Evidence of meeting #20 for Health in the 41st Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was doctors.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Geneviève Moineau  President and Chief Executive Officer, Association of Faculties of Medicine of Canada
Francine Lemire  Executive Director and Chief Executive Officer, College of Family Physicians of Canada
Fleur-Ange Lefebvre  Executive Director and Chief Executive Officer, Federation of Medical Regulatory Authorities of Canada
Danielle Fréchette  Executive Director, Health Systems Innovation and External Relations, Royal College of Physicians and Surgeons of Canada

9:40 a.m.

President and Chief Executive Officer, Association of Faculties of Medicine of Canada

Dr. Geneviève Moineau

May I respond to that?

9:45 a.m.

Conservative

Terence Young Conservative Oakville, ON

Please, yes.

9:45 a.m.

President and Chief Executive Officer, Association of Faculties of Medicine of Canada

Dr. Geneviève Moineau

That's agreed, and I think in our recommendations there's a full recognition of the fact that physicians aren't the answer. They need to be part of the answer of providing health care. I think what would help is in fact ensuring that all health care providers are regulated. Some are regulated in some provinces, but they're not in others.

I see again there a role for the federal government to look at which health care providers are regulated and which are not. If your naturopath or other care provider is regulated, they will gain the respect. What happens if you're not regulated is that there is a significant variety in the quality of care provided.

April 3rd, 2014 / 9:45 a.m.

Conservative

Terence Young Conservative Oakville, ON

Can I ask you why you choose the federal government? I'll tell you why.

The primary power the federal government has over the health care regulations—the criminal power, if you go back to our Constitution—has been interpreted somewhat broadly, but it's quite limited.

What is to prevent the provinces...? They have the Council of the Federation. They went to the drug companies; they said we're going to pay less for generic drugs. They can do things.

What's to prevent the provinces from sending a couple of people to Winnipeg, each province, and doing things on their own?

Why do you always come and say the federal government should be doing something? The federal government has very limited powers to do that. There's nothing to prevent the provinces from getting together and solving any problem, if they choose to.

9:45 a.m.

President and Chief Executive Officer, Association of Faculties of Medicine of Canada

Dr. Geneviève Moineau

Where we see the benefit of involving the federal government is that it helps to facilitate the provinces getting together. That's exactly the example of our physician resource planning task force. It's understanding that looking at a physician resource is only one piece of the bigger pie of the entire resource planning for health care. That really is a conversation that we need to eventually have, but you have to start somewhere. We're excited to be part of that.

Again, that is a federal-provincial-territorial endeavour, and we believe that's why it will be successful. It's helping the provinces get together in doing that work.

If I could just get back to what Ms. Davies asked earlier about the—

9:45 a.m.

Conservative

The Chair Conservative Ben Lobb

No, I'm sorry.

To be fair to all the members, we can't go over the time. But perhaps Mr. Wilks or Mr. Lunney can follow up on that same train of thought when their time comes around.

Next up, Ms. Fry, you have seven minutes, please.

9:45 a.m.

Liberal

Hedy Fry Liberal Vancouver Centre, BC

Thank you very much, Mr. Chair.

I want to thank everybody for coming. I'm going to echo that there are four very powerful women sitting here on a panel. That's great.

The idea of these multidisciplinary teams that we've been talking about is not a new thing. In fact, money was put into the health accord, in 2004, and was agreed on by the federal government and premiers of every province. It was to pull together that federal leadership role, etc., in the change and reform of primary care practice, looking at the team, at how it links to an acute care setting—as Libby was asking you—and how, if you work for the hospital, you will know how to take people as soon as they are ready to leave and move them into a new system.

I want to ask what happened to that. That is the first question. Why did that stall in about 2007 and nothing has happened since? The federal government put money on the table for that to happen.

The second thing is that I have noted that some provinces did a little bit of it, and there are excellent examples out there. Calgary has a great clinic. Ontario has been doing a lot of good work. I think Nova Scotia has been doing some good work on this. However, they lack the ability to move any further.

With regard to the concept of scope of practice, whenever I travel across the country and I meet with ministers of health—and it really doesn't matter what their political stripe is—they all say the same thing. They say there are three areas that we, as a Council of the Federation, cannot move on alone. One is health human resources, of course the other is pharmaceuticals, and the third one is primary care reform.

The bottom line is that since the Council of the Federation has admitted that they can't take the steps they need, I wonder if you have a plan for ensuring we get that right mix of people, and that the mix doesn't only include health care professionals but housing advocates, social workers, and even school counsellors, to link into that team?

In the absence of the federal government at the table, what are your plans to try to move this agenda forward? If we don't, we will not have efficient, effective, and timely care, and we will be wasting a lot of money on acute care beds. What are you planning to do on that?

First, what happened to the plan in 2004 for primary care reform and health human resources?

9:50 a.m.

Executive Director, Health Systems Innovation and External Relations, Royal College of Physicians and Surgeons of Canada

Danielle Fréchette

Again, we have a few minutes to answer something that would require days of conversation.

