Evidence of meeting #74 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was services.
A recording is available from Parliament.
5:05 p.m.
Conservative
5:05 p.m.
Liberal
Wayne Easter Liberal Malpeque, PE
Thank you, Madam Chair.
Mr. Dibble, before I get to another question, I'll give you the opportunity to respond to the question I asked you previously about what the federal or provincial governments could do, from either a policy or a financial perspective, to get us further down this road.
5:05 p.m.
Cardiologist, As an Individual
Thank you. I did actually try to sneak that answer into another answer.
I think one thing that would be very helpful, since these technologies cost money, is that rather than necessarily relying on communities and co-ops trying to pay for them, perhaps there could be federal grants or programs through which these rural communities could apply for the funds to bring those sorts of technologies into their communities. Obviously, health care is a provincial issue, but a federal grant program could certainly offer people a Rosie, or a Doctor in a Box, or adequate telehealth, so that someone like me could do a stress test and an echocardiogram and see a patient all in one fell swoop.
5:10 p.m.
Liberal
Wayne Easter Liberal Malpeque, PE
Both doctors have mentioned how you can use telemedicine and other technologies to use nurses in a remote area, or just three blocks down the street in Toronto, for that matter. In terms of your own time as specialists, you already are extremely busy, so when there is an opportunity to help in a situation that's further afield, how do you manage to schedule that in? That has to be a problem.
You have your own patients in your local practice for sure, but when you're doing remote medicine, whether it's in Nain, Labrador, or wherever it might be, how do you manage that? Also, is there a way of creating greater efficiencies in that area?
I think Mr. Dibble said earlier that one of the problems for a rural doctor is that they're the only one there, they're on call 24/7, and they eventually wear out. I've seen that happen with my own doctor. So how do you not put yourself in the same position, as a doctor, when you're doing your stuff in your own practice and this remote stuff? How do you see creating some efficiencies so that we don't end up burning out the specialist too?
5:10 p.m.
Cardiologist, As an Individual
I'll speak briefly to that. I think one thing is trying to make sure that doctors don't have to spend as much time on the road actually travelling to rural areas. For example, right now Dr. Ballagh drives to Kirkland Lake to provide services there. The time he spends driving could be spent seeing patients. I think making sure that the technologies are there, so that you don't have to physically be in the room, will create some time there.
Obviously, any community that is using doctors for remote areas has to have enough doctors, so that you're not taking away from that community. For example, right now I am the only cardiologist in my hospital. It would be tough to spend one day a week in a rural community. But we're working hard on recruitment, and I am very confident that by the end of next year we'll have plenty of cardiologists in my community. We're already talking about outreach programs. Rather than driving an hour in this direction or that direction, I'd rather just spend the time, if I could, remotely, so that we could save the time in the car.
5:10 p.m.
Assistant Clinical Professor of Surgery, McMaster University; Adjunct Professor of Otolaryngology, University of Western Ontario, As an Individual
Very briefly, we need more bodies. It's interesting that in the public eye, the physician shortage is all about the family doctor shortage, because of the problems we've talked about, but we have a shortage of doctors in specialties as well, or maybe we don't have a shortage of those doctors now, but we have a shortage of resources to actually put those doctors to work. You've read about orthopedic surgeons, who are graduates, who can't find operating room time. Some of these guys are doing calls at our hospital on weekends to get in with our group, so that when operating room time becomes available they can actually have a job.
I sit on the national council for my specialty. We received a report last year that currently we're training 30% more ear, nose, and throat doctors than we're going to have resources for when they graduate. In other words, there aren't going to be enough resources like operating room time, clinic time, nurses, or hospital resources for those doctors to actually have surgical work. But you're right; we get overwhelmed. I'm working in four different communities.
To answer your question, we just have to manage our time very, very carefully.
5:10 p.m.
Liberal
Wayne Easter Liberal Malpeque, PE
It's certainly something for the committee to ponder, Madam Chair.
I'll let somebody else have a turn.
5:10 p.m.
Conservative
The Chair Conservative Joy Smith
I think we'll stop the pondering right now, but that's a very good comment, absolutely.
Since we have a few more minutes, we'll go back to the seven-minute round and begin with Dr. Morin.
5:10 p.m.
NDP
Dany Morin NDP Chicoutimi—Le Fjord, QC
Thank you so much.
My next question is for Dr. Dibble. Earlier you mentioned that it would be a good idea to have a federal grant program for medical infrastructure and for new technology. I'm not against it, but when we talk about asking for more money, one question comes to mind: what kind of number do you think would be enough for that federal grant program, and where should we take the money from?
In terms of our current economic situation in Canada, money doesn't grow on trees. So we need to either cut something else.... If you have a suggestion as to where the federal government should move money around, I want to hear it.
