Health Committee on Nov. 2nd, 2009

[The Chair, Conservative, Joy Smith]

Very quickly.

[Shelagh Jane Woods]

It's our hope that many of the students who are trained will return to their communities, but it is not a condition. The initiative is designed to help make improvements in the whole workforce. We have a lot of evidence that if training takes place in a culturally appropriate way and in a culturally appropriate setting, many students will choose to remain in their own or other aboriginal communities. That would be a good result, in our view.

[The Chair, Conservative, Joy Smith]

Thank you very much, Ms. Woods.

Now we'll go to Ms. Hughes.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

I have a variety of questions; I'm just trying to figure out where I want to start.

First of all, I should welcome you to the committee and thank you very much for your reports. We can see that there has been some headway and that we still have a long way to go.

With respect to the internal agreements, when the internal agreement was negotiated, there were concerns expressed that cross-jurisdictional qualifications for health professions might exacerbate shortages in some provinces and territories as it became easier to move to major centres out of province. The advantages of free movement are evident, but I'm wondering what has been done to ensure the added mobility doesn't shortchange regions that are already suffering from health care shortages.

[Brendan Walsh, Manager, Labour Mobility and Immigration Portal, Department of Human Resources and Skills Development]

Thank you for the question.

The decision by individuals to relocate, particularly to another jurisdiction, is influenced by many factors, not just whether their certifications can be recognized. What we're looking at under the revised chapter 7 is more of an enabling agreement. It enables workers who are certified to have their qualifications recognized, so it removes a barrier that used to be there. The chapter is neutral on whether workers are actually going to be encouraged to move, so I think that's important to remember.

There is, though, an acknowledgement that in having easier mobility and easier certification qualifications, as people move across jurisdictions there is a risk it could lead to some skills shortages. We've heard those concerns. One of the things that ministers did when they agreed to the new agreement is that, as part of the annual report, we're going to be monitoring that situation specifically. There's a specific commitment that governments, in addition to assessing the overall effectiveness of the chapter, will have a particular focus on whether there are any unintended negative consequences that could be attributed to the chapter, for example, shortages of health service providers in regions.

I think it's a bit early to say that anything has been happening in that regard yet. Governments are aware of the risk, and we're committed to monitoring it as part of our annual review of the chapter.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Thank you.

I have a couple of questions for Ms. Woods. On the aboriginal front, you mentioned how things seem to be improving. However, I'm concerned. I think it's good that we can provide more doctors who are more culturally aware of what is happening in those areas and who will maybe service those areas, but given that there's been a 2% funding cap for so long within aboriginal communities, I think we're actually restraining some of these future professionals from coming forward.

I'm wondering where you see the challenges with that. With respect to educating them a bit earlier in life, you mentioned they would be better served if it's one of their own. What are the challenges there, as you see them? I know that funding is a big one.

[Shelagh Jane Woods]

That is a complex question. There are a lot of challenges in the whole area. We do still see that, in basic education, high school completion rates lag behind those of other Canadians. And there has been really a lot of effort put towards that over the past 30 or 40 years.

But to be fair, it's a wide world with a lot more choices now. So it's not as if the choices of aboriginal kids who can go out and get a good education are really limited to the things we would have seen traditionally, like nurses, school teachers, etc.

So I would say that one of the basic challenges we face both on the side of the aboriginal students and in terms of our own recruiting is that there is a tremendous shortage of health care professionals. It's a big world out there. There are a lot of things people can do, and you can't compel people to take the courses.

What I find hopeful is that we've begun to put more and more emphasis on training the aboriginal people themselves in ways that accommodate their needs. The fact is that many of them are mature students who have family responsibilities, and the ones who are based in the communities may not be readily able to leave their communities for two years, three years, four years, or five years. So if you can make a lot of the training available to them on site, spread out over time so they can keep their jobs and work on their academic qualifications, we find that works very well.

More than the money, that's really the kind of challenge we face.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

But at the end of the day, there are still challenges with respect to having that funding cut in place.

[Shelagh Jane Woods]

I'm not sure of the funding cut you're referring to.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Sorry, I meant the funding cap, not the funding cut.

[Shelagh Jane Woods]

It's not a cap on our money. I think you might be talking about Indian Affairs' post-secondary education.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

That's right, but that is hindering them moving forward. Don't you believe so?

