Health Committee on April 2nd, 2009

[The Chair, Conservative, Joy Smith]

Good afternoon, ladies and gentlemen. I want to welcome you to this study.

I understand that we have a lot of witnesses today to listen to, so I'm going to extend the time a little bit for the witnesses. I believe we have six who will be presenting.

Dr. Bennett.

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

I wanted to apologize to the witnesses on behalf of the committee. To have seven witnesses in one hour is unacceptable. It doesn't allow us to do our work.

I believe that in the future the clerk needs to ask the committee what we would prefer. We might have been asked to have an extra session or to add time enough to do a proper piece of work. We don't have enough time for the officials to give us a portrait of what's been done and what they hope to do. If this is the way we're going to conduct the study, we might as well stop right now. We won't be able to do good work. I want to see a work plan, and we may have to have a steering committee meeting.

I don't know if Shelagh Jane Woods is going to speak. Aboriginal health human resources is one of the most important things we're going to have to address, and she's tucked under the whole Department of Health.

[The Chair, Conservative, Joy Smith]

The sooner we get started, the sooner we get the testimony. I will extend it.

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

I know these witnesses were booked because we were supposed to hear the department on Tuesday, and the bill went over time. They should have been called and asked if they wanted to rebook when they'd have more time to present and a better opportunity to persuade the committee.

This is no way to proceed. If we're going to skate across the surface, we might as well just write the report now, because most of us know what would be in it. If we're actually going to drill down and find some real solutions, then you have to give us the time to do the work. By the time their opening statements are done, we'll be done.

[The Chair, Conservative, Joy Smith]

The other solution to that—

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

I can read opening statements.

[The Chair, Conservative, Joy Smith]

Dr. Bennett, could I just get a word in, please? The other solution would be to bump up our work plan to right after the Easter break and just have witnesses and questions today.

What is the will of the committee?

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

I was angry when I thought they were only here for two hours, and now I realize they're only here for an hour. This was impossible when it was two hours. It's insulting to have to do it in an hour.

[The Chair, Conservative, Joy Smith]

Dr. Bennett, if we could get this resolved, we won't waste time.

I'm asking the will of the committee. Everyone wants to hear full testimony, and we want to have a chance to ask questions. We also need the chance to do some business, but the option would be to hear witnesses today, do the questioning, and bump up the business plan for the first day back.

Could I have some discussion on this?

Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

I was going to suggest going the two hours. I believe Madame Davidson had a suggestion as well.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

I was going to suggest that it's important to hear from the individual witnesses. If the department people are all from Ottawa, why don't we hear from them on another day? Maybe they're not all from Ottawa, but if they are we could hear from the witnesses who have travelled.

[The Chair, Conservative, Joy Smith]

We're happy to have you all here, and everyone is anxious to hear your testimony and ask you questions.

Who would like to bump up the business for the first day back on Tuesday and hear witnesses today?

[Some hon. members]

Agreed.

[The Chair, Conservative, Joy Smith]

Today we will hear all the witnesses and have all the questions. We will do the business plan the following day.

Pursuant to Standing Order 108(2), we are studying health human resources. I would like to hear, first of all, from the Department of Health.

Ms. McDade.

[Kathryn McDade, Director General, Health Care Policy Directorate, Strategic Policy Branch, Department of Health]

Thank you, Chair.

On behalf of Health Canada, I would like to thank the committee for the opportunity to participate in your study of health human resources.

I'd like to provide you with a brief overview of Health Canada's investments in health human resources. In doing so, I will try to focus in particular on some of the specific interests that are identified in the terms of reference for the committee's study, including recruitment and retention, team-based health care, accreditation of foreign-trained professionals, and aboriginal peoples.

Health human resources has been a priority for Health Canada since 2003, at which time Canada's first ministers made a commitment to work together to secure and maintain a stable and optimal health workforce in Canada. First ministers recognize that having an adequate supply and distribution of health care providers across the country is a key factor in enabling Canadians to access the health services they need. To support this commitment, Health Canada has made targeted investments and played a policy leadership role through collaboration with governments, professions, health care organizations, and other federal departments. All of our investments are intended to complement the quite significant investments that provincial and territorial governments make in health human resources in the context of their responsibility for delivery of health care services to the vast majority of Canadians.

