Thank you very much, Madam Chair, and members of the committee, for taking the time and for inviting us to come and speak with you.
At the AFMC we spend a lot of time thinking about and enabling national projects that deal with medical education, and I would echo everything that Dr. Jalali said. There's a great deal of innovation happening in our faculties of medicine and I get to see it in my professional life on a daily basis, and it's very exciting.
I want to preface my comments, though, by saying that while we think of innovation often in terms of high technological innovation, in some ways, and in human health resources, HHR in particular, innovation is really about doing things differently than we are currently doing them. So I want to talk a little bit about health human resources, and I do want to talk about innovation. But it isn't going to be about microchips and it isn't going to be about the Internet. It's going to be about changing the way we think about health human resource planning in the country. I think that's a very important form of innovation.
I don't need to tell any of you about our health human resource challenges in this country. I know you all know them inside and out, backwards and forwards. I will make some points, though, just to show you that we understand some of the elements that I know you're concerned about. For HHR, the challenges we have go far beyond wait times. The effects of our health human resource challenges in this country are affecting consumers of health care, but other players, other people, in this country as well. It's not all about physicians. I'm here from the Association of Faculties of Medicine of Canada, but we play a role in health care delivery. We are not the end of the story by any stretch. Really, it's also more than just about shortages. That's where some of our innovative thinking needs to kick in.
Beyond wait times, I can say that we are concerned at the AFMC not only about unacceptable wait times, but things like lack of adequate chronic disease management, lack of care close to home, major health disparities among communities across the country, and a significant lack of coordinated, inter-professional care. I think I speak for all of our deans of medicine, whom I represent, and I'm sure everyone here, when I say we should be and could be doing a lot better in all of these areas.
Yes, the public feels the pinch of our health human resource challenges, but so do the provincial jurisdictions that are trying to plan their health care systems, and our national health human resource challenges affect their day-to-day lives. Every elected official I've met at the provincial, municipal, and federal levels hears stories on a daily basis from constituents about the challenges they are facing, so you all deal with this on a daily basis as well. You feel the pinch.
Our learners who are in our faculties of medicine, either at the undergraduate or postgraduate level, are facing enormous challenges just trying to decide what part of medicine they want to practise. “What should I be?” Our health human resource system and our lack of data and national modelling is making it difficult for them to make choices. Those days where we used to joke, “There's no such thing as an unemployed doctor”, are coming to an end, if they're not already here.
Finally, the provincial regulatory authorities are having a difficult time with our challenges, so this is about the patient for sure. It is about Canadians in general, though.
I'm not going to dwell too much on beyond physicians again. We all know that the role of the physician and other health care providers is changing and should be changing, but we all need to re-calibrate. I know that those charged with health human resource planning, using the current tools that are available, are not able to do this as well as they could. Forecasting scope-of-practice change and the changing role of the professions needs to be more front and centre.
Again, it's not just about shortages. For a very long time, everybody thought that our health human resource problems were presenting themselves in terms of shortages, but we now have anecdotal evidence, if not hard data, around surpluses in certain areas. In a country that faces the challenges we have, I don't think we want surpluses. The cost of training a physician is quite significant. We need to be thinking of the cost that the taxpayer pays to educate a physician as a major investment and we should be using those investments properly. An underutilized physician is an issue. They're not underutilized because they don't want to be working; they're underutilized in many cases because we haven't planned the supply properly.
You hear about geographic misalignment every day. Consumption of health care services is not the same in every province across the country, and certainly it's not the same in rural, remote, and northern communities. We have a major misalignment between supply and the needs of Canadians, I would argue. Canada has changed, and I don't think our workforce balance has changed to keep up with the times.
Finally, we have a disturbingly homogeneous workforce. We won't have the time to discuss this specifically right now, but the data clearly shows that those who are graduating and entering medical school represent a very thin slice of the upper end of the socio-economic pie in Canada. This is concerning to us.
I'm going to back up to what is innovative and what we want to bring to the table—and again it isn't rocket science but it isn't being done—and that's national collaborative data sharing and analysis.
We've heard in the last few weeks of three provinces that are using fairly sophisticated tools to measure needs in their jurisdictions, and the supply of people practising medicine that they are creating in terms of physicians in their province. And that's four, so that means there are several jurisdictions that are not currently using a robust tool for HHR modelling, but even among those that do, they face the immense challenge, which has been exacerbated I think of late by the extreme mobility of physicians. Provinces can no longer plan their physician workforce within a provincial lens. It's very difficult to do that with people moving around as much as they are, and that's the same for other health professionals.
So what we're missing I think, what we think at the AFMC, and we've been saying this for quite a long time, is a national approach to health human resource planning, a national tool that the jurisdictions can draw on, feed into, that would in fact examine the needs of Canadians from coast to coast to coast, and the supply today, tomorrow, and in 5 years, and in 10 years. Where are we going? Again, it takes between 8 and 12 years to train a physician. So when we play with admission levels today, we don't feel the impact of that for 8, to 10, to 12 years, and yet we make changes and two years later we undo those changes. We have this constant desire to play with the numbers before we've even seen the benefits of our actions.
I want to make sure there's enough time for questions and answers. I'm just trying to put on the table what it is we're coming with, and that is what I believe is an innovative approach to a national data and analysis modelling centre, which is the word that we're using. We used to say observatory, but people really didn't like that term for whatever reason, so now we've renamed it, but underneath the hood it's the same idea. It's a tool that the federal government could invest in, which would allow the provinces to share and aggregate their data and have a look at what Canada as a whole needs, and what Canada as a whole is currently producing.
I know that all of these issues touch on provincial jurisdictions, and that's a challenge, although I think in the area that we've identified there is certainly much precedent for federal intervention in terms of data analysis and data collection. I do think that the federal government really would be well positioned to assist the provinces in doing this work.