Evidence of meeting #37 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 care.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

  • John Haggie  President, Canadian Medical Association
  • Nick Busing  President and Chief Executive Officer, Association of Faculties of Medicine of Canada
  • Michael Brennan  Chief Executive Officer, Canadian Physiotherapy Association
  • Claudia von Zweck  Executive Director, Canadian Association of Occupational Therapists

May 9th, 2012 / 3:30 p.m.

NDP

Chris Charlton Hamilton Mountain, ON

I just think we should point out to the witnesses this new spirit of cooperation they're seeing here between the government and opposition members, because it's rare.

I'm really glad you're here to witness it.

3:30 p.m.

Voices

Oh, oh!

3:30 p.m.

Conservative

The Chair Ed Komarnicki

Indeed, in some respects, it is somewhat different and novel compared to what has been the case in the past.

3:30 p.m.

Conservative

Kellie Leitch Simcoe—Grey, ON

It's because of our great chair.

3:30 p.m.

Conservative

The Chair Ed Komarnicki

That's right.

Is there anything further? If not, we'll suspend for probably about 45 minutes. They're 30-minute bells and the vote will take 10 or 15 minutes.

4:15 p.m.

Conservative

The Chair Ed Komarnicki

Time is short, the witnesses are here, and we may have more votes, so we'll just get right to it and ask you to present. Then we may have to adjourn again.

We will start with Mr. Haggie with the Canadian Medical Association, and then move to the Association of Faculties of Medicine of Canada.

Please go ahead.

4:15 p.m.

Dr. John Haggie President, Canadian Medical Association

Good afternoon.

Thank you very much for the opportunity to appear before this committee to discuss ways to ensure an adequate supply of physicians in the Canadian health care system.

The reality today is that nearly five million Canadians do not have family physicians, including more than 900,000 here in Ontario. Over one third of all Canadian physicians are over the age of 55. Many will either retire soon or reduce their practice workload.

Many physician practices are at capacity and unable to take on new patients. Canada's supply of new physicians relative to our population is well below the Organisation for Economic Co-operation and Development average. We're the seventh-lowest supplier of physicians per capita amongst OECD nations. Canada ranks below the European Union nations and the United States.

Ensuring Canada has the appropriate number of physicians with the appropriate mix of specialities to meet patients' needs requires planning and leadership at the federal level. Canada must address specific shortages and ensure self-sufficiency in health human resources for this country. Better planning would also help address the issue of wait times and their negative impact on patient care.

The Canadian Medical Association recommends, first, ensuring a needs-based speciality mix; second, targeting health infrastructure investments to optimize the supply of health human resources; and third, addressing the issue of foreign credential recognition.

On our first area of focus, ensuring a needs-based specialty mix, a CMA survey this year of provincial and territorial medical associations on physician resources underscores the pressing need for a pan-Canadian approach to health human resource planning. All jurisdictions in Canada are experiencing challenges, although shortages by type of practice vary from province to province.

Ensuring an appropriate specialty mix requires planning. At present there is no pan-Canadian system to monitor or manage the specialty mix. Our survey found only three jurisdictions that have a long-term physician resource plan in place, while, until today, only one jurisdiction had employed a supply- and needs-based projection model—Nova Scotia just released a second one of these today.

The consequences of this lack of planning are evident. From 1988 to 2010, the number of post-graduate trainee positions in geriatric medicine—care of the elderly—was essentially constant at only 18 physicians, while the number of trainees in pediatric medicine—childhood illnesses—increased by 58%, in clear contradiction to the demographic trends.

The last time the federal government prepared a needs-based projection of physician requirements in Canada was 1975.

The second issue I wish to address is health infrastructure. Recruitment of specialists and subspecialists is affected by the limitations of existing hospital infrastructure, such as operating rooms. Ensuring that infrastructure is in place to allow the doctors that we do have to carry out their work would no doubt help address Canada's persistent problems with wait times.

