Health Committee on April 2nd, 2009

[The Chair, Conservative, Joy Smith]

And I thank you. That was very compelling testimony, Dr. Kuling. Thank you very much.

We're now going to go into two rounds of questions. The first round is going to be seven minutes. I'm going to ask, with the indulgence of the committee, if we could go until quarter past five. I have some business I have to talk to you about before the break.

Does the committee agree to suspend at quarter past five? Is that agreeable?

[Some hon. members]

Agreed.

[The Chair, Conservative, Joy Smith]

Great. We're now going to go to questions. We will start with another doctor, Dr. Bennett.

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

Thanks very much, and thanks to everybody for coming.

I hope the doctors will understand, but I think we have to set the tone for what actually exists. I thank the officials for their remarks, but I want to know what the strategy is. In any strategy I've ever been part of, it's what, by when, and how. I haven't heard a strategy in terms of how we're going to close the gap for these five million Canadians who don't have a family doctor.

What timeline will it take until every Canadian has a family doctor? What do we know about pediatric nephrologists, pediatric neurologists...? What about the things we know we will increasingly need in geriatrics? What do we know could be increased by primary care reform and physicians being able to see more patients? I see a lot of programs, but I don't see a strategy.

Then I guess what I want to know is, on the FPT committee, what kind of reporting happens? How are the provinces doing? I don't think a strategy is just poaching doctors from province to province. What actually is the plan for the FPT committee? Do they have a strategy?

These words are a bit concerning: “These funds are not used for 'direct' HHR investments”. They're for data, but I didn't hear any. They're for policy research, but I don't know what that means. And “the identification and dissemination of innovative models....”

I would just like to know how you think we're doing on this in terms of reaching the goal of sufficient health human resources. There's a global health shortage. We're hearing this big sucking sound from the States.

What are we going to do as a country? What is the role of the federal government in working with the provinces and territories for us to get there?

I don't know if that stuff exists somewhere, and if you could table it with the committee, but I would like to know, by next year, in your strategy, will it be six million without a family doctor, or seven million, or will it be four million, if things went according to plan?

[The Chair, Conservative, Joy Smith]

Who would like to take that question?

Ms. McDade, you're a brave woman.

[Kathryn McDade]

Thank you.

That was actually several questions, and I'll try not to mangle the several responses.

Dr. Bennett, I will start from the end of your question. In respect of what progress is being made, I will acknowledge upfront that there is no hard national target for reducing the number of Canadians without a family physician, or, put another way, a hard target for the supply of health professionals.

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

In the aging nursing force, the average age is 50. How are we going to get it down? Do you have strategies for this?

[Kathryn McDade]

Maybe we should talk a bit about the numbers, and then flip over on the strategies. I heard you ask about the federal role and federal strategies, but I think you also asked more broadly about provincial-territorial strategies. I think at least two witnesses acknowledged that there has been considerable progress in the number of health professionals employed and the number who are in the pipeline. We have many who are still in training, and we expect the vast majority to go into practice.

You mentioned pediatric nephrology. I don't have here in front of me a full suite of statistics on the health professions, but between 2003 and 2007—the most recent years for which CIHI data are available—the total number of physicians increased by 7.1%. The comparable number for registered nurses is 11.7%. These are people actually in practice, employed.

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

But you're counting me.

[Kathryn McDade]

Well, I don't know if CIHI counts non-practising physicians, but you make a good point.

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

Jean Charest made that point in 2004, at the FMM.

[Kathryn McDade]

I can give you more written information on the methodology behind the data, but I take your point that there may be non-practising physicians counted.

In respect of the pipeline and who's in it, there has been a significant increase in the number of undergraduate medical seats. Over the period 2002 to 2008, there was an increase of 31%. That's a six-year period; that's not insignificant. These are undergraduate medical seats, people at the beginning of their training. It will be many years, as Dr. Fullerton said, until they're actually in practice. But there is progress.

