Evidence of meeting #17 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.
4:30 p.m.
Conservative
The Chair Conservative Joy Smith
I'm sorry, Monsieur Malo, you asked such a great question that everybody wants to answer.
Ms. Neufeld, you wanted to comment.
4:30 p.m.
President, Canadian Nurses Association
I will be brief. I just want to reiterate the importance of the leadership role. You probably do know that when you combine the Department of National Defence, Corrections Canada, Veterans Affairs, and FNIHB, the federal government is the fifth largest employer of health care workers in this country, so it has a wonderful opportunity to really show leadership in the kinds of initiatives we need to see go forward.
4:30 p.m.
Chief Executive Officer, Royal College of Physicians and Surgeons of Canada
Thank you, Madam Chair.
We and our colleagues in other national and pan-Canadian organizations regularly interact with our colleagues in provincial agencies and departments. We learn and share much with each other.
But I would echo Kaaren's comments that leadership is really of the essence here. The problems are too important to be relegated to a narrow bureaucratic framework that is concerned about stepping on interprovincial barriers. I think our citizens, whatever province they come from, are looking for national pan-Canadian and federal leadership in this area.
4:30 p.m.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
From what I understand, the provinces can't lead on their own. It's the federal government that has to provide that impetus, based on what I understand from our panelists.
I have a question for you, Dr. Ouellet: have you determined how much money you're requesting to optimize the mentorship program for foreign workers?
4:30 p.m.
President, Canadian Medical Association
The answer is yes. I have to see where I put that. It's $5 million over five years for mentoring for people who have studied outside Canada. We think we need that money to help people.
We're still talking about doctors who have studied outside Canada and who are driving taxis or delivering pizzas. This phenomenon occurs; it's true. However, we want instead to train people who are able to be trained in order to help reduce the current shortage of physicians. However, we have to have ways of doing that, and we're trying to find solutions, such as mentoring. Some are almost ready to do it, but they need a little support. This solution could help reduce the shortage of physicians. It wouldn't involve taking all the courses over, but rather completing training. In some cases, some don't need much more to pass their exams.
What we absolutely want is to have people who meet the same standards as we do. We don't want to accept physicians who don't meet standards. No one would want that. We're completely ready to encourage these foreign graduates to come, but we want them to be properly trained. That's why we're requesting federal government support.
4:35 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
Thanks, Madam Chairperson. Thanks to all of you.
At our last session we heard from a number of umbrella organizations, and they seemed to suggest that our major focus as a committee should be on looking at scope of practice and the service delivery model. I don't disagree with that and I think there is a lot to be gained from it, but I'm a little worried about what Canadians are saying now about the shortage of doctors, nurses, and technologists, and some of you have talked about that.
In my view, we're reaching a crisis situation where in fact if we don't do something urgent, all the analysis of our service delivery models in the world won't do anything to deal with people's need to have access now to quality health care services.
I want to ask specifically, starting with Linda and then Kaaren first, with nurses, what specific recommendation do you make for the federal government so we can get away from this jurisdictional football and start to give some clear direction to the federal government for things that we could do? I think, Linda, you touched on EI. I need to hear more about what we can do to change the EI system to make it useful for training of nurses. I'd like to hear a little bit more about the idea of this observatory, and if it's such a common-sense idea, why isn't it happening?
Then I'd also like at some point to hear from Andrew about the whole impact of the interprovincial trade agreement on what we're trying to achieve.
But let me start first with the crisis and what we could be doing immediately.
Linda.
4:35 p.m.
President, Canadian Federation of Nurses Unions
I will take the example of EI, which we've been working on since 1999. I'm not sure if the committee knows, but if you're a plumber in this country, you can apply with your employer to take an apprenticeship program under EI, get your education, your salary paid, and then you get the next level of being a plumber. But if you're under a category of a professional, that is not available.
