Evidence of meeting #8 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was dementia.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

  • Eleanor White  President, Canadian Chiropractic Association
  • John Haggie  President, Canadian Medical Association
  • Barb Mildon  President-elect, Canadian Nurses Association
  • Frank Molnar  Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society
  • Maura Ricketts  Director, Office of Public Health, Canadian Medical Association
  • Don Wildfong  Nurse Advisor, Policy and Leadership, Canadian Nurses Association

4:55 p.m.

President, Canadian Medical Association

Dr. John Haggie

In my province, 35% of the practitioners currently in practice are within five years of retirement, if you take 65 as a retirement date. However, what is happening is that a significant number of those practitioners are not retiring in the way the generation before them did. They are altering the way they work. They still have a lot to contribute. They have skills that they want to pass on. So they move away from the more acute, physically demanding areas of their specialties into something a little less exciting, from a physical point of view. That's one factor.

The aim of this country should be that it should be self-sufficient in terms of physicians. That then leads to the question of what that means.

We have had a huge increase in the number of medical students in this country. There are still more Canadians studying medicine abroad than there are studying medicine in Canada. That then raises all sorts of issues about repatriation.

There have been a variety of arguments, both legal and otherwise, that say these people who have been trained abroad and who have taken the Canadian exam should be entered into the residency program, for example, at the same rate. That's resolved itself at the moment.

The issue in terms of residency posts is that there are an inadequate number. We probably need 1.2 residency posts for every Canadian graduate, but if you have 3,500 Canadians who have graduated elsewhere, those numbers don't match.

The other problem is that we really don't know what residency spots are entirely appropriate. How many family physicians as a percentage of the global output of medical schools, residency programs, do we actually need, or will we need? If chronic disease is going to be the new paradigm, and it is, do we need to focus more on those specialties and disciplines and residency programs that actually produce that kind of graduate, rather than the acute specialty programs such as general surgery?

In my case, for example, we don't have the data on that. That's come to light lately because residents have done training and then found difficulty getting employed.

That's the background. Then there is question about how you deal with those doctors who have trained overseas and may not actually be Canadians and want to emigrate. I know for a fact that FMRAC, the Federation of Medical Regulatory Authorities of Canada, is actually looking at a streamlined, common licensing process for physicians, whether they trained in this country or they trained abroad.

That might answer some of those issues. Then you've got capacity issues in terms of whether they're coming in for residency spots, again because that's going to be it. Again, it's not a simple answer, unfortunately. It illustrates the complexity of what is an adaptive complex system.

5 p.m.

NDP

Djaouida Sellah Saint-Bruno—Saint-Hubert, QC

My second question is for Mr. Molnar.

The committee has also learned that, if 14% of the population today is 65 and over, in 2036 it will be 25%; that's 10 million people. Right now, what percentage of health care services goes to people age 65 and over? And how does your organization adapt to these changing demographics?

5 p.m.

Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society

Dr. Frank Molnar

Once again, my CMA president is going to have more data than I will. Acute care is where I live. In acute care, seniors are the main clientele despite the fact that the posters describing our hospital don't have any seniors on them. The Canadian Geriatric Society is a very small society. We have probably 200 geriatricians in this country. We should probably have 500 to 600 geriatricians. We don't have enough physicians trained in care of the elderly—those are family physicians who have an extra year of training.

Overall, if you look at geriatric medicine care of the elderly, the numbers of physicians who have the expertise in dealing with the multiple chronic diseases, who have cross-trained in multiple areas and can deal with cognition, are probably somewhere between 40% and 45% of what we really need. So we're far behind. The earning potential for those groups is lower than their peers', so it's not a competitive speciality. So we're not really getting a lot of residents into these areas. We're falling further and further behind. I would echo the comments that were made before. There's a real mismatch between the training positions that are being offered and what our society needs. The data is not there, but there is a huge mismatch. In geriatric medicine care of the elderly, that gap is growing.

I'm sure Dr. Haggie could talk to the numbers.

5 p.m.

Conservative

The Chair Joy Smith

Thank you, Dr. Molnar.

Did you want to make a comment on that, Dr. Haggie?

5 p.m.

President, Canadian Medical Association

Dr. John Haggie

No. I think I would really just echo what has been said. I don't know that there's an awful lot more I can add, quite frankly.

5 p.m.

Conservative

The Chair Joy Smith

Thank you.

Now we'll go to Mr. Brown, please.

October 17th, 2011 / 5 p.m.

Conservative

Patrick Brown Barrie, ON

Thank you, Madame Chair.

This committee has done a lot of work on neurological disorders over the last few years, and I took an interest in Mr. Molnar's comments about dementia. A common thread has been on tax credits for caregivers. I wanted to tuck into some other areas related to dementia, ways that might alleviate some of the challenges that society and individuals inflicted with this disease live. I wanted to know what your thoughts were on the New Horizons program.

In the community I come from, Barrie, Ontario, one program that I thought was helpful was art for the aging. They had programs like that in seniors homes that would stimulate mental activity for those who were, unfortunately, going through dementia. There were also programs that engaged them in physical activity. I know we don't know a lot about dementia, but I understand that one thing we do know is that a way to delay onset is to increase the level of activity. The New Horizons program has a budget, I think, of $28 million for programs like that in seniors homes. Is this the type of thing you think is a wise investment?

5 p.m.

Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society

Dr. Frank Molnar

I think the investment in terms of cognitive stimulation, exercise, etc., is useful all the way through one's lifespan. One, there's a lot of evidence now showing that all the stuff we've been talking about—exercise, nutrition—actually prevents dementia. Two, once you have dementia, to be given cognitive stimulation will certainly slow down the dementia. In my clinical practice, we see a lot of people with dementia who are living alone, becoming withdrawn, becoming socially isolated, and we see their dementias accelerate. As soon as they move into a residence that has some cognitive-stimulating program, their cognitive scores and their function actually improve to a degree we don't see with medications. So the cognitive stimulation can actually outperform the medications in many instances.

So absolutely, it's a worthwhile investment.

5:05 p.m.

Conservative

Patrick Brown Barrie, ON

Okay. You said these can potentially prevent dementia. That's obviously an exciting concept. Do you know what types of techniques are being used in other countries, which Canada should look at? Are there any examples or models where there are more robust programs that would enable preventing this disease or delaying onset?

5:05 p.m.

Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society

Dr. Frank Molnar

Like all physicians, I have a whole pile of articles that are sitting in my office. I actually have a whole box of articles on different systems, different approaches to dementia, different systems around the world. So I do have a collection. I haven't gone through them, so I don't know that—

5:05 p.m.

Conservative

Patrick Brown Barrie, ON

I think members of the committee would be very interested in stuff like that, and if you could send them to the clerk, I'm sure she could distribute them—

5:05 p.m.

Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society

5:05 p.m.

Conservative

Patrick Brown Barrie, ON

—because I think one of the hopes we have is to have a study on neurological disorders, and stuff like that would be really interesting.

5:05 p.m.

Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society

Dr. Frank Molnar

I will be very happy to share it. You have my card, and the box is ready to ship tomorrow. It will be one less thing in my office.

5:05 p.m.

Conservative

Patrick Brown Barrie, ON

You want to read it too, Colin. I know you do.

The other question I want to ask is—