On the issue of physicians leaving and returning to Canada, for the first time in the last couple years we've been in a slight net inflow position, so we no longer have more physicians leaving the country, Canadian-trained physicians, than we have coming back from practice or from studies in other jurisdictions. That's positive.

As for a national strategy, which I think is the core, what is the health human resource strategy? There is a pan-Canadian HHR planning framework, which I'd be happy to share with the clerk, that was approved by federal-provincial-territorial ministers in 2005. It acknowledges that provinces and territories retain responsibility for a whole range of measures that will actually affect health care delivery on the ground. But it makes shared commitments in particular areas: more rapid integration of internationally educated health professionals, as well as changes to both inter-professional education and inter-professional practice, which most experts acknowledge is an indirect way of dealing with the supply shortage. So there is a set of measures in the framework that's a combination of provincial-territorial activities and shared activities.

To go to your point, Dr. Bennett, about the federal role in this, in all of the areas I talked about—whether it's data, policy research, best practices—projects have been undertaken that are intended to support this national planning framework. I wouldn't call it a strategy, but a national HHR planning framework.

I don't know if I've missed any aspects of your question, but I've tried to answer all of them.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. McDade.

Monsieur Malo.

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

Thank you very much, Madam Chair.

Madam Prince St-Amand, my question is directed to you. You have seven minutes to answer.

You stated in your presentation that thousands of organizations and individuals are involved in the foreign-trained workers accreditation process.

Could you explain in concrete terms how it works, what a trained individual has to do in order to be able to work here?

[The Chair, Conservative, Joy Smith]

Who would like to take that one?

Ms. Corinne Prince St-Amand.

[Corinne Prince St-Amand]

Thank you very much for the question.

I mentioned that there are many players involved in the assessment and recognition of credentials in this country. We have to think about it in terms of the regulated occupations as well as the non-regulated occupations.

In terms of regulated occupations, the over 440 regulatory bodies across the country are key players. There are also five provincial assessment bodies in the country that do credential assessment and recognition on behalf of some regulatory bodies and the individuals themselves. If they'd like to get their credentials assessed against Canadian standards, they can go to one of these five assessment bodies and pay a fee to get an assessment of what the equivalency would be in Canadian terms.

There is a project currently under way at HRSDC to develop a sixth assessment agency for the four Atlantic provinces. That project has been approved by the four Atlantic premiers, and discussions are under way about which province that provincial assessment agency will be situated in.

There are also over 200 post-secondary educational institutions that assess individuals' credentials for the purposes of further study. If you are a student living in France and you would like to come to Quebec to study at the Université du Québec, you need to see what the courses you have taken in France are equivalent to, or what existing diplomas or degrees you will be credited with before you are able to undertake further studies at a Canadian college or university.

There are virtually thousands of players in this field when you add individual employers who are faced every day with individuals' curricula vitae coming across their desks—often in other languages—with their credentials attached. The employer sits there and has to determine and decipher whether that individual has the skills and competencies to do the work the employer is looking for.

So it's not necessarily in terms of credential assessment for the purposes of licensure, as regulatory bodies are performing those tasks in the regulated occupations. Many of the health occupations are regulated. But in the world we work in, we're looking at both regulated and non-regulated occupations. It's important to assist employers as well with tools to assist these provincial assessment agencies that are in many cases dealing with those non-regulated occupations.

There are also more than 53 provincial and territorial ministries. When you think about the issue of credential recognition in this country and look across Canada province by province, including the territories, the issue is led in many jurisdictions by one of four ministries or a combination of ministries. It could be the immigration ministry, and it some provinces it is. It could be the labour market ministry. It could be the education ministry. There's always an interest in the health occupations to be played by the provincial health ministries. In my opening comments I was trying to give the committee a sense of the complexity of the issue by naming the thousands of individual players in the field.

[The Chair, Conservative, Joy Smith]

You have more time, Monsieur Malo.

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

Would Ms. White like to comment?

