Human Resources Committee on May 7th, 2012

[Phil McColeman, Conservative, Brant, ON]

Okay, so they're being judged. They're losing some status because of their productivity.

[Marlene Wyatt]

Well, because the students take the extra time, they're not able to see as many clients, etc.—

[Phil McColeman, Conservative, Brant, ON]

Could I make my comment?

I owned a business and had apprentices working for my company. I welcomed every one of them, and my carpenters took the time to make sure they were apprenticed properly.

I have a hard time understanding that lack of social responsibility.

[Pat Vanderkooy]

I understand how you might have misconstrued that piece of it. It's not about not wanting to be a preceptor. In fact, the majority of our dieticians in the workforce survey said that, yes, they had been preceptors at some point. All of us really do enjoy having students, but we know that the system within which we work—this publicly funded health system—judges our profession and funds our work by productivity output statistics.

We are simply caught between a rock and a hard place, in that our departments—our professional contribution in the systems—have to keep up certain productivity statistics while we are preceptoring. That doesn't even account for the coordination of these students within a little system. So there might be six students running around in the hospital or a community program. Who is coordinating them? Who is directing where their placements are going? All of this takes time.

So, in essence, the problem is that there is no funded time to do the preceptoring that the professional people very much enjoy doing. You don't enjoy it when your work is piling up and you essentially have to stay for unpaid overtime. It's a real problem that way.

[The Chair, Conservative, Ed Komarnicki]

Thank you, Mr. McColeman. Your time is up.

[Phil McColeman, Conservative, Brant, ON]

Is that right? Ah, you're mean.

[Voices]

Oh, oh!

[The Chair, Conservative, Ed Komarnicki]

Mr. Stewart, go ahead.

[Kennedy Stewart, NDP, Burnaby—Douglas, BC]

Thank you, Chair. It's a pleasure visiting today.

Thank you to the witnesses.

I'd like to start with Ms. Vanderkooy, if I may. I just have to say that I've seen the value of dieticians firsthand. I have a lot of interaction with the local urban first nation reserve, and the changes it makes in people's lives when they start eating properly just.... It stops folks going further up the medical chain, that's for sure. So thank you for your work.

You said you have a problem with the supply of dieticians: there are not enough dieticians. I just wonder about the distribution. We've heard from surgeons and from dentists who say there is a distribution problem. How about your distribution?

[Pat Vanderkooy]

We did refer to it.

[Marlene Wyatt]

Yes, we do have a distribution problem. I think we referred to it very briefly when we said rural, remote, northern, and aboriginal communities. Those are the areas that are hurting the most.

We have tried to put some targeted programs, especially at the clinical placement level, in those areas, and it helps. But one of the issues with providing clinical placements in rural/remote areas is travel, etc. It's kind of a double-edged sword.

That would be where we are with the shortage of dietitians, and it did come out in our workforce survey.

I think the point made by the medical folks was that if we had a better handle on this, and they quoted some statistics, we'd be able to better address the issue. We did a point-in-time survey, which is the only data we have to measure that.

I'm not sure where you're from. In Newfoundland, for instance—I'm doing some work in Newfoundland currently—there are a lot of areas that are rural/remote, and all of our training is centred in one area. We're trying to move the training out, but again, the students have limited funds to travel to rural or remote placements.

[Kennedy Stewart, NDP, Burnaby—Douglas, BC]

Thanks. Maybe we can come back to that.

[Pat Vanderkooy]

We also have some shortages in public health. This profession we belong to, the dietitians, is one of the few health professions directly employed in public health units. Typically, public health units would be nurses and dietitians. That is another area where the distribution has become quite skewed, and it's problematic for our workforce.

[Kennedy Stewart, NDP, Burnaby—Douglas, BC]

Thanks. Maybe we can come back to that in a second.

I'll move to Mrs. Hassan.

I think a database is a great suggestion from both of you, actually. I think the more data we have, the better. And if it were a regularized thing, I'm sure it would help with placements and would help stop the yo-yoing.

