Health Committee on May 13th, 2010

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you very much, Madam Chair.

I would like to discuss foreign physicians with Mr. Tepper and Ms. Garrison. You had very little time to answer my colleagues' question.

According to you, have more foreign physicians been brought into the public health care system? Have you seen any measures that have been particularly successful? I am thinking of one initiative in particular I was discussing with my colleague Ms. Demers earlier. She was telling me that there is a very good program in Alberta. We have also met on a few occasions with people there to discuss the integration of foreign physicians.

What is your philosophy in this regard? Do you have any concrete examples of initiatives which have been particularly fruitful?

[Dr. Joshua Tepper]

All jurisdictions in the last decade, I would say, have made significant changes to the integration of international medical graduates. The level of movement reflects to some degree how many international medical graduates are in that jurisdiction. For example, Ontario--this was true as of a few years ago--has more international medical graduates arriving each year physically than the rest of Canada combined, and therefore when you take a look at Manitoba, which doubled their number of international medical graduate positions from two to four, it's just a different scale from when Ontario goes from 75 to 200. It's just the nature of where the demographic arrivals are.

Each jurisdiction has taken a slightly different approach in how they assess, integrate, and license, as well as on whether there are any practice or other restrictions and on how they integrate them into the workforce. I think there have been a number of very good models. One of the things Ontario has done is allow physician assistant models to be IMGs, which gives them a really nice entry into the workforce, and many of those people then go on very successfully to get full licences. You mentioned Alberta's program. Quebec has seen a large surge as well in its educational capacity and how they have done it.

What ACHDHR has managed to facilitate for the first time a common entry criteria and assessment process for international medical graduates going into education and training. This is a big accomplishment showing where the pan-Canadian approach works well. This is a huge accomplishment, the result of about three years of work by all jurisdictions and the Medical Council of Canada, etc. Coming up with this common standard with the exam banks, etc., would be another big pan-Canadian success story,

[Nicolas Dufour, Bloc, Repentigny, QC]

If I understand what you are saying correctly, currently the provinces have managed overall to integrate foreign doctors very well because of the latitude they have in the health care area.

[Dr. Joshua Tepper]

I think it's hard. The term “international medical graduates” represents a huge group of people, and the people who self-identify as international medical graduates are all very different. It is a very heterogeneous group. Medical education systems are very different around the world. There are people who will say they went to medical school, but they have never seen a patient because their education system, as it is structured, may give them an MD but doesn't actually give them any clinical experience. There are other people who say they are doctors, but they may not have actually practised in 15 years, for whatever reasons. The integration of these very different people with different educational backgrounds and different practice experiences is a very mixed bag. We have to be careful with broadly using the term “IMGs” broadly. We have to understand the range of people who are captured within that term.

What I would say is that all jurisdictions have tried very hard and have seen a quantitative increase in their numbers--quite a substantial increase--and I'm happy to provide at least some of the data. I don't have access to all of them, but I can provide data about the increase in many jurisdictions, not just of total doctors--to your previous question--but of the specific IMG subset and the increased trend line. I believe I can get that for you for several jurisdictions.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you very much.

Ms. Woods, we have heard a lot of witnesses talk about the measures we should put in place so as to increase the number of doctors for the Innu and first nations peoples. You have very little time to answer my question, but what initiative has struck you? What do you think you can do?

[Shelagh Jane Woods]

Mr. Dufour, all I can tell you is that a great deal of money has been allocated to support medical students. To date, over 60 people are receiving funds from us. That is our first initiative to support doctors and increase those numbers.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you, Monsieur Dufour.

We'll now go to Ms. McLeod.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you, Madam Chair. I would like to understand a little bit more in terms of the advisory committee on health delivery and human resources. You talked about it quite extensively, but how often do you meet? How many subcommittees are there? Could you share that?

I'm also very curious to know about your interprofessional committee--what it's doing, where it's going. Is it supporting all professionals who are members?

[Margo Craig Garrison, Federal Co-Chair, Advisory Committee on Health Delivery and Human Resources]

I'd like to take that question.

I'm Margo Craig Garrison. I'm the federal co-chair at the moment, and have been since January. I defer to Dr. Tepper, in many instances, because he has much broader experience than I do. I am also working at Health Canada. I am the director of health human resources policy in the strategic policy branch.

To answer your question, the committee is composed of membership from all of the jurisdictions, plus an assortment of other organizations. HEAL is the one that you've heard mentioned here already today. We also have representation from the Canadian Institute for Health Information, the Canadian Institutes of Health Research, and Human Resources and Skills Development Canada. There's a local regional health authority involved, as well as representation from aboriginal communities and from the first nations and Inuit health branch.

