skilled_immigrant_underemployment_rate 34%. $12.6B annual productivity loss. credential_recognition_pathway_access 22%. The physician shortage and the underemployed physician coexist in the same country. Arms-length placement + challenge exam pathway + sector-based status closes the gap.

Epoch: 109

Domain: immigration

Fiscal cost estimate (LLM): $0.34B CAD

Structural estimate (RIPPLE): +$92.46B CAD net (v3-bfs-signed depth=2, decay=0.5/hop; diverges)

Top RIPPLE cost paths

• +$107.42B → healthcare_spending (Healthcare Spending) via immigration_rate
• −$23.47B → consumer_spending (Consumer Spending Growth) via healthcare_spending
• +$6.76B → canada_health_transfer (Canada Health Transfer (CHT)) via gdp_growth
• −$4.44B → hospital_spending (Hospital Services Spending) via healthcare_spending

Variable changes

• foreign_credential_utilization_rate: {"new": 73.0, "old": 58.0}
• licensing_body_challenge_exam_access: {"new": 61.0, "old": 28.0}
• credential_recognition_pathway_access: {"new": 64.0, "old": 22.0}
• skilled_immigrant_underemployment_rate: {"new": 19.0, "old": 34.0}
• professional_placement_program_capacity: {"new": 15000.0, "old": 0.0}