Evidence of meeting #36 for Human Resources, Skills and Social Development and the Status of Persons with Disabilities in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was health.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

  • Danielle Fréchette  Director, Health Policy and External Relations, Royal College of Physicians and Surgeons of Canada
  • Robert Sutherland  President, Canadian Dental Association
  • Euan Swan  Manager, Dental Programs, Canadian Dental Association
  • Pat Vanderkooy  Manager, Public Affairs, Dietitians of Canada
  • Noura Hassan  President, Canadian Federation of Medical Students
  • Chloé Ward  Vice-President, Advocacy, Canadian Federation of Medical Students
  • Christine Nielsen  Executive Director, Canadian Society for Medical Laboratory Science
  • Marlene Wyatt  Director, Professional Affairs, Dietitians of Canada

4:25 p.m.

Conservative

The Chair Ed Komarnicki

Thank you, Mr. Shory. That is your time, but we will allow a response.

Go ahead, Ms. Fréchette.

4:25 p.m.

Director, Health Policy and External Relations, Royal College of Physicians and Surgeons of Canada

Danielle Fréchette

Again, I wouldn't say that we have a shortage of physicians. We have shortages in different locales, so it is a distribution issue. If we could match qualified workers with available positions, I think we would be ahead of the curve ball. This is also predicated on having a longer-term understanding of what the needs are, and we are not there. We are not sophisticated there.

4:25 p.m.

Conservative

The Chair Ed Komarnicki

Thank you very much for that.

I'm not sure if anyone has any concluding remarks, either from the dental association or from the college. You're welcome to make them now before we conclude.

Mr. Sutherland, I see you do. Go ahead.

4:25 p.m.

President, Canadian Dental Association

Dr. Robert Sutherland

I will just comment from the dental point of view on the same question, if I may.

The profession has taken a number of steps to improve and streamline this sort of processing to get foreign-trained, non-accredited dentists into Canada to practise their skills.

We have a program that has three parts to it that can be completed in a year's time, and at the end of that, on successful completion, they can sit the same examination that a graduate from any dental school in Canada would sit. When they pass that, they can practise in any province in Canada. There is freedom of movement across the country.

If for some reason they're not successful there, there is access to gap training programs and upgrading programs that are offered in essentially all the universities in Canada.

Dentistry is very proud of its track record in this area.

4:25 p.m.

Conservative

The Chair Ed Komarnicki

Thank you.

Mr. Swan, do you have a comment to make?

4:25 p.m.

Manager, Dental Programs, Canadian Dental Association

Dr. Euan Swan

No, thank you.

4:25 p.m.

Conservative

The Chair Ed Komarnicki

Ms. Fréchette.

4:25 p.m.

Director, Health Policy and External Relations, Royal College of Physicians and Surgeons of Canada

Danielle Fréchette

Thank you.

It would be encouraging to see the certifying bodies working together, with some federal resources to ramp up our assessment capabilities and technology. We know that simulation is huge, and to really capitalize on the potential of simulation, to give our foreign-trained physicians a quicker diagnostic of where they're at, would help pave the way for their integration as well.

Thank you.

4:25 p.m.

Conservative

The Chair Ed Komarnicki

Thank you very much for that presentation.

We will suspend now for our next panel.

Thank you very much for coming before this committee.

4:35 p.m.

Conservative

The Chair Ed Komarnicki

I call the meeting to order.

We have a good group of witnesses here with us today, and we're waiting to hear each of your presentations, and there'll be some questions and answers.

We'll start with the dieticians, I understand. Please go ahead.

4:35 p.m.

Pat Vanderkooy Manager, Public Affairs, Dietitians of Canada

Good afternoon. I'm Pat Vanderkooy, representing Dietitians of Canada, with public affairs. My colleague is Marlene Wyatt, with professional affairs in our association.

You have before you an outline, and we will shortly be following up with a brief that we will submit.

Dietitians of Canada is our only national professional association of dietitians in Canada. We're already on record calling for cross-sector collaboration, national leadership, and coordinated action to address key issues.

Today I'll address access to dietitians' services in all sectors with a sufficient dietitian workforce. In Canada, dieticians are the only regulated health professionals with accredited education and training in food and human nutrition. Becoming a registered dietician requires five years of post-secondary training, four years at an accredited four-year university program, and an additional year of practicum training.

Of the 9,500 dieticians in Canada today, most are employed in our publicly funded health system. As well, dieticians work in academic settings, in the food industry, and as private consultants and counsellors.

With growing interest in healthy lifestyles and the urgent need to prevent and better manage chronic diseases and obesity, dieticians are in high demand. Dieticians participate in collaborative care as members of interprofessional health teams. In Canada, however, access to dieticians is limited by a shortage of dieticians. Today I'll address three aspects of that shortage.