Health Canada has made investments in three key health human resource initiatives. First is the pan-Canadian health human resource strategy, which is funded at $20 million annually. Second is the internationally educated health professionals initiative, with annual funding of $18 million. Third is the aboriginal health human resources initiative, a five-year initiative with total funding of $100 million.

I would like to provide you with a brief overview of the objectives and accomplishments to date of each of these initiatives. Along with my colleague, Shelagh Jane Woods, I would be pleased to provide additional details during the question and answer portion of this afternoon's session, or in writing, as the Committee wishes.

The Pan-Canadian Health Human Resources Strategy has the broad objective of helping to ensure the availability of appropriate, skilled and competent health care professionals to deliver safe and effective health services.

Under the strategy, Health Canada provides contribution funding to a wide range of partners to support development of health human resource data and forecasting models, policy research, and the identification and dissemination of innovative models and practices. Our funds are not used for direct HHR investments, such as training of health care providers, salaries, or other workforce costs.

The federal-provincial-territorial advisory committee on health delivery and human resources has been instrumental in developing the strategy and in implementing it. This is a federal-provincial-territorial committee that provides policy and strategic advice to the conference of deputy ministers, and is also a forum for collaboration on shared priorities.

A significant proportion of the projects that have been funded under the strategy have focused on recruitment and retention of health professionals. We've worked with undergraduate medical education programs to adapt curriculae to encourage more medical students to enter family practice. We've invested in post-licensure professional development and training programs to assist the health workforce to adopt new delivery methods. In order to increase retention of health workers, including nurses, we've invested in pilot projects and other initiatives to strengthen employment practices in the health sector.

To ensure that health care providers have the necessary skills to deliver health services in a changing health system, Health Canada has worked with provincial and territorial governments and other stakeholders on projects to promote inter-professional education and a more collaborative approach to care.

We've invested in more than 32 interprofessional-practice projects, which have increased awareness and sharing of best practices related to collaborative care, have increased the number of institutions providing mandatory interprofessional education courses, have increased the number of educators who are able to teach interprofessional practice models, and have increased the number of health professionals trained for collaborative practice.

I'd like to turn now to the second of Health Canada's key HHR initiatives, which is the internationally educated health professionals initiative, or IEHPI.

Internationally educated health professionals are a significant component of the health workforce. For example, 23% of Canada's doctors and 7% of our nurses were trained outside the country. It's well documented that these professionals can face significant challenges in integrating into the workforce.

In 2005, the Government of Canada launched the IEHPI with funding of $75 million over five years. The general goal of the initiative is to reduce barriers for internationally educated professionals and to promote access to information and pathfinding, competency assessment, training, orientation, and other supports for integration into the workforce. The bulk of IEHPI funding, about 80% of the total, is directed to provincial and territorial governments through bilateral agreements with Health Canada. The remainder supports pan-Canadian initiatives.

Provinces and territories have used their portion of the funding in a range of programs. They have developed innovative initiatives in the areas of credential assessment, bridge training, career counselling and information services, and orientation. Just to give a couple of quick examples, one is a new one-stop information counselling and pathfinding service that's been established in the province of Ontario. It has served over 3,000 clients to date. The second I would cite is a new competency assessment program for internationally educated nurses that was originally developed in Alberta and has now been implemented in all the western provinces and in Nova Scotia.

The pan-Canadian portion of IEHPI funding has supported the development of a widely subscribed orientation program on the Canadian health system. At the moment, it is supporting the development of national assessment approaches for both international medical graduates and internationally educated nurses.

Some of the most persistent and critical health workforce challenges are around health care delivery to Aboriginal peoples.