[Shelagh Jane Woods]

I don't think so necessarily. We've provided a lot of bursary and scholarship money to aboriginal students—as my colleague, Kathryn, mentioned—to about 1,400 students, and that doesn't include this year's students. There is good take-up, and there is a little more demand than there is supply, but I don't see it as being a major hindrance so far.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Thank you.

Attracting physicians trained outside of Canada is complicated by the placement opportunities for residency programs. How are you working to address this?

[Kathryn McDade]

I did bring along some numbers on the residency issue because there has been quite remarkable progress in the past few years actually. Just to put it into context, before we talk about the specific issue of internationally educated doctors and their capacity to come in as residents, in terms of medical school enrollments generally—all undergraduate seats, not just foreign-trained—first-year undergraduate seats increased by 31% from 2002 until 2008. So that was a six-year period with a pretty dramatic increase in undergrad seats. If you assume there's a very low attrition rate—there has historically been a pretty low attrition rate out of undergraduate medicine, and most of those students do, of course, take on residencies, either in family medicine or specialties—down the road that will represent quite a significant new flow of professionals.

[The Chair, Conservative, Joy Smith]

Ms. McDade, could we wrap up as quickly as possible?

[Kathryn McDade]

Yes.

Just to give you a number on internationally trained medical graduates, in 2003 there were 75 students from outside the country, foreign-trained, who were successful in getting residency seats in Canada. In the current year, in 2009, that number is up to 442. So from 2003 to 2009, that's basically a quadrupling of the numbers. It is quite dramatic.

[The Chair, Conservative, Joy Smith]

Thank you.

Mr. Uppal.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Thank you, Madam Chair.

And thank you for contributing to this important study.

There are always regular reports of shortages of doctors, nurses, and other health professionals. Can you tell us what the actual shortages are in the country right now?

[Kathryn McDade]

The most recent data we have are from the Health Council of Canada, a study published at the beginning of 2008, based on 2007 data. This is survey data. It's a survey of Canadians. It found that 14% of Canadians don't have access to a regular family physician. If you translate that into raw numbers, that's 4.6 million Canadians. And this number was widely reported.

Not so widely reported, but included in the same Health Council report, was the following fact: of that 14%, 10% had access to a regular place of care. These are people who are using clinics, community-based health services. They don't consider themselves to have a regular physician, but they may have a team of physicians who serve them. When you look at it that way, the number goes up to 96% of Canadians with access to either a regular physician or a regular place of care. So it's a much smaller number than was reported.

There are a considerable number of students in the pipeline now. We would expect that as these students graduate from undergrad medical education and take their residencies, we would have the prospect of significantly addressing the shortages that remain.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Would you say the situation is improving? Do you have data to show that it's improving?

[Kathryn McDade]

Yes, I think it's definitely improving—it has been improving since 2002-03. The investments are quite dramatic in undergrad, in residencies, and in graduating physicians.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Beyond increasing the supply of health care professionals, what is being done to reduce recruitment and retention challenges?

[Kathryn McDade]

Health Canada, in partnership with the federal-provincial-territorial committee, has been working on the shortages issue, the numbers recruited into the profession. We have also invested in a number of projects directed at getting people to remain in the profession once they're in. This has been especially relevant in nursing. There is a relatively high attrition rate. I don't have the number at my fingertips, but the attrition rate in nursing is quite significant.

We did work on something called the healthy workplace initiative. It wasn't limited to nursing, but it provided $5 million over several years for 11 provincial projects. For national projects, it considered how to strengthen workplaces to increase retention. In the last few months, our minister announced a new initiative with the Canadian Federation of Nurses Unions. It provides more than $4 million over a period of three years. It will look specifically at nursing and develop innovative projects in nine centres across the country to try to increase the retention rate.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

I was fortunate, in Edmonton, to be able to go to a centre—it was funded partially by the federal government—that had foreign-trained doctors. Some of them even had surgery experience, but for various reasons they weren't able to become licensed doctors here. However, through this program they were able to be trained as paramedics. And these people were grateful to be back in the health field, to be working directly with patients and helping out in Canadian society.

Are there other creative programs like this across the country?