Health Committee on June 20th, 2022

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 28 of the House of Commons Standing Committee on Health. Today, we're meeting for a one-hour briefing on labour shortages in the health care sector and the foreign credential recognition program. In the second hour, we'll have a briefing from the Public Health Agency of Canada in relation to the study of the emergency situation facing Canadians in light of the COVID-19 pandemic.

I'll forgo the usual announcement on hybrid proceedings. We're all quite familiar with them at this point, as are the officials who are appearing before us.

I would like it if we could do this right off the top, folks, because I always tend to forget this at the end. I'd like to set a deadline for the submission of witness lists for the children's health study that we will be resuming in September. After discussions with the clerk, I'm going to make a suggestion of July 18. The clerk will send out a reminder a couple of weeks before the deadline.

Is July 18 for witness lists on the children's health study okay?

[Some hon. members]

Agreed.

[The Chair, Liberal, Sean Casey]

It's adopted by consensus. Thank you.

In accordance with our routine motion, I'm informing the committee that all witnesses have completed the required connection tests in advance of the meeting.

I will now welcome our witnesses who are with us for the first hour this afternoon. From the Department of Employment and Social Development, we have Andrew Brown, senior assistant deputy minister of the skills and employment branch, and Erin Connell, director, skilled newcomers, employment integration and partnership, of the skills and employment branch.

We're going to begin with the five-minute opening statement, if one of you has an opening statement to present.

Welcome to the committee. You now have the floor.

[Andrew Brown, Senior Assistant Deputy Minister, Skills and Employment Branch, Department of Employment and Social Development]

Thank you, Chair and committee members.

I am joining you from the traditional unceded territory of the Algonquin Anishinabe people.

I'm pleased to join you today to provide an overview of labour shortages in the health care sector. As you may know, labour market pressures are affecting practically all sectors of the economy and most regions of the country.

As of March 2022, there were more than one million job vacancies across Canada, which is significantly higher than prepandemic levels. These vacancies will take longer to fill, given the scarcity of such highly qualified workers among the unemployed and the need for specialized training.

Canada's health sector is not immune. This sector was already experiencing a shortage of workers prior to COVID‑19, and these shortages have been further exacerbated by the pandemic.

In fact, as of the fourth quarter of 2021, this sector had the second-highest number of job vacancies in Canada, 126,000. Over the medium-term, forecasted job openings over the next 10 years will be particularly acute for key occupations, including registered nurses and licensed practical nurses, physicians and personal support workers.

ESDC has placed a priority on helping to address the health human resource crisis through its skills and training programs.

For example, budget 2021 announced $960 million for the sectoral workforce solutions program to help key sectors of the economy implement solutions to address current and emerging workforce needs. The health sector is a key sector for investment under the SWSP. The program launched a call for proposals in January that closed in March of this year, and these proposals are currently under assessment. Projects are expected to begin as early as summer 2022.

Additionally, as announced in the fall economic statement of 2020, ESDC is funding a $38.5-million pilot project to help address labour shortages in long-term and home care. This pilot will train up to 2,600 supportive care assistants through a microcertificate program and paid work placement. Of these, 1,300 are expected to continue on to pursue full personal support worker certification.

There is also the foreign credential recognition program, FCRP, which is a contributions program that supports the labour market integration of skilled newcomers through enhancing foreign credential recognition processes. This includes funding projects to standardize national exams, centralize information portals and provide alternative assessment processes.

The FCRP also provides loans for expenses related to training, licensing exams as well as support services, in order to help skilled newcomers navigate foreign credential recognition processes.

Lastly, the FCRP provides employment supports, including training, work placements, wage subsidies, mentoring and coaching, to help skilled newcomers gain Canadian work experience in their field of study and fully use their talent.

Indeed, internationally educated health professionals play a critical role in the Canadian health care system. These foreign-trained professionals account for a full 25% of Canada's health care and social services workforce, compared with just 10% of working adults for the wider population. However, despite our increasing need for health care workers and reliance upon internationally educated health professionals to fill these roles, these international professionals still face some barriers to licensure and re-entry into their professions, such as costly qualifying exams, limited access to residency training, language barriers and navigating the foreign credential recognition process.

Foreign credential recognition and licencing for regulated occupations, such as nurses, physicians and paramedics, is a provincial or territorial responsibility, and in most cases they further delegate that authority and legislation to regulatory authorities. Within Canada, there are more than 600 regulators overseeing more than 150 regulated occupations.