First is our labour shortage and essentially the bottleneck in our practical training component. Last year Dieticians of Canada produced a snapshot of the dietetic workforce in Canada. We found, one, that all provinces and territories have vacancies that are difficult to fill, especially in the rural, remote, and northern communities, and almost half of the dietician workforce currently is planning to retire within the next ten years. Dietician vacancies are already impacting the quality of health services. Some employers, to fill gaps, have hired non-professional educators or health professionals with different scopes of practice. In our health care systems there is limited funding to support practicum training. There are gaps in training opportunities as well in smaller communities and among aboriginal populations. Based on our projections, there is an urgent need to increase the practical training capacity for dietician candidates in Canada.

Second, as with other professions, we also have a growing number of internationally educated colleagues who wish to practise in Canada. We require bridging programs for qualification to practise. We believe it's only fair and equitable that these internationally educated dieticians have the opportunity to be employed here in their chosen profession. Currently, we have only one such program for dietician bridging supported by government funding. In the past five years, this program at Ryerson University in Toronto has graduated over 100 internationally educated dieticians. Before this program was established, very few internationally educated dieticians were able to gain registration for practise in Ontario. Today, almost all the graduates of this bridging program have succeeded in passing the national certification exam and are employed as registered dieticians. Demand for this program remains high, with applicants from across Canada.

My third point today is that, as you may know, the Canadian Institute for Health Information tracks workforce data for six other health professions. We dieticians are not one of these professions. We don't have continuous, up-to-date, accurate information about our workforce trends and the projected needs in Canada. We support the continuation of the work of the Canadian Health Human Resources Research Network. We really need access to information for innovation in development, training, regulation, recruitment, and retention.

What is it that we need? We need a comprehensive health human resources strategy so that Canadians will have access to the right care at the right time.

We recommend, as dietitians of Canada, improved and increased training capacity in accredited universities and practicum programs. Our profession needs more spots for practicum training to increase the number of practice-ready dietitians. We need support to coordinate this practicum training and an efficient system that addresses the newer competency standards that we have developed.

We also require improved workforce mobility, and specifically here we ask for sufficient support for bridging programs for internationally educated dietitians. This would require sustained government funding to ensure the continuation of our one current dietitian bridging program in Canada, and of course it would be great if there were assistance to develop and implement bridging programs for dietitians in other parts of Canada.

Last, we do need improved labour market information. Our profession requires support from the research network. We would like to have assistance from CIHI and Stats Canada to initiate data collection for dietitians, and some support from the provincial and territorial models for supply and demand responses.

I thank you for this opportunity to address you on behalf of health human resources challenges in our profession. We look forward to your questions, and also to your report and recommendations in the near future.

4:40 p.m.

Conservative

The Chair Ed Komarnicki

Thank you, Ms. Vanderkooy. We appreciate your presentation.

I know the next presenters, the Canadian Federation of Medical Students. We've had the great privilege of having met many of them on the Hill, lobbying many of us from year to year, and we appreciate that very much. It's good to have you involved in our study. We're looking forward to hearing from you.

I understand you're going to split your presentation, so we'll commence with either Ms. Hassan or Ms. Ward. Go ahead.

4:40 p.m.

Noura Hassan President, Canadian Federation of Medical Students

Good afternoon. Thank you for having us. I am Noura Hassan. I am president of the Canadian Federation of Medical Students. I am here with Chloé Ward, who is our vice-president of advocacy.

I would be happy to answer your questions in English or in French.

The Canadian Federation of Medical Students represents over 7,800 medical students attending 14 medical schools in Canada. Thank you for having us to discuss the issue of labour shortages in Canada.

Today we wanted to address three key issues in health human resources from our perspective. First, we wanted to bring to your attention a pending oversupply of physicians. We had a presentation from the Royal College earlier, so we're going to build on that, providing a little more of the student perspective.

Second, we'd like to address some labour shortages in key medical specialties. Last, we're going to discuss the geographic maldistribution of health human resources in Canada.

As you all know, more than 20 years ago, in 1990, Canada was faced with a significant physician undersupply. This issue was addressed by a number of medical stakeholders, including the Canadian Medical Association and the Canadian Medical Forum, and that led to an increase in admissions at medical schools across the country. At this point, we are training more physicians than ever in Canada. Essentially this is good news because it limits the likelihood of physician undersupply as it stands right now. However, as you also know, it takes from six to eleven years to train a physician who is ready to practise in Canada. For that reason, it's clear that we only see the impact of any changes in policy with respect to medical school admissions five or ten years down the road. It's not an immediate result.