We have made much progress, and you would acknowledge that we have many pockets of excellence. I would submit that what we often do is to pull the cake out of the oven before it's fully baked. We go about with our own energies and resources, without the convening power and sustainability to move this ship called our health care system, which you can't turn on a dime. We don't have the support to systematically scale up and adapt great ideas and experiments that are happening right now in the country.

9:50 a.m.

Liberal

Hedy Fry Liberal Vancouver Centre, BC

Why not?

9:50 a.m.

Executive Director, Health Systems Innovation and External Relations, Royal College of Physicians and Surgeons of Canada

Danielle Fréchette

It is something that requires sustained effort and we don't have anyone who has agreed to take this on as a commitment to Canadians. Those of us sitting at this table are chugging away. The research that we're doing on physician unemployment is self-funded. I do a lot of it during my holidays and weekends because I'm committed to it. My daughter, who is finishing her honours degree, read my brief and when she saw the dog's breakfast of regulation and education, she was really dismayed. She said, “Mom, this is a mess. How can this be? I hope you can convince the people around this table that our government, my government, has to do something for me”. So we are all working at it in the best way we can, but we need someone to bring us together.

To the point about there being a whole bunch of people with the flu sitting in a family physician's office, and they're churning them through, well maybe if there were interprofessional teams and a good robust electronic medical record, the family physician wouldn't just be taking care of the common flu. He'd be taking or she would be taking care of more complex issues.

9:50 a.m.

Liberal

Hedy Fry Liberal Vancouver Centre, BC

Francine.

9:50 a.m.

Executive Director and Chief Executive Officer, College of Family Physicians of Canada

Dr. Francine Lemire

There's no magic, I don't believe, in terms of explaining what happened. I certainly do agree with what Danielle has described. The funding has helped to create some innovation and I think you refer to this yourself. There's been some incredible pockets of innovation around the country, but we need to be sustaining this and really scale it up. I would argue that in fact there is a role for federal leadership in that.

I lived for a long time in Newfoundland. I have an artificial leg and it's always been an interesting thing to me that when I was living in Quebec, all my costs related to that leg were covered. In Newfoundland, none of it was covered and in Ontario, some of it is covered. Yet if I don't have that artificial leg, I cannot make my own contribution to society.

So how come we have this variety of things in a country like Canada that overall is a rich country? I think we do need some of these standards, and we do need to try to sustain some of these efforts at innovation. Probably all of us providers, physicians, nurses, all of us, need to give up a little bit of the turf and really try to put our communities at the centre, try to see how we can really be community-centred and meet those community needs.

9:50 a.m.

Executive Director and Chief Executive Officer, Federation of Medical Regulatory Authorities of Canada

Dr. Fleur-Ange Lefebvre

The federal government has a significant role. For the last four years we have been harbouring under two sets of expectations. The first is the Agreement on Internal Trade. The changes to the chapter on labour mobility came into effect five years ago on April 1, 2009. These are federal-provincial-territorial agreements. They don't come out of health. They come out of labour and industry. So we have the Agreement on Internal Trade that nevertheless contains the chapter on labour mobility and includes the mobility of regulated professionals including health professionals.

The other one is the pan-Canadian framework for the assessment and recognition of foreign qualifications. These have been driving a lot of the work that we've been doing on national standards, but now there is the consequence of these agreements and these frameworks. We need to have the same locus. The discussions we had were coordinated through the federal government. That has to continue. There has to be a sustained effort to make sure that these agreements and these frameworks are not in fact resulting in unwanted and unexpected consequences. At the same time as we identify other opportunities, this discussion has to go on.

9:55 a.m.

Conservative

The Chair Conservative Ben Lobb

Mr. Lunney, seven minutes, please....

9:55 a.m.

Conservative

James Lunney Conservative Nanaimo—Alberni, BC

Thank you very much.

Well, others have commented on the four powerful women at the beginning here. I think when I first saw you, I said, “Boy, they sent a SWAT team”. What I mean by that actually, after hearing your presentations, is that we have four very highly professional, highly qualified, and very good communicators. I think all of your presentations are very well organized and you've put a lot of thought into this, so I compliment you on that.

Can I ask about the number of physicians in Canada? I think, Francine, was it you that mentioned 30,000 family physicians? What is the total number of physicians in Canada? I think I have in my mind 88,000, something like that.

9:55 a.m.

Executive Director and Chief Executive Officer, College of Family Physicians of Canada

Dr. Francine Lemire

That's about right. But of course that doesn't necessarily mean that they are full-time clinicians. There lies the difficulty in terms of really understanding clearly what is a full-time equivalent in this country.

9:55 a.m.

Conservative

James Lunney Conservative Nanaimo—Alberni, BC

That's a very good observation. Is that because so many are approaching retirement? Or are there other demographic issues at play in part-time versus full-time engagement?

9:55 a.m.

Executive Director and Chief Executive Officer, College of Family Physicians of Canada

Dr. Francine Lemire

I'll begin the answer and hopefully I'm not being asked to solve all that in the next few minutes. We do have an important cohort of baby boomers who are at the end of their professional careers. Interestingly enough I think they remain quite engaged in clinical practice, but probably a proportion of them are actually slowing down a little bit and not necessarily working full time. That's one factor.

