Health Committee on April 3rd, 2014

[Voices]

Oh,oh!

[Dr. Francine Lemire]

I will say to you what I have said elsewhere. Certainly for family medicine, in trying to increase the attraction of that discipline we have said, more or less they can do family practice, they can pursue areas of special interests, they can have flexibility in the profession. All this is true, except that now we need to deal with some of those consequences: that as a family physician, paid by society and being conferred that privilege by society, you have a responsibility to society.

For me as a family doctor, that's being able to see all men and women of any age, all presenting problems. By that I don't mean since you have chest pains, I'll send you to a cardiologist.

Provide superb follow-up, look after a defined population, and do so in more than one practice setting. That is a societal responsibility we have as family physicians, and that we need to promote. It's not a pick and choose. You can't break those five things. They are part of the core of this profession.

[The Chair, Conservative, Ben Lobb]

Thank you.

[Terence Young, Conservative, Oakville, ON]

Do I have more time, Chair?

[The Chair, Conservative, Ben Lobb]

You're out of time, and we have about six minutes left. If it's okay, I'll give three minutes to Dr. Fry, and three minutes to Mr. Lizon, and then we'll wrap it up.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Mr. Chair, for giving me that time.

Having been a family practitioner, I can tell you, it's difficult to hire somebody when, in an urban setting, 55% of your income goes to overhead. You don't have a lot of room to manoeuvre.

I'm going back to the mix. Currently, we have an unbalanced mix. For instance, there are too few family care physicians, and a lot of people are going directly to obstetricians, to pediatricians, to specialists for what is really primary care. That is an expensive way to deal with the system.

You mentioned, Dr. Lemire, the need for family physicians or primary care people to be paid better so they can do it. Looking at capitation models, salaried models, etc., is one way to look at it. But how do you look at a 10-year plan, say, with everybody working together saying here are the number of pediatricians they're going to be needing in 10 years, so you don't allow people to graduate, and everyone wants to go into a specialty. They can't. We don't need them. There are too many of them. Let's go to this, and let's set that.

The only people, I think, who can set that mix are the colleges of nurses, physicians, pharmacists, etc., working together to look at the appropriate mix. How do you see that happening? Can that happen without the federal government at the table?

[Dr. Geneviève Moineau]

We were just discussing it. I'll take that. That is exactly the mandate of the physician resource task force that has been commissioned by the committee on health workforce. This was based on the first recommendation of the future of medical education project: determine the right mix, number, and distribution.

All our organizations around the table are on the task force or on the technical steering committee that is looking at that question. At the end of the day, we want to be able to help inform the provinces, and remember, this is a federal-provincial-territorial activity.

Based on our data, it appears we will need fewer of these, so it comes back to the provinces appropriately allocating the number of residency positions, and in Quebec, the provincial government establishing the number of PREMs, as they call it, to say this is the number of practising physicians we will accept in our province.

We hope that type of evidence-informed planning will come out of the work of the task force.

[The Chair, Conservative, Ben Lobb]

Okay, just to be fair—

[Danielle Fréchette]

But the work of the federal government isn't done because you acknowledged just a moment ago that we have advanced practice nurses. So we have a shortage of psychiatrists in the country, or at the very least a distribution problem. But advanced practice nurses in psychiatry are there. Although we're going to get the doctor number right, we need the federal government to help pull everybody together so we can actually better allocate the number of psychiatrists as we know how many advanced practice psychiatry nurses are being trained.

[The Chair, Conservative, Ben Lobb]

Okay, Mr. Lizon.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you. I'll ask two quick questions and we'll see how much time we have.

One is on the model of paying family doctors per visit versus salary-based. I think both would have pros and cons. On the salary-based, I think you may run into a problem that I'll be waiting for a visit for six or seven months because the doctor decides to see two patients a day.

The second question I have is to Madame Fréchette. You probably know that the committee just completed this study of prescription drug abuse and misuse. Many witnesses appeared and stated that one of the problems of overprescribing, drug abuse and misuse, is the lack of proper training of physicians.

Perhaps you can address both please.

[Dr. Geneviève Moineau]

With regard to the different models of payment, absolutely, but this is something that should be studied. I would suggest that our current payment model is not ideal and we need to look at how to improve upon the payment model.

From the point of view of the education around medication, and specifically certain restricted substances, I think that has been addressed within our medical schools. I think what needs to happen is that, again, this is the importance of the ongoing education of physicians. As everything changes so quickly in medicine, there needs to be ongoing, continuing professional development of physicians who are in practice. Certainly, one of the very helpful tools that have been developed in this area was actually developed with the support of FMRAC.

I don't know if Fleur-Ange wants to speak to that.

[Dr. Fleur-Ange Lefebvre]

Well, we can. It's so important to remember that physicians graduate with a certain skill set, and within five years we know that their chances of passing their exit exam are not very good because they've tailored their practice. So they have to demonstrate to the regulators, on an annual basis, that they keep up, that they fulfill the minimum number of CME-CPD credits that they have to, that are set by the two certifying colleges. But we're asking them to go further. Everything they do must be tailored to what they actually do with their practice population every day.

[Danielle Fréchette]

So to follow up on the points that have been made, a very robust electronic medical record would also help clinicians understand the breadth of things that are being fed to the patient. That would help curb some of the drug abuse, because if I'm getting opioids from three different physicians you may not know. So that would help.

Second, we also have the introduction of new things on the menu for physicians, like medical marijuana, and I think we're all consistent in our plea to say we need more systematic evidence so that the members of our organizations can prescribe this safely. Our advice to them, based on what the Canadian Medical Protective Association has advised us to do, is that if you are not comfortable with it, don't prescribe it. It's just like a pilot would not fly a plane that they're not comfortable flying.

[The Chair, Conservative, Ben Lobb]

That was pretty good timing. We're just about 30 seconds over time.

Thank you once again for a tremendous presentation. There are other members who must get on to their next committee.

The meeting is adjourned.