Health Committee on April 2nd, 2009

[Dr. Peter Kuling]

I think of the residents I have been directly involved in training just in the past two years. I've had residents from Tibet, Pakistan, Iraq, Egypt, and the Caribbean, and all very excellent. But I get the end product; they come for their assessment and their verification period. It's certainly not quite as easy, as you would understand, to grant a license immediately. All of these foreign-trained physicians were very grateful to have at least a two-year residency to understand the culture and the way we do things—the medications, the treatments, and so forth—and meet our Canadian standard so that they provide safe care.

I run a training centre that we are committed in the next three years to triple in size, tripling the number of residents. Right now, we are faced with trying to get capital funds to expand our centre—nothing fancy, just for examination rooms where we can see patients and observe and teach and so forth. Our frustration is that we have to go to the government and have to hit five different silos of funding provincially. There is no coordination. Everybody increases medical school enrolments and brings in IMGs, and we're at the very end, where we have to the residency training. Nobody has thought out how to expand our current teaching facilities so that we can actually accommodate this.

I see a crisis looming there. We're playing off all different kinds of silos in this.

[The Chair, Conservative, Joy Smith]

Dr. Fernando, please.

[Dr. Mary Fernando]

To address what Mary was saying about IMGs, I would like to table a study by, I believe, the Canadian Medical Association that shows that the average duration of IMG practice, after they have been trained in Canada, is three years.

The second thing I would like to table shows.... If we aren't even able to keep our own physicians, we have a problem. We are second only to India as a supplier for the American medical market—second only to India. We train world-class physicians. Quite frankly, my issue is why we don't give them pensions and keep them here or give them more money—you pick it; pick whatever you want. If you think we can afford more money from a public purse, do that. But we can't keep training doctors and shipping them out while having IMGs come and stay here for three years.

Would you like both of these documents?

[The Chair, Conservative, Joy Smith]

Yes, please, if you would, table them; I'd really appreciate it. We'll distribute them among all our committee members.

Unfortunately, we've run out of time. We'll have to put you down for the next question, if that's okay, Ms. McLeod.

Could we please now go to our next round? This is a five-minute round for questions and answers.

Dr. Bennett, please. Are you sharing your time with...?

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

We will not have enough time for a full round since we only have ten minutes left.

[The Chair, Conservative, Joy Smith]

We'll do the best we can.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Maybe we could allow three minutes.

[The Chair, Conservative, Joy Smith]

Three minutes per round?

[Carolyn Bennett, Liberal, St. Paul's, ON]

We can go a bit longer. The committee could decide to just have a five-minute round, and we'll go until we're done. Do you really have 15 minutes of business, Madam Chair?

[The Chair, Conservative, Joy Smith]

I did, but I'm flexible on it. What is the committee's...?

There's actually two hours' worth.

Anyway, we could do the next round. We'll go to 5:30. I'll take five minutes with you to tell you what I need you to do for the next meeting, then, and we'll dispense with the other.

Dr. Bennett, are you sharing your time?-

[Carolyn Bennett, Liberal, St. Paul's, ON]

Yes, I'm sharing my time with the physicians. I'm going give them all of my time, because they don't often get a chance to ask the officials questions. We don't often have these kinds of interesting mixed panels.

If Dr. Kuling or Dr. Fullerton or Dr. Fernando had questions for the officials, I would enjoy hearing them.

[The Chair, Conservative, Joy Smith]

Dr. Kuling, you're up first.

[Dr. Peter Kuling]

I would love to ask that question to the officials. It's nice to have the strategy in which.... It's two questions, or one question and basically part of my last comments. We've had a strategy of increasing medical enrolments and we've had a strategy of trying to streamline international medical graduates coming into Canada, gaining acceptance, and getting into our training programs.

Is there a strategy to roll that all the way through their training, with all the capital investment required and the HR teachers? We need teachers to assess and train and to get them licensed and into practice. What types of meetings are ongoing with the provinces, so that I just have to go to one person to say yes, we can triple our unit; yes, we want to hire three more teachers and accommodate these new students? Have you taken it from A all the way through, or is the ball dropped once they're here and have become Canadian citizens and we have recognized their credentials?

[The Chair, Conservative, Joy Smith]

Who would like to answer that?

[Kathryn McDade]

I'll try that one, Madam Chair.

The honest answer is that there is not engagement at the federal-provincial-territorial level on issues related to capital funding for hospitals and universities. That responsibility for both undergraduate medical education--and I know you're focusing primarily on residency training--but also of course for ongoing professional development does rest squarely with the provincial governments.

[Carolyn Bennett, Liberal, St. Paul's, ON]

They can apply for Canadian Foundation for Innovation money if they're doing research like Peter is.

[Kathryn McDade]

The specific questions you're asking around how many places I need to go to to put together the capital funding, or put together the combination of the capital funding, the support for teaching resources, and maybe on top of that the support for clinical resources in the clinical setting, that responsibility for those on-the-ground choices and decisions is clearly made by provincial-territorial governments, and no, there is not engagement on that level of health care delivery decision-making.

Along the lines of Dr. Bennett's intervention, although there isn't a federal role in the decision-making, there's rarely very clearly a federal role on the financial side in terms of supporting many of those decisions. At the broadest level, our primary support for medical education and for employment of the health care workforce is via the Canada health transfer, which is the major federal transfer that supports health care delivery. In that context, as you well know, the federal government committed some time ago, in 2004, to a significant increase in that transfer and to an annual escalator of 6% that is built in to the transfer. That was recently confirmed by the government. At that level the federal government is not uninvolved; it has a role in financing provincial health care delivery.

Dr. Bennett mentioned the Canadian Foundation for Innovation. There's a whole tier of support for research and development, whether it's through CFI, through dedicated research chairs, through the work of CIHR, and we could go on and on. Some of those are not within the responsibility of Health Canada, so I wouldn't be in a position to provide details, but that would be my general answer.

[The Chair, Conservative, Joy Smith]

Dr. Fernando is next.

Our time is just about up.

[Dr. Mary Fernando]

Jumping off from what you just said in terms of being a major financial contributor to health, as the federal government is pouring money into increasing training, into IMGs, into the health care system in various ways, what is your policy for retention? I want to come back to the fact that we train enough, but we don't keep them. Unless we answer that question, it's like pouring money into a sieve. I can understand the federal frustration of pouring money in and not getting the numbers one would expect. On a public purse we cannot compete with the mammoth we live beside. We need a retention strategy.

[The Chair, Conservative, Joy Smith]

Who would like to answer that question?

Ms. McDade.

[Kathryn McDade]

I assume you'd like me to be brief, as much as I possibly can.

[The Chair, Conservative, Joy Smith]

Yes, please.

[Kathryn McDade]

At the level of health care delivery and the retention of individual physicians, with the exception of my colleague who is responsible for first nations and Inuit health care, in the vast majority of cases those decisions on specific policies and incentives rest with the provincial-territorial governments. So whether it's compensation, enhancements, relocation assistance, return of service agreements for students who are still in studies and incurring student financial--

[Dr. Mary Fernando]

The federal government does prevent the provinces from using pensions as a retention matter.

[Kathryn McDade]

On the pension issue, with apologies, I'm not a tax law specialist and I'm not going to try to comment on pension law.

In closing, in my comments I did outline a number of ways, from policy research, data perspective, and innovative models, in which the federal government has supported provincial-territorial governments in addressing the challenge around recruitment and retention. I'm not going to go through all of them again. I think they're set out in the notes.