The committee meets generally about three times a year. There are regular conference calls in between, particularly if there's an issue that requires the attention of the members.

In terms of the subcommittees that we have in place right now, we have one that looks at internationally educated health professionals. That's something that's starting up, which Dr. Tepper referred to. It looks at nurses, physicians, and other internationally educated health professionals. We also have an entry-to-practice subcommittee, which has been long-standing for many years.

In addition, we have a health and education task force, acknowledging the importance of bridging the health and education ministries to support health professional education across the country.

I'm trying to think whether there are any others.

[Dr. Joshua Tepper]

There's some data modelling.

[Margo Craig Garrison]

Yes. We have a planning and partnerships subcommittee. I should remember that because I'm also the co-chair of it. We look at partnership issues and the broader stakeholder issues, as well as data modelling. Most recently we had a discussion around productivity. There's a lot of activity that takes place under this rather large umbrella.

[Dr. Joshua Tepper]

There are also time-specific committees that may be looking at a specific issue. If a large change is coming through from an organization or something, we'll strike a committee for six months, a year, or 18 months to deal with that, or if there's direction from the deputies, we'll strike a unique committee.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

With respect to the newly formed interprofessional committee, can you talk a little bit about who is on it and what the mandate is?

[Dr. Joshua Tepper]

Probably the easiest thing to do would be to send you the terms of reference and membership. It's open to all members of ACHDHR. It's co-chaired, but I forget who's co-chairing it now.

It has been an evolution from the previous interprofessional—

[The Chair, Conservative, Joy Smith]

Doctor, I'll just interrupt you for a moment.

If you could send those terms of reference to the clerk, we'll make sure they're distributed to the whole committee. Thank you.

Go ahead, Dr. Tepper and Ms. McLeod.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

I think I'll switch track. There was some suggestion—I can't remember from which witness now—that we have a number of Canadian physicians trained abroad and coming back. At the same time, we have a number of foreign graduates trained and going back home. They were saying that if there was a bit of a swap with the seats, we would have more capacity to train our Canadians coming home after training abroad.

[Dr. Joshua Tepper]

There are two slightly different issues there. One is Canadians studying abroad. These are Canadians who might typically go to Australia, Ireland, or some of the U.S. offshore schools for their medical training and then wish to come back for residency. They are considered international medical graduates because they have done their training internationally.

The second group you're talking about are visa trainees. They are usually here for subspecialty training. There has been a lot of discussion about whether these visa trainees from other countries are taking needed capacity. That has been an oft-discussed piece.

Most jurisdictions with medical schools have very hard conversations with their universities to ensure that they are only taking visas where excess capacity is needed. I know that in Ontario we actually have a letter on file to that effect in order to mitigate that situation.

This again has been a long-standing conversation, and each jurisdiction has very hard conversations with their medical schools to make sure that they're not there. Often the visa trainees are in very unique sub-subspecialty areas that are not the type of entrance, core, postgraduate training that CSAs—Canadian students abroad—or other foreign medical graduates would be typically seeking.

We monitor it closely. It is something we watch closely.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

It looks as though this suggestion was perhaps quite a simplification.

[Abby Hoffman]

Could I just add one point to this particular conversation?

It is the case as well that there are a not insignificant number of vacant residency seats each year. They tend to be more in family medicine than in subspecialties, and there tend to be more in some provinces than others, so the notion that there is a zero-sum direct relationship between these visa residents and Canadian-trained physicians, or Canadians who have been trained abroad in competition for the same seats, isn't exactly the case.

There are some residency seats that could be filled, but as you probably heard in other testimony, that matching process is complicated. It's not unreasonable that there's a bit of a surplus, but there are some seats that could be filled by Canadian international medical graduates.

[The Chair, Conservative, Joy Smith]

Please be brief, Dr. Tepper.

[Dr. Joshua Tepper]

In responding to Mr. Dufour especially, in no way do I want my comments to be taken as saying there's no more work to do. There is always more work to do. There are always more barriers to break down and more pathways to facilitate, absolutely. The overall trend has been dramatic or substantial, but that does not mean there isn't more to do.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Tepper.

It's now Dr. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair, and thank you to all the witnesses.

I'll begin with a question about data. What are public data and what do communities have to pay for?

[Jeff Latimer]

Thank you very much for the question.

I can start by telling you what is publicly available at Statistics Canada. Basically, our Canadian community health survey, which is our largest population survey at Statistics Canada, collects data on approximately 66,000 Canadians every year on the determinants of health status and on the utilization of health services.

We release that information to the public at three levels of geography: the national level, the provincial level, and what we call a health region level, corresponding to an administrative level of geography at which provinces and territories manage their health services delivery.

That is available on our website free of charge to any Canadian.