Health Canada recognizes that Aboriginal peoples access their health care services from all levels of government — provincial/territorial and federal. We recognize that all health systems are facing shortages of qualified health personnel, and that there is at the same time a great need for both more Aboriginal health practitioners and more non-Aboriginal practitioners with some cultural competency in the care of Aboriginal patients.

The Government of Canada has been working to enhance and improve aboriginal health human resources for some time. In 2005, the government announced a new targeted investment of $100 million, over five years, for the aboriginal health human resources initiative, which is helping to develop and implement health human resource strategies that respond to the unique needs and diversity of aboriginal peoples.

The AHHRI is in its final year, and we are seeing some early results from our investments. For example, over the four-year period, between 2005-06 and 2008-09, we increased the number of aboriginal students receiving bursaries and scholarships for health career studies to a total of 1,398 students. Working with our partners, we've developed a number of tools to be used by Canada's 17 medical schools to help decrease barriers to admission and increase enrolment of aboriginal medical students.

A mid-term program review of the AHHRI is currently under way. It will give us more information on resources, implementation of activities, and outcomes. The review is expected to be completed by the end of May of this year. It will allow us to capture best practices and to formulate lessons learned in aboriginal health human resources.

In closing, I would note that although the three initiatives I've described very briefly today are relatively new, they are contributing to our progress in addressing some of the most compelling HHR challenges that confront governments, including several of the challenges the committee has identified in its terms of reference.

Thank you, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you very much, Ms. McDade. You made some very insightful comments, and I know that the committee is looking forward to asking you some questions after we hear from everybody else.

From the Department of Citizenship and Immigration, we have Ms. Corinne Prince St-Amand, who is the director general of foreign credentials. Ms. St-Amand, please take the floor.

[Corinne Prince St-Amand, Director General, Foreign Credentials Referral Office, Department of Citizenship and Immigration]

Thank you, Madam Chair.

My name is Corinne Prince St-Amand and I am Executive Director of the Foreign Credentials Referral Office at Citizenship and Immigration Canada.

I want to thank the Committee for this opportunity to provide an overview of CIC's role in health human resources. Today I will focus primarily on the accreditation of foreign trained professionals.

CIC is involved in health human resources in a number of ways, from the selection of immigrants to their overall integration into society to helping internationally trained individuals get their credentials recognized.

I will focus this afternoon on the theme of your study as it relates to the accreditation of health professionals.

I think we all recognize that immigration has been and continues to be vital to Canada's growth and economic strength. However, recognizing the foreign credentials of internationally trained individuals continues to be a challenge across the country.

In Canada, the provinces and territories are responsible for assessing and recognizing credentials. The system involves many jurisdictions and stakeholders, including five provincial assessment agencies, over 200 post-secondary educational institutions, and more than 440 regulatory bodies.

In fact, over 53 provincial and territorial ministries are involved in this issue, and the issue spans immigration, labour market, health, and education ministries. There are literally thousands of players on this file when you include employers who are also important assessors of credentials and work experience in non-regulated occupations.

The federal government has an important role to play, which complements and supports the provincial and territorial roles, and that is to ensure that newcomers are able to put their talents, skills, and resources to work once they arrive in Canada.

To that end, in May 2007, the Government of Canada established the Foreign Credentials Referral Office to help internationally trained and educated individuals find authoritative and accurate information about the Canadian labour market and Canada's credential assessment and recognition processes.

The Foreign Credentials Referral Office provides a coordinated focus at the federal level to work with the provinces, with the regulatory bodies, and with employers to coordinate federal-provincial efforts, to share best practices across the country and across the myriad of players that I've mentioned, and to try to avoid overlap and duplication on an issue that is extremely complex.

Since it was launched in 2007, in-person services are now available across the country through 330 Service Canada centres. We have helped 46,000 people to date get the information they need. Our website has received over 550,000 visits, the majority from overseas, so people are starting to get the information they need before they arrive in Canada.

