Health Committee on April 3rd, 2014

[The Chair, Conservative, Ben Lobb]

Well, I would be embarrassed if I told you how much time you had left.

[Voices]

Oh, oh!

[The Chair, Conservative, Ben Lobb]

You owe me.

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

Let me just make this one comment, Mr. Chair.

[The Chair, Conservative, Ben Lobb]

No, no, Mr. Lunney—

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

At St. Michael's Hospital they've been working together for many years now.

I do have a great other question—

[The Chair, Conservative, Ben Lobb]

I'm sure you do.

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

—so I hope I get another round.

[The Chair, Conservative, Ben Lobb]

Next up is Mr. Gravelle.

You want Mr. Morin to go next? Okay.

Go ahead, Mr. Morin.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you, Mr. Chair.

I have many questions for our witnesses, but I'd like to start with a quick comment.

If you're able, I would suggest that, in the future, you give your presentations in French. In fact, the committee hears few presentations in French, less than 10%. I noticed that French speakers gave their presentations in English. Even though they were good presentations, we have to make sure that French is adequately represented during House of Commons committee meetings. So I would kindly ask that you keep that in mind for the next time.

Now, I'd like to hear how the integration of nurse practitioners in Canada is going. It's a recent and growing initiative. You are probably in the best position to give us an update on how things are coming along.

I'd also like you to tell us where things stand with physician assistants. That role is gaining considerable traction in the United States, but not in Canada, I don't think.

Could you give us a progress report on the situation?

[Danielle Fréchette]

I referred to the expanding scope of practice of nurses in a variety of areas, beyond front-line medicine. In fact, the Canadian Nurses Association now recognizes more than 20 specialties.

Why can we not coordinate the effects of that expanding scope of practice with health workforce planning efforts? They are all positive things; the curriculum is very comprehensive, with accredited training programs. But we don't have an overview of the situation, and that is why we would like the federal government to help us put all the puzzle pieces together.

As for establishing physician assistant positions, Manitoba has been offering programs since the 1990s. Students receive a master's level education. Ontario has offered programs for a few years now. The practice is growing across the country, with about 300 physician assistants right now. With a new practice developing, I thought what a perfect opportunity to do things properly, but no, everyone prefers to do it their own way.

It's a matter of mutual respect. If doctors believe that physician assistants are as well trained as they are and subject to the same stringent level of regulation they are, they will gladly work with them. The first and foremost focus of doctors is the health and safety of their patients. If, however, someone on their team has an unclear skill set or role, things will not work as well.

[Dr. Geneviève Moineau]

I agree with what Ms. Fréchette just said. In principle, a new profession could fix some of the problems plaguing health care. It will help us deal with the perceived lack of certain types of physicians. But the profession has to be regulated.

In a perfect world, the regulatory framework would be consistent from province to province. The federal government could play a national role and provide some assistance in that regard.

Coming back to Ms. Davies' question as to why this is all so complicated, I would say the problem is turf wars. Before everyone will work together, someone up top has to make them come together and work alongside side one another. Unfortunately, turf wars exist even within the medical community, among doctors. Today, we get along well and things go quite smoothly. Overall, things run smoothly. But help is needed in that regard.

[Dr. Francine Lemire]

I won't repeat everything that was said, but I would like to point out that the College of Family Physicians of Canada has formed a partnership with physician assistants. It allows them to use our platform, which we use to ensure their skills remain up to date.

We have an agreement to help foster a good relationship with them so we can gain a better understanding of what physician assistants do. In fact, the Canadian Association of Physician Assistants uses our platform.

There are some promising examples of collaboration. Things aren't moving at lightening speed, but I think we should still learn from certain initiatives that serve as positive examples going forward.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

I would think that your organizations welcome the expanded roles of pharmacists and nurse practitioners, who have the authority to prescribe certain types of drugs. Do you support those kinds of developments or do you have reservations about them?

[The Chair, Conservative, Ben Lobb]

We are over time just like we were with Mr. Lunney, so perhaps we can pick it up when Mr. Gravelle has his time.

