Evidence of meeting #10 for Human Resources, Skills and Social Development and the Status of Persons with Disabilities in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was pharmacists.
A recording is available from Parliament.
12:10 p.m.
Conservative
The Chair Conservative Dean Allison
Thank you.
Could we have Ms. Fralick and then Ms. Sholzberg-Gray, please?
12:10 p.m.
Chief Executive Officer, The Canadian Physiotherapy Association, Health Action Lobby
Thank you.
I'm fully supportive of the comments made by my colleagues.
The one thing I might add that could be of interest to you is that two or three years ago, as the discussions were unfolding about the establishment of the health council, HEAL hoped that it would in fact be the body, but of course being more of an FPT animal it didn't quite have what we feel such a centre, forum, or institution should have.
HEAL did not go as far as figuring out the specific costs. If we can engage someone at the federal level to have that conversation, we'd probably be happy to do that. I agree with Mr. Tholl that it would not be as onerous a task as one might think.
We did, however, come up with a checklist of guiding principles for such a body. That is available on our website. I would be happy to send that over to the clerk for distribution to this committee. It might help you formulate your thinking.
12:15 p.m.
President and Chief Executive Officer, Canadian Healthcare Association
Just to add to that discussion, as you all know, there have been a number of labour sector studies for various health disciplines or health professions. There was a nursing one, a physician one, a pharmacist one, a home care one. The Canadian Healthcare Association was involved in all of these, sometimes on the steering committee, sometimes on the management committee. They were sometimes concerned that they were working in silos, and while we were all trying to plan for the future, the assumptions on which we were planning were different and really needed to be more integrated than not. Frankly, that's why we kept meeting throughout this process, doing various sector studies, seeing how we could get together so we weren't operating in silos.
So what we're really seeing is some kind of mechanism to bring together all of the various information gathering, research processes, planning processes, and what not, not in a way that steps on anyone's jurisdiction, but in a way that understands that people are mobile and can move from province to province, region to region. We need to address those issues as well as needs across the country.
I think a number of us are working on next steps and seeing whether we can get together the funds. We're putting our information together, for a concept paper on various models for this kind of national or pan-Canadian mechanism, even though various principles associated with it have been put forward by a number of us over the years. It really emanated from those labour sector studies that operated individually.
12:15 p.m.
Conservative
The Chair Conservative Dean Allison
Thank you.
Thank you, Ms. Brown.
We're going to move to the next questioner, Mr. Lessard, for five minutes.
12:15 p.m.
Bloc
Yves Lessard Bloc Chambly—Borduas, QC
Thank you, Mr. Speaker.
We agree that a major helping hand is needed where health workers as a whole are concerned. Mr. McMillan said earlier that the problem was twofold: we need to recruit and maintain professionals.
You are very deserving. I worked in the health network for 30 years. I watched it being built and also fall apart. This is why I want to be sure I understand the message you are sending us today and to see whether it is practicable. The only convergence that I see in your presentations is that of saying that some authority that is responsible for supervising and coordinating our actions must be created. Ms. Fralick said earlier that everyone thought that the Health Council was going to do it, but this is not the case.
Should we not conclude that this should be done elsewhere?
I come back to areas of jurisdiction. The solution to the problem on which you are working so hard seems to me to be political in nature. Ms. Sholzberg-Gray represents 4,500 institutions and 1,100,000 workers, but these people are under provincial jurisdiction, for example, that of Quebec, under the authority of the personnel department of the provinces, etc. In Ottawa, however, 10,000 public servants are concerned with health and do not manage any hospitals.
Is the problem not political? I would not like you to think that we have understood. We agree with the objective sought, which is to remedy the situation and lend a helping hand. But I would like us to get on the right track, because we will have to discuss this among ourselves again. This is why I asked you whether you had worked in this connection with the corporations and associations in the provinces and Quebec.
12:15 p.m.
Chief Executive Officer, The Canadian Physiotherapy Association, Health Action Lobby
Initially I will just clarify that my earlier comments about the Health Council and the work of HEAL referred to the work prior to the Health Council being established. In other words, what we were lobbying for was the same sort of mechanism we're talking about here today. In fact, we're saying that the Health Council did not meet our needs in that regard. This is not to take away from the good work they've been trying to do, but it is a different body than we would envision.
In terms of the politics of the situation, I know everyone is chomping at the bit to speak to that. All I would say is that the Health Council is that political body that perhaps you're referring to, and we see it as not being the full picture and not able to do what we think needs to be done. We believe there is a need for a body separate from the political process, certainly with connections, but separate and inclusive of the other voices that need to be part of understanding the problem and the solution, and hopefully able, frankly, to transcend the politics.
One thing I neglected to mention when I referred to the EICP initiative is that it certainly had political involvement, because it was funded through Health Canada, through the federal government. However, the work was carried out by the health provider associations, and we are able to transcend political barriers. To see the progress made even in the understanding in the work amongst those health professions was really quite remarkable over the two and a half years of the project. So we feel that this body that we envision needs to be outside the overt political influence, perhaps, that currently exists.
I'll leave it at that. As I say, I know my colleagues wish to jump into the conversation.
12:20 p.m.
Senior Nurse Consultant, Health Human Resources Planning, Canadian Nurses Association
I think the other aspect, when you talk politics, is some of the language that we've used around this, recognizing that health is primarily a provincial-territorial matter. We have not been promoting the notion of this being a supervisory body that would oversee or take over the mandate of provincial and territorial governments. What we're talking about is a mechanism to work in partnership with provincial and territorial governments.