Prior to the establishment of the Foreign Credentials Referral Office at Citizenship and Immigration Canada, Human Resources and Skills Development Canada laid the foundation for consistent foreign credential referral processes by developing partnerships with provinces, territories, and other stakeholders. They also established an overseas platform as a pilot, to give skilled immigrants the information they need to start preparing to enter the Canadian labour market.

Our two departments will continue to work together as the Foreign Credentials Referral Office assumes responsibility for the overseas platform in the near future.

Provincial, territorial, and municipal governments also offer services to newcomers in many ways, including through the “Going to Canada” immigration portal. This tool helps prospective immigrants access in one place the services and information they need and reduces the requirement to navigate through a series of websites.

The Prime Minister, provincial premiers and territorial leaders recognize the importance of foreign qualification recognition to the economic health of the country. They have tasked the Forum of Labour Market Ministries, with the support of Immigration Ministries, to develop a pan-Canadian framework by September of this year.

To support the efforts from the first ministers, the Foreign Credentials Referral Office received additional funding in budget 2009, some $13.7 million over two years, to contribute to the development of a pan-Canadian qualifications framework by harmonizing standards and clearing pathways to foreign qualification recognition for high-priority, regulated occupations. Many, we expect, will be in the health field, beginning overseas.

The sooner prospective immigrants know the steps they need to take, the sooner Canada can benefit from their contribution to society and our economy. To address the physician shortage across the country, some progress has been made in several provinces by way of ensuring internationally trained medical graduates receive the certification they need to practise in Canada. For example, in 2008, more doctors were licensed than ever before in Ontario, with the number of foreign-trained physicians reaching a record high as well. Compared to 2007, this represents a 43% increase in the number of internationally trained medical graduates who have been licensed. Since 2004, statistics have shown a steady increase year after year in the number of licences awarded to such professionals in Ontario. In Alberta, 40% of doctors licensed in 2008 were internationally trained medical graduates, which is also the highest percentage ever for that province.

Thank you, Madam Chair. I hope this has provided you with an overview of CIC's role in health human resources.

[The Chair, Conservative, Joy Smith]

Thank you very much. It certainly has been very helpful.

Let's go on to the Department of Human Resources and Skills Development, Ms. Carol White, the director general of labour market integration.

[Carol White, Director General, Labour Market Integration, Department of Human Resources and Skills Development]

Thank you, Madam Chair.

I'm Carol White, director general of the labour market integration directorate at Human Resources and Skills Development Canada. Our area of responsibility is foreign credential recognition, labour mobility, and labour market information.

On behalf of RHSDC, I would like to thank the Committee for the opportunity to participate in a study of health human resources.

In my remarks, I would like to provide a brief overview of HRSDC's investments and activities as they relate to the labour market integration of health human resources, particularly the recognition of foreign-trained professionals.

HRSDC recognizes it cannot achieve its objective--which is having the best-educated, most skilled, and most flexible workforce in the world--by working alone, given that provincial and territorial governments and regulatory bodies have the primary jurisdiction over regulated occupations, including those in the health professions.

I want to speak first about labour mobility. Labour mobility is the freedom of workers to practise their occupation or trade wherever opportunities exist.

The Agreement on Internal Trade provides the basis for improving labour mobility for regulated occupations; including 29 health professions.

On January 16, 2009, first ministers signed a new agreement which included a series of amendments to the labour mobility chapter that will enhance the mobility of Canada's health human resources.

This marks a significant milestone. As of April 1, 2009, the credentials of Canadians' health care workers are to be recognized across provincial and territorial boundaries. This revised chapter of the agreement on internal trade states that any worker certified for an occupation by a regulatory authority by one province or territory is to be certified for that occupation by all others. Any exception to this mobility must be justified to meet a legitimate objective, such as the protection of public health or safety.

With full mobility in place, governments now have an added responsibility to ensure there is a consistent evaluation and entry point into the Canadian labour market. HRSDC's foreign credential recognition program provides contribution funding and works with provinces, territories, stakeholders, and other partners to facilitate the assessment and recognition of qualifications acquired in other countries.

