Health Committee on April 23rd, 2009

[The Chair, Conservative, Joy Smith]

Sorry, your time is done, Ms. Murray.

We'll go to Ms. Wasylycia-Leis now.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Let me just take it into another direction we really haven't touched on.

I agree with and really appreciate all your comments around looking at the whole delivery model, thinking outside the box, multidisciplinary approaches, holistic medicine practices, blah, blah, blah.

The fact of the matter is that we've got a real serious crisis right now in Canada. Canadians are desperately trying to get some answers from us and they're looking to Parliament. We have a health human resources strategy that was just renewed, but based on the analysis of the last five years, that didn't produce much. So what advice can we give to the federal government and the Minister of Health today to put some teeth behind that supposed national health human resources strategy? The strategy has money attached to it in the sense that money was parcelled off from the transfer to be designated for dealing with health human resources. What do we do at least in the short term on that front?

Secondly, do you see a federal role for dealing in the short term with some of the shortages? For example, in the past it was the federal government that built colleges for doctors. These days, everybody sort of washes their hands and says it's not our doing, it's up to the provinces. If we don't get some coordination at the federal level, the whole thing's going to come crashing down before we get a chance to put in place all this stuff we've been talking about for thirty years. So I guess I'd like to hear some short-term recommendations as well in terms of dealing with some of these problems.

[Jean-Marie Berthelot]

Well, I don't think it would be a recommendation, but I think we maybe need to think about trying to identify where we would be ten or twenty years from now, even just projecting the number of human resources we have now. I think that's something that we don't do as a country, and it's something we should probably be doing.

Nationally, how many physicians and nurses we have, which is the pool available... With the interprovincial trade agreement now, where professionals can be recognized across the country, that's the pool of people we have to deal with. That's one thing. The second thing is, there's no short-term solution for physicians. It takes a long time to train a physician. It takes a long time to train a nurse. I think we need to maybe do an inventory of all the increases in number of seats in nursing, physicians, and other occupations.

It's my personal evaluation, but I think we would see that there has been progress, at least in terms of the training. It doesn't mean that it addresses today's problems, because it takes a long time to train a specialist. I think we should be careful about acknowledging a lot of effort that has been done by many provincial governments. We talked about the primary care transition fund of $800 million. To be frank, that's not a lot when you're talking about $172 billion a year in terms of spending. However, you see that in many jurisdictions there's group practice, groupe de médecine familiale in Quebec. Many provinces have implemented different ways of providing care. In Ontario you have.... What are they called?

[Francine Anne Roy, Director, Health Resources Information, Canadian Institute for Health Information]

Nurse practitioners.

[Jean-Marie Berthelot]

Nurse practitioners are heading group practice clinics.

There are changes that have been made. However, it's a big workforce, with people who have a lot of skill and need a lot of education. It takes time to change. But in the numbers we produce, we already see an increase in the number in the workforce available. There's an increase above and beyond the population growth. The other issue is how they are organized and how they work, but I think some progress has been made.

[The Chair, Conservative, Joy Smith]

Yes, Dr. Besner.

[Dr. Jeanne Besner]

I think one of the things that also was helpful to me, and it may or may not be to you, is there is a pan-Canadian planning framework that identifies all of the elements of health human resources planning that will lead us to the outcomes we want to get at the patient care provider and system level. We have a lot of evidence about different pieces of that puzzle, but the evidence has never been pulled together.

We haven't done the comparisons of the supply in one province versus another and why that is and so on and so forth. I think we have a lot of information that has never been pooled together into a systematic way of looking at where we want to go, but the framework for doing that is there. I know when—

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Do you think it's up to our committee to pool this information? Who could do this? Who could do the inventory that projects that stuff?

[Dr. Jeanne Besner]

I don't know, but I know that when we started our program of research eight years ago, I used that framework to do the literature review. That's how we began to identify where we wanted to zero in on the elements of the research that we felt needed to be done. It identified where the biggest gaps were.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Besner. Thank you, Ms. Wasylycia-Leis.

I now go to Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair.

I'm going to focus a bit more specifically on physician levels. That's an acute concern in my riding.

My first question would be for the Canadian Institute of Health Information, because I found some of your statistics interesting. I wanted to know if you've been able to break it down between care outside of hospitals and hospital-based care in terms of some of the shortages. I know that when our hospital goes on a recruitment tour for physicians, the sense in the community is that it's family doctors, family doctors, and family doctors, but I was shocked by the levels of the shortages that exist in fully staffed hospitals. Do you have any statistics or information on the breakdown specifically for hospital shortages?

[Jean-Marie Berthelot]

Well, “shortage” is a relative term, so CIHI doesn't make statements about if there or is there not a shortage. We have information about where are the physicians' main locations of practice. I don't have the data with me, but we could provide information about how it varies by health region, by city, and by riding, if you want, in terms of the proportion of physicians working in the community versus those mainly working in hospitals. Some physicians would work in both or many of them would work in both. That we could do, but I don't have any information about--

[Patrick Brown, Conservative, Barrie, ON]

If that information could be passed on to the committee, I'm sure it would be appreciated.

[Jean-Marie Berthelot]

Yes.

[Patrick Brown, Conservative, Barrie, ON]

In terms of the Health Council, I know that one of the working groups was on health human resources, and that's terrific. Do you know if that working group looked at--I know Judy was a little bit into this--any collection of data, province by province, on how medical enrolment is changing and whether we are going to see some positive trends in the future based on increased enrollment? In Ontario, there's that medical school in Thunder Bay, and there's obviously talk elsewhere of medical enrollment expansion. Do you have any national picture of the direction in which we're heading?

