Health Committee on April 1st, 2010

[Dr. Ali Varastehpour]

I have heard anecdotally, but I know a lot of physicians, and as a matter of fact we have a lot of support in the Canadian medical community. One of the faculty at the Royal Alexandra Hospital personally told one of my colleagues to talk to the minister. Instead of doing observership, which is ridiculous for you and for me, request one year of internship, and you will know everything. This has been in books in Canada, by the way. This is not new.

In the 1980s you had to do one year of internship and you would be a doctor--end of story--but they removed it. I don't think there is a resistance; they will be very happy to have somebody work for them as a resident.

[David Tilson, Conservative, Dufferin—Caledon, ON]

Well, that's what we heard in immigration.

Dr. Martin--

[The Chair, Conservative, Joy Smith]

I'm sorry, Mr. Tilson, but we've gone quite a bit over time.

Ms. Murray, you're next. If you'd like to continue that line of questioning, that would be fine.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you, Madam Chair; I have a different line of questioning.

I appreciate the panel's input here. I have some experience in corporate system re-engineering, so I was struck by the comments from both Dr. Martin and Dr. Bowmer about system re-engineering. What's occurring to me is that the IMGs may not be seen as the patient in this re-engineering. I know that some of the facilities have patient-centred care initiatives to do improvements in the provision of service to patients, but in fact in a way the IMGs are at the centre of this, because if the IMGs are served, then our system is served and Canadian patients are served.

This is very complex and interjurisdictional. There are success stories here and there, and there are pipeline blockages here and there. It's a complex system breakdown. In provincial politics I heard lots about this almost ten years ago, and I'm sure the problem began before that.

Is there a system engineering organization or framework for looking at this as a system design problem, a way to cross jurisdictions and put the IMGs, those humans who are driving taxis and so on, at the centre of it? I'd like an answer to that, and if there isn't, would that be something that you would recommend? And do you have any thoughts about how to do it, or who could do it, or what kind of framework could do it?

Thank you.

[The Chair, Conservative, Joy Smith]

Go ahead, Ms. Lefebvre.

[Dr. Fleur-Ange Lefebvre]

Thank you.

While we have national exams and national accreditation for undergraduate, postgraduate, and continuing medical education activities across this country, the move to national standards for registration and licensure is new. That is going to help. That is a re-engineering process.

We have 13 jurisdictions in this country that license physicians in 13 different ways, and they have agreed that we're moving to national standards. Now, it's going to take some time, because there are 13 pieces of legislation that are going to have to be opened up, but they're determined.

May I segue to Monsieur Malo and Monsieur Dufour,

and tell them that, nevertheless, Quebec signed the Agreement on Internal Trade, which includes chapter 7 on labour mobility? Furthermore, they signed the Pan-Canadian Framework for the Assessment and Recognition of Foreign Qualifications. So they are fully participating.

[The Chair, Conservative, Joy Smith]

Thank you.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you, Madam Lefebvre.

That may be one part of it. Again, that's not the whole system.

Is there anyone who is looking at the whole system? You get a blockage here; you move that, and there's a blockage there. It's a system redesign that I'm hearing is needed.

[Dr. Ian Bowmer]

I think the federal government has taken some leadership in this role. When a blockage has been identified, there has been funding. An example is the assessment process, which was really run independently by seven regional or provincial jurisdictions, but is now being brought together as one. The national assessment collaboration, which was funded by Health Canada and HRSDC, was an attempt to do this. It came out of the 2004 IMG task force recommendations.

We're still very much piecemeal as far as the remedial activity is concerned. Just to put it into context, the residency programs aren't the only way international medical graduates come into practice in this country. Approximately 1,400 or 1,500, according to the national physician database, enter practice every year. Only half of them enter from residency. The other half enter through provincial programs. Some of them are mentored observerships, while some of them come just straight from the minimum requirement, which is actually the evaluating exam, straight into a practice, with a mentored process.

