Health Committee on Feb. 5th, 2013

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I want to take this opportunity to thank the witnesses here today. Whenever you come, I have so many questions and just so little time. Where do I start?

We've already had some excellent witnesses here about Canadian innovation and the potential for jobs and opportunities into the future. One of the things brought up before was that there is a little bit of a disconnect between Canadians and how they work on commercialization.

I'd like to start my questions with Steve Denniss, if that's okay. First of all, it's great to see a fellow kinesiologist here at the committee. You mentioned MaRS. I think MaRS is a great example of an incubator and of getting people together and starting to think outside the box.

We had the faculties of medicine here, and one of the things we heard about was how the culture is a little different in the States where they have medical schools that will partner with academic industry, so you can have researchers working half-time with companies and half-time with the faculties back and forth.

Is there anything you could suggest, such as maybe the federal government working with different medical education institutions? How could we help medical schools educate a little bit more on the business side of things to help create jobs through these innovations? In Canada sometimes we lose that to other countries, because we don't have that culture here. It's great that the two of you are here together, so I thought maybe we'd start with your comments and then we could hear from Mr. Gold after that.

[Dr. Steven Denniss]

Whoever has the answer to that question you should definitely talk to, because that's a pretty important question. I wouldn't say that I have the answer to that question. I would say that in the States, because they're in more of a private health care environment, there's a lot more reason to adopt health care technologies, because if you're a private hospital and your hospital is more efficient, you could kind of compete on that. You could say, “Come to us because we have the latest and greatest technologies”.

In our more public health care system, there's less of an initiative to do that, but when you hear health care providers and hospitals speaking, they want to adopt the technologies. I think there might be a little bit of risk aversion, because our environment is obviously more risk-averse as opposed to the environment of the States which is more one of risk management. I think because the health care system and the way that clinicians practise are very practice-based and very best-practice based, probably the best way to get closer to that would be to try to create a framework to say this is how the hospital engages with the business that wants to come in and innovate and provide a solution. This is how we go about structuring that so both sides are protected.

[Colin Carrie, Conservative, Oshawa, ON]

Do you think that's something though that should be part of medical school curriculum, just like a basic business course, to get people to start thinking in that regard?

[Dr. Steven Denniss]

In my experience, when you talk to medical students, right from the top down there is that culture of the big bad business just coming in to take the money. I think the culture could start to change so that they really think of businesses as providing solutions to real problems that exist in society, in medicine, in health care.

One of the problems you get right now—and different programs have said this, one of which is called EXCITE and comes out of MaRS—is really trying to get companies to work with health care groups throughout the process, because right now what happens is that a company guesses what the problem is in the hospital, pours $1 million into creating the thing, throws it over the wall, puts some savvy marketing and sales behind it, and hopes it gets adopted. It's trying to solve a real problem, but it didn't really have the requirements coming back from the hospital as to exactly what it needed so it could go and do its thing and create a product that could actually solve that problem.

That would be the ideal situation that you would get to. If you could build a framework within a hospital that did that and had the right procurement channels to make that happen, that would be something to aspire to, I think.

[Colin Carrie, Conservative, Oshawa, ON]

Mr. Gold.

[Irving Gold]

You raise a really interesting point.

I must say that things have changed significantly, at least in the seven years that I've been working with the faculties of medicine. I think the culture among emerging researchers and medical students is less about the big, bad, private sector. The notion that Canadians, in order to survive in the health care sector, must develop ethical, principle-based relationships with industry and leverage our intellectual capital and really commercialize that to the economic benefit of all Canadians—

[Colin Carrie, Conservative, Oshawa, ON]

Are you doing that right now?

[Irving Gold]

We are.

I think it gets under-reported and is not discussed enough. We're a small country so the numbers are never going to be the same as they are in the United States, just because of the numbers of medical students and faculties. We have emerging researchers, young and mid-career researchers, who are embarking on new, for them, relationships with industry. If you talk to the colleagues at Rx & D, BIOTECanada, and MEDEC, they'll tell you that one of the big barriers is that we've got some legislative hurdles that federally we need to fix in order to make innovation more possible and commercialization a little bit easier. We hear all the time, though, that in terms of R and D the federal government is investing quite a bit and it's the private sector that isn't stepping up to the plate enough. Their response to us has been that it has a lot to do with the legislative environment.

