Health Committee on Dec. 9th, 2009

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you.

Thanks for the testimony and the encouraging remarks as to progress that's been made. I was part of a provincial government back in 2000 and 2001 that was dealing with the impacts of not having enough doctors and the frustrations around foreign-trained doctors. This is, as we know, a long-time challenge. It's heartening that there's progress, but there's still clearly lots more to be done.

I have a couple of examples of why I'm still mystified about the complexity for international medical graduates. On the one hand, I have a colleague who's a doctor and sits in this House, who described going to Australia, paying a $100 registration fee, and being able to practise the next day. That makes sense to me.

My other real-life example is a son who married a woman from the EU who had completed her medical training and actually later became top in her country. But when she came to Canada following her training and prior to doing a residency, she heard so many horror stories about how long it was going to take for her to get into the queue and complete her training and about the possibility that she would never get to be a doctor in Canada that she went back to her home country in Europe, and that was the end of the marriage.

I see both sides—both the possibility of solutions, but also that we're not there yet.

I'd be interested in just one comment from each of you. If you could have one thing recommended by this committee in terms of our health human resources study with respect to this issue, what would that be?

[The Chair, Conservative, Joy Smith]

Keep in mind that you have a very short time to answer, because Dr. Bennett is sharing the time.

Who would like to answer that?

Go ahead.

[Dr. Fleur-Ange Lefebvre]

Thank you.

There are roadblocks, and they're roadblocks because of resources. One of the big resource requirements is assessment. It's a roadblock for funding and it's a roadblock for faculty. We have increased the undergraduate enrolment, so they are busy dealing with new trainees, with increases in numbers that we've never seen before.

So it's the capacity issue: we can't keep telling you that enough.

[Dr. Ian Bowmer]

I'd just add that the reason for the clear flow to Australia is that Australia actually acknowledges our assessment process. One of the things that perhaps need to happen is this mutual recognition of assessment processes. We had been working with Australia for a while. They've just changed their whole process around. In terms of the recognition of a competent assessment authority, I think everybody recognizes that the qualifications are not the same from country to country, but the assessments can be standardized, and that's something we could work on.

[The Chair, Conservative, Joy Smith]

Go ahead.

[Sandra Banner]

I think we must recognize that we have a cohort of internationally trained physicians that is somewhat predictable, and we need some predictable funding to allow both assessment and training to follow. We are an immigration-based country. This should not be a surprise to any of us that the source of some of our physicians will be through immigration, and we must have set aside in every section a dependable source of funding for training.

[The Chair, Conservative, Joy Smith]

There's one minute left.

Do you want to go right ahead?

[Dr. Nicodeme Mugisho-Demu]

Yes.

Dr. Bowmer was right about the need to have that mutual recognition, and if in that case Australia was able to take the Canadian physician, it's because they have that mutual recognition.

That could be done as well. Canada could look into where we get most of the IMGs coming from, what country that is, and, based on those statistics, they can go over there. There could be investigations to see what the educational systems in those countries are and to have some kind of recognition or upgrading of that education system to have people coming in knowing what they're capable of or not.

[The Chair, Conservative, Joy Smith]

Thank you.

Monsieur Malo.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you, Madam Chair.

I want to thank the witnesses for being here this afternoon.

Mr. Mugisho-Demu, I would ask you to explain whether... In your statement, you indicated to us that some programs were currently underway in the province of Alberta, your province, but that these programs led nowhere and that students enrolled in them were unable to find ways to be included in the medical system, the area in which they would like to practice.

Have you indicated these problems to officials at the Alberta Department of Health, for example? Have you provided any solutions? These are the preliminary questions that I have for you following your testimony.

[Dr. Nicodeme Mugisho-Demu]

Thank you, sir.

Earlier, I indicated that we had a problem ensuring program or project integration. Last July, we appeared before the legislative assembly in Edmonton. We had raised this problem at the legislature, and we explained that these programs were provided on an individual basis. They are not connected to any university.

So, when these people complete their two years, the funding ends and it leads nowhere. If this project was tied to a university, such as the University of Calgary or the University of Alberta, for example, there would be better communication about the program, to the extent that we could integrate the experience the students gained over these two years. Two years is a really long time, and if these people were able to benefit from that experience to reduce the amount of time that they have to spend in residency programs, it would be a good way of reducing costs and time, and this would help both foreign doctors and the Canadian health care system.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Could you tell us about your own experience?