The CMA recognizes the federal government's commitment to address the issue of foreign credential recognition and recognizes that physicians are in the target group for 2012. The medical profession is well positioned to support the federal government's objective.

Under the auspices of the National Assessment Collaboration—a group of federal, provincial, and other stakeholders—the medical profession is working to streamline the evaluation process for international medical graduates for their licensure in Canada.

The pan-Canadian portable eligibility for licensure is another important issue for physicians. In 2009, the Federation of Medical Regulatory Authorities adopted an agreement on national standards for medical registration in Canada that reflects the revised labour mobility chapter of the Agreement on Internal Trade. The federation and the Medical Council of Canada are working on a one-stop process for IMGs to apply for licensure in Canada.

Close to one-quarter of all physicians in Canada are IMGs. I'm one of them. While the CMA fully supports bringing into practise qualified IMGs already in Canada, actively recruiting doctors from abroad cannot be the only solution to our physician shortage. Canada must strive for greater self-sufficiency in the education and training of physicians.

To conclude, for several years now, the CMA has advocated health care transformation. With the Canadian Nurses Association, it has developed six principles to guide transformation. These principles have been endorsed by over 100 medical, health, and patient organizations.

One of these principles is sustainability. Addressing health human resource shortages is critical to ensuring a sustainable system that's also accessible and patient-centred.

Despite progress, our country continues to experience a persistent shortage of physicians. This is hardly surprising given that few jurisdictions engage in any health human resource planning and that the federal government has not examined physician supply in almost 40 years.

Canada requires a pan-Canadian approach to ensure adequate health human resources in support of a sustainable health care system.

Thank you very much for your attention. I'll be pleased, if the opportunity presents itself, to answer any questions.

Merci beaucoup.

4:20 p.m.

Conservative

The Chair Ed Komarnicki

Thank you for that presentation.

We have another presentation to hear. I hear the bells going again, so we will need unanimous consent to continue.

Is there a will to hear the next presentation? Do we have unanimous consent? It will take probably seven or eight minutes.

4:20 p.m.

Some hon. members

Agreed.

4:20 p.m.

Conservative

The Chair Ed Komarnicki

We will hear from the next set of witnesses.

After that, you'll be excused. You can stay if you want to because we'll come back after the next vote, but there won't be a whole lot of time.

So go ahead and present, and we'll suspend after that.

4:20 p.m.

Dr. Nick Busing President and Chief Executive Officer, Association of Faculties of Medicine of Canada

Thank you very much, Mr. Chair.

I appreciate the opportunity to present on behalf of the Association of Faculties of Medicine of Canada. I would suggest that you pick up the document I have here. There is some data that I'll be referring to and referencing in some of the slides.

I would say right up front that you will find some of my comments—and in fact some of my information—very complementary to that which you've heard from the CMA. Notwithstanding the fact that we did not plan it that way, I am very appreciative of how clearly we represent similar views.

As you know, physicians are a highly skilled part of our workforce, and the care they provide is in high demand. At the same time, we continue to struggle with some shortages, particularly in rural and other underserviced areas. It is clear that if we're to meet the needs of Canadians, we need to achieve the right number, mix, and distribution of physicians. This is precisely what's being recommended through the future of medical education in Canada postgraduate project—FMEC PG.

In the following short presentation, I will outline why AFMC feels it is critically important to address certain physician shortages and also offer some specific strategies.

As you will note if you look at the second slide, our first recommendation from our report is to ensure the right number, mix, and distribution of physicians to meet societal needs. We've structured our report with what we consider to be key transformative actions. The transformative action to make that happen reads as follows: “create a national approach, founded on robust data, to establish and adjust the number and type of speciality positions needed in Canadian residency programs in order to meet societal needs”.

As you will see from that same slide, there are two other FMEC recommendations quoted, plus seven more recommendations that are in the report I have circulated. I encourage you to look at that report. I'd be pleased to answer any questions with regard to it.