Nonetheless, the Government of Canada recognizes the challenges faced by internationally educated health professionals. This is why addressing their labour market integration has been a key focus of the foreign credential recognition program, particularly since the onset of the pandemic. The program is currently investing $22 million in 20 projects focused on the labour market integration of internationally educated health professionals.

Additionally, since 2018, over $13.5 million in loans have been issued through the program's foreign credential recognition loans to more than 1,500 borrowers, two-thirds of whom work in health care.

Budget 2022 announced an additional $115 million over five years, with $30 million ongoing, to expand the foreign credential recognition program. Along with existing investments in the program, the incremental funding will help up to 11,000 skilled newcomers get their credentials recognized and find work in their field. For example, these investments will support projects to standardize national exams, make it easier to access information, improve timelines and reduce red tape, in order to reduce barriers to foreign credential recognition, starting with a focus on the health care sector.

In addition to investments already mentioned, labour market transfer agreements delivered through ESDC provide approximately $3.4 billion in funding for individuals and employers to obtain skills training and employment supports through labour market development agreements and workforce development agreements with provinces and territories. Over a million Canadians benefit from programming and supports under these agreements.

ESDC will continue to work collaboratively with federal partners, counterparts in provincial and territorial governments, and regulatory authorities to help alleviate current and future labour market pressures in the health sector.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you very much, Mr. Brown.

We're now going to rounds of questions beginning with the Conservatives.

Dr. Ellis, please, you have six minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Mr. Chair.

Thank you, Mr. Brown, for appearing here today. As you well know, this is an exceedingly important question that faces all Canadians, with somewhere between 10% to 20% of Canadians not having access to a family physician, which, as we know, is absolutely atrocious.

I have some questions. There are a lot of numbers that you threw around there, and being a physician, I guess I'm really quite curious as to how exactly you work with the medical regulatory authorities to get rid of red tape and do things like standardize national exams and so on.

[Andrew Brown]

Certainly one of the things that we are looking to do there is to take a look at ways to really facilitate the process for internationally educated health care professionals.

Ms. Connell may be able to assist in terms of describing a bit how we are working with provinces and territories and their regulatory agencies.

[Erin Connell, Director, Skilled Newcomers, Employment Integration and Partnership, Skills and Employment Branch, Department of Employment and Social Development]

Yes, I'd be happy to.

As mentioned, the foreign credential recognition program is a grants and contributions program, project-based funding, and we are currently funding a number of regulatory authorities in this domain, including the Medical Council of Canada.

An example here is updating online licensure tools for international medical graduates and helping them put exams online to increase accessibility for IMGs.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

I certainly have had a lot of international medical graduates reach out to me personally and certainly as a member of Parliament to help them understand the system and help them navigate it.

I guess the fact of the matter is that it's very difficult for them to meet these requirements. Specifically, there was a Ukrainian medical graduate willing—think about this—to take a family medicine spot anywhere in Canada who was able to apply to the CaRMS matching system and, in the second round, there are 99 unfilled family medicine spots in Canada this year for residents in training. There are 99. For some reason, he didn't get one, which is absolutely shocking because he tells me he's willing to go anywhere in Canada to get a residency spot.

It seems like all we're doing is talking and talking, and I guess the question that remains is.... Let's look at what happens in Nova Scotia. You need requirements for licensure, which means you need to be accepted from the World Directory of Medical Schools. It also means that you need to have some part of your LMCC, and you need to have documentation that you are certified with the College of Family Physicians or that you completed a one-year rotating internship in Canada before 1993.

Does this mean that all we're going to do is ask international medical graduates to, again, compete in the CaRMS matching system in round two?

[Erin Connell]

It is an unfortunate situation for a number of international medical graduates. They are limited by the CaRMS system that is dictated by CaRMS. As you know, the residency system is very competitive with limited seats. I don't think we as a program have levers to increase the number of seats, but we are happy to work with partners to try to facilitate and expedite the process where possible.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Through you, Chair, to the witnesses, the primary problem here is really the length of time that it requires for somebody who's trained elsewhere to come to Canada, do all these exams and then get accepted to the resident matching service, which is what Ms. Connell is referring to, the CaRMS system.

The fact of the matter is, if we're not going to change every step of the process, what are we spending all of the money on? I don't have an issue with spending money, even though I'm a Conservative, if we're going to do something. The question is, though, if we're not changing it, what are we spending the money on? I do not understand.

