire 30 to 40 more workers — if they were available in Antigonish. About 1,000 stores across Canada now sell its chocolates, thanks in part to a deal with the Empire Company, the Nova Scotia-based grocer that owns the Sobeys and Canada Safeway supermarket chains.
The Syrian Family That Rebuilt a Chocolate Empire in Nova Scotia
What an incredible story. Tucked in it is a comment about labor shortages, but given the aging population of Antigonish, that makes sense. Mr. Hadhad is doing precisely what the government of Canada and the people of Antigonish hoped he would do when they invited him and his family; create jobs that would attract more young workers. “Building a business in Canada, he said, is much easier in than in Syria,” he said.
But.
he was also keen to discuss what’s become something of a personal mission for him: eliminating barriers for newcomers and showing Canadians the economic value of immigrants.
A former medical student, Mr. Hadhad is disturbed that many immigrants are unable to use their skills immediately when they come to Canada; instead, they often must undergo additional schooling, and face slow and costly certification processes.
Mr. Hadhad was told that if he wanted to pursue his medical studies, he would have to return to high school, obtain a Canadian undergraduate degree and then take medical school admission exams.
The Syrian Family That Rebuilt a Chocolate Empire in Nova Scotia
Here’s a guy who was halfway through medical school when he arrived. He was told he would have to repeat all his education starting from high school to finish his degree and become a practicing physician.
Let’s set aside the humanitarian aspect of this. Forget that most immigrants don’t arrive with the second set of skills Mr. Haddad had—running a chocolate business—or the confidence and support to reinvent themselves. Instead, let’s look at this purely from a policy perspective. Was Mr. Haddad’s career change a net gain or a net loss for Canada?
About a month before The New York Times ran the chocolateer story, it ran another one with the headline, “Alleviating Canada’s Acute Shortage of Family Doctors“. According to that article, “Nova Scotia’s latest monthly tally, released in mid-October, showed that 110,640 people, or 11 percent of the population, were on the wait list for a family doctor.”
Nova Scotia [is] not alone. The recently re-elected Coalition Avenir Québec government dropped its promise to ensure that everyone has a family doctor. More than 800,000 Quebecers are without one. In Ontario, the provincial advocacy group for family physicians estimates that 1.8 million residents do not have a family doctor and another 1.7 million people are under the care of physicians older than 65 who are nearing retirement.
The desperation to secure a physician pushed Janet Mort in British Columbia to drastic measures. She took out an ad in a local newspaper in search of a physician to fill her 82-year-old husband’s prescriptions after his physician retired, as reported by Global News. Her strategy was successful.
For others, the process to find a family doctor has meant working the phones to call individual clinics or to join growing provincial wait lists. Those who turn to the services of walk-in family doctors find longer wait room times and no continuity of care. And some people add to the congestion in overburdened hospital emergency departments.
Alleviating Canada’s Acute Shortage of Family Doctors
This is a many-faceted problem but one of the causes is that physicians are not trained in how to run a private practice as a business:
[Katherine Stringer, the head of the Department of Family Medicine at Dalhousie University in Halifax,] acknowledged that while family doctors are in effect small business owners, the training they receive on how to run their business while in medical school is “very rudimentary.”
As a result, Dr. Stringer said, for many new doctors “it’s a very stressful first year.” Emulating a strategy used for new technology companies, the medical school has brought in mentors to help new doctors find their way. Dalhousie is also working with the province on establishing teams to set up all of the patient record compiling needed for a new practice.
Alleviating Canada’s Acute Shortage of Family Doctors
Guess which could-have-been-a-doctor has proven he has prodigious business-building skills? While I believe in the healing power of chocolate, I suspect that the 110,640 people waiting to get a primary care physician would have preferred another option.
Nor is primary care the only area where Nova Scotia’s health system suffers from a labor crisis. A quick search on the topic yields disturbing results. A Nova Scotia woman died on New Year’s eve while waiting for care in an emergency room. The same article notes that emergency room deaths are rising in the province while 43,000 people left Nova Scotia emergency rooms without being seen by a doctor last year.
It gets worse. One hospital closed its emergency room for a month and is not sure if it will be able to run a full emergency room in the future.
There are, of course, many reasons for Canada’s healthcare crisis. Cost-cutting measures and (often related) rise in time-consuming paperwork are significant drivers. But telling eager, trained physicians that they will have to repeat their education, starting in high school, does not help.