We do have a number of physicians who have important academic roles in teaching or research so obviously they are not full-time clinicians. Certainly with the feminization of the profession—and I am not pejorative when I say this but we still need to be realistic—new physicians entering practice in all of our specialties are entering practice very often when they are at the prime of their child-bearing years.

So the notion of a full-time equivalent I think is changing. I think that as we think about the renewal of that workforce we need to be able to recognize those factors, not to bemoan them and feel unhappy about them, but to plan for them.

For example, a family doctor working for 30 years in Corner Brook who is retiring and is being replaced by a woman family physician in the prime of her reproductive years.... We might in fact need more than one of those physicians to be able to replace the work of that physician. Then we may need not only more physicians and a bit, but we may need a family practice nurse or a nurse practitioner who can also do some of the work of that doctor.

We need and I believe we have a responsibility to also prepare our members as they are entering practice, if in fact they are women in their child-bearing years, to say if you are going to enter practice and you want to look after a population, there are a few things you need to put together. So we have work to do. Those are some of the factors. I'm not sure what my colleagues want to add to that.

9:55 a.m.

Conservative

James Lunney Conservative Nanaimo—Alberni, BC

Well, thanks. I want to pick up a couple of other issues, but I thank you for covering that for us. I think it's very interesting that we recognize those factors. Women of course obviously need to have the opportunity to fulfill their child-bearing opportunities and family issues and so on, as well as all the other issues that have been raised there.

When you talk about a team-based approach you mentioned naturopaths, chiropractors, and the issue of regulation came up. I think chiropractors have been regulated in every province across the country for many years. There are about 9,000 chiropractors and about 40% of the conditions coming into a physician's office are musculoskeletal oriented, something that chiropractors are quite well skilled in.

If we're looking at barriers to interprofessional cooperation, are there any representatives of the colleges here? Is there any interaction in the colleges encouraged or taking place where chiropractors, for example, and naturopaths—I don't want to under-represent them. There are about 1,400 to 1,600 naturopaths in the community.

I have another angle I want to talk about just briefly and the time is short. Could you comment on whether there are any promising examples of collaboration? Is there any at the education level, at least, of doctors interacting with chiropractors?

For full disclosure, I'm not here to represent the profession but I practised for 24 years as a chiropractor in two provinces.

10 a.m.

Executive Director, Health Systems Innovation and External Relations, Royal College of Physicians and Surgeons of Canada

Danielle Fréchette

Thank you.

We are observing a lot more collaboration with the traditional and complementary and alternative medicine world, especially when we are dealing with populations who are either indigenous or in rural remote communities.

We've actually drilled into some of the literature and a number of patients in these rural and remote communities, especially women, turn to naturopaths for care of chronic conditions because they don't have access to a primary care provider. This is a part of the workforce that we have not been factoring into our health workforce plans.

There are some models where in orthopedics, for example, you can have a partnership with a chiropractor, an occupational therapist, and a physiotherapist and that always impacts on how much care is provided and how fast care is provided to patients. That is why the work of this committee is quite important and hopefully we'll be able to muster all the resources to really get a more fulsome picture. So if there are barriers to access to a care provider who is fully qualified to offer services in their particular sphere, then we can tackle them.

10 a.m.

Conservative

James Lunney Conservative Nanaimo—Alberni, BC

Thank you for that, Danielle.

I want to ask the same question of you, Geneviève, because you represent the colleges. As a clinician for 24 years, I actually never had experience with a local doctor where he actually came in, observed what I did, and saw how I communicated with the patients and what we were actually doing, who wouldn't refer patients afterwards, but there's this disconnect often.

Is there any interchange happening at the college level?

10 a.m.

President and Chief Executive Officer, Association of Faculties of Medicine of Canada

Dr. Geneviève Moineau

Just for clarity, I represent the faculties of medicine of Canada, so those that do the education at the level of the MD.

In fact, absolutely; this is where, when I discussed our future of medical education in Canada project, it was very clear that one of the very important recommendations was to advance inter- and intra-professional practice. Each one of our faculties of medicine has really advanced significantly in this recommendation. There are excellent examples in every school where students are learning side by side with a variety of health professions and are exposed to practitioners during their training. The more education occurs in distributed settings, as is the case now....

We have education happening not only in the big cities, in the tertiary care hospitals, but much more in communities, in distributed medical education settings. The settings are related to campuses that have been set up in smaller communities and in the tremendous network of educational experiences that are happening in the rural and remote areas as well. That allows our students to be exposed to a variety of care providers.

I can't speak specifically to the profession of chiropractor, but as a concept, this is absolutely embraced by all of our schools.

10 a.m.

Conservative

James Lunney Conservative Nanaimo—Alberni, BC

Thank you for that.

10 a.m.

Conservative

The Chair Conservative Ben Lobb

Okay, thank you.

10 a.m.

Conservative

James Lunney Conservative Nanaimo—Alberni, BC

Oh. I was going to ask how much time I had left.