Health Committee on Nov. 25th, 2009

[The Chair, Conservative, Joy Smith]

Good afternoon, everyone.

I'm so glad you're here, committee members. We're going to very quickly go over some business. First of all, we're going to go over a motion.

Dr. Carrie, could you read it into the record, please?

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair. I think it's very timely.

We heard the questions in the House a few minutes ago, and I've been told we're supposed to be doing clause-by-clause on this bill in the Senate tomorrow, so I'm very glad that I've put it forward. I'll read it into the record:

That the Standing Committee on Health report to the House its opinion that C-6 is necessary to fill regulatory gaps and allow government the power to issue recalls and that the current framework for product recalls does not allow for timely and consistent action to protect Canadians; and that due to the committee extending its hours in order to ensure the timely passage of C-6 as well as the House of Commons unanimously passing this important piece of long overdue legislation, this House should strongly encourage members of the Senate Standing Committee on Social Affairs, Science and Technology to act responsibly and, in the interest of the safety and welfare of all Canadians, pass this crucial piece of legislation without delay.

[The Chair, Conservative, Joy Smith]

We'll open it for discussion now.

Ms. Murray.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you, Madam Chair.

First, I'd like to put on record that no Liberal Senator is delaying Bill C-6. The Senators are dealing with Bill C-6 in a responsible manner. They, like the Liberals on this committee, support the safety of consumer products for Canadians.

I consider this motion not only extraneous, but insulting. This bill was in the House for 70 sitting days and it has been in the Senate for only 28 sitting days. I think the member opposite will agree that there were some complex issues that needed to be addressed and witnesses to be heard from in order to understand this bill. This has been expedited.

The government first spoke to Bill C-6 in the Senate on June 23, which was the day before the House adjourned. Liberal Senator Day spoke to the bill two sitting days later, on September 16. This bill was referred to committee on October 7, but it didn't even get heard in committee until October 21. So this is a bill that will end up spending half the number of sitting days in the Senate that it did in the House, and on clause-by-clause, so a vote will be taking place next week. The senators have all been responsibly passing this in an expeditious fashion, so the Liberals will be abstaining on this extraneous vote.

Thank you, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you.

Is there any other discussion?

Monsieur Malo.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Madam Chair, after having studied the matter, the way in which this committee has gone about expressing its desire that Bill C-6 be passed with all due speed is through the work that has been done in the House itself. If my colleague considers the Senate to be an obstacle to the way in which Parliament should work, he should actually be talking about abolishing it.

At the moment, the Senate is there, and senators are studying the bill. They already know that we want the bill passed for the benefit of our fellow citizens because of all the discussions that we have had in the House of Commons.

So, for those reasons, Madam Chair, I will vote against my colleague's motion.

[The Chair, Conservative, Joy Smith]

Is there any further discussion?

Can we go to the vote now?

[Some hon. members]

Yes.

[The Chair, Conservative, Joy Smith]

(Motion agreed to)

Thank you very much.

I want to let the committee know that the minister will appear before the committee on Wednesday, December 2, to discuss supplementary estimates (B).

I want to also let the committee know that we will consider the HHR draft report--yay--on Monday, December 7. Having said that, I will note that committee business is now closed and I would ask our witnesses to please take their seats.

Good afternoon to our witnesses.

I want to welcome you to the health committee. We are so pleased to have you here today. We are very concerned about the HHR study that we're doing right now and we are so pleased that you can be here to give us further insight.

Pursuant to Standing Order 108(2), we'll begin with our study on health human resources.

We have in front of us, first, from the Association of Faculties of Medicine of Canada, Dr. Nick Busing, president and chief executive officer.

Welcome, Dr. Busing.

From the Canadian Association of Naturopathic Doctors, we have with us Dr. Paul Saunders, vice-chair of the government relations committee, and Dr. David Lescheid, scientific adviser to the government relations committee.

Welcome to you both.

From the Canadian Pharmacists Association, we have with us Dr. Jeff Poston, executive director.

Welcome, Dr. Poston.

From the Canadian Physiotherapy Association, we have with us Michael Brennan, chief executive officer.

I should mention that we also have Steve Slade with us, who is from the Association of Faculties of Medicine of Canada.

Is that “Dr.” Steve Slade?

[Steve Slade, Vice-President, Research and Analysis, Association of Faculties of Medicine of Canada]

No, it's “Mr.”.

[The Chair, Conservative, Joy Smith]

Okay. Mr. Steve Slade is the vice-president of research and analysis.

We're very pleased to have all of you here. We will have a five-minute presentation from each association. Following that, we will go into our first round of questions and answers.

We'll begin with Dr. Nick Busing, president and chief executive officer of the Association of Faculties of Medicine of Canada.

