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.
5:10 p.m.
Conservative
5:10 p.m.
Physician, As an Individual
Very briefly, it appears in the modern era in which we find ourselves that you cannot talk people numbers in human resources alone. You must talk along with IT and new communications. To have human resource groups here but not have, somehow, an interface with a group for Internet technology is just old. I think we have to understand that you must use both.
5:10 p.m.
Conservative
Patrick Brown Conservative Barrie, ON
Thank you, Ms. Chair.
I'm a bit frustrated by the whole issue of physician shortages. In my riding there are 30,000 people without a family doctor. It tends to be one of the things I hear most at the door or at my office. One thing in particular that is a bit frustrating is that I know of eleven foreign doctors in my riding who seem to have similar challenges. So I'd like to delve a little bit more into a few of the comments mentioned today.
First, when people ask me about what we're doing, I obviously reference the foreign credential office, but it doesn't seem to be of significant benefit to people in this predicament. For the eleven doctors that I know of, the challenges relate directly to the fact that the cost of books ranges from $1,000 to $2,000, and they're making minimum wage and can barely afford the books. What, if anything, is being done to help with the process of going through that equivalency exam for new Canadians?
Secondly, the bigger challenge that foreign doctors appear to face in my riding is that they can't get a residency spot even after they've been successful in the equivalency exam.
Is there anything the foreign credential office does to assist in those two particular circumstances: with the cost of the books for the equivalency exam and the cost of the exam itself, and the next steps after they pass the equivalency exam?
5:10 p.m.
Conservative
The Chair Conservative Joy Smith
Who would like to answer that? I share Mr. Brown's sentiments.
Ms. McDade.
5:10 p.m.
Director General, Health Care Policy Directorate, Strategic Policy Branch, Department of Health
On the issue of financial assistance related to the equivalency and additional training, I'd have to get back to you on whether there is a specific mechanism. If there is one, it would be student financial assistance, and it would be an HRSDC mechanism. I'm afraid I don't know that. None of us are actually responsible for student financial assistance and probably don't know that area well enough to respond.
5:10 p.m.
Conservative
Patrick Brown Conservative Barrie, ON
They're not really students any more. These are people who have been practising in their countries for 10 or 15 years.
5:10 p.m.
Conservative
The Chair Conservative Joy Smith
I'll just intercede here. Dr. Kuling, I think you wanted to make some comments on this.
5:10 p.m.
Physician, As an Individual
Yes.
I have tremendous respect for the training and the experience that these international medical graduates have gone through. When I think of those residents I've just told you about, the ones I've trained, they were all practising in their previous environments. But I can't name one of them who would have been safe to practise without going through the two-year residency program with me. It might be hard to understand, but being a physician in Iraq is a lot different from being a physician in Canada.
5:15 p.m.
Physician, As an Individual
These were all practising physicians, some of them with as much as ten years of experience. None of them are practice-ready at that point.
5:15 p.m.
Conservative
Patrick Brown Conservative Barrie, ON
My question is about how difficult it is to get a residency spot.
5:15 p.m.
Physician, As an Individual
Agreed. I would love to triple my site, but it's not easy.
5:15 p.m.
Conservative
Patrick Brown Conservative Barrie, ON
What, if anything, is being done to assist with the difficulties financially of writing an equivalency exam? And once these people have written the equivalency exam, what are we doing to remove barriers to getting a residency spot?
5:15 p.m.
Physician, As an Individual
Agreed. That's not my area. I accept them once they're there.
5:15 p.m.
Director General, Health Care Policy Directorate, Strategic Policy Branch, Department of Health
I don't have a statistic for you, but in my answer to Dr. Bennett's question, I did quote the statistic from CIHI that there has been a 31% increase in undergraduate medical seats.
I can't tell you, because I don't have the number in front of me, what the relevant increase in residency seats is, but obviously the expectation of the provinces and of the clinician trainers is that the vast majority of those undergraduates will move on to residency.
As you point out, there is also room in the residency matching service for international medical graduates who didn't do their undergrad training in Canada, so there's no question that there are increases in the availability of those seats. I don't have a number in front of me, but whether it's for Canadian-trained undergraduate medical students or for international medical graduates, there has been an increase—there has to be—at the residency end to accommodate those undergraduate students.
5:15 p.m.
Conservative
The Chair Conservative Joy Smith
I'm going to intercede here for just a minute, because time is up. I just want to say that we are bringing in experts on recruitment, and they will have the answers to those questions in our subsequent meetings. We can understand that you don't have the complete answer, but I hope that's helpful.
Let's go now to Monsieur Dufour.
5:15 p.m.
Bloc
Nicolas Dufour Bloc Repentigny, QC
Thank you very much, Madam Chair.
I must say that I liked the exchange between the physicians and the officials from Health Canada. The time they had to put their questions to Health Canada was probably too short. So I would like to give them more time to ask their questions and to hear the answers of the officials.
5:15 p.m.
Physician, As an Individual
I heard the answer from the officials about the federal-provincial sharing for ensuring that when we increase medical school enrolment there are enough residency spots, and capital, teachers, buildings, and exam rooms.
What I haven't heard is whether the federal government--I know they fund the provincial--are actually holding the provinces' feet to the fire to make sure that this sort of planning occurs. Because otherwise you're planning in a void. You're planning all this increased funding for increased spots and all the rest, and you get different provinces around the country that may or may not plug that into my teaching centre or an equivalent teaching centre somewhere else.
I'm still frustrated, and I wonder if there's some mechanism whereby the federal government can hold Ontario, Saskatchewan, or Newfoundland accountable and ensure that there are training centres at that other end. I'm feeling that frustration at the other end.
5:15 p.m.
Director General, Health Care Policy Directorate, Strategic Policy Branch, Department of Health
Thank you for the question.
What I would say is that there isn't accountability at the level that you're describing. So, no, there is not any federal intervention with the provinces of Saskatchewan and Quebec or other jurisdictions with respect to specific decisions they're taking about your centre or any other medical or teaching facility. That's not the context in which major transfers are provided to provincial and territorial jurisdictions for health or other social programs as well. So not at that level.
At the broader level of shared principles around supporting recruitment and retention, moving to inter-professional practice and more rapid integration of international medical graduates, that's the document I referred to earlier—the HHR collaborative planning framework. There are shared commitments. There are principles underlying the way the governments will work together, and those principles support the very areas you're talking about. However, it wouldn't be accurate to say with the level of detail you're talking about that the federal government has any accountability relationships with the provinces.