Health Committee on Nov. 18th, 2009

[Nicolas Dufour, Bloc, Repentigny, QC]

Mr. Maxted, you were telling us earlier that what is really required faced with this situation is a national pan-Canadian strategy. Given that the area of health falls under the exclusive jurisdiction of the provinces, do you really believe that a pan-Canadian plan would change something?

[Dr. John Maxted]

Yes, I do. When I put that out there, I'm putting that out there not just on behalf of my particular College of Family Physicians of Canada, but on behalf of the other two organizations that we often work together with, the Royal College of Physicians and Surgeons of Canada, as well as the Canadian Medical Association, all of whom believe that this country needs some kind of pan-Canadian infrastructure for the coordination and management of health human resources in this country.

The problem is that it is happening haphazardly across the country. It's happening in different jurisdictions. Some are doing better than others. We could sit here for the next two weeks talking about the patchwork of good locations and bad locations to practise or to work in. There are places where people have access to health care, primary care services, and places where they don't. Some of that is the result of poor planning, but it's difficult for those jurisdictions to plan solely on their own.

As we've gone around the country, we've realized that we really don't know at the end of the day who has access and who doesn't have access unless we start to create some kind of registry, unless we start to actually try to distribute a little bit more equitably than what's being distributed right now.

[Nicolas Dufour, Bloc, Repentigny, QC]

I must tell you, Mr. Maxted, that it is not really being left to chance, it is much more being left to the provinces. Furthermore, if we take the two pan-Canadian groups that you named, we are certainly not talking about the Collège des médecins du Québec, for example, nor any other Quebec physicians' association.

Mr. Switzer, in the case of the Local Health Integration Network, it is mentioned on your Website that “[...] people living locally were better able to define their health care needs and priorities“. It is also stated that communities are the best able to determine their needs.

In that context, how might the federal government be useful other than in providing the necessary funding for your operations?

[Gary Switzer]

Thank you.

The federal government, from our view, could help—as they've assisted the provinces in the past with wait time strategies—to provide the focus on a provincial basis, a national basis on wait times, for critical issues that we face right across Canada. There are challenges with funding through Infoway, for example, and to provide the motivation and the investment to help us stitch our networks together is very important. It's not going to take away the benefit of having a local community define their needs, just as we were talking about with the community health centre understanding the local population and the population's help in designing a system to satisfy them.

[Nicolas Dufour, Bloc, Repentigny, QC]

Madam Chair, I will be asking no further questions, given that, of course, we know that this is an area that falls under the exclusive jurisdiction of Quebec, such that there is no point in this debate.

I am in complete agreement with several of the positions that you have advanced. It is clear that there must be a sharing of information on the good and the bad moves. The only problem is that it is not within the Parliament of Canada that this must be done, but probably between the provincial legislatures, which have exclusive jurisdiction over health care issues. I therefore have no further questions.

[The Chair, Conservative, Joy Smith]

Thank you, Monsieur Dufour, for your very eloquent questions.

Now we'll go to Ms. Hughes.

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

Thank you.

There are quite a few questions we could ask and will be asking.

You said your doctors are salaried?

[Jack McCarthy]

That's correct.

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

I know that the community health centre in Sault Ste. Marie has salaried doctors as well. I'm just wondering if you've had difficulty attracting doctors because it's on salary.

[Jack McCarthy]

I'd answer that in two ways. At the particular CHC I have been at, we have not had difficulty attracting physicians, and certainly we have retained our physicians. That's been my direct experience. I think keeping the salary competitive with the other models of primary care delivery has been a challenge for CHCs in recruiting and retention. There's always that need to keep salaries competitive with other models of remuneration. Maybe that answers the question.

So yes, there has been some difficulty in recruiting physicians to community health centres with salaried models, particularly in rural and northern areas in the province of Ontario, which I'm most familiar with.

[Dr. John Maxted]

If I may, fee for service took a bit of a slam earlier this afternoon. I think what you need to recognize is that fewer than 50% of family doctors across the country are making more than 90% from fee for service, and 70% to 80% of doctors would prefer a blended funded formula whereby they would make their compensation, remuneration, from a variety of sources. Fee for service is losing a lot of popularity, and as I said, fewer than 50% are getting greater than 90% from it at this point in time.

So it's not a popular way of being funded, and it certainly is becoming less and less popular.

[Gary Switzer]

I'd add that in our CHCs we've had great success in recruiting. A lot of our doctors are over the age of 50 and 60. They're winding down in their careers and their volumes, and they're working 20 hours a week at our CHCs. They bring their experience, their networks, their relationships, the relationships with the hospitals, to that CHC, and they're usually within the community they work in. So we've had great success with that.