At this point we're starting to see a change in paradigm. In the not-too-distant future, some graduating medical students will not be finding jobs upon completion of their specialty training. When I say “specialty training”, I'm not only speaking about Royal College specialties, I'm also talking about family medicine. We have information from CIHI suggesting a net influx of 1,600 physicians in 2010. This is important to note because this does not reflect the biggest medical classes that have graduated. Bigger cohorts have yet to pass through the system. So we're going to keep seeing a more important net influx of physicians as the years go on.

As it stands right now, we need a mechanism that will help us match the residency training positions to Canadian health care needs from one end of Canada to the other. So essentially what we need is a joint mechanism. Ideally, it would be a federal-provincial effort that will help us ensure that we're not training too many physicians in Canada.

We have to stop this reactive yo-yo trend that we've been experiencing in Canada with respect to human health resource training. We have to be proactive to make sure we're serving the interests of students, medical schools, and our taxpayers.

May 7th, 2012 / 4:45 p.m.

Chloé Ward Vice-President, Advocacy, Canadian Federation of Medical Students

One of the more pressing problems we're seeing is that many specialists are unable to find work in their specific field. Essentially, we are reaching a point, as Noura indicated, where there soon will be enough doctors, but these doctors will not be aligned with the specialties in demand.

Training spots in the various medical specialties simply do not match the population needs of Canadians. There are over 60 medical specialties that medical students can choose from. We're currently doing a very poor job of identifying current and future medical doctor labour shortages with respect to specialty and by geographic location.

For example, many specialists in cardiac surgery, radiation oncology, and orthopedic surgery currently have difficulties finding jobs in their fields. Because these specialists are highly trained, whenever they're unable to find work, they're often forced to leave the country.

The lack of a national level of cooperation is a large impediment. For instance, Ontario projects that before 2017 there will be labour shortages in almost every medical specialty in Ontario. Quebec is expecting an oversupply of physicians by 2016.

We're seeing similar trends across the country. When medical students apply to specialty spots after medical school, they apply through the CaRMS portal, which is essentially a national portal redistributing medical students across the country, not necessarily within their home province.

As of right now, there is no national health human resources database that tracks this kind of information. “The Future of Medical Education in Canada Postgraduate Project”, which is funded by Health Canada, actually calls for HHR planning on a national level, with government involvement.

Basically, we have demographic data on our population and on disease prevalence, and we know what the burdens are for our health care system. All we need now is a national database to collate this information and make it available so that we can use this information in the future to make projections and essentially align the residency and training spots in different specialties with the needs of Canadians.

According to the Society of Rural Physicians of Canada, 21% of Canadians are rural, but only 9% of Canadian physicians practise in rural areas. One of the main reasons that we have some underserved rural and remote areas in Canada—we're echoing previous messages from today—is that we're training few students from these rural and remote communities.

It is estimated that over 90% of medical students come from wealthy urban areas—essentially areas where there are no physician shortages. We know that medical students from rural or remote communities are far more likely to return to their communities to practise after medical school.

In Budget 2011, as you know, there was money allocated to forgive the loans of physicians and health care providers who begin to work in underserved rural and remote communities in Canada. This program aims to improve access to primary health care in underserved regions. We applaud this initiative; however, this program is inherently flawed as it currently stands.

Essentially, the loan forgiveness incentive begins only after residency, meaning that medical residents make payments on the federal portion of their Canada student loan during residency years. This greatly diminishes the incentive of loan forgiveness to attract physicians to underserved rural and remote areas. We need to defer the interest on and payment of the federal portion of the Canada student loan during residency in order to render this program effective.

4:50 p.m.

President, Canadian Federation of Medical Students

Noura Hassan

Briefly, in conclusion, we really want to make it clear that as the doctors of tomorrow and the representatives of the Canadian Federation of Medical Students, we want to ensure that we're training not only the right number but the right mix of physicians in Canada, in order to be able to serve the health care needs of Canadian taxpayers.

What does that mean? It implies that we need to attract and also retain physicians in the rural and remote areas in Canada that need and deserve adequate health care. As it stands right now, we don't necessarily need to train more physicians; we just need to make sure they're distributed more efficiently across the country.

As we outlined earlier, there is a problem in physician maldistribution by geographic location and specialty, and that needs to be addressed. The way we need to see this addressed on a national level is to have a national human health resource database that will help us deliver adequate health care to all Canadians.

Finally, as Chloé highlighted earlier, there is a need to adjust the repayment schedule for the Canada student loans program in order to ensure that people can take advantage of these great resources that are being presented to residents who are interested in practising in rural and remote areas.

We look forward to answering your questions. Thank you for your attention.