Borders & Belonging: Analysis

Healthcare gig platforms help migrant workers survive – but at what cost?

Platforms like Uber, DoorDash and Deliveroo give migrants a stepping-stone to better jobs. They aren’t such a good idea in healthcare, though

Laura Lam
20 April 2022, 11.17am

Not like delivering a pizza

Andia / Alamy Stock Photo. All rights reserved
Toronto University CERC Migration logo with extra white space.png

Immigrants often find themselves having to take work for which they are overqualified. That’s partly why so many work for labour platforms such as Uber or food delivery services like DoorDash or Deliveroo as a stepping-stone: it gives them an income without too much commitment while they settle into a new home country.

Immigrants also often find themselves meeting the demand for healthcare workers in wealthy countries: there’s a documented transnational transport of care work from the Global South to the Global North.

No surprises, then, that there is a proliferation of platforms bringing together care workers looking for work with people who need caring for. But caring for someone involves greater intimacy than delivering groceries to a stranger – while care work platforms bring the same problems for workers that are found in other gig economy sectors.

The pandemic highlighted the devastation that can result from a shortage of healthcare workers, as well as the gruelling conditions of that work. Global economies have recognised the importance of care – market economies might flounder, but the economy of care does not stop.

Migrants have filled the gap. In Canada in 2016, 36% of nurse aides, orderlies and patient service associates were immigrants, an increase of around 10% within a decade. Contrastingly, immigrants made up only 24% in all other occupations in 2016, and that was up only 5% from a decade earlier.

Immigrants working in healthcare positions share the problem of overqualification, devaluation and underemployment that all immigrants tend to endure

But it’s hard for migrants to climb the career ladder beyond that basic level: one snapshot shows that Ontario’s nursing regulatory body approved only 42% of international nurses’ applications, compared with 89% of domestic applications. Even though 45% of the most recent immigrants in the care sector have at least a bachelor’s degree, care professionals consistently find it hard to get their foreign credentials recognised and their experience properly valued. Many are stuck in uncertainty, unsure when they will be able to put their education and experience into practice.

The difficulties of internationally educated nurses, who often face a lengthy and cost-intensive licensure process, became a matter of government policy during the pandemic, as people with COVID flooded hospitals.

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In short, immigrants working in healthcare positions share the problem of overqualification, devaluation and underemployment that all immigrants tend to endure.

That’s where the stepping-stone of digital labour platforms comes into play. Driving for Uber or delivering food for DoorDash or Deliveroo is not the ultimate goal, but this transitionary step gives immigrants a modicum of security while they figure out next steps. But what happens when the platform economy seeps into the work of care?

Platforms to the rescue?

A large part of care is relational – it is directly caring for another’s physical and emotional wellbeing. Who does the caring matters just as much, if not more, than the actual act of caring.

There are two predominant types of digital care platforms: digital placement agencies and the on-demand model. Digital placement agencies work like temporary worker agencies, with the platforms charging a monthly operation fee for helping select a carer. On-demand models operate by connecting care recipients with care workers, where care workers can charge their own rate for services. If driving for Uber is a stepping-stone towards greater labour market integration, digital care platforms for healthcare workers become an intermediary that seems tailored specifically to their needs to find work in their field of training.

In some ways, digital care platforms can be a good thing for migrant care professionals who face labour market barriers. They allow the worker to work in their field in some capacity, perhaps helping to retain their sense of identity and self.

However, there are less rosy consequences for workers too. Platforms can entrench existing inequalities by reinforcing the existing asymmetry of power between care providers and care receivers – often implicitly reinforcing the fear that care receivers need to be ‘protected from’ care workers. Platform care workers often bear the brunt of the risk when they know little about a new client and what or who they might be interacting with. Meanwhile, care platforms serve solely as the intermediary, with little responsibility for how care is received and who performs the duty of care.

With a global care-worker shortage, many questions remain about how the sector can achieve quality and scale at the same time. Migrant care workers on platforms can seize the work as opportunities to set their own course of work and professional trajectory, yet it comes with their work increasingly individualised and with a dearth of basic protections. Just like other digital platforms, care platforms might be able to serve as a transitionary step, but what are the costs associated with it?

For some highly educated, experienced and internationally trained care workers, the opportunities found through care platforms can help them keep their identity while they jump the many hurdles to pursue better employment in their field. Yet behind these opportunities are undeniable risks, underemployment and issues of fairness as the work of care can become a site of exploitation.

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