Health Committee on April 3rd, 2014

[Dr. Geneviève Moineau]

Different models have been established. Other provinces do have them, but they were set up differently.

You said that older doctors weren't accustomed to working under that model. And that's precisely one of the dimensions we feel is important. Doctors need ongoing education. It would be very worthwhile to study that aspect in order to help those doctors by giving them the training they need to feel comfortable working in a team.

[Dr. Francine Lemire]

I would add to that that the training of our doctors now and in the future must focus heavily on the importance of working as part of a team. Their training must expose them to experiences that will enhance their ability to work in a team going forward.

There is no doubt that the community health centre model is philosophically relevant in terms of meeting a community's needs. Other models exist as well. Quebec's local community service centres, or CLSCs, are really the equivalent of community health centres. The stumbling block, however, lies in the productivity.

[Claude Gravelle, NDP, Nickel Belt, ON]

Thank you very much.

Thank you very much.

I've just been told that I have two minutes.

I worked with a doctor from England who wanted to come to Canada to practise. It took me several months to bring him. Last month I was working with a doctor from Brazil who also wants to become a Canadian citizen and practise in northern Ontario. She was successful last month in getting her Canadian citizenship. Last week I started working with a doctor from Russia.

It's difficult to get the Canadian citizenship official papers or whatever. If we could get the Minister of Immigration to fast-track these semi-qualified doctors to come to Canada, could the college of medicine fast-track the doctors? I know that from every country their qualifications are different, but if we were able to get foreign-qualified doctors, could the college of medicine help in fast-tracking their education to become qualified Canadian doctors?

[Dr. Fleur-Ange Lefebvre]

You used the word “semi-qualified”, which has alarm bells going off all over the place, for me.

[Voices]

Oh, oh!

[Claude Gravelle, NDP, Nickel Belt, ON]

They are fully qualified in their country, but probably not qualified in Canada. They may be lacking something—

[Dr. Fleur-Ange Lefebvre]

Are these people who you deem require more training and would not be eligible for a licence as they stand?

[Claude Gravelle, NDP, Nickel Belt, ON]

—because they haven't been trained in Canada. They haven't been educated in Canada.

[Dr. Fleur-Ange Lefebvre]

But some foreign-trained doctors will qualify for practice under a provisional licence.

[Claude Gravelle, NDP, Nickel Belt, ON]

For example, a doctor from England did qualify, but the doctor from Brazil and the doctor from Russia—

[Dr. Fleur-Ange Lefebvre]

You know, we have very strong human rights legislation in Canada, and it doesn't allow us to look at some cohorts differently than others. We have to look at individuals. We have standards in place and we have what we call the selection criteria, which can be made available to the committee. This is where we say that first of all they need to demonstrate language proficiency. Citizenship and Immigration won't allow you around that, and neither will we. They have to work with patients in the right language. They have to demonstrate good standing. They have to demonstrate good character. They have to demonstrate that they are healthy. They have to take some exams that only foreign grads have to take. Then, when they get here, we will not allow someone to practise medicine under a provisional licence unless they undergo a period of observed practice in an assessment mode.

We have a limited number of slots. It's complicated, but everybody has to go through the same system.

[Claude Gravelle, NDP, Nickel Belt, ON]

I think you hit the nail on the head there when you said that you had limited slots, because the doctor from Brazil, who is now a Canadian citizen, is waiting until next year to practise because there are no slots for her to practise.

[Dr. Fleur-Ange Lefebvre]

There are slots for practise and there are slots to enter a residency. They are two different cohorts of doctors.

[The Chair, Conservative, Ben Lobb]

Thank you for that.

Mr. Wilks.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thank you, Mr. Chair.

I'd like to thank the witnesses for being here today. I will share my time with Mr. Lunney. I just want to make a couple of comments here.