Each province has a different way of doing this. Standardizing it would be a very useful opportunity, but again it is a resource issue. As Madame Lefebvre pointed out, it involves not only the exams but also this idea of making sure that someone is safe in practice, and therefore having an observed clinical practice. That is perhaps one.

The next step is to try to coordinate this process across the country, because every province is different.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Bowmer.

We'll now go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

There are so many questions and so little time. I'd like to throw the questions out first, if that's okay.

Dr. Bowmer, you mentioned different standards. I was wondering if there are reciprocal recognition movements going on. I know the U.K., Australia, the United States... You mentioned that Canada and the U.S. have joint accreditation. Are we looking at anything that would expedite reciprocal recognition agreements, and if so, who should do it?

I was also going to ask you to comment. Dr. Varastehpour, I noticed you and Madame Lefebvre nodding in disagreement.

Dr. Varastehpour, I was really concerned when you said that money talks here and that people are buying their way into the Canadian system. I was actually hoping that if you have examples, perhaps you could provide them to our committee so that we could understand it a little bit better. I think it's a concern for all of us.

As well, perhaps you could give your viewpoint on the main barriers facing IMGs in having their skills, training, and education recognized in Canada. I get the feeling there's a lot of politics involved here. If there's any leadership that we could take, who should do it?

[Dr. Ali Varastehpour]

I have a hard time understanding you.

[Colin Carrie, Conservative, Oshawa, ON]

Pardon me?

[Dr. Ali Varastehpour]

I have a hard time understanding you completely. If you could phrase your question in a limited manner, I could probably answer it.

[Colin Carrie, Conservative, Oshawa, ON]

Okay.

[Dr. Ali Varastehpour]

I was listening and I had a ballpark understanding of your comments, but...

[Colin Carrie, Conservative, Oshawa, ON]

What are the main barriers facing IMGs in having their skills, training, and education recognized in Canada?

However, I wonder if Dr. Bowmer could start with my first couple of questions. I know I've posed a lot in a limited time.

Thank you.

[Dr. Ian Bowmer]

There are a number of attempts. The College of Family Physicians—and perhaps it should speak to this—is actually undertaking reciprocal agreements with other countries, where the acceptance of training in that other country would be accepted automatically in ours. The Royal College of Physicians and Surgeons, the other specialty organization for medicine, surgery, etc., is doing exactly the same.

I would point out, though, that because the training is acceptable, it doesn't mean that the qualification will be equivalent. I like to use the example of anesthesia in the U.S. In Canada, we require an anesthesiologist to manage our intensive care units; in the U.S. they do not. So even though we accept their training, we require additional training if an anesthesiologist is going to provide full service in Canada. That's one level.

The other level—and perhaps your Quebec colleagues can talk to this better—is the France-Québec Entente, which is actually a reciprocal arrangement with the regulatory authority in that country. It is an interesting model where Quebec would accept an individual, and Madame Lefebvre can probably explain that better, but it is an example for this committee.

[The Chair, Conservative, Joy Smith]

Is there anybody else who would like to comment on that issue for Dr. Carrie?

Yes, Madame Lefebvre.

[Dr. Fleur-Ange Lefebvre]

Yes, just briefly.

We are working with the College of Family Physicians and the Royal College to see about recognizing foreign training. We have something in various jurisdictions called the fairness commissions, however, and that's something that could possibly work counter to this.

Can we look at an IMG from one country differently than an IMG from another country? We're going to try to develop something that is defensible from a human rights perspective, but we do have to work with the fairness commissioners in these jurisdictions where they exist.

[Colin Carrie, Conservative, Oshawa, ON]

Do I have enough time to briefly—

[The Chair, Conservative, Joy Smith]

You have about a minute.

[Colin Carrie, Conservative, Oshawa, ON]

Madame Lefebvre, could you comment on the statement, “buying their way into the Canadian system” or “money talks here”?

[Dr. Fleur-Ange Lefebvre]

We see physicians at the time of licensure. How they get into the system, or the access to residency positions, is not a role of the regulatory authorities.

[Colin Carrie, Conservative, Oshawa, ON]

It's not.

Dr. Varastehpour, are you able to comment on the barriers?