Evidence of meeting #50 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was year.
A recording is available from Parliament.
December 9th, 2009 / 3:35 p.m.
Conservative
Patricia Davidson Conservative Sarnia—Lambton, ON
Yes, Madam Chair.
We have an agenda before us. We have witnesses sitting here who have come out on a horrible day. We have until 4:30 only. I would suggest very strongly that we move ahead with our agenda.
We have certainly heard the concerns of Dr. Bennett. I think we've heard enough of them. You know the message. Why don't we move on?
3:35 p.m.
Conservative
The Chair Conservative Joy Smith
With the will of the committee, can I just move on and have our witnesses present?
Thank you.
3:35 p.m.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
Madam Chair, would you report back to this committee what will happen in the next three months--
3:35 p.m.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
--when there are weather concerns for our briefing on Wednesday afternoon?
3:35 p.m.
Conservative
The Chair Conservative Joy Smith
Well, if people can't get here, Dr. Bennett, I'm sorry; unless you go by sleigh and snow dog, I don't know how you'll get them here.
3:35 p.m.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
Madam Chair, tomorrow the briefing is by telephone. We could have had the briefing by telephone today. That is the point.
3:35 p.m.
Conservative
The Chair Conservative Joy Smith
People are at airports. People are all over.
This is the end of this discussion.
We'll now go on to the witnesses.
3:35 p.m.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
Excuse me, Joyce. We need a commitment that the minister will not schedule her briefings--
3:35 p.m.
Conservative
The Chair Conservative Joy Smith
What I'm going to have you do now is present. We have before us, pursuant to Standing Order--
3:35 p.m.
Conservative
The Chair Conservative Joy Smith
I will not recognize you at all, Dr. Bennett, if you're going to continue with this kind of conduct.
3:35 p.m.
Conservative
The Chair Conservative Joy Smith
You're done.
Pursuant to Standing Order 108(2), study of human health resources, we will start with our witnesses.
The first one is from Alberta International Medical Graduates Association.
I hope I pronounce your name right: Nicodeme Mugisho-Demu, vice-president, Calgary.
How did I do? Was it okay?
3:35 p.m.
Dr. Nicodeme Mugisho-Demu Vice-President, Calgary, Alberta International Medical Graduates Association
You were close.
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Voices
Oh, oh!
3:35 p.m.
Conservative
The Chair Conservative Joy Smith
Great. Welcome.
We also have, from the Federation of Medical Regulatory Authorities of Canada, Fleur-Ange Lefebvre.
Did I do that okay?
3:35 p.m.
Dr. Fleur-Ange Lefebvre Executive Director and Chief Executive Officer, Federation of Medical Regulatory Authorities of Canada
Close.
3:35 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you.
We also have, from the Medical Council of Canada, Ian Bowmer, executive director; and from the Canadian Resident Matching Service, Sandra Banner, executive director and chief executive officer.
Each organization has five minutes.
If you would be so kind as to give your presentation, we will begin with you, Mr. Nicodeme Mugisho-Demu.
3:35 p.m.
Vice-President, Calgary, Alberta International Medical Graduates Association
Thank you, Your Honour.
As you pointed out, my name is Nicodeme Mugisho-Demu, and I represent the Alberta International Medical Graduates Association. We are a not-for-profit organization that is committed to integrating foreign physicians into the Canadian medical system without compromising current Canadian medical standards. We are, then, a bridge between over 600 foreign physicians in Alberta and the Canadian medical system.
We all agree on the need to integrate foreign physicians into the Canadian medical system, especially at these times, when a Canadian patient may spend hours in the waiting room just for a prescription renewal, while we have foreign physicians doing such jobs as security guards. There is even a well-known person who made a joke, that if a pregnant woman has a choice between calling 9-1-1 and the cab, she should call the cab, because if anything happens down the road, God forbid, the driver can make the delivery: he's a foreign physician.
It might make you laugh, but this is the sad reality.
The question is how do we make sure that we tap into the resource represented by IMGs so that we can make things better for Canadians and for these IMGs? We as an association will be a key player in this process, because we understand the Canadian medical system requirement and the foreign physicians' needs and challenges in this situation.
There are some challenges. The first one is the lack of assessment procedures that take into account IMGs' prior medical experience. We need to have such a procedure, one that will take into account their prior medical experience and how long they've been out of practice as well as provide an upgrading procedure. This will help to integrate these people into the Canadian medical system. I know some organizations are working on this basis, and, as an association, we are working currently on a fast-track assessment research program funded by Citizenship and Immigration Canada. This research program will be completed by March 2010, and we will be more than happy to share the results of the research with the House for its consideration.
Another challenge is the fact that the few programs in existence for foreign physicians are not integrated. These programs don't work together. We have to make sure they work together. I will give you an example of how serious this is.
In Calgary we have the Calgary clinical assistants program, and in Edmonton we have the surgical preceptorship program and the clinical preceptorship program. These are two-year programs. The IMGs work for two years under supervision, undergoing some evaluations that are comparable to those of Canadian graduates. These are great programs, but at the end of the two years, they're just dropped. These programs become bridges to nowhere. If these people have to apply for international medical programs, for example, for their full licensure, there is no consideration whatsoever of that experience. They have to spend the same amount of time in the residency program as if they would if they hadn't gone through that program. This is a waste of time and resources, both for the Canadian medical system and for the IMGs.