[Dr. Nick Busing, President and Chief Executive Officer, Association of Faculties of Medicine of Canada]

Thank you very much, Madam Chair.

We did circulate a document that is my version of a PowerPoint presentation. I would ask you to perhaps follow along with me, because I'm going to refer to some data on it, and some of my comments may be a bit out of context unless you have it. If I may, I'll tell you as I move through the pages.

Once again, thank you very much for giving us this opportunity.

For those of you who don't know about the Association of Faculties of Medicine of Canada, we represent the 17 Canadian faculties of medicine. We have a tripartite mission: educating the future physicians and scientists of this country; doing health research; and providing clinical care, particularly in our tertiary and quaternity care centres.

We are currently graduating over 2,300 physicians a year. We have more than 10,000 students studying to be physicians. We have 12,000 post-graduate trainees and, now, with our distributed campuses, we have 21,000 faculty across the country in full- and part-time positions. Canadian faculties of medicine receive $2.6 billion in health research.

As it states in my introduction slide, there is a significant alignment between the priorities of AFMC--and I've mentioned three strategic goals--and the standing committee's invitation and request to us to address issues of national HHR planning, innovative solutions, research and data collection, labour mobility, collaborative practice, and recruitment and retention. Within our five minutes, I'd like to touch on most of those.

The next slide says to you that we are on the same page. At our recent Deans on the Hill event, in which we met at least four or five of you around the table in one-on-one meetings, from all of your caucuses it became clear that the issue of HHR crosses all political boundaries, of all stripes. Regardless of the party or the person we interacted with, we heard clearly the message that this is a critical issue for the country, so we think we have the right group of people here to hear our observations.

We'll address four proposals very briefly.

I would ask you to go to the next slide, entitled “New Training Opportunities for Canadian International Medical Graduates”. This slide tells you that we have in our system 830 residents in training who are here on a visa. A visa resident is somebody who is not a Canadian; is not expected to stay in Canada; is supported by a sponsor, usually a sponsoring government; and is expected to return home. So that is a large number of trainees in a system which we're already currently expanding.

The next slide talks about international medical graduates. It gets a bit complicated, because an international medical graduate is somebody who is either a landed immigrant in Canada or a Canadian who studied medicine abroad and has returned here. So this is another cohort, of which, as you see, there are 1,387 who applied for training in Canada. We had capacity for 392.

So we have a relatively simple proposal, which we have spoken to some of you about in the past and which we want to reiterate. That is, we think it is time to modestly reduce the number of visa residents we have in our system and increase our capacity to take more international medical graduates. I know that all of you have constituents whose children are studying medicine abroad and want to return to Canada. They will be labelled an international medical graduate when they come back. This is a modest proposal to increase the capacity to take these sorts of students into our system.

However, visa residents come with a price tag. Faculties of medicine receive funding for visa residents. This is a proposal to replace 50 visa positions with international medical graduate positions funded by the federal government. We could fine-tune this proposal for you and suggest that that you may want to identify particular areas of need for those 50 positions. I think this could be a win-win opportunity on a small level.

The next slide is complicated and it is complicated for a purpose: to remind you that getting international medical graduates into practice in Canada is not a simple effort whatsoever. In fact, we have six major assessment centres across Canada assessing international medical graduates.

And yes, I know that many of you wonder why can't we take that physician when he or she arrives in the country and move them from a job outside of medicine into our operating rooms immediately. But there is a transition required, and this slide just reinforces for you the complexity of getting international medical graduates into practice.

The third one--

[The Chair, Conservative, Joy Smith]

I'm sorry, but we're just over five minutes. If you could quickly go over....

[Dr. Nick Busing]

On pathways to medical practice, we're talking about the need for a summit on pathways to practice. We think we should bring all the players together, the stakeholders, to exchange perspectives and try to rationalize the complex system of six assessment centres in a national strategy.

I will move right to the other issues. I'm sorry, but we have too much data for five minutes.

[The Chair, Conservative, Joy Smith]

Yes, I'm sure, but we are going to have questions and answers, so I think we'll have to go on to our next one now, Dr. Busing.

[Dr. Nick Busing]

That's great.

Thank you.

[The Chair, Conservative, Joy Smith]

We'll now go to Dr. Paul Saunders.

[Dr. Paul Saunders, Vice-Chair, Government Relations Committee, Canadian Association of Naturopathic Doctors]

Good afternoon, committee members.

My name is Dr. Paul Saunders. I'm a naturopathic doctor in private practice in Ancaster, Ontario. I'm on the faculty of the Canadian College of Naturopathic Medicine and engaged in teaching, research, and clinical education. I am vice-chair of the CAND government relations committee.