Responding more nimbly to labor market changes
The obvious solution, of course, is to test the immigrant healthcare workers on what they know and train them to fill the gaps. Canada is aware of this possibility. For example, The Globe and Mail reports Ontario is implementing a “Practice-Ready Assessment” program that “could add hundreds of foreign-trained doctors to the overstretched health care system within months.” The same article states, “Some estimates put the number of foreign-trained physicians living in Ontario but not working in their field as high as 13,000. They are blocked by licensing hurdles and other barriers because their medical training was done elsewhere.”
Thirteen-thousand foreign-trained physicians are theoretically available to an overstretched system but have been blocked from practicing because they have not been given a chance to prove what they know. Ontario is one of just three Canadian provinces that are taking this approach so far. And they haven’t implemented it yet. A quick internet search will show similar mismatches with skilled nurses. Like a story in The New York Times from a few months ago entitled “‘Disaster Mode’: Emergency Rooms Across Canada Close Amid Crisis.” From the article: “Increasingly, I think many of us realize we are not going to, in the short term, train our way out of this…. We can’t produce nurses quickly, with the exception, possibly, of some foreign graduates.”
Meanwhile, here in the United States, we find another labor mismatch crisis hidden in a feel-good story. New York City is addressing equity and climate change goals by training low-income workers to service modern electrical systems like heat pumps and electric vehicle charging stations. Here’s the story of one apprentice, Robert Clark:
Before joining, he struggled to find work, in part because of a felony conviction for burglary. “It’s a no-brainer,” he said of joining the Civilian Climate Corps, which pays him $20 per hour to learn skills and receive the certifications that he needs to get work. He hopes to go back to school to become an engineer.
Green energy has a problem: There aren’t enough electricians. Here’s one solution.
Did you catch that last sentence? Mr. Clark wants to go back to school to become an engineer.
There’s only one problem. New York City’s Civilian Climate Corps is a collaboration between the municipal government and employers. No colleges or universities are mentioned in the article or on the organization’s website. When Mr. Clark is ready to go back to college and become an engineer, will he get credit for the knowledge and skills he has learned through the program? As of today, I see no evidence of any pathway to do so. New York City has a robust collection of community colleges within the CUNY system. Why are they not involved? If Mr. Clark had completed his apprenticeship in a CUNY-affiliated program and received CUNY credit, it would be natural for him to return to CUNY someday to get his engineering degree. As it stands today, CUNY means nothing to him, and his knowledge means nothing to CUNY.
We need to be able to meet students where they are and get them where they need to go. “Meeting students where they are” is often a euphemism for talking about skill deficits. There is so much more than deficits to “where students are,” including pre-existing skills. Today, we are seeing alternative skills networks being built around the edges of academia, particularly in credentialed trades like electricians and allied healthcare. Becoming certified in medical billing in the United States does not require a degree and can lead to earning a decent living. It’s an example of a relatively quick path to financial sustainability. I’m unsure whether similar pathways exist in Canada, where the medical paperwork processing explosion seems to be a newer phenomenon. Economies and job markets change.
Meanwhile, people continue to aspire. Mr. Clark wants to go “back to school” to become an engineer. Nobody has told him that, as far as the system is concerned, he never went to school. Until academia better integrates itself into this network of ever-shifting needs and skill gaps, it will continue to face shrinking enrollments and dwindling relevance.
To truly meet students where they are and get them to where they want to go, we need to assess what they already know on a granular level, give them credit for it, and help them fill in any gaps on an equally granular level. The knowledge Mr. Roberts gains working on heat pumps and electric car chargers will likely not line up neatly with traditional college course curricula. Mr. Hadhad may also have skill gaps that do not line up neatly with the courses he would have needed to take to become a Canadian physician. (For example, he would have no reason to know basic details about how the Canadian healthcare system works.) Both came from backgrounds where becoming an income earner quickly was a high priority. Both have highly valued skills that the workforce needs.
Perhaps one day, Mr. Roberts could someday create a breakthrough in heat pump efficiency or electric car charging speeds. If so, I imagine two likely paths for him to learn the skills he will need to make that contribution to society. Either he will go to college, or he will learn what he needs on the job.
In general, employers do not make good educators. If employer training becomes the dominant path, it will be a narrow and inefficient one. Some institution is needed to fill the educational role. Colleges and universities could provide this role while weaving career paths through the traditional liberal arts education that has served humanity so well for so long. But only if they build the pathways to accommodate these continuous and granular needs. If they don’t, then somebody else will.
Reminder: related webinar
While we’re not going to be taking a deep dive into these issues, the webinar I’ll be facilitating this week will provide some basic groundwork for understanding CBE.
It’s next Wednesday, January 18th, at 1 PM EST.
