Health Committee on May 27th, 2008

[Lui Temelkovski, Liberal, Oak Ridges—Markham, ON]

What would it take to move that up?

[Dr. Brian Day]

We need to expand medical schools. There has been some progress in the last few years across the country, but it's not enough. We would like to see us get closer to the British statistic of 13 medical school spots per 100,000 citizens.

[Lui Temelkovski, Liberal, Oak Ridges—Markham, ON]

You're saying there are 13 schools per 100,000?

[Dr. Brian Day]

No, we have seven spots in medical school for every 100,000 citizens.

[Lui Temelkovski, Liberal, Oak Ridges—Markham, ON]

And they have 13?

[Dr. Brian Day]

They have 13.

[Lui Temelkovski, Liberal, Oak Ridges—Markham, ON]

That is roughly double. Would that be part of the investment we would have to make?

[Dr. Brian Day]

Yes, and the point I've been trying to make in my presentation is that we are spending a lot of money to keep people waiting in Canada. It costs more to have wait lists than not to have wait lists. Research shows that.

These people on wait lists are deteriorating while they wait. They end up being lost to the economy if they're not working. Their medical costs rise as they deteriorate medically. And we know, as doctors, that if we keep someone waiting for a year, it ends up costing more. They're going to the doctor for prescriptions during that time; they're on pain killers, and they're sometimes getting addicted; and they medically deteriorate while they wait. So it's actually cheaper to eliminate wait lists.

[Lui Temelkovski, Liberal, Oak Ridges—Markham, ON]

Was there a genuine concern or request to increase the number of physicians in Canada?

[William Tholl, Secretary General and Chief Executive Officer, Canadian Medical Association]

Perhaps I can answer that question.

We bottomed out at an intake of about 1,500 new graduates a year in the mid-1990s, and we're now up to about 2,700 enrollees in medical school today. So there has been a genuine concerted effort to increase physician supply.

We estimate that in order to get to a steady state, because it's going to take some time for those new medical students to graduate from the system, we probably would need about another 300, getting to about 3,000 doctors per year entering medical school, in order to get to a steady state.

[Lui Temelkovski, Liberal, Oak Ridges—Markham, ON]

It was mentioned by Professor Maioni, I believe, that there was some mistrust between the provincial, territorial, and federal governments when they were sitting around the table to set up this 10-year plan.

Does that mistrust still exist?

[Dr. Antonia Maioni]

I think it exists so long as there's a tension in terms of the roles of the spheres of government about who in fact makes decisions in health care. I think that's one of the questions that has not been resolved. It's not been resolved who should make decisions that would perhaps alleviate some of the problems that Dr. Day and other witnesses have made. It's not clear the federal government can do all that much about the number of graduates of medical schools, for example, when medical schools are under post-secondary education, which is a provincial responsibility.

So the big political questions about who decides have not been resolved. When you tackle that question of who makes the decisions, you're getting at the question about who gets.... If you decide, you decide who gets what, who gets what when, who gets how much, and who gets what kind and whether services can be provided privately, publicly, and how much money should be involved. But the big question is who should decide, and I think that fundamental tension is still there.

Not to belittle le pas en avant that the 2004 plan did make, it did break a logjam that was, in effect, paralyzing political debate about health care. So we've moved a step closer, but I don't think we've actually resolved that fundamental issue yet.

[Lui Temelkovski, Liberal, Oak Ridges—Markham, ON]

Dr. Day.

[Dr. Brian Day]

There are right now, as we speak, 1,500 young Canadians born here, educated here, with undergraduate degrees here who are going to medical school in foreign countries because they can't get a place in Canada. The federal government could have a role in helping repatriate them, because we know from statistics that these students tend not to come back, and we're losing young talent. That's one of the deficiencies that's happening as a result of our inability to create spaces in Canada. But certainly in the short term we should be trying to encourage those 1,500 young Canadians to come back to Canada and practice.

[Lui Temelkovski, Liberal, Oak Ridges—Markham, ON]

My understanding is that doctors are coming back in larger numbers then previously. They were leaving more so before and now they're returning.

[Dr. Brian Day]

The doctors, yes, but these students--we know from statistics and surveys among them--do not tend to come back. These are young students who are going to medical school in foreign countries right now.