[Dr. Nicodeme Mugisho-Demu]

Thank you for that question.

I arrived in Canada as a refugee as a result of problems that I had experienced in my country. I needed to find a job. I was receiving assistance, but I didn't like that. I started to work as a security officer for G4S. It was really depressing, until I found a job as a medical receptionist. The doors opened even wider when I began a program and started working under the supervision of doctors. This helped me a great deal.

As a result of those experiences, I lost the passion and interest I had in medicine. As a doctor, that wasn't what I had planned for myself. I lost my passion, but I thought that I could help other foreign doctors as a result of my experience. Working with doctors in Alberta would benefit them. I started my company, Blue Sky Staffing Network, to help foreign doctors communicate with private clinics. That is what I am doing now, and I hope to get help to do this. I work hard for the association that I am representing today, in order to ensure that we speak with one voice and help foreign doctors become part of the Canadian system.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

My time is up? Very well.

Thank you very much.

[The Chair, Conservative, Joy Smith]

I'm sorry, your time is up.

Ms. Wasylycia-Leis.

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

Thank you, Madam Chairperson.

Thanks to all of you for your patience as we run back and forth for votes.

I would like to begin by asking the question about the fact that physicians have been given the later timetable under the government's new framework document--I don't know why that is, exactly--and whether or not physicians couldn't have been included in the list of those to receive the information about their training within the year.

[Dr. Fleur-Ange Lefebvre]

If I may, we were surprised when the announcement came through as well. The way that Minister Kenney was portrayed in the media...he said that doctors had refused to come to the table, or implied that doctors had refused to come to the table. We quickly got onto the system and said, “What table didn't we come to?” And apparently, that's not quite what was said.

We're actually pretty proud; we're ahead of the curve on this one. We think the confusion may stem from a request that we made to the Forum of Labour Market Ministers asking for an extension to the implementation deadline that was originally April 1, 2009, when it comes to implementing the agreement on internal trade.

We had asked for a two-year extension, and we think that is where the confusion started to arise. We know we're most likely not going to be granted that deadline. But as we're working on the AIT, we're working on foreign credential recognition at the same time, so we think we'll be ready before then.

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

Are you saying that physicians could now be added to the list of those that will be processed starting in 2010?

[Dr. Fleur-Ange Lefebvre]

The quick survey I did of our members when the announcement of the pan-Canadian framework came out indicated that most of them already provide an answer to an IMG before a year. And that's what it is, right? It's not that after a year you're licensed; it's that after a year you know what your chances are of achieving licensure.

We're already ahead of that year deadline, so we're already there.

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

In effect, it's proceeding regardless of the deadline set out in the government framework document?

[Dr. Fleur-Ange Lefebvre]

We are proceeding in compliance with the agreement on internal trade, which will place us ahead of the pan-Canadian framework.

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

Okay.

We know there is a shortfall, they say, of about four million to five million Canadians without a family doctor. How many physicians-in-waiting are there from foreign countries in Canada today? Does anybody know?

As well, to what extent can we help meet the demand in Canada if we fix the problem of foreign credential recognition?

[Sandra Banner]

As I indicated, CaRMS is the only route in--aside from a program in Alberta, but the same people who apply to Alberta apply to CaRMS, so we have that count. We have, as I said, approximately 1,600 who declare themselves to have written the exams and to be ready to begin postgraduate training. That number has been consistent since 2007: 800 of those are recycling and about 800 are new.

The opportunities for those 1,600.... Last year we had close to 500 who entered postgraduate training, of those 1,600. This year, from the numbers we see coming back from the provinces, that will be down slightly. There seem to be fewer opportunities available to international medical graduates this year than in the previous year. We're looking at possibly a 4:1 ratio of the number of positions available and the number of internationally trained physicians who are competing for those positions.

[Dr. Ian Bowmer]

Chair, perhaps I can add to that.

The committee is probably aware that, unlike the United States, where every international medical graduate has to go through a residency program, about half of the physicians, international medical graduates, entering practice every year go directly into practice without going through a residency program, and about half of them entering go through a residency program. A number of physicians in the community have never gone through a Canadian residency program because they've been assessed by the regulatory authorities on the basis of examination and credentials that they are ready to go into practice. Whether that's supervised or independent practice is another question.

The sole source is not just the residency program, but the residency programs across this country are really the way to do the standardized assessment.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Bowmer.

We'll now go to Mr. Brown.