I do apologize, but I'm trying to be fair here for both sides.

[Hedy Fry, Liberal, Vancouver Centre, BC]

This must be a chiropractic trait.

[Some hon. members]

Oh, oh!

[The Chair, Conservative, Ben Lobb]

Yes, that could be.

Next up is Mr. Lizon.

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

Thank you very much, Mr. Chair.

Thank you to all the witnesses for coming here this morning.

I will continue on the topic my colleague Terence Young asked you about.

I checked some statistics. We say we have a shortage of physicians in Canada. I'm representing a riding in Mississauga. It's in the GTA. It's hard for people at the present time to find a family physician. Some people are retiring. Some physicians are selling their business, and therefore there is a continuation, but some are not. Therefore, people are left looking for a family physician.

Statistics tell us that last year we had the largest number of physicians in the history of this country. How does this translate to the problem we have of a shortage of physicians to serve people?

[Dr. Francine Lemire]

Based on what we know, we're catching up on numbers. The area in which we're failing is distribution. That's what I see as a big problem now and in the future and something that obviously needs to be addressed collectively.

The collective is the way we prepare physicians and we have conversations with them about their social responsibility. I think some element probably needs to be enforced, using some element of regulation to make physicians understand where they are needed, as opposed to making them believe that they have full freedom to put their shingle on the street.

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

Yes, but at the end of the day physicians are employed by the province or provincial bodies. In Ontario most of them are—by the hospital or, if they have their own practice, they bill OHIP. How do you make them go to somewhere they are needed? You can't force people to do it. We have underserviced, remote areas and we have incentives for doctors.

I know some cases in which young doctors took advantage of the incentives and then came back because there are no schools for children offered in the same way as in larger centres.

There are other problems. Incentives are there, but that fact doesn't necessarily mean that people are going to take their offer at face value and go there and stay there.

[Dr. Francine Lemire]

It's multifactorial, and it relates not only to the practice of the physician but the job of his or her spouse and the other issues you've discussed. It's not an easy situation, and certainly none of us, I don't think, at this table can enforce anything with our providers. We can train them according to the best standards, we can advocate, nudge, but we certainly cannot force them.

This is an area in which there needs to be some government policies that influence those choices, there needs to be some community engagement that helps to work on retention of physicians, and there has to be some ownership by the providers themselves.

[Dr. Geneviève Moineau]

Thank you for the great question.

We believe, and this is part of the work we're doing through the physician resource task force, that medical students should understand from the very beginning that they have a social accountability and that they will be asked to work where the needs are greatest.

We also believe that the problem isn't so much an incorrect number of physicians but a distribution problem. I would suggest that the model that currently exists in the province of Quebec, in which new graduating physicians can only work where the government states that there will be a position, is a model you may want to look at. That, I can tell you, is really helping within that province.

Just to correct a point, the vast majority of physicians are actually self-employed, and we bill the province for services. This was part of the initial conversation about what the crux of the problem is. A physician can chose to work two half-days a week or work six days a week, at this point in time.

[The Chair, Conservative, Ben Lobb]

We're over our time again, but we will probably have enough time when we're through with this round to ask some more questions, which will allow our panellists to expand on these thoughts.

Mr. Gravelle.

[Claude Gravelle, NDP, Nickel Belt, ON]

Thank you, Mr. Chair. It certainly is a pleasure for me to be on this committee and at my first meeting with this health committee. I hope everything goes well.

Mr. Chair, I have two very important questions, so could you let me know when I have two minutes left, please?

My riding is in northern Ontario, and we always have a hard time attracting doctors in northern Ontario. We have now and have had for the last 10 years, maybe, the Northern Ontario School of Medicine, which is helping greatly. We certainly would like to improve that right across northern Canada.

My question pertains to community health centres.

Before becoming an MP, I was on the committee of a community health centre. Attracting doctors to work in community health centres was tough because they weren't accustomed to working in a team. Older doctors were never encouraged to work as part of a team. Younger doctors have an easier time with that.

Do other provinces have community health centres like the ones in my riding? And if so, are they regulated?