[Lui Temelkovski, Liberal, Oak Ridges—Markham, ON]

Professor, my only--

[Dr. Antonia Maioni]

Well, they're often not able to come back. It depends on the country where they're studying. In some cases, their degree is not recognized by medical boards, so it's not just the government's fault. There's some kind of corporate professional accountability at play here as well. Those degrees actually have to be recognized, and they're not always recognized, so of those 1,500, some can't come back.

Another point--just to point out what Dr. Day was saying--is that it's not just the absolute number of physicians--

[The Chair, Conservative, Joy Smith]

Dr. Maioni, just very briefly, if you could. We are way over.

[Dr. Antonia Maioni]

It's simply the distribution of physicians as well. For example, at McGill, my university, the big problem is having residency in primary care filled. It's not about the specialists. They've got a lot of residents willing to do that; it's the primary care doctor that is the real rare specimen these days.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Maioni.

Madame Gagnon.

[Christiane Gagnon, Bloc, Québec, QC]

Thank you.

You are frustrated at not having more time, but we would also be frustrated were we unable to ask as many questions as we would like.

A number of witnesses have told us that the 10-year Plan was not really a success. Ms. Ballermann, representing the Canadian Health of Professionals Secretariat—, you say that enforcement of the 10-year Plan is not a success. It has not yielded the desired results with respect to health human resources. Having made that observation with respect to human resources and other aspects of the plan—as a number of you have done—how do you think we should go about developing a long-term plan, for example, in order to have more students studying medicine or various health care technologies? That is where there is a problem. There are waiting lists. We are told that the problem is not necessarily related to money but, rather, to resources.

What long-term advice would you give the government—be it the federal government or another level of government, since we really do not know who has the ultimate authority—as a means of guiding provincial actions in this area?

[Elisabeth Ballermann]

Thank you.

Absolutely, we do require significantly increased seats in post-secondary education, not just for physicians and nurses, but for the panoply of health providers. There are examples, for example, in my home province of Alberta, where the government identified a certain shortage of nurses when the vacancies for health science professionals, the people whom we represent, exceeded those in nursing. But the Alberta government said they were creating 200 more nursing seats in post-secondary education and 40 for the allied health professions. The focus needs to include all the health care providers, and we need the data from across the country to address that. Data among some of the disciplines we represent--some of which have small handfuls because they're so specialized, some of which have only several thousand--are lacking simply because of the size of these groups. But their presence or absence is key to providing all of the services that are in the health care system--the diagnostic testing, the therapeutic testing. So clearly we need to increase the seats.

When we have the seats, we need to ensure that they're effectively utilized, insofar as we have to make sure we select the students in such a way that we don't lose them from the limited seats. There is a problem with attrition in some training programs, so if you start with 20 students and only 10 graduate, you've lost that opportunity for 10 people. So the selection of students, the seats themselves--all of these need to be addressed.

[Christiane Gagnon, Bloc, Québec, QC]

There is no doubt that the zero deficit objective was what resulted in this situation. However, the Canada Health and Social Transfer was not paid over a number of years, when the Liberals were in office. We are behind by some 15 or 20 years in terms of everything that could have been done to meet today's needs.

An alliance was established to monitor waiting times in various provinces. Some provinces are doing better than others in that respect. Perhaps they are better equipped or are devoting more money to it. I am thinking of Saskatchewan and Manitoba. There is also Quebec, which is going it alone and asking not to be a part of any national strategy.

I don't know which of you is in the best position to answer my question. What do you think of the support being given the provinces? Do they have more human resources? Are the provinces investing more money than the federal government? And what conclusions can be drawn from the comments made by the Wait Time Alliance?

[Dr. Brian Day]

Well, there are two things. First, there's a lack of comparability of data across the country. Different provinces are measuring things differently. You'll find, for instance, in certain provinces you are not put on a wait list. Even after you've seen a specialist and you've been told you need surgery, there are another two or three steps before you're actually put on the wait list.

Second, in our opinion, there are major concerns with the fact that governments are tending to target the four or five specific areas. As practising doctors and surgeons, for instance, we see resources being narrowed. We call it the balloon effect, where you take resources--whether they be nurses, doctors, or money--from one area of necessary care and put them into another. That's the problem with starting off with only five targeted areas; there is that balloon effect.