Evidence of meeting #14 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was physicians.
A recording is available from Parliament.
4:40 p.m.
Conservative
4:40 p.m.
Director General, Health Care Policy Directorate, Strategic Policy Branch, Department of Health
I can try.
I'm sorry, Ms. Hughes, but I didn't catch the statistic on student financial assistance that you gave.
4:40 p.m.
NDP
Carol Hughes NDP Algoma—Manitoulin—Kapuskasing, ON
You mentioned there were 1,398 aboriginal students receiving financial assistance to help them become medical professionals. I'm just wondering what the breakdown of those professions is, if you happen to have that.
4:40 p.m.
Director General, Health Care Policy Directorate, Strategic Policy Branch, Department of Health
I'll turn that over to my colleague, as I don't know if we have it here.
4:40 p.m.
Shelagh Jane Woods Director General, Primary Health and Public Health Directorate, First Nations and Inuit Health Branch, Department of Health
I don't have it here, but I can tell you a little bit more about it, which is that it covers a whole range of professions. The aboriginal health human resources initiative that Kathryn referred to provides bursary and scholarship money to first nations, Inuit, and Métis in a very broad range of health-related occupations. So there are a number of medical students and nurses—you can pretty well name the profession—in the health field who are receiving assistance. I would be happy to get you the statistics.
4:40 p.m.
Conservative
4:40 p.m.
Physician, As an Individual
Yes. Regarding your question about mobility and licensing, one of the issues we found is that doctors who are willing to go to remote areas—even for six months or several months at a time—to do locum work are unable to get licensed in the province they're needed in. So the concern may be less about doctors moving to wealthier provinces. Ontario, as you know, is not doing all that well right now, and the other provinces are also having their difficulties.
I think the main impetus for mobility in licensure is to allow relief so that physicians can go and assist in another area, which would make life easier for them. What happens is that it's a domino affect. Doctors can't get the support they need there, so what happens is that they don't want to go to a remote area to work because they can't even get away for a holiday. But if you can provide more mobility for other physicians to potentially relieve the physicians already working in those areas, you will get, I think, an improved chance of people going to those areas as physicians.
Does that make sense to you?
4:45 p.m.
Physician, As an Individual
Thank you.
I think that if you look at the numbers for mobility between provinces, they're quite small compared with the numbers of physicians we send out of the country. For example—and I have documents here to give you some numbers—we have sent 19,000 Canadian-trained physicians to the States in the last 30 years.
I also want to point out something very important. When we train physicians, there's no guarantee we will keep them. Very importantly, the CIHI figures are under-estimates. For example, if you use the CIHI figures for physicians going out of the country and coming back into the country over the last 30 years, we're missing about 4,000 physicians. However, strangely enough, we have over 9,000 physicians, I think, practising at this point in the States alone. So we are not catching physicians as they leave.
I think that's a far more serious problem. That's where the majority of our physician losses come from.
4:45 p.m.
NDP
4:45 p.m.
Physician, As an Individual
I think I heard you mention two other points. One was on the mobility between rich provinces and poor provinces. There is no doubt that the richer fee schedules do take the new graduates to their province and rob from the other provinces. That's very clear. I see that with the new residents I train who are looking for a province to practise in.
There is no standard across the country to make sure that rich and poor provinces.... They do steal from one another, and that is a problem.
The second part that I also heard you mention is that rural practice is suffering. Rural practice is suffering. It's very difficult to get relief physicians for a vacation, but it's also very difficult in rural practice to carry on your day-to-day activities. And there are many rural communities that are doing everything--they're standing on their heads--trying to recruit physicians into their small communities.
The problem here is that there is no relief on a day-to-day basis, and I think there has to be some sort of strategy to amalgamate small communities so that you could take a Wednesday off or you could not be on call for maybe two or three nights in the week so you could catch up on your sleep. So there is a real issue there, too.
4:45 p.m.
NDP
Carol Hughes NDP Algoma—Manitoulin—Kapuskasing, ON
Concerning the comments from Health Canada and HRDC on current thinking on attracting and retraining health professionals to rural and isolated communities, I'm just wondering where the federal thinking is leading at this point.
4:45 p.m.
Conservative
The Chair Conservative Joy Smith
Who would like to take that question?
Ms. Woods, would you like to do that one, please?
4:45 p.m.
Director General, Primary Health and Public Health Directorate, First Nations and Inuit Health Branch, Department of Health
Sure. Could you just repeat the question?
4:45 p.m.
NDP
Carol Hughes NDP Algoma—Manitoulin—Kapuskasing, ON
Basically we're trying to figure out where the federal thinking is with regard to whether there is advancement, or what the thoughts are with regard to trying to attract physicians and retraining physicians specifically for rural communities and isolated communities.
4:45 p.m.
Director General, Primary Health and Public Health Directorate, First Nations and Inuit Health Branch, Department of Health
There are a couple of things. I work in the first nations and Inuit health branch. We have regional offices, and each one of those has one or more physicians. There are now a number of first nations health authorities. Each one of those has a physician or physicians attached to it.
As you can imagine, the kinds of difficulties that we've heard about are, if anything, magnified in the first nations context. We're not always a competitive employer. We can't pay as much as wealthier jurisdictions. The conditions are extremely difficult. So in many cases the branch and the regional offices resort to innovative practices such as they can.
Because provinces are really responsible for the provision of primary care, when it comes to primary care we make arrangements, for example, in Manitoba with the northern medical unit of the University of Manitoba to supply the doctors. Because it's not practical to say each community or even each large grouping of communities will have a full-time doctor, we have a whole roster of physicians who will spend a certain amount of time in a certain community. They're associated with universities, or they have their own practices, so it's done on a part-time basis. We're realists: we know we won't be able to attract full-time physicians for most of these places.