There are, particularly for those students who are interested in creating a research career for themselves, many more mentors than there used to be and many more folks who are encouraging that type of interaction.

[Colin Carrie, Conservative, Oshawa, ON]

Mr. Denniss mentioned barrier-free entrepreneurial innovation supports by the government that people don't even know about.

Do you work with your students and let them know that these things are available? Were you even aware of them?

[Irving Gold]

Yes. I don't, but faculties of medicine have people, particularly in the research environment, who in fact communicate that as broadly as possible, for sure.

For instance, we have a standing committee on research and graduate studies with all the deans of research on it. The deans of research across the country and in our faculties of medicine have very close contact with their industry partners.

[The Chair, Conservative, Joy Smith]

Thank you so much, Dr. Gold.

Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I wanted to go back to Dr. Gold on the area of HHR. Possibly the biggest key to keeping the system working is to look at HHR. Looking at HHR, not just from the point of view of physicians but from the point of view of other health care practitioners, is a mix we need to look at.

I am glad that you brought this up, because currently we just look at the gross numbers and everyone says, we don't have enough doctors or we have too many doctors, we don't have enough nurses or we have too many nurses. The supply and demand piece and a long-term study of what's going to be coming up—given that it takes 10 years to even graduate from medical school, never mind go out and do work which could be another four years—you have such a long time that we need to look at two generations. We also need to look at what the current areas and subsets in medicine are and where they go. The bottom line in some subsets of medicine is that we don't have enough people in the subsets and then we have too many people in other subsets.

There's the whole area of incentives. Could you talk about how we can look at incentives to getting people to go to areas they don't want to go to? How do you look at incentives of getting people not to go? I know that the pressure is great when you start off owing $100,000 to want to go into the specialty that's going to give you as much money to pay off your debt immediately. How do we find the ability to say, “Everybody is 55 now, so 15 to 20 years from now we will need more students to go into a particular specialty”? How do you see that happening? I know the database will help. What incentives do you see? You can't force a person to do something they don't want to do. You have incentives. What are the incentives?

[Irving Gold]

Steve can add to this.

As you were speaking, something very specific came to mind. We completed a study called the Future of Medical Education in Canada. One of the elements of that report was focused on the hidden curriculum. I want to mention that it's not only incentives. It's about eliminating disincentives and those aren't always the same. You can throw money at particular sub-specialties and you'll get a certain number following the money. But if you look at family medicine, for example, you will see that a lot of progress has been made, and a lot of that progress was less about money and was more about de-stigmatizing family medicine as a lesser profession. That's an inside job. That was done within the medical profession, within our faculties of medicine. It was something we did as a profession to help fix the problem. It's not always about incenting people. It's also about eliminating some of the disincentives.

I think incentives are equally important.

[Hedy Fry, Liberal, Vancouver Centre, BC]

And incentives need not be monetary, I'm not suggesting that.

[Irving Gold]

Right. But for instance, watching the demographics of Canada, I think there is the realization that we probably are not graduating enough folks who are going into geriatrics or care of the elderly. This was a very slow-motion train wreck that most of us could have probably predicted 10, 15 years ago. But geriatrics is facing, I think, in many ways, the similar stigma as family medicine. It's not particularly well paid. It's not seen as a particularly sexy sub-specialty. I think we will probably need to do in that area what we did in family medicine.

I'm sure Steve has a lot to add, but that's just something that jumped to my mind.

[Steve Slade]

The only thing I would add here is that the federal government I think has been quite innovative in two main areas with respect to specific programs. The Canada student loan forgiveness program, which is giving a break to rural family doctors and rural nurses, is an innovative approach that will make a difference. A couple of years ago the federal government also elected to fund family medicine residency programs in rural places—so actual specific funding for the residents in that training. I think it's that kind of innovative thinking.

And as Irving has mentioned, on this geriatric medicine thing, there are only 24 positions posted in that field of training. They don't fill. That's compared to several hundred pediatric training positions. I think there is a willingness there with our faculties of medicine to do this course correction, but the whole system has to come in line. So there's a role for the federal government to look at how we can help out the provinces, and how the provinces themselves can bring in incentives and programs that will make a difference.