Priorities for funding under the program include projects that are national in scope, that address priority occupations and sectors or those that have been identified as a priority by provincial/territorial governments. For any national project, there must also be clear evidence of provincial/territorial involvement and support.

Typical project activities that are funded through this contribution program are research and analysis, planning and process development, design and development of tools that will assist regulators in assessing the credentials and qualifications of the internationally trained, activations of systems to assess credentials, the development and dissemination of information, and partnership development and related implementation activities.

Since 2003 the foreign credential recognition program has made direct investments of over $11.8 million in health-related occupations. This amounts to approximately 19% of the program's overall $63.5 million grants and contributions funding since 2003. These investments have funded 28 different projects and represent 11% of all projects funded through this program.

Managers of the program maintain a regular dialog with Health Canada and committees of experts in the health sector in order to ensure the strategic investment of program funds and the prevention of funding duplication. Input and feedback from Health Canada officials are sollicited on health-related project proposals received by the program.

The foreign credential recognition program has made significant progress in strengthening the foreign credential recognition capacity of regulated and non-regulated occupations, and has facilitated strategic foreign credential recognition partnerships and initiatives across Canada and overseas. Many of these investments have directly contributed to the efforts of medical professions to address the recommendations made by the Canadian task force on licensure of international medical graduates in 2004.

The foreign credential recognition program began work with regulated professions in three priority occupations, two in the health sector, including physicians and nurses. Since that time our work has expanded to nine other health occupations. To give you a brief example of some of the kinds of projects we've funded, we made investments with the Medical Council of Canada to provide international medical graduates with increased access to the assessment and evaluation tools before coming to Canada.

The Medical Council of Canada developed an Internet-based self-assessment evaluation examination to help international medical graduates determine their readiness to challenge the assessment process for physicians in Canada. The availability of this MCC evaluation examination has increased approximately threefold since 2004 and it is now available in 20 locations, 12 of them outside of Canada.

The Medical Council of Canada has also created the physician credentials registry of Canada using funds from this program. International medical graduates can apply online to have their educational and training credentials verified while still in their country of origin.

Despite the progress of all governments, barriers to effective labour market integration for foreign-trained health professionals remain. Successful labour market integration requires that Canada has the right processes, information and resources in place to recognize the knowledge, skills and experience of immigrants.

In response, on January 16, 2009, first ministers directed the federal-provincial-territorial forum of labour market ministers to take concerted action to ensure that the assessment and recognition of foreign qualifications is consistent, timely, fair, and transparent across Canada.

By September 2009 labour market ministers will develop a principles-based pan-Canadian framework for foreign qualification assessment and recognition, along with an implementation plan to put the framework into effect.

First ministers have agreed to complete this work under aggressive timelines so as to ensure that initial subset of priority regulated occupations is achieving service standards by 2010. Where appropriate and practical, these service standards will enable the assessment of international qualifications to be completed within at least one year of the applicant's seeking licensure or registration.

The phased implementation plan will be guided by an agreed-to set of priority occupations. Health occupations are expected to be heavily represented amongst these priority occupations.

In closing, I would like to recognize the department's efforts to create an integrated system of fair and objective assessment processes and to increase consistency between jurisdictions with respect to recognition and registration processes for internationally trained professionals while also improving labour mobility across Canada.

Thank you, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you very much. This has been very interesting. I have to thank Dr. Bennett too for her suggestion to have this extended.

I would like to now go to our physicians. This is quite exciting to hear right from the ground, the grassroots, and I've heard a lot about all of you.

Dr. Mary Fernando, we'll start with you.

[Dr. Mary Fernando, Physician, As an Individual]

Thank you. I would like to thank the committee for allowing me the opportunity to participate in your study.

My recommendation, and it's one I've worked on for a number of years now, is that to retain physicians and to protect our investment in the doctors we train, Canada should change federal tax laws to allow provinces to negotiate pensions for physicians. No physician in Canada presently can receive pensions.