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

Nearly 25% of Canadians in the rural areas are without a family doctor, compared to 8% in the urban areas. Have you noticed whether there has been an increase in stress leave among the health care professionals?

Second, I come from an area that has a high rate in terms of an aging population, and we're seeing that across Canada as a whole. In Elliot Lake, for example, their main focus is to attract seniors to the area, but when the seniors get there, they're being told, oh, they'll get a doctor eventually. I know that from province to province your ability to obtain a doctor varies, depending on which province you live in and where you're moving to. I had a call from a lady in Elliot Lake last week. She's been there for two years, and she is still not able to get a doctor. In order for her to obtain another family physician, she needs to get off the Ontario plan with her doctor, the authorization that she signed with that doctor. And she's not guaranteed that she's going to get a family physician.

So she has to remove herself from the list of the Toronto physician in order to try to obtain one.

These are problematic areas. I don't know if the LHIN is dealing with that, but Mr. Maxted, you'd probably be able to answer with regard to the stress on the family physicians. I'm just wondering how we are dealing with the aging workforce, because we also have doctors who are retiring. What do we need to do? How short are we going to be in the next 10 years?

[Dr. John Maxted]

You're going to be a little surprised by my answer, but my answer is that the doctors in the rural communities are happier than the doctors in the urban locations.

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

They're happier?

[Dr. John Maxted]

Yes. In the studies that we've done--and I quote the National Physician Survey from 2007 as an example of that database--they say they're more professionally satisfied. There are different reasons for that, which we won't go into right now, but I honestly believe that the approach, in order to improve the resources, is not just a question of trying to get more family doctors--and I've certainly referred and spoken to that in my notes--I believe it's also looking at the changes in patterns of practice and taking a more inter-professional approach to care.

We have to emphasize once again the primary care models developing across the country. There are numerous examples. Quebec was mentioned earlier, and we've talked about Ontario, but there are the PCNs, the primary care networks, in Alberta; there are the physician integrated networks in Manitoba. There are other models throughout the country, jurisdictional though they be, that have some very unique and common characteristics that I think are actually the way of the future, and they're going to be one of the solutions to the challenges you're posing.

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

But on the family health teams, there are still big waiting lists there for people to see physicians.

Maybe we can get there in a little bit, in regard to the flu season and how you're dealing with that, but I understand there's also a big waiting list for these family health teams even though they have an integrated approach. It all started out so well, yet there are still some big problems. Maybe the family doctors in the rural areas are happy, but the patients aren't, because they're still waiting for a family doctor.

[Gary Switzer]

Perhaps I could help here.

We've launched 150 family health teams in Ontario, and 50 new teams have been approved. So we keep adding new family health teams. There was a slow adoption rate for family physicians to move to that model, but once they moved to that model, for the physicians I talked to, their stress level went down. Why did it go down? It's because they have access to a nutritionist, access to a nurse educator, access to NPs, and access to social workers, plus their income went up. So they're very satisfied. But there are still lineups quite a bit, and as a result of that, we're also introducing nurse practitioner only clinics.

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

The issue here is still that there are patients out there who are not able to access even the hospital care, because if a patient is mandated to this one doctor in Toronto, for example, as this lady is, even to go to the hospital to get a service, she is being denied because her file is not down there, unless they call it an emergency thing. Going there for her allergy shots won't work.

[The Chair, Conservative, Joy Smith]

Ms. Hughes, I'm sorry, we're over time. Do you mind if we have him answer that?

[Gary Switzer]

Don't you want me to answer that?

We're in a race that never ends. There's a significant shortage of primary care right across Canada, and unfortunately we will have lineups. Without electronic health records to transfer files in real time or to have a portal so that physicians can dip in and read the file of a patient from another community, we're going to have these bumps along the way.

[The Chair, Conservative, Joy Smith]

Thank you.

Ms. Davidson.

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

Thank you very much, Madam Chair. I'm going to be sharing my time with Mrs. McLeod.

Thanks very much to the three of you for appearing before us this afternoon. Certainly I think we've been hearing some interesting points of view and maybe something a little bit different from what we've heard at the committee thus far. So it's good to hear that.

Gary, I want to ask you about the LHINs. We all know that they're in Ontario. Are there comparable bodies in the other provinces and territories?

[Gary Switzer]

Yes. Ontario was actually the last jurisdiction to go this route. We have what we call a made-in-Ontario solution that is quite unique, where we maintain the local provider boards for local governance and direction in their community and the devolution of authority. We do not include public health. We do not include OHIP, for example. We do not include labs.

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

But you include all the other disciplines, do you?