[Hedy Fry, Liberal, Vancouver Centre, BC]

How much time do I have, Madam Chair?

[The Chair, Conservative, Joy Smith]

You have about two minutes.

[Hedy Fry, Liberal, Vancouver Centre, BC]

The student loan forgiveness, which I understand on the surface is a good thing, doesn't seem to be implementable or work well in practice. We've heard from the medical students, who say that a lot of them—as they go through medicine itself, the initial 10 years—don't want to have these big loans. So they take their loans and they put them into a bank; they take a bank loan to pay off their student loans. If that doesn't work for them, when they finish they're still looking at how they're going to pay the bank off. They don't want to go to Fort St. John to do it. They want to work in a big city with a tertiary care that's going to get them a lot of money.

How do you deal with that, which in itself is an incentive and, on the flip side of the coin, is a disincentive? How do you deal with that?

[Steve Slade]

I would suggest that you are in a transitional time right now. I've heard the exact same story. A lot of students contacted us when the program came into effect and they said, “I transitioned my loan to a bank” or “I talked with another organization and I got what looked like a good deal at the time. I heard from the Canada student loans people saying we would love to help you, but you actually no longer have a student loan that we can forgive.” I think you're in a transition. I think that when the word is out on the street, people, before they give up their Canada student loans, are going to find out if they would qualify for the program.

But I think really the take-home message is to look at that kind of role. Because we had tons of feedback from undergraduate deans and from students saying, “I want that, I will do that, I will go out and do a residency in a rural place because that's going to help me with that loan.” With that kind of innovative thinking program-wise, I think it may take a few years to see the benefit, but I think it will happen.

[The Chair, Conservative, Joy Smith]

Thank you so much.

We'll now go to Ms. Block.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

I'd like to thank all of our witnesses for being here today. You can certainly tell how there is much overlap in all of the issues that each one of you have identified. You can talk about one piece when it comes to being entrepreneurial in health care and recognize that it takes folks at many different tables to make that happen.

I want to follow up on your comments, Mr. Gold, in terms of legislative hurdles. You may be aware of the Red Tape Reduction Commission and the fact that we are looking at ways to reduce legislative and regulatory burdens on different sectors and industries. I'm wondering if you would be able to give me some examples of legislation that is creating a hurdle for entrepreneurship in medicine.

[Irving Gold]

I wish I could. What I was sharing with you was what our industry partners are telling us. I would not be equipped to identify either the problems or proposed solutions for those. My point was merely that we are at the table as faculties of medicine and we are encouraging our researchers to engage with industry. What we're hearing, at least from our industry partners, is that the lack of commercialization is not about not finding willing partners in our faculties, but that there are other factors that are impeding that process. I guess that was the reason I brought that up.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Okay. Thank you.

I guess, then, what I'd like to follow up with is, you made reference to a national data and analysis centre, but then also to the need for a health human resource plan, and also to the federal government's role in planning. I'm wondering if you see that there's a significant difference between the centre for national data and analysis and the actual planning that you've referenced.

[Irving Gold]

Absolutely. We are not proposing any federal role in health human resource planning. This is clearly a provincial issue. But we are saying that the federal government could be enabling, a tool that all jurisdictions could contribute to and draw upon to inform their own provincial process. We are very clear about the jurisdictional issues and know that asking the federal government to take a planning role would be a non-starter.

But what the jurisdictions have told us—and we've now spoken to all jurisdictions—is, if what you're talking about is creating a place were we can—I'm going to oversimplify—upload our data, our needs within our population, the demographic information of our population, help you do national trending, and also allow us to upload our supply and how that's changing, and if that will allow you to create a national picture that we can then take into account as we plan, we would love that.

But the centre is not about telling provinces what they should do, it's about saying, “Well, if you're going to produce 10% less of this, you should know that your neighbouring provinces, which you draw the most upon, are also producing y and z”. It's about sharing that information, because right now the jurisdictions are not aware, necessarily, of who's producing what, what the needs are, and what the needs are going to be in 5 to 10 years. That's the challenge. This is really about information flow. The precedent with things like CIHI exists where the federal government helps in terms of national data and analysis, even, but we are stopping at that point.

Thank you for the opportunity to clarify.