A couple of you, in my opinion, hit the nail on the head with a couple of things. One is that I think there is an opportunity to work with the medical professions to evaluate fee-for-service versus a primary health care model. In my small community in British Columbia, Sparwood, we've switched over to the primary health care model that we believe works far better than fee for service. We have three medical doctors, yet 20 minutes down the road in Fernie, which has 4,000 people, there are 18 medical doctors, most of them part time because they are there to ski. They are not there to actually ply the trade, but they can make enough money to stay there year-round. Someone mentioned social licence, and I think that's a significant issue in some areas.

Finally, I think that one of the things in British Columbia that has been an interest to watch over the years is that the province's implementation of the health authorities has been a failed project, I think. As far as I'm concerned, it's a buffer between municipalities and the province and it has become very challenging for even the medical profession to access who they need to access at the proper time.

These are a couple my comments because I wanted to allow Dr. Lunney to speak again.

Go ahead, Dr. Lunney.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Thank you very much, Dave.

I really appreciate that you have all been thinking about this, and you gave some examples: physician assistants, anesthesia assistants, arthroplasty assistants, and nurse practitioners. People are trying to experiment with more effective models and the team-based approach. You did put some good thought into that, and I appreciate that it's the AFMC talking about the federal government probably having a good role to play in actually monitoring different models and encouraging some experimentation, but mostly monitoring and documenting the best models because some might work better than others obviously, especially in rural areas.

Talking about urban-rural areas, I'm just a little concerned because 80% of our population is urban. All the resources are urban, and of course we have to get past that somehow to serve the rest of Canada, which is outside our big cities.

For example, and this fits in with telehealth, in British Columbia there is an innovative cancer clinic in Vancouver where they are treating patients. The oncologist is treating, and there are four GPs, and now expanded to six. They are doing some innovative work that is getting good outcomes by upping vitamin D levels, counselling and managing stress, giving them good diet and exercise, and so on. The province has expanded the program. They are reaching out through telehealth to the rural areas with high-needs patients and then connecting them so they can always get through to somebody to explain what's going on in their body. It's an innovative model.

We want to expand models like that, but this is integrated medicine in a sense.

I wanted to ask quickly about orthomolecular doctors because you have some licensing and regulating issues here with doctors who practise outside the box, and somebody recommends a licorice supplement. There's a lot of interest in the public in clinical nutrition where low-cost, low-risk things actually can give some benefits to the patients. They are interested, but we have some trouble with the regulators.

Would one of you care to comment on that? I know some of the colleges are actually interested in establishing faculties of integrated medicine since the public is interested. Why are we having trouble with the regulator?

[Dr. Fleur-Ange Lefebvre]

There is no such thing as trouble with the regulator.

[Voices]

Oh, oh!

[Dr. Fleur-Ange Lefebvre]

You want to talk about regulators dealing with out-of-the-box substances, we could, of course, go down the road of medical marijuana, but let's not do that right now.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

I appreciate the position taken by the CMA recently.

[Dr. Fleur-Ange Lefebvre]

Regulators do not develop the standards of practice, on average. They rely on the specialty societies. People who do this, this is their expertise, but the regulator will say to these physicians that they need to bear in mind that the standard of practice is x. If they're going out of standard practice x, they will possibly need to tell us why.

You have to remember that it is the physician who is held accountable for the appropriate care for that individual patient at that individual time. It's a complex situation. I don't know how many subspecialties we have right now, but it's a lot. So you have to remember these patients are not your experimental pool of people.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

I see a couple of others want to respond.

[Dr. Geneviève Moineau]

Again, we have probably the best medical education in the world in Canada, based on the strengths of many of the organizations represented here today. Part of that strength comes from the fact that we practise medicine as evidence-based. So the care that is provided to our patients must be the best care and must be considering patient safety.

From that perspective, before we are to be the proponents of any therapies or treatments, there needs to be the appropriate amount of evidence to show that.

Now there are times when treatments are not harmful, but again, these should not be advocated if there's no evidence that they're actually helpful.

[The Chair, Conservative, Ben Lobb]

Thank you.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

End of time...?