In the recently released federal-provincial-territorial pan-Canadian planning framework for HHR, they talk about intersectoral and interdisciplinary multi-stakeholder planning, but they don't outline a mechanism for that. That's what we're trying to promote, something that would work in partnership with them that would provide analytical support to their planning process.
Many of the smaller provinces don't have the capacity to do the kind of HHR planning that large provinces like Ontario and their government have. So we see this as a real value perhaps as a starting point in helping those smaller governments to understand the planning process, where all the data fits in, where the research fits in, and how they're affected by the other provinces, from a mobility perspective and other aspects. So certainly we see this as a partnership, not a supervisory body.
12:20 p.m.
Conservative
The Chair Conservative Dean Allison
That's all the time. Sorry, Ms. Cooper. I'll catch you next time.
We're going to move to Ms. Savoie for five minutes.
12:20 p.m.
NDP
Denise Savoie NDP Victoria, BC
Thank you.
In many fields we hear from students who are struggling under huge student debt, and you mentioned that for medical students it's the equivalent of holding a small mortgage. I wonder if there's anything, in your opinion, that the federal government could be doing in that respect.
12:20 p.m.
Secretary General and Chief Executive Officer, Canadian Medical Association
Through you, Mr. Chair, yes, there are two very specific things. One is to look at forgiving Canada student loans until such time as doctors have finished their clinical training, i.e. their residency training. Right now they have to start repaying their loans. Two, open up the terms and conditions for the loans in terms of making them more accessible, particularly to those with limited means.
12:20 p.m.
NDP
Denise Savoie NDP Victoria, BC
Thank you. That's an interesting answer.
I guess the corollary to that is do you think there is any reason...? All post-secondary education is subsidized to some extent, and the rest is paid through tuition fees. To what extent would it be useful to have some requirements of residency, for example, if there's a shortage in rural areas, or simply residency in Canada--although I'm hearing that outflow is disappearing? To what extent could we federally, or indeed provincially, impose some residency requirements in exchange for that education that's obtained in Canada and partially subsidized by Canadians?
12:20 p.m.
President, Canadian Medical Association
We traditionally have never done that.
12:20 p.m.
President, Canadian Medical Association
As the proportional share of the educational cost is borne more by the trainee than the institution, I think this poses some fairly serious human rights and ethical questions, and traditionally we've not looked at it that way.
12:25 p.m.
NDP
Denise Savoie NDP Victoria, BC
So you would say that the greatest portion of costs is paid by the students, as opposed to the part that's subsidized?
12:25 p.m.
Secretary General and Chief Executive Officer, Canadian Medical Association
A higher percentage, at any rate.
And, Mr. Chair, if I may, coercive measures, return-of-service measures, have proven not to be effective. All you need to do is look at DND and the challenges it currently is having in terms of recruiting and retaining physicians in the military, where you start counting the clock--your four-year payback--and then look forward to leaving. That instills the wrong culture--one of leaving, rather than staying.
12:25 p.m.
President, Canadian Pharmacists Association
I just wanted to add that this is a national political issue, and it is good to give a better system for repayment of your loans, but maybe we need to look at the tuition fees that these students are being asked to pay.
Like it or not, we used to have a system when I went to school where anybody could go to university. Now we have tuition fees in pharmacy of $8,000 per student, and really, we don't have the same universal access we had years ago.
The second thing we need to look at is expanding the enrolment in these areas. It frustrates me to no end that in Ontario we license 600 pharmacists every year; 300 of them come from outside the country. I have kids who may try to get into pharmacy some year, and their ability to get into those limited spaces is maybe going to keep them away from this profession. Meanwhile, we're taking these pharmacists from outside the country.
Why are we doing that? Why aren't we having our own kids in these institutions?
12:25 p.m.
NDP
Denise Savoie NDP Victoria, BC
I guess these caps to some extent were somehow arbitrarily imposed on enrolment. Nobody was looking at the demographics; hence, some of the problems we're facing.
In answering the question you referred to loan remission or loan forgiveness in some ways, but we're still talking loans. In some cases the fact that there are these high loans to pay is still a disincentive.
Going back to rural areas, as one of my colleagues was referring to, is there something up front, when the student needs it, that could be done in terms of tuition fees federally, aside from going the loan route?
12:25 p.m.
Secretary General and Chief Executive Officer, Canadian Medical Association
There are two points. One is just to observe. There are only three professions where tuition fees, at least in Ontario, were not capped, and those were dentistry, the legal profession, and medicine. So that's one of the reasons it's not $9,000; it's now $14,000 or $15,000.
12:25 p.m.
Secretary General and Chief Executive Officer, Canadian Medical Association
They were deregulated. The top was blown off.
What can governments do? I've already indicated the two things I would suggest the federal government do in terms of its responsibilities. Fee setting is not the federal government's responsibility.
I can tell you what we're doing at the Canadian Medical Association. We're making very preferential interest rates available to students, so if they're going to get into debt, we advise them on how to manage that debt and get out of it as quickly as possible.
12:25 p.m.
Conservative
The Chair Conservative Dean Allison
That's it for time.
We'll move on to the last questioner of the second round, and that will be Mr. Storseth.