On the training and development side, we're quite excited about the recent developments in adapting the curriculum for medical students to give them sensitivity to an awareness of aboriginal needs--cultural competency is what we like to call it--and all of the 17 medical schools in Canada have agreed to adopt this new curriculum and adapt it and work it into their own.
Over time we see that is more welcoming, not only to the many aboriginal students who are picking up medical studies, but also to the non-aboriginal practitioners. And the reality is that aboriginal people will be served in large measure by non-aboriginal practitioners, particularly in urban settings. So we're trying to enhance and increase the number of people who have that kind of cultural competency, if you will, an ability to medically treat patients in the way they would like to be treated. So we think this will make a big difference over time.
The other thing is, of course, often as people get exposed to this, they become very interested in it, so part of it is really awareness-building.
4:50 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you so very much.
Now we'll go to Dr. Carrie.
I'll give you the floor, Dr. Carrie. I'm hoping that everyone will listen carefully to this.
4:50 p.m.
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you very much, Madam Chair. I'd like to split my questioning with my colleague from Kamloops.
I'd like to talk to the officials a bit about the foreign credentials program. I'm very proud that we made the investment, and I do think it's overdue.
I come from Oshawa, and we're very underserved. A friend of mine actually married a western-trained physician-surgeon from China, who was having problems getting accredited here. She ended up going back to school here for traditional Chinese medicine. I thought it was quite ironic that we had a western-trained physician-surgeon who came here to learn traditional Chinese medicine. She's practising that right now. She seems to be quite happy. She doesn't have the hours of Dr. Kuling.
I think it's a little discouraging. Do we keep statistics on where most of the foreign health care workers come from?
You mentioned the Medical Council of Canada, which has assessment offices. How many different languages are there in these assessment offices?
You mentioned that there are 12 offices outside Canada. We talk about poaching from other countries. How many health care professionals, when they come here, actually end up working in their fields?
If we find that most of the health care professionals are coming from certain countries, are we able to set up offices overseas?
Can you answer those questions in three minutes?
April 2nd, 2009 / 4:50 p.m.
Director General, Foreign Credentials Referral Office, Department of Citizenship and Immigration
I'll try my best, and I would like to actually split my answer with my colleague from HRSDC, because I think the statistic that you referenced was a project that has been funded from HRSDC's foreign credential recognition program, funding to the Medical Council of Canada.
You mentioned China, and I'm glad you did, because the foreign credentials referral office is, as I said in my opening statement, going to be taking over the overseas component of a pilot that HRSDC has currently in place. The Association of Canadian Community Colleges is being funded to actually have offices in three countries around the world--three of our top source countries, actually. They have offices in the Philippines, in Manila; in China, in Guangzhou; and in India, in New Delhi. They also are currently offering itinerant services. So from the Guangzhou office, we have itinerant service in Beijing as well as in Shanghai. And in India, there is itinerant service in Chandigarh as well as Ahmadabad.
What is offered overseas is information, pathfinding, and referral, to try to get ahead of this issue I raised earlier about immigrants coming to this country and just only then beginning their employment search, their pathway to credential assessment and recognition. So individuals are offered up to a two-day session where they are getting information on employment in the Canadian provinces and territories. They've decided where they would like to land, and they can focus their queries on that particular province and the cities within that province. They're getting information on the process of credential assessment and recognition and the fact that if they are a physician, if they're going to land in Toronto, they're going to have to see a different regulatory body than if they would like to land in Vancouver.
They are actually completing an action plan in that two-day session, where they are learning about social insurance numbers. They can have access to a website that is actually an HRSDC product called “The Working in Canada Tool”, which has up-to-date information not only on all of the regulatory bodies and the national associations, but also on live employment opportunities coming off the job bank. So they can actually connect with a potential employer while they are in their home country.
There have been some really successful cases where individuals are connecting with employers overseas, landing at the airport and starting work the next day. That really is the vision. That is the strategy to really speed up this process: beginning to do as much of the credential assessment, as much of the job search, as much of the language assessment, all overseas, while they're still in their home country, waiting in the various times they are given to complete their medical checks, security checks, etc., using that window of opportunity in the immigration process to do as much there as possible.
4:55 p.m.
Conservative
The Chair Conservative Joy Smith
I understand this is a very important question. I also have noted that Dr. Fullerton and Dr. Kuling would like to make some comments on it as well.
Dr. Fullerton.
4:55 p.m.
Physician, As an Individual
Yes, thank you, Madam Chair.
I think we tend to focus on the IMGs, the international medical graduates, as being a solution to our physician and health resource problems here. They are a small part of that solution. Certainly I can understand why we're focused on them, because it's certainly going to help in the short term. But I'd like to reiterate Dr. Kuling's point, which was we really do need a more sustained, self-sufficient source of physicians. From my readings and my understandings, the studies indicate that when IMGs tend to arrive here, they will locate often in rural areas because that's where their positions are, but they eventually, after a few years only, are often migrating to the cities, to the urban centres. There are good statistics to show that, but I don't have them in front of me here today.
So as much as we would look to the IMGs as being a solution, they're a small part of the solution, and I'm hoping that we're coming up with a better long-term strategy for this. I also don't agree with the ethics of taking away physicians from other countries, just as we wouldn't want 200,000 physicians, every single physician we produce here, to be drained to the United States.
So I think we have to be cognizant of the big picture, and I appreciate that. Thank you.