[John Abbott]

The answer is that we don't, but we do know, just by some of the information that's come our way, that different provinces are starting to add capacity to their medical schools.

One comment, more of a personal one versus being the Health Council's, is that from the committee's perspective, one issue or a case study to look at is whether Canada can be or should be self-sufficient in its medical doctors. Nobody's ever really answered that question.

If you develop one or two or three scenarios and try to get to the answer there, it would tease out a lot of the issues in terms of how we conduct care, roles of physicians versus roles of nurses, and what have you, because the fact that in 2009 we're still having to recruit offshore--literally--begs the question.

[Patrick Brown, Conservative, Barrie, ON]

Here's my challenge. I always hear that we have to recruit offshore, but when I asked Dr. Murdoch, who works at the U of T medical school, how many applications they had for their 25 foreign spots, he said they had 11,000 applications. So the notion that it's one of our tools for success doesn't appear to be the case, because if it were a tool for success, we could solve it there alone.

What I'm more interested in is the working group specifically related to physicians. What areas has the working group focused on in terms of physicians?

[Dr. Jeanne Besner]

We didn't.

[Jean-Marie Berthelot]

If I can add to that, we know how many physicians are enrolled in these faculties. We know how many spots there are in the faculties of medicine in the country and we report the trend. This is part of this report, on page 30. We do update the statistics on a yearly basis. That was a flagship report, so it's two years behind, but we do have that information. It's made available and it can be traced.

In terms of internationally trained physicians, what we see is that we rely less on them than we have in the past. The number of internationally trained physicians in the physician workforce has been relatively stable, at about 13,000 to 14,000 out of 64,000 physicians, for probably the last ten years.

The issue of being self-sufficient is very complex, because there's also the right to a better future for people who live outside Canada. I think the ethical issues there relate to when Canada may be recruiting in countries where there is a shortage of physicians, countries in development, but we need to acknowledge that about one out of five Canadians are not born in Canada, and we have about one out of 85 doctors that are trained outside of Canada. I think we need to be careful about saying that we would need to have an objective of zero internationally trained physicians. That may not be appropriate.

[Patrick Brown, Conservative, Barrie, ON]

Don't get me wrong. I'd love to see more internationally trained physicians.

[The Chair, Conservative, Joy Smith]

I'm sorry, but you're over time.

Go ahead, Ms. Wong.

[Alice Wong, Conservative, Richmond, BC]

First of all, I am really fascinated by this committee. Maybe I should have chosen this one.

Thank you very much for coming. My background is in entrepreneurship education, but then I happen to have served in a college that had two years of nursing, moving into four years. A lot of students were coming from overseas. A lot of them were immigrants. I have some questions in that area specifically, especially regarding nursing. Coming from B.C., I can only use the B.C. models in my comments and questions.

First of all, regarding nursing education, we heard there is a shortage of nurses, but I also heard that there's a shortage of nursing educators. There could be very complex reasons, and I don't know whether you have looked at that area. Very often funding is one area, but there is also a lack of nurses wishing to go into academia, where they do train nurses and they do research as well. We have a pool of people, a resource of people who really have the experience. I don't know whether your study has even touched on the area of resources in nursing education and the model that could be used to utilize such rich resources. That's question number one.

Question number two is related to foreign-trained medical professionals. It is true that we are losing some of our physicians to overseas, because they offer better working conditions and other things, but at the same time we have an influx of people who really have that training and just need the foreign credential recognition and the extra training. Again going back to the B.C. model, several colleges that have now been upgraded to universities are offering one-year special programs for foreign-trained nurses with a degree. What they're preparing them for is the background in practical areas in the province and the language they need to write the RN exam, the registered nursing exam. Has that even been touched? Dr. Besner, in your studies about nursing, I don't know whether that has been considered as one of the possible solutions to the shortages.

My third question is about mobility. I agree 100% that shortage is a relative term. Even within the same province there's a shortage of physicians or nurses in the north, but in certain areas nurses or other professional practitioners are still waiting for jobs. It is the distribution as well. I don't know whether you have looked at that as part of your research.

I have tons of questions, because I'm new to this committee. I don't know whether I'll be coming back again, but I just wanted to ask.

Thank you.

[The Chair, Conservative, Joy Smith]

Who would like to tackle that one?

Go ahead, Dr. Besner, and then Mr. Berthelot.

[Dr. Jeanne Besner]

In terms of your question around models of nursing education, we recognize that there is a shortage of nursing faculty. The faculty is aging, and so on. There is beginning to be work looking at different models, such clinical scholars and so on. We know that in nursing we have an approach to clinical education that is very different from the approach in medicine, so we need to start looking at those. My team and I personally haven't, but work is going on in that area.

A lot of work is currently being done in looking at the assessment of internationally educated nurses and whether it's equitable to the process that Canadian nursing students go through. It is beginning to emerge. You've identified a lot of issues with internationally educated nurses in terms of cultural adaptation and language, but there is work going on. I don't know if it's particular to the western provinces, but there is work going on through the Mount Royal College. It's an assessment project that was funded by Health Canada.

I can't answer your question about distribution. There are a lot of differences across the country in terms of the mix of different kinds of providers who are available to staff service delivery models and so on. There's a lot of difference across the country.

[Alice Wong, Conservative, Richmond, BC]

I think that some of the measures that both the provincial governments and federal government have done include encouraging new grads to go to areas where there's a greater demand for nurses or physicians. Have you looked at that?