Health Committee on March 25th, 2010

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair.

I'm curious about how the recent changes to Ontario recruitment and retention abilities have affected the aboriginal communities in Ontario. I come from the riding of Barrie, where we have huge physician shortages. They came out two weeks ago with changes that said if you no longer meet the rural index they will no longer be able to offer tuition paybacks or incentive grants. In my community that means $55,000 that the community can no longer offer, and 17 doctors in my riding are affected by that.

Is this affecting areas with aboriginal populations, and is it something you were able to use as an incentive previously? Is it something that the province didn't make available?

[Dr. Marcia Anderson]

This is the first I've heard of it, so I'm not going to pretend this is a well-thought-out and researched answer. I can certainly see the potential for that to affect our communities. I'm from Manitoba, so I'm less familiar with Ontario policies, and I defer to anyone else who is. Everyone else is shaking their heads.

I think it relates back to the previous issue about funding parity and the ability to offer competitive packages. I'm not sure how your rural index is calculated, but based on community size, many small, distributed communities often can't support a full-time physician anyway. Anything that makes it harder or more challenging, and where they may be more likely to pick a place where they are eligible for that bonus, could be a step backwards. I can see how that could potentially be harmful.

[Patrick Brown, Conservative, Barrie, ON]

I know that was the most effective carrot we were able to offer, so I imagine if that's been taken away from the aboriginal communities in Ontario as well it would be particularly challenging.

What types of recruitment efforts are utilized? What tools are you given and what tools would you like to be given to entice doctors to aboriginal areas?

[Dr. Marcia Anderson]

Salary certainly is one. One of the real challenges our physicians face is if they are working in small communities and have to maintain fee-for-service practices, it can be very difficult to make competitive salaries. So there's a preference to maintain salaried positions, despite the health care system's attempt to shift away from them. So maintaining salaried positions is going to be one real key.

In Manitoba there are northern recruitment bonuses as well. I think it's important to realize that, at least in Manitoba, all physician services are paid for by the province. It's the province's responsibility to recruit and retain physicians and set the bonuses. So we need to continue to support our provinces in that.

The third thing I will mention is the support that's necessary for any professional when they're in a small community on their own, whether they're a nurse, a physician, or a CHR. We all need to have that kind of professional and personal support, and I think that is really an area that's overlooked. Our organizations need to have the capacity to pay for ongoing cyber-technology, whether it be for “webinars”, online mentoring forums, or what not. We need to do a better job of supporting our staff when they are in remote rural locations.

[Patrick Brown, Conservative, Barrie, ON]

In Ontario and Quebec we've started to see investments in nurse practitioners as a way to help alleviate some of the shortages. In Ontario they have the one-to-four ratio, where every four doctors can have the use of one nurse practitioner if they can find them. In my riding a nurse practitioner can take 800 patients off the wait list, but the challenge is that many of the doctors don't want a nurse practitioner or haven't been able to get one because they're still in the elementary stages of educating and training enough nurse practitioners in Ontario.

Do you find that to be a similar challenge? Is there an adequate number of nurse practitioners in aboriginal communities?

[Audrey-Claire Lawrence]

I think the issue Rhonda highlighted is that a lot of funding is at the base level to get people in, and we don't want to erode that funding, because it's inadequate as it stands. But when people try to bridge or build up their programs so practical nurses become RNs, and RNs become nurse practitioners, the funding may not be available or may be incomplete.

There's the issue of being able to hold a position while somebody takes a year off to complete a degree program or obtain the credentials they need to be a nurse practitioner. There's nothing wrong with putting in an employment requirement that they have to stay in a position for two years after an employer has paid for training. That kind of thing would be fine, but people need the funding at the time. As mentioned, many of the people who do make it as nurses and physicians tend to be more mature students. They have families and kids. So there's the issue of day care funding. Other related expenses also need to be taken into account. I think that area needs to be explored.

[The Vice-Chair, Liberal, Joyce Murray]

Thank you.

Ms. Hughes.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Thank you.

I have a question with respect to the First Nations University of Canada in Saskatchewan. I'm assuming that there are health courses being given there. I'm wondering, based on the fact that the government has pulled the funding from that university, what the impact will be on some of the first nations who are taking the courses there, if any.

[Rhonda Goodtrack]

Thank you very much.

Currently we have students enrolled in the nursing program at First Nations University. As I said, it's a partnership between Saskatoon, Regina, and Prince Albert, and they have students in all sites. All the students who are currently enrolled will be able to finish their program. I believe the University of Regina will be managing that piece.

In terms of future or prospective students, they come to aboriginal-run institutions such as First Nations University because of the indigenous piece that's there. They want that piece. If First Nations University isn't allowed to continue, students are going to miss out on it, absolutely.