[Andrew Brown]

Perhaps I'll jump in there to respond to the question. The federal government has really more of a convening role here with provinces and territories to be identifying exactly some of the challenges that have just been identified.

Notably, one is the time required for an individual coming to Canada who's been trained abroad to have their training and experience recognized, so that they are able to gain experience here and ultimately become recognized as a licensed professional in Canada.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

I don't have an issue with that, but the fact of the matter is that, if we're not going to recognize the training and experience and credentials they bring with them, that means they're still starting so many years behind. They still need to then access the Canadian training system, which we all know is a huge roadblock.

I believe that what Canadians out there are talking about is recognizing the credentials and the experience that international medical graduates bring with them already. To spend more money to say we're going to get people into a system that already exists quite frankly doesn't make any sense to me. That's not what Canadians think you're spending their money on.

[Andrew Brown]

We certainly hear that comment. I think that's one thing we can continue to push as we work with provinces and territories. It's really noting the shortages we're facing, particularly in the health sector, and looking at ways that foreign credentials can be recognized more quickly, so when foreign-trained professionals arrive in Canada, they can get to work more quickly in Canada.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Brown and Dr. Ellis.

Next we're going to go to Dr. Powlowski, please.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Thank you both for being here. This is certainly a problem we've been trying to wrestle with. How do we make it easier for foreign-trained graduates to get licensed?

Apparently, we budgeted $150 million, I believe, to help the foreign credential recognition programs. I think that was broken down so some of that money could be used to help with costly exams. Okay, I can see that. There's the cost of navigating the difficult credentialing program. Okay, I can see that.

Then there was some mention of more residency programs, although I think someone here then mentioned that was provincial jurisdiction. I would suggest, with the federal spending power, the federal government could work with the province to help create further residency programs. Could it not?

During this study, I remember asking the dean of Queen's University's medical school, I think, or it may have been the nursing school, if they would or could take more people to train. They said that, yes, they could.

Is some of the money in the $150 million going towards creating more residency programs?

[Andrew Brown]

Thanks for the question.

Perhaps I can turn to Ms. Connell to provide a little more clarity with respect to the $115 million that was announced.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I'm sorry. Is it $115 million, rather than $150 million?

[Erin Connell]

It's $115 million over five years and $30 million per year after that. That's in addition to our base funding.

That funding is a grants and contributions program. We do give funding to provinces and territories, regulatory authorities and other organizations to support the labour market integration of skilled newcomers. We will be continuing to earmark some of these funds towards the health sector, given the crisis and the number of regulated occupations in the health sector.

Increasing the number of residency spots specifically is within provincial-territorial jurisdiction. That said, whether it's FCRP or the new sectoral workforce solutions program, these programs would be willing to work in partnership with our partners to help support efforts that advance the labour market integration of internationally educated health professionals.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I take that to mean you would be willing to use some of this money to create further residency programs.

[Erin Connell]

We could potentially support provinces and territories that wish to create additional spots in residency programs.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

As Dr. Ellis has pointed out, there were 99 unfulfilled family doctor residency programs. Perhaps the obstacle isn't so much the residency programs, but the problem is with the licensure. Certainly, the Medical Council of Canada sets up national licensing exams, the LMCCs.

Is some of that money going to go toward helping to perhaps provide education for foreign graduates who want to study and spend some time in order to upgrade their knowledge and skills, so that they can pass the LMCC exams?

[Erin Connell]

That could certainly be a project under consideration for the foreign credential recognition program. We already have two project agreements with the Medical Council of Canada, as well as other provinces, territories, regulatory authorities and immigrant-serving organizations. We already have funding agreements with 20 partners in the health space.

We are open to discussing further ideas, whether it is to pilot or test something new, or to ramp up current efforts to expedite the process, put exams online or test new bridging models for international medical graduates.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

There is also the possibility, it would seem to me, of creating more opportunities for practice-ready assessments, which to my understanding is a way by which foreign graduates can work with a licensed doctor in Canada for 12 weeks, and then the people at the Medical Council of Canada make recommendations as to the further training that's available. That would certainly seem to be an opportunity.

When we asked some of the witnesses earlier on in this study about this, they said that the number of people who went through this process, the practice-ready assessment, was in the order of hundreds, whereas we have far more empty positions than that.

Could some of that money be used in order to make it easier for people to undergo the practice-ready assessments?

[Erin Connell]

The practice-ready assessment program is currently being offered in seven jurisdictions. Again, we would certainly be willing to work with the provinces and territories to support their priorities.