5:15 p.m.
Cardiologist, As an Individual
It's difficult for me because I can't say I understand all the financial workings of the federal government.
5:15 p.m.
Voices
Oh, oh!
5:15 p.m.
Cardiologist, As an Individual
The closest experience I have to this is I sit on the AED committee for the Heart and Stroke Foundation of Ontario. On an annual basis we read all the requests for AEDs to be put into communities, and we made the decisions as to where they went.
One thing that can be done.... It may not necessarily be a request for funds, because you don't necessarily know how those funds are going to be used once they go into a global budget of a community's facility. Perhaps it could be a request for a Rosie or a Doctor in a Box.
It's difficult to know where that money will come from. I often ask what you would rather live without, your heart or your lungs. You need both. You can't do without either, although you can live deaf, I like to point out to my colleague Dr. Ballagh. It's not necessarily a nice life, but....
5:15 p.m.
Conservative
5:15 p.m.
Cardiologist, As an Individual
I think I'd give cardiologists' the first right to be able to say something like that.
Anyway, the funds have to be there. Most people feel that health care and education are two supremely important things. We just have to make sure we use the funds we have available for those things as wisely as possible.
Just because some people chose to live north of the French River, for example, they shouldn't have access to health care. They're Canadians, after all. We need to make it as feasible as possible.
We don't want to mandate doctors like me to go up there who won't be able to function as a cardiologist full time, but maybe they could make it so that I work from my own community back home.
If these communities can appeal for those sorts of technologies, that's great. That's money very well spent. I'd have to see the whole budget to know what else you should cut, though.
5:15 p.m.
NDP
Dany Morin NDP Chicoutimi—Le Fjord, QC
Thank you very much.
My next question is for Mr. Béland.
A lot of people are indeed becoming more familiar with the health cooperatives concept. In English, we hear more about community health centres. These are quite similar health care models. They may even overlap. Since you are a pan-Canadian organization, I would like you to tell us more about this system, and especially about the community health centres.
5:15 p.m.
Communications and Programs Manager, Conseil canadien de la coopération et de la mutualité
In some provinces, the community health centres are equivalent to some degree to the CLSCs, the local community service centres. They are really a public system. It is interesting to note that Alberta is considering the creation of family care clinics and is studying the possibility of adopting the cooperative model.
Also interesting, the four Saskatchewan cooperatives are a part of the community health centres network and of the public network. The democratic process is what differentiates a cooperative model organization from one that is not built around that model. In the first case, the population, the members, are involved. Often they make a financial contribution, small or large. The fact is that members become the owners, to a certain extent, of their health development tool, in their community. And so, there is more involvement on the part of those members.
Members of cooperatives believe in the collective responsibility for health, but also believe in personal responsibility. The principle is that people should be involved in fostering their own health, and learn to manage it themselves. You can see the difference. Generally speaking, the additional services involve prevention, essentially because people want to help each other out. Rather than using a program or a standard approach that allocates funds to a specific purpose, the model trusts the communities and allows them to determine their own needs themselves. In a lot of cases, their solutions really meet their needs, since they are the ones who know what they are. That is the difference we have observed.
5:20 p.m.
NDP
Dany Morin NDP Chicoutimi—Le Fjord, QC
Okay, I'll be quick.
I think that a lot of people are afraid of cooperatives because they are under the impression that they provide medical care that should be free. Can you reassure those people so that they really understand the usefulness and complementarity of cooperatives?
February 14th, 2013 / 5:20 p.m.
Executive Director, Conseil canadien de la coopération et de la mutualité
I am a member of the Aylmer cooperative. It has 9,000 members. Every year I attend the annual general meeting.
I asked one physician why he worked at the cooperative. He replied that it was because the services he receives from the cooperative allow him to put the emphasis on his medical practice, rather than having to deal with administration, reports, and all of the red tape that involves. He added that he really wanted to practice medicine. So they try to give people the opportunity of putting the emphasis on what they do best: practice medicine.
5:20 p.m.
Conservative
5:20 p.m.
Conservative
Patrick Brown Conservative Barrie, ON
Thank you.
One question I wanted to get in, and I didn't get a chance in my initial round, is with regard to international collaboration on research. I know one of the vehicles for innovation is certainly health research, and we do a lot of that with the federal government through the various federal agencies, like the CIHR. I want to know if you think there are adequate levels of collaboration in the research community. I can think of one example, and I've mentioned this before to a different panel. It's the artificial pancreas project, which the Juvenile Diabetes Research Foundation did in Hamilton and Waterloo, and there was a similar research effort in Australia. I'm sure research is being done across the board in each country on similar topics.
Is it your experience that an adequate level of collaboration exists in research in the medical communities?