I can't comment on administration at this point, but the capacity to have the indigenous knowledge piece incorporated is critical for aboriginal health care.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Just to add to that, how important is it, because there is a lack of the cultural aspect in the general education for health professionals, to ensure that it is put into all the curriculums for health care?

[Rhonda Goodtrack]

It is very important that indigenous knowledge be incorporated in all health disciplines. We have been working with the Indigenous Physicians Association of Canada. We have a cultural competency framework that is discussed in the briefing note that was circulated and is also on our website for download. It's very important that this piece be incorporated to help improve the care that the practitioner delivers to the end-user, the patient, the client.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

I want to touch upon the silos that are currently out there; I'll leave this question open.

When we're looking at the life expectancy of registered Indians, it's 6.6 years less than that of the Canadian population—that was in 2001. And I'm looking at the Auditor General report of 2008: the infant mortality rates, the incidence of tuberculosis, the diabetes rates are all higher. So we're not just talking about doctors and about nurses; there are many other health care needs out there. I can tell you that Wikwemikong First Nation has been advocating for a dialysis machine, and in Manitoba people were looking for an X-ray machine.

How imperative is it for us to address the need out there for other health care professionals? Do you have any suggestions for how we can address this issue?

[Dr. Marcia Anderson]

That is an excellent point, the range of health professions that ought to be looked at. One of the reasons we can be here today as organizations is that we have reached a critical mass in our profession. We're very thankful for it. The reason we don't see physiotherapist organizations or occupational therapist organizations or pharmacist or X-ray techs is that they don't have that critical mass yet. We have to tread the very difficult line of taking care of our own interests as mediciners—nurses or CHRs, etc.—rather than ensuring that our students are aware of the range of options available to them.

If you're talking about a student from a rural remote community, they'll never have seen an occupational therapist or have any clue as to what it even means or what that person does. I know that's probably true for most of the general population, though: occupational therapy is a tough one.

This goes back to one of the points I raised earlier, which is that we have to be working with students, families, and teachers much earlier to ensure that when students are at an age at which they can start to understand what the range of different health professions is, they are prepared to enter one, whether they want to be the CHR and work in heath promotion in their community or want to become an X-ray tech or a PT or whatever. It's the common beginning that we need to focus more on.

[The Vice-Chair, Liberal, Joyce Murray]

Thank you, Dr. Anderson.

It's Ms. Block's turn.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you very much, Madam Chair.

This has been a good conversation to be included in. I'm not a regular member of the health committee. Before I was a member of Parliament, I was the chair of a district health board in Saskatchewan in the third-smallest health district in Saskatchewan and then a member of the largest health region, Saskatoon. It seems to me we were discussing these very issues back in 1993, 1994, and 1995. I believe some progress has been made. I'm hearing that from you. I recall back in 1997, as the chair working through the SIMAS agreement--I don't know, Rhonda, if you're familiar with the Saskatchewan Indian and Métis Affairs Secretariat when we were trying to find ways to encourage first nations young people to get involved in health care professions.

I believe we've made some progress with the first nations graduates coming out of post-secondary education. Simply because we're talking about recruitment and retention and trying to recruit health professionals to remote and rural areas, do you have any data on how many are returning to their home communities and providing services?

[Rhonda Goodtrack]

There's nothing in place to be able to capture that data. Anecdotally, some are returning. We were talking about the experience of one of my students in the nursing program. She's from Onion Lake on the Alberta-Saskatchewan border, and I asked her if she was going back when she'd done nursing school. She said ideally she'd love to, but the reality is she's going to stay in an urban centre until her kids are done school, because she doesn't want them to struggle the way she is struggling in the maths and sciences.

[Dr. Marcia Anderson]

We are trying to collect that data through the survey I mentioned before. We don't have it yet. One thing I often state is to keep in mind what it means to work in indigenous health and serve the indigenous community in Canada. Certainly one way is by working in rural and remote first nations, Inuit, and Métis communities, and also by teaching indigenous health in the faculties of medicine; by working in urban centres, since 50% of our population is urban and all tertiary care is delivered in urban areas; by working in health policy; and by working in indigenous health research. I passively encourage our members to work in any of those areas, not just in the remote and rural communities.

[The Vice-Chair, Liberal, Joyce Murray]

That concludes our meeting. I want to thank you for taking the time from what are obviously very busy schedules and the tough issues you're working to resolve on behalf of Canadians. So thanks for coming to help us understand these issues better.

I would like to let the members know that the Subcommittee on Neurological Disease is meeting right now.

The meeting is adjourned.