I'm just wondering if you surveyed students. In particular, you talked about an oversupply of students. What I'd be worried about is that some intend to leave Canada anyway, no matter what the incentives are. Have you surveyed the students and asked them what their intentions are? I guess there's being forced to leave and there's wanting to leave. I'm just wondering if you have any information on that.

[Noura Hassan]

We haven't formally surveyed our students recently to see whether they intend to stay. But if we simply look at the data we can collect from the Canadian resident matching service, CaRMS, which is the way we apply to residency or specialty training positions, the vast majority of students graduating from Canadian medical schools stay in Canada for residency training. The reason we do that is because we want to practise in Canada. It's much easier to practise where you've trained, so the vast majority of people do want to stay in Canada.

It's unfortunate that the Royal College is not here anymore, because they'd be able to give you a better idea of where their graduates go.

In general, there is a vast appetite to stay in the country.

[Chloé Ward]

I have one thing to add to that.

CIHI has actually released some data indicating that in recent years there has not been an increase in the number of physicians trained in Canada who are leaving the country. It appears that most are staying.

[Kennedy Stewart, NDP, Burnaby—Douglas, BC]

We've heard a lot about student loan forgiveness. I'm on the industry committee. It's a global world now. Everybody moves around.

I'm just wondering if that's the best way to direct government moneys. Wouldn't it be better to just pay somebody, as other countries do? They just pay people more to work in rural and remote communities. Do you think a more broadly placed plan, rather than something attached to loans, might be a better way to go? Maybe I'll leave that open to you all.

[The Chair, Conservative, Ed Komarnicki]

I see that a number of people want to comment.

Go ahead, Chloé, and then we'll move on to Ms. Nielsen and Ms. Vanderkooy.

[Chloé Ward]

There are definitely a number of ways you can incentivize medical trainees to go into different professions. We have been focusing on that, because it is a new program the government announced in Budget 2011. They have indicated in Budget 2012 that they will continue to implement this program, which will begin in 2012 and 2013. Since this is an existing program that is going to come into effect very shortly, and since it is inherently flawed in what its main goal is, which is basically to attract physicians to these underserved rural and remote communities, we've been focusing on just this.

This is something very tangible that will not cost the government very much to change. It will greatly improve the efficacy of this program that is going to come into place in the next few months.

[The Chair, Conservative, Ed Komarnicki]

Mr. Stewart, your time is up, but we will hear from Ms. Nielsen and then Ms. Vanderkooy.

Go ahead.

[Christine Nielsen]

In my profession, medical laboratory science, right now about 80% of the students go to university first. They have their B.Sc. and think they're destined for medical school and find out that's not happening. There are very few jobs you can do without getting your next professional certification or licence, or without moving into the master's realm. My students today are graduating at about 25 to 27 years of age with six to eight years of student loans behind them. Even though my profession is not included in the loans relief program, I do believe it would be an incentive to move to rural and remote locations.

The other bonus behind that employment is they don't offer, as the large urban areas do, a job that's a point to or casual employment; they offer a real full-time job. We think that a real full-time job along with a loan forgiveness program that would help them pay back years of loans would definitely help. I do know there are some programs where there are things such as workforce relocation bonuses, but what we find is sometimes other employers will buy out the contract or the return to service agreement.

I'm not too sure what the perfect solution is, but we'd like to be included in the pilot, if we could.

[The Chair, Conservative, Ed Komarnicki]

Okay, a short response if you could, Ms. Vanderkooy.

[Pat Vanderkooy]

There's also the matter of a differential in wages for those who are employed in hospitals versus those who are employed in community settings, like community health centres and family health teams. There is the rural versus the urban pay differentials, as well as benefits, such as having access to a pension plan. There are other incentives that possibly would attract people to the different sectors.

[The Chair, Conservative, Ed Komarnicki]

Thank you for that.

Mr. Mayes, go ahead.

[Colin Mayes, Conservative, Okanagan—Shuswap, BC]

Thank you, Mr. Chair. Thank you to the witnesses for being here today.

You've all made statements about the shortages in certain disciplines. You've all said that we need more data. On what do you base those statements if you don't have data? It seems strange to me that you're making knowledgeable statements of the shortages and everything else, and then you say you need more data.

Could all three of you answer that?