The next slide, slide 3, talks about the growth in our trainees. The first and foremost way to achieve the right number of physicians is through our medical education system. In recent years, enrolment in undergraduate medical education has grown to levels that we have never seen before. What's shown in our chart is the flow of much larger medical classes through to postgraduate residency training.

The number of incoming medical residences has doubled over the decade, from 1,547 in 2000 to 2,912 in 2011. Residency programs are also an important entry point for international medical graduates, and that will be taken up in our next slide on the right numbers. As shown by the green line on that slide, since 2000 there has been a 400%-plus increase in the number of international medical graduates entering MD training. At all levels—not only at the entry level, but throughout the system—there are 2,139 IMGs enrolled in Canada's post-MD training programs. This represents approximately 17% of all residents training in medicine in Canada.

Slide 5 shows you a map of our country. The map shows where medical education currently happens in Canada. We have 18 main medical campuses situated in relatively large cities, spanning the country from St. John's, Newfoundland, to Vancouver, British Columbia. In addition, we have 13 satellite campuses situated in communities like Moncton, New Brunswick, Windsor, Ontario, and Prince George, British Columbia.

Finally, we have about 900 small clinical teaching facilities, many of which are in doctors' offices and clinics in rural communities. These teaching sites are situated in communities that are frequently most in need of physicians. Apart from aiming for the right number of physicians, we also need to train an appropriate number of family doctors, other specialists, and scientists.

I'll say a word about shifting demographics. Our next slide shows that, in 2001, 13% of Canadians were aged 65 or older. It is estimated that by 2036 one in four Canadians will be 65 or older. This demographic shift will create and in fact is creating new demands on our health care system. We may ask ourselves if the mix of physicians we're training today will be poised to care for tomorrow's elderly.

That takes us to the next slide and the comment made by Dr. Haggie. Enrolment increases in pediatric residency programs look very much like the overall increase in our postgraduate programs; however, the picture is dramatically different for geriatric medicine and programs for care of the elderly. Over the past decade, relatively few doctors have taken the opportunity to train in geriatric medicine and care of the elderly. You will see the numbers, as highlighted by Dr. Haggie, in the next graph.

It is imperative, in our view, that a multi-stakeholder forum be established to identify, prioritize, and address areas where the training of future health care providers can be brought into greater alignment with future health care needs. AFMC would like to take this opportunity to repeat its call for such a forum. I would also like to remind you that in the report of the House of Commons Standing Committee on Health, “Promoting Innovative Solutions to Health Human Resources Challenges”, the committee made this its number one recommendation.

We propose that a national health human resources data and analysis centre be established to provide a formal structure for the collection and analysis of Canada's disparate data sets, the collection of data where needed, and to serve as a resource to governments, federal and provincial, in matters of policy planning for health human resources. The centre would bring together caregivers, patients, federal, provincial, and territorial governments, managers, researchers, and other stakeholders to analyze data, make evidence-based recommendations, and build consensus around forward-looking strategies.

As a first step, AFMC is proposing that it form a secretariat for this initiative and hold a series of national, regional, and provincial consultations that would culminate in an actionable business plan, including a budget for such a centre. The anticipated cost for this work is $600,000. The work could be completed within two years.

Thank you for your time.

If there is any time, I'd be pleased to answer any questions.

4:30 p.m.

Conservative

The Chair Ed Komarnicki

Thank you for that presentation.

I'm wondering if everyone's okay to hear yet one more witness. Is everybody okay with that? I'll need unanimous consent. If we don't have it, then what we'll do is we'll—

4:30 p.m.

NDP

Chris Charlton Hamilton Mountain, ON

What time is the vote? Do we know?

4:30 p.m.

Conservative

The Chair Ed Komarnicki

It's a 30-minute bell, so we have probably another 15 or 20 minutes.

4:30 p.m.

NDP

Chris Charlton Hamilton Mountain, ON

I don't think we can....