There's a shortage of physicians, as you know. The two crucial facts about this shortage are, first, it's getting worse, and second, it's dangerous for patients. If we compare where Canada stood in 2004, when we had three million Canadians without family physicians, to today, we now have five million Canadians without family physicians. Or if we compare our OECD ranking for physician numbers, it has moved down from 16th to 26th.

Second, the shortage is dangerous for patients. An OECD study of 21 countries over 25 years showed that decreasing physician numbers increases premature mortality, infant mortality, perinatal mortality, and decreases life expectancy.

The problem for the federal government is that the federal government provides health funding for the provinces, but the federal government has a limited ability to ensure that this funding will successfully increase physician numbers.

There are migration pressures in the recent economic downturn. The average age of physicians in Canada is about 50, and many have lost 30% to 40% of their retirement savings in the present financial downturn. And the U.S. is expecting a 200,000 shortfall of its physician force by 2020. Further, President Obama is making it more financially rewarding to practise in the U.S. by initiatives such as decreasing malpractice and overhead costs and increasing reimbursement rates for primary care physicians. This combination of increased U.S. physician shortages and incomes with the reduction in Canadian physicians' savings has a potential to result in a tsunami of physician shortages in Canada.

Historical analysis shows that recessions are correlated with the exodus of physicians from Canada. I just want to make sure you have the chart in front of you. Perfect. If we take a look at these recessionary periods in the past and place them on a migration chart of Canadian physicians--this is the pie chart--we see a perfect correlation and a definite and unmistakable pattern. Recessions cause a serious exodus of physicians from Canada.

The solution is to act proactively with a solution that only the federal government can provide. It is time to make an historic change and allow physicians to obtain pensions. What is needed to implement this solution? My research shows that Canada is the only country that does not allow its publicly funded physician force to contribute to pensions. The federal government must change tax laws and deem physicians eligible for pensions. I've been told that by deeming physicians eligible for pensions, provincial agreements remain in place.

An overwhelming majority of Canadian physicians support pensions. In 2005 the general council of the Canadian Medical Association passed my motion to request that the federal government change tax laws to allow self-employed physicians to contribute to pensions.

A previous Medical Post poll found that 91% of physicians wanted pensions. Moreover, 76% considered it to be the most important negotiation strategy. A February 2009 Medical Post poll showed that 88% of physicians across Canada support pensions. The Medical Post is also starting an old-fashioned newspaper campaign to get pensions for physicians.

In summary, altering federal tax law to allow physicians to negotiate for pensions is a retention initiative that is strongly supported by physicians and protects the investments Canada has made in training physicians by reversing the historical trend of physician losses as a result of recessions.

For those of us who believe that access to health care is a basic human right, ensuring Canadians have access to physicians by retaining them with pensions is the right thing to do.

I hope this committee will act on this recommendation and coordinate with the CMA and myself to change federal tax laws, and do so in a way that provincial agreements are not impacted.

I thank you.

[The Chair, Conservative, Joy Smith]

I thank you, Doctor, for those very insightful comments.

We'll now go to Dr. Merrilee Fullerton.

[Dr. Merrilee Fullerton, Physician, As an Individual]

Thank you very much, and good afternoon.

When I began practising medicine two decades ago, there was concern about a physician surplus in Ontario and Canada. The boomer generation was predicted to be the healthiest of all previous generations, and the need for physician services was expected to drop. Scientific advances were going to keep people healthier, shorten hospital stays, and improve patient outcomes. The growing cost of Canadian health care was a concern even then and attributed in part to physician services.

In response, medical school positions were cut across the country, hospital beds were eliminated, and hospital wings mothballed. At the same time, practice patterns changed. More years of university education prior to medical school were mandated, and an additional year of training was added to the family medicine residency. Taken together, these separate actions all combined to create our current physician shortage.

Attempts have been made to fix this shortage recently. Medical training positions have been restored to previous levels and more, but it will take several years to repair the damage. Changing demographics, technological and pharmaceutical advances, and increasing patient expectations also play a part in current and future shortages of human health resources. Some of my numbers are very similar to Dr. Fernando's, and I'm not going to repeat those. We know that there are five million people waiting in Canada for a family physician. One million of them are in Ontario.