So if I look at LPNs, licensed practical nurses, in lay terms they are assisting nurses. A lot of them would like to become registered nurses. But you need to leave your job; you have to go to a full-time, four-year program, and there's no bridge funding or anything that could help them. A lot of registered nurses are from the old school program, the two-year or three-year program. They would like to do their baccalaureate program--again, no bridge funding--or, even better, to go as a nurse practitioner--again, no bridge funding. It's those kinds of issues that we could apply under EI immediately if we modify the apprenticeship program.
When we look at the shortage and the service delivery model, yes, it's a crisis. I've just been to Saskatchewan and Manitoba, and I arrived with Kaaren on a flight this morning. We have nurse practitioners in both of those provinces who are eager to work in their full scope of practice and they're not allowed to because of either a provincial regulation or the team they're working in. So I get very nervous when I hear a different health care worker as a physician's assistant. Well, we're going to introduce something else when what we currently have is not even put into practice. I have issues and concerns with that.
Even if Andrew is a specialist in the blood sector, thank God, and not in psychiatry...I'm not completely insane, to put it on the record; I'm just very determined, Andrew.
Thank you.
4:35 p.m.
President, Canadian Nurses Association
Thank you very much for the question.
The observatory is an opportunity, as I indicated, for researchers, governments, employers, health professionals, for us, to be able to come together and to really take stock of the innovative practices that are there that can be applied to provide new models of care.
The Canadian Nurses Association just recently published a paper on wait times, where we pulled together all of the information that showed the new models of care, whether it's nurse practitioners working in personal care homes...so long-term care situations, not just in primary care, but certainly also in primary care--to show the difference that can be made when a family practice nurse is able to work to her full scope in primary care.
Those are just short examples of innovations. The idea of the observatory is really a knowledge translation opportunity where you can bring people together who have the opportunity to spend that time thinking about these innovations, because it is the application of them into new, novel situations, whether it's in the north or whether it's within a provincial setting, that is going to make the difference. We need to provide that opportunity for health professionals, for international organizations, for researchers, for governance for us to come together.
4:40 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
Does everybody on this panel agree that one recommendation of our committee should be for the establishment of a national institute on health human resources, or, i.e., an observatory? Does everybody agree?
4:40 p.m.
Voices
Agreed.
4:40 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
There is no disagreement at all.
Before I lose my time, Andrew, we let these amendments on the AIT happen without giving it too much thought in terms of the impact on the health care system. I think we need to figure out from you what we need to do to change that, or reconsider it, or know how bad it is.
4:40 p.m.
Conservative
4:40 p.m.
Associate Professor, Canadian Memorial Chiropractic College, Canadian Chiropractic Association
Yes, thank you very much.
I just want to make a comment on the last bit before we move to a new topic. I want to completely support the honourable members on the importance of the observatory.
I also want to point out as well that I really do support the spirit that the observatory has to include all health professionals within their full scope of practice. We have a blueprint for health care in Ontario. The blueprint includes not even half of the regulated health professionals in the province. There is a blueprint plan, and funding, that doesn't even include half the health professionals.
These are the issues for people who are not on the main front lines of health care. So I fully support inclusion.
4:40 p.m.
Chief Executive Officer, Royal College of Physicians and Surgeons of Canada
Thank you.
I'll address the question about the Agreement on Internal Trade. The concern, in the short term, is the increased mobility of physicians in their primary jurisdiction who may be operating without addressing a full scope of practice. For example, we have a specialist in obstetrics and gynecology who is certified to cover that entire field, but there may be individuals who are in a practice location whose practice is only gynecology. The issue is that if that individual finds it easy to move without examination or scrutiny to another location, they may be able to represent themselves as covering all the dimensions of practice without having the experience or the credibility to do so.
In this respect, we will see a further maldistribution of physicians across the country. We think this is short term. We are not in any way supportive of restricting the mobility of any health professional or physician on that basis. But we caution that we see the potential for disruption in practice--loss of continuity as physicians migrate from less attractive to more attractive locations.
It is a reality in this country that if you go north of Vancouver you will not find a Royal College-certified specialist. They don't exist. Those are seen as less attractive environments, and therefore internationally educated health professionals migrate to those in order to satisfy the local requirements for registration and licensure. That means we have a huge potential problem on our hands.