[Carol White]

Yes. I would like to add that the very complex nature of federal credential and qualification recognition in this country has led first ministers to make the commitment to develop a pan-Canadian framework so that we can begin to work together as governments to develop assessment methods that are fair, transparent, and timely.

Individuals need to know how long it's going to take for their credentials to be assessed, what they may need to do in addition to the assessment so that they can become accredited, and if, for example, they are not to become accredited for whatever reason, what other opportunities there are for them in professions that may be related to the one they have their experience or their training in.

We think it's a significant commitment made by first ministers. We also think the agreement on internal trade succeeded because first ministers and all governments contributed and worked together on that initiative. We see the same kind of commitment with this pan-Canadian framework on credential recognition.

[The Chair, Conservative, Joy Smith]

Ms. St-Amand.

[Corinne Prince St-Amand]

Just to build on what Carol said about the first ministers' commitment, to respond to Monsieur Malo as well as to respond in part to Dr. Bennett's question earlier, first ministers, as Carol has said, have asked for the framework by September of this year.

In leading up to the first ministers meeting in January of this year, the forum of labour market ministers, right up to the ministerial level, all agreed that not only would they recommend to their premiers as well as to the Prime Minister what was needed and what labour market ministers were needed to be directed to do, but they also outlined a timeframe, and that was that within 12 months of the receipt of a full application for licensure, internationally trained individuals would have an answer as to whether they would be able to be licensed or not.

If they would not be able to be licensed, they would be provided with information on what further was needed. If they had no chance at all in being licensed, they would be given information on alternative occupations where they could use their experience, their expertise, and their training in an associated field.

So this is an important issue, in that for the very first time the issue of foreign qualification recognition has been squarely on the agenda of the premiers and the Prime Minister, and for the very first time we have seen a clear timeline and target that we are looking to achieve.

They also indicated that, where possible, the credential assessment and recognition processes would begin overseas. Again, we feel that beginning overseas will save some time in the process. Instead of allowing physicians to come to Canada and spend two to three years trying to figure out the system and having to perform other duties or other employment, they could in fact use the time in the immigration process while they were still in their home country to get at these issues in advance. That would save them from moving to Canada with their families and not being able to practise their profession. It would also save the country in terms of economics.

[The Chair, Conservative, Joy Smith]

Ms. McDade, I think you wanted to add a couple of comments as well. Then we'll go on to our next question.

[Kathryn McDade]

Thank you, Madam Chair.

Very quickly, because I know the time is running out, I just wanted to note that even prior to the commitment by first ministers, which Ms. White has indicated was only in January of this year, governments were working together under the advisory committee on health delivery and human resources on an integration and common assessment framework for both doctors and nurses. The framework on the common assessment for international medical graduates is under way. A business case has basically been developed and will be moving forward for approval. On internationally educated nurses, the work is at a more preliminary stage, but there again, there is a commitment by all governments to work on a national assessment service for nurses.

So in those two key professions, there's work that well predates what my colleagues have described being done by first ministers.

[The Chair, Conservative, Joy Smith]

Thank you so much.

Now we'll go to Ms. Hughes.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Thank you.

I certainly appreciate the fact that you're here, and I certainly have a lot of concerns with regard to the health care sector. I have a sister who has Alzheimer's disease, and I know what it's like not having a place for her. I know that we're going to be seeing many more people with Alzheimer's.

I'd like a response to my question from the physicians as well, aside from some of the other comments. We've all heard reports of provincial recruitment and competition for all sorts of health professionals. Many smaller cities, let alone rural communities, are virtually bidding for health professionals. What is the department's assessment of the impact of the April 1 change to cross-border internal mobility? With the shortages, there have been fears expressed that lifting cross-border restrictions will see HHR migration to wealthier larger provinces and urban centres. I'm just wondering if this concern has been validated.

The other thing I was interested in knowing as well is in regard to the comment that there are 1,398 aboriginal students receiving financial assistance. I'm just wondering if you have a breakdown of the professions there.