I'm joined today by my colleague Dr. David Lescheid, who is a naturopathic doctor in private practice here in Ottawa, a clinical researcher, and scientific adviser to the CAND government relations committee. We want to thank you for the invitation to present to you today.

Naturopathic medicine is a distinct primary health care system that blends modern scientific knowledge with traditional and natural forms of medicine. Naturopathic doctors are primary care professionals with a minimum of seven years of post-secondary education, including an undergraduate degree and four years of full-time study at an accredited naturopathic college.

We have a detailed infrastructure of educational requirements, licensing examinations, jurisdictional examinations, and legislation in six provinces across Canada. We are fully compliant with chapter 7 of the Agreement on Internal Trade.

We are one of only three health care professions in Canada that offer primary care for patients, along with medical doctors and nurse practitioners. Our scope includes the ability to communicate a diagnosis.

An increasing number of Canadians are using naturopathic doctors as their primary care providers despite the fact that naturopathic services are not covered by public health care systems. For example, in P.E.I., 8,000 individuals do not have primary health care, and it's estimated that over 5,000 of them are treated by the qualified naturopathic doctors in P.E.I.

While conventional medicine is experiencing an increase in the number of MDs retiring and a reduction in the number of medical students choosing family practice, we are experiencing significant growth. In the two accredited colleges in Canada, there are over 715 students currently enrolled, with 160 students entering the program each year. We have a viable career choice for these individuals and, as a result of the growth of our profession, over 65% of them are between the ages of 25 and 35. I don't qualify for that, but it is an indication that when our naturopathic doctors graduate, they will be in practice for a long time.

Treating and preventing many different illnesses is a big scope of our practice and one of our unique capabilities, and we feel that we are in an effective position to offer this to the overburdened Canadian health care system.

I want to turn the rest of the presentation over to Dr. David Lescheid.

[Dr. David Lescheid, Scientific Advisor, Goverment Relations Committee, Canadian Association of Naturopathic Doctors]

It's great to be here today. Thanks for the opportunity.

Naturopathic doctors' services are covered under extended health care plans, but not under any publicly funded plans. Patients taking a proactive approach to health by seeing an ND are therefore eliminating any financial burden on Canada's already overtaxed health care system.

Recent government and independent international reports have made it clear that Canada has an opportunity to improve its delivery of health care. In our view, an integrative, collaborative, team-based approach is necessary to support and revitalize Canada's health care system to enable it to meet current and future challenges. The challenge is to effectively integrate and utilize both publicly and privately funded health care professionals.

There are some examples of NDs who are working collaboratively with conventional health care professionals in multidisciplinary clinics, community health care centres, hospitals, and remote and rural communities. That's an important point. Canadians in remote and rural communities must often travel many hours to find a health care provider, if one is available at all. Those living in these areas tend to take a more traditional view of health and find they're in tune with the approach taken by naturopathic doctors.

Removing barriers to collaborative, innovative, multidisciplinary practices would assist Canadians by providing access to the health care professional of their choice who can provide the right services at the right time in one location. Barriers include a lack of funding, direct access to diagnostic services, access to substances, and professional bias. These things result in an inability to treat appropriately or refer or receive referrals, putting patients in an awkward position that results in fragmented patient care and, ultimately, increased costs.

Clearly there is a need to develop a more proactive, efficient, effective, and ultimately more sustainable health care system in Canada. We need to lower our health care footprint and minimize the impact we have on the cost of maintaining a health care system that remains socialized and accessible to all. We need to improve our health promotion strategies and support health care professionals with expertise in health promotion and disease prevention.

In the context of the terms of reference for the health committee's study of human health resources, we recommend that, first, the funeral government...I mean the federal government. That's a bit of a slip there.

[The Chair, Conservative, Joy Smith]

That was a Freudian slip, I assume.

[Voices]

Oh, oh!

[Dr. David Lescheid]

We recommend that the federal government: provide leadership and support for the development of fully integrated collaborative health care teams; provide leadership to ensure that all health care professionals are able to practice to their full scope, therefore addressing the shortage of primary care providers and allowing greater access for patients; provide leadership by funding initiatives to remove these barriers to truly collaborative, multidisciplinary, integrated care; and ensure health care professionals, such as NDs, have access to all the substances they require to treat patients safely and effectively--

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Lescheid.

Keep in mind that we do have your written presentation and the committee is very careful.

I've let everybody go over a minute and that cuts into our question-and-answer time. I'm not trying to be rude. It's very difficult. Just watch when I turn the light on, because I hate interrupting you guys.

[Dr. David Lescheid]

Oh, that's fine.

[The Chair, Conservative, Joy Smith]

Thank you.

We'll now go to the Canadian Physiotherapy Association, with Michael Brennan, chief executive officer.