4:40 p.m.
Conservative
4:40 p.m.
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you very much, Madam Chair.
I want to thank all the witnesses for being here.
I must say that I do like what I'm hearing as far as working on collaborative care. I've heard Dr. Ouellet, Dr. Padmos, Ms. Neufeld on innovation, yet practical solutions, and Dr. Valade's examples of collaborative care. I thought maybe we'd start with this side and work across.
I have two questions. The government does want to decrease things like wait times. How would, for example, chiropractors help decrease wait times or help deal with the burden on the health care system? The second question is, what benefits do you see for the health care system with greater collaboration?
Maybe we can start on this side and move across, with the chiropractors first.
Thank you.
4:40 p.m.
President, Canadian Chiropractic Association
As you all know, chiropractors specialize in neuromusculoskeletal problems, which probably represent 30% of what's seen, at any given time, at a medical doctor's office. If 30% of the people seen in a day could be directed to a chiropractor, that would definitely decrease wait times. It would open up the time for medical doctors to see patients with other kinds of problems. Definitely our profession specializes in neuromusculoskeletal problems.
We have 7,000 chiropractors in Canada who are, because of funding, underutilized, but we are a definite player in the game. As a matter of a fact, some of the colleagues I know in Quebec have some contacts with hospitals, and people in emergency try to send patients with neuromusculoskeletal problems to chiropractors' offices. This decreases, big time, the amount of wait times for people in the waiting room.
That's just in the emergency sector. Directly in medical offices, some 60,000 medical doctors in Canada have 30% of their patients consulting for neuromusculoskeletal problems. Just do the math on all the patients who come to their offices. So we are definitely addressing the human resources deficit in this country.
4:45 p.m.
Associate Professor, Canadian Memorial Chiropractic College, Canadian Chiropractic Association
Thanks very much for the question about collaboration.
I would like to expand a little bit upon the really unique, and I believe creative, work that has been funded under the primary health care transition fund. In Ontario, for example, we received approximately $2 million to fund three integration projects. I was a principal investigator for the one that received about $700,000 to fund integration in a hospital setting. It was not just about chiropractors. The ministry actually funded us to look at how an integrated model of care would work in a department of family and community medicine. We also received funding for the same type of study in a community health centre, as well as in family health teams in Ontario.
This covered all three sectors of how services are delivered in Canada. All of these integration projects actually were featured at the primary health care summit that the health ministry put on. They were three of 60 projects that were presented at that national level, receiving that recognition.
We learned very clearly from the establishment of that model that when services are delivered across a team, and that team has eliminated the hierarchical structure such that team members are actually equal players, with their roles appreciated and respected, then patients greatly benefit from the delivery of services.
As well, we did an ethnographic type of study that looked qualitatively at the attitudes and perspectives of the other health care providers, and we saw a major shift in those perspectives over a two-year period with the inclusion of chiropractic services.
At the end of our study, we also did a physician satisfaction survey. We have approximately 45 physicians in our department, and they were 100% supportive of the continuation of chiropractic services. Several of them commented--it's been published in two papers--that they felt it significantly affected their ability to manage their patients appropriately.
4:45 p.m.
Conservative
The Chair Conservative Joy Smith
I'm sorry to interrupt you, but there are other people who want to speak, and we're just about out of time on this issue.
Dr. Padmos, please.
4:45 p.m.
Chief Executive Officer, Royal College of Physicians and Surgeons of Canada
I'll try to answer both questions, because I think they're related.
The issues on wait times need, I suppose, urgent action, but not exclusive action, on the supply side. They also need action in terms of working smarter. One way we work smarter is by working better together.
Kaaren has mentioned the hand-off of responsibilities to others who are better or less qualified than the primary professionals, but it's that collaborative environment, which is synergistic, which is supportive, which provides great improvement in the safety net for patients, that is most obvious when it's not there. When mistakes are being made and recriminations and blame are being thrown about, we end up with toxic and very difficult work environments that are not good for patient care.