Let's look forward. Over the next 20 years we can expect a doubling of the number of people over the age of 65, a significant increase in the need for chronic acute care as well as long-term care, and double the number of serious chronic diseases such as cancer, diabetes, heart disease, and dementia, including Alzheimer's. A serious nursing shortage is predicted, in the range of 113,000 by the year 2016. That's a number coming from the Canadian Nursing Association. As well, there's increased competition from other countries, as Dr. Fernando has said, for our human health resources.

As a front-line physician, I see first-hand the difficulties these shortages are creating for my patients and the providers I work with. Almost daily I'm asked whether I know of any family physicians accepting new patients. I used to be able to give a couple of names, but now I don't know anyone. The family health teams in my area have wait lists. Some patients who are officially rostered—that means signed up with a doctor officially—tell me that they are waiting weeks for an appointment: two or three weeks, just to get in. They may have a family doctor rostered to them, but they can't get in to see them in a timely way.

Patients are having difficulty meeting disability insurance requirements because of lengthy wait times for specialists and diagnostics. They're at risk of losing their disability insurance because they can't access the resources they need to access.

Neurosurgical and orthopedic patients wait for diagnostics, such as MRI and CT, for many months. Then they wait again for months to see the specialist. This leads to increased anxiety on the part of the patient and the physician, not to mention potential deterioration and quality-of-life issues during the wait, which requires continued evaluation.

Waits for other diagnostics are rising in my area; patients are waiting months for a simple ultrasound. Some of this has to do with the lack of diagnostic technicians. It's not just physicians, not just nurses; it's the technicians for the diagnostics as well.

In family practice, multi-senior generations present unique and complicated problems. What I mean by multi-senior generations is that the patient is in their 90s and the children are in their 70s. In these cases, the provider needs to do more to arrange simple types of care. This, of course, requires additional staffing and resources, and it's very time-consuming in an office setting.

More patients are coming to me, even friends, neighbours, and acquaintances, and telling me about their dissatisfaction with the lengthy wait for care. I don't mean necessarily MRIs, CTs, and all the wait lists we see in the newspaper; this is just to get in to their family doctor, if they have one.

Staff may be discouraged that they cannot provide more timely care. We see morale suffering in the front lines.

While we look to other professionals and team care to improve the current situation, there are shortages of many other providers, including pharmacists and some of the others I've mentioned.

We can take steps to turn the tide. There are solutions, but you need to hear from us, and I thank the committee so much for inviting us here today.

As with anything else, the first step is to recognize the magnitude and the enormity of the problem. On that, the committee's work is crucial. We must develop a strategy to move forward to address the many challenges, only a few of which I've outlined, and ensure that all Canadians have timely access to quality health care.

I believe this strategy could include a cultural shift towards engaging patients and empowering them to take responsibility in their own care, including information technology improvements. I don't mean that we send things to the pharmacists so that they can get the prescription right; I mean linking patients to physicians and their staff in a direct way. We live in a modern world with modern communications. There's no reason why that can't happen, and it doesn't only have to happen with government help; it can happen with other groups.

I think we need to consider home monitoring and understand that this change involves technologies as well. It's already starting to happen. We see people doing blood glucose monitoring from home. The elderly patient does not have to drive in a snowstorm to the doctor's office, pay for parking, and wait. There are other ways to practise medicine, and family practice and physicians are crucial to that.

If the committee would do me the indulgence of remembering some of these things, I would very much appreciate it.

Thank you so much for inviting me today. Merci beaucoup.

[The Chair, Conservative, Joy Smith]

I can tell you, Dr. Fullerton, that not only will we remember it, but every word you have said is also recorded. We all, as a committee, selected this topic to be studied. This is not just a very brief thing; it's a very intense study, and we are very concerned. All members around this table are very concerned about it.