One of the solutions, and the most effective one, would be for all the programs to help foreign physicians to be made into university-based programs. That way, there would better coordination of these programs, and the foreign physicians would have the opportunity to get acquainted with their future colleagues, other medical students.
The other problem is a shortage of residency positions. Of course, this is justified by the lack of preceptors, as well as sometimes the finance. But if we consider that most IMGs apply for family practice—this is an area where the shortage is mostly felt—expanding the qualifications to be a preceptor to family physicians in private clinics and rural areas is a solution to this problem. Then they will be able to mentor these foreign physicians. The House could look into some incentives and tax breaks for physicians who are supervising those physicians.
Those are some of the points we have.
We thank you again for listening to us and for giving us this opportunity to talk in front of this great nation.
Thank you.
3:40 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you very much for the insightful comments. It's very useful to our committee.
We'll now go to the Federation of Medical Regulatory Authorities of Canada, Madam Fleur-Ange Lefebvre.
3:40 p.m.
Executive Director and Chief Executive Officer, Federation of Medical Regulatory Authorities of Canada
Madam Chair and committee members, thank you for this opportunity to speak to you today on labour mobility and international medical graduates.
I would like to say that I would be happy to answer questions in both official languages.
I am addressing you today on behalf of FMRAC and its 13 members, the provincial and territorial medical regulatory authorities. You may be more familiar with them under the name “College of Physicians and Surgeons of”, and then tack on the name of a province; in Quebec it's Collège des médecins du Québec. They are statutory bodies established by provincial or territorial legislation to serve the public's interest by setting standards of practice and of professional conduct and by determining the qualifications for licensure and for maintenance of licensure.
You will have before you a copy of the latest draft of the FMRAC Agreement on National Standards for Medical Registration in Canada, dated October 21, 2009. And since it's out for consultation with our members, and hopefully approval by their respective councils, there will be a few more changes, but these are not expected to be substantive.
When the recent changes to chapter 7, on labour mobility, of the Agreement on Internal Trade came, medical regulators were already developing national standards for registration of physicians. The timelines have been somewhat accelerated as a result of the need to come into compliance with the AIT. This, while not always a bad thing, does present some challenges.
Since the AIT mandates that no extra requirements can be made of physicians who already hold a licence to practise in a Canadian jurisdiction and who want to move to another jurisdiction within the country, standardization will in fact enhance labour mobility. When we are done, most likely by the end of summer 2010, all medical regulatory authorities in Canada will approach licensure in the same way.
The need for definitions in our document that I've shown you cannot be overemphasized. I have to show you another document. My president didn't want me to do this, but I'd already printed it so I told him I would anyway. This is a 76-page document that we developed last spring, entitled “Inventory of Medical Licensure Terminology in Canada: Definitions, Descriptions, Conditions and Provisions”. It describes more than 125 different categories of licensure, both full and provisional. It has served to highlight the degree of variability across the country and has galvanized FMRAC and its members towards standardization.
There has long been a “gold” standard for physician training in Canada that leads to a full licence in every jurisdiction. We are proposing to now call it the “Canadian” standard.
This agreement, among all medical regulatory authorities, covers not only the Canadian standard, but additional standards for recognition of international medical graduates seeking licensure in Canada.
Medical regulatory authorities agree that IMGs who do not meet the Canadian standard will initially be eligible for a provisional licence. Section three, on pages 5 and 6 of your document, outlines the conditions that must be met prior to the issuance of a provisional licence.
Section four addresses how a physician can move from a provisional to a full licence. Details about the assessment of competence and the types of restrictions that will apply to a provisional licence are part of the ongoing work of the medical regulatory authorities under the coordination of the FMRAC.
I cannot stress this enough. The intent is for every medical regulatory authority across the country to apply the same categories and definitions for full and provisional licences, to require the same conditions prior to initial licensure, and to require the same conditions for any subsequent change to the status of a physician's licence.
A nationwide agreement on what constitutes a full and a provisional licence will achieve the goal of the AIT. Even physicians with provisional licences will have enhanced mobility if every jurisdiction uses the same categories, assuming the receiving jurisdiction has the resources for the supervision requirements and other conditions that may exist as part of that provisional licence.
The work we are doing to standardize licensure processes also assists in standardizing foreign credentials recognition.
Medical regulators in this country can already proudly point to foreign credential recognition taking a matter of a few weeks—much less time than the one year prescribed in the recently announced pan-Canadian framework that we heard about last week. Our members have worked and continue to work tirelessly to help IMGs become licensed and find training and work in health care. In fact, in recent times, in several provinces, the majority of new physicians registered have been international medical graduates.
Provincial and federal departments of labour and of health are very aware of the intensity with which medical regulators across Canada are developing a renewed national standard for physician registration, one that includes a common approach to the recognition and licensure of IMGs, as well as to the output of our Canadian system.
Medical regulatory authorities are tasked by governments to ensure that physicians provide safe and effective care. They must walk a fine line between expectations for quality care and for access to any service at all.
Thank you. We would be pleased to answer any questions.
3:50 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you so very much.
We'll now go to the Medical Council of Canada, with Mr. Ian Bowmer, executive director.