I want to thank you. Some of your insightful comments were just great. You think you've heard it all, and then people like you come in and we've got new ones again, so thank you.

We'll now go to Dr. Peter Kuling. Welcome.

[Dr. Peter Kuling, Physician, As an Individual]

Good afternoon.

My name is Dr. Peter Kuling. Thank you for this opportunity to appear before you to discuss the committee's study on health human resources.

I've spent most of my career practising family medicine in Prince Albert, Saskatchewan. There, I had an office and a hospital practice, where I did obstetrics, emergency, and both minor surgery and surgical assists. I had a predominantly aboriginal practice with very complex medical problems.

For the past ten years I have practised in the Ottawa area, again providing both office and hospital care. Now I train new family physicians, both Canadian and international medical graduates. This is all part of my role as the medical director of the Ottawa Hospital's interdisciplinary academic family health team. As someone on the front lines caring for patients while also training my eventual replacement, I see what has been called the perfect storm of demographics facing medicine every day.

Research done by the Canadian Medical Association backs up what I see. Most physicians work 50 hours a week, but 70% of them work an additional 30 hours on call. Only half of physicians are satisfied with their work-life balance. In fact, physicians have twice the suicide risk of the general population. One in four physicians experience mental health issues, with female physicians being especially at risk.

My typical work week involves seeing patients in the clinic and in the hospital and doing both resident and medical student teaching as well as administrative duties. However, I also have two rotating call schedules: one covering the hospital service, which is a predominantly geriatric population with dementia and medical and pyscho-social problems, and the other is my obstetric and newborn practice. This past week I delivered four babies after hours. One night I was the hospital from three in the afternoon until midnight. The next night I was in the hospital from ten p.m. until seven in the morning. Even with these two disrupted nights on obstetrical call, I continued my usual weekday clinics, teaching, and administration.

My work-life balance is better here than it was in Saskatchewan. In a rural setting even physicians who are not on call get called. They get called out at night to assist their colleagues. In my case, in Prince Albert, it was to deal with an overburdened emergency room, or an ambulance transfer of a patient, or assisting in the OR, or for an emergency surgery, or a number of other issues.

I have to tell you a story. I had a physician couple who are friends of mine from Prince Albert come to visit me in Ottawa. They're both physicians, and they have separate phone lines on each side of the bed. When they arrived in Ottawa, they were visibly exhausted. In fact they slept most of the weekend and then went back to Prince Albert. Why? Well, over the previous 30 days, one or both of them were out of their bed every night between midnight and six in the morning caring for patients. Did I add that they also have three children?

I'm not trying to pass on a sob story about physicians. The overwhelming majority of my physician colleagues love to care for patients, as I do. That's why we got into this work. However, the current reality is that the number of hours worked by doctors in clinics, hospitals, and offices across the country is not sustainable. The impact of hours on the health of physicians is devastating.

Our failure as a nation to develop a sustainable physician supply and an appropriate health workforce planning policy is driving physicians to alter, restrict, and, worst of all, abandon treating patients altogether.

We must never forget that all of this has an impact on our patients. We have too few physicians trying to do their best, caring for too many patients. This was made all too clear for me very recently when I came to our office and saw patients lining up in the cold weather outside our door before it was opened. They were lining up because one of my physicians decided to increase his patient population by taking five new patients a month. On the first day of the month, there's a lineup outside our door.

We simply must build a national strategy to ensure that all Canadians have access to a family physician, while also incorporating measures to improve access to specialty care. Such a strategy must recognize that the new and next generations of doctors are not working and will not work the ridiculous hours that physicians of my generation work.

Primary care physicians can and are providing excellent front-line care by working with allied health care providers in collaborative team environments. We must support these initiatives with strong workforce strategies or risk that the number of patients without a family physician will increase, and this will further clog our emergency rooms and our hospitals.

The core of any health care system is access to a primary care physician. With a strong, clear strategy we can strengthen that core while building a healthy physician workforce with a better work-life balance, because healthier physicians will lead to healthier patients.

Thank you.