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.
4:55 p.m.
NDP
Matthew Kellway NDP Beaches—East York, ON
All right.
To Dr. Dibble and Dr. Ballagh, regarding the application of innovation and technologies that you guys are using out in rural communities, is there any reason this doesn't apply to urban health care as well?
4:55 p.m.
Cardiologist, As an Individual
No, I would say there is no reason, especially if there are difficulties, as you describe, of having to wait six months despite being in Canada's largest metropolis. Anybody should be able to access this.
I think where the biggest problem is and what those statistics I revealed from the Society of Rural Physicians speak to is that Toronto still has a greater percentage of doctors per capita than the rural areas do. That's why I focused on that. But truthfully, that's right; anybody should be able to access this if they need it.
4:55 p.m.
Assistant Clinical Professor of Surgery, McMaster University; Adjunct Professor of Otolaryngology, University of Western Ontario, As an Individual
I would just say, on the doctor shortage front, that our community grew at a terrible time. We grew at a time when we had cut the number of medical school slots in our province. We were just starting to see the effects of those cuts when we actually started to have our massive growth. So at our worst, 35% of our population didn't have access to a family doctor, and as a consequence they were all getting their total medical care—their annual checkups, and Pap tests for ladies—through the walk-in clinics and the urgent care facilities.
Ours is the second-busiest emergency room in the province of Ontario. It's not in downtown Toronto or downtown London. So there are urban places where these kinds of crises are happening, and we're in the middle of one of them in Barrie. That's part of the reason that's our passion with regard to the doctor shortage.
I was previously the chair of our physician recruitment task force, and when I first moved to Barrie it was not something I would ever have imagined us needing. I can say to you that we have really had to innovate to get our doctors on board.
In terms of technology, I can see the emergency room of our hospital from my office, but there are three traffic lights between there and my office, and I have to get parked. For me to run to emergency to see a patient versus having the technology to show me what the patient looks like can save me that dash and can sometimes save the patient's life. There is no difference between rural and urban when it comes to that kind of technology and that kind of communication.
4:55 p.m.
Conservative
David Wilks Conservative Kootenay—Columbia, BC
Thanks, Chair, and I thank you people for showing up here today.
Dr. Ballagh, it was interesting to hear you talk about the armed forces and the physician extender. My son was over in Afghanistan for the last combat mission. He's a combat engineer, so he deals with all the IEDs. He likes to find things and blow them up, and hopefully not get blown up himself.
With regard to that, I'm curious about your type of service when it comes to the remoteness. Is that something, with your specialty in the inner ear, you could deal with? That could be a problem for a combat engineer if he or she gets their bell rung. Is there remote technology available where you could, for instance, be in Barrie and deal with something in Afghanistan? If someone were able to contact you through that remoteness, could you deal with it and guide them through it?
4:55 p.m.
Assistant Clinical Professor of Surgery, McMaster University; Adjunct Professor of Otolaryngology, University of Western Ontario, As an Individual
First of all, can you thank your son for his service to our country? I try to do that every time I meet a new military person I work with.
5 p.m.
Assistant Clinical Professor of Surgery, McMaster University; Adjunct Professor of Otolaryngology, University of Western Ontario, As an Individual
In terms of remote access and that kind of transfer of information, I can say that we, as preceptors for these physician assistants and for some of the physicians in the military, are often asked via e-mail, months or years after, questions about patient care and that sort of thing.
In terms of direct contact at this point in time, those things are evolving, but they're not happening right now. They're not happening as quickly as they could be. For that physician extender who's on the front line in Afghanistan who has a patient with a neck wound that is bleeding, right now it's very difficult for them to show that to me back in Barrie.
5 p.m.
Conservative
David Wilks Conservative Kootenay—Columbia, BC
It would seem to me that through the federal government there may be an opportunity to do some R and D on that. Certainly for our men and women in the armed forces, when they're in harm's way thousands of miles away and something bad does happen, those minutes and seconds count.
5 p.m.
Assistant Clinical Professor of Surgery, McMaster University; Adjunct Professor of Otolaryngology, University of Western Ontario, As an Individual
The learning goes two ways. I had one of our elite soldiers who's also a medic come and work with me on a Saturday. I don't normally oblige them to come in on a Saturday, so I thought I'd give him a cup of coffee and teach him something.
I gave him the scenario that an IED had gone off, his Buffalo had turned upside down—that's their ambulance—and he had to do a cricothyrotomy because the patient had an emergency airway obstruction. I asked him to tell me what steps he would go through. He said, “Dr. Ballagh, in the three that I've done, this is what I did.” I don't mind telling you that as a certified specialist in ear, nose, and throat, I've not done one. I actually learned from him that day, so the transfer of information goes back and forth.
5 p.m.
Conservative
David Wilks Conservative Kootenay—Columbia, BC
That's cool.
Dr. Dibble, I'm intrigued with this Doctor in a Box, and Rosie is another thing that is pretty cool, especially for rural living.
The defibrillators that we've been able to put in every recreational facility across Canada, more or less, have probably saved tens of hundreds of lives since their emergence. It would seem to me as though the Doctor in a Box concept in emergency vehicles, whether it be in ambulances and/or police vehicles, may be of assistance to those who are first responders when they get into a situation where they're in trouble and they need help very quickly. Do you see that as an emerging opportunity for first responders in ambulances and/or police officers who have very little capacity when it comes to medical understanding but could be talked through something?
5 p.m.
Cardiologist, As an Individual
Yes, absolutely. I think it could be used by any kind of first responder who has the ability to deal with a crisis situation but may not have that medical expertise to deal with it.
The automatic external defibrillators you talked about that are across the country are great for anybody who has succumbed suddenly to a cardiac abnormality, but that's not what everybody needs emergency access for. The AED will not provide any help to somebody who does not have one of those rhythms that needs to be shocked, whereas the Doctor in a Box will be able to help assess the situation and provide guidance.
An ER physician with trauma expertise could help by talking to the people who have the ability to be guided remotely on how to deal with the crisis at hand. I'm not sure it would work as well as an AED on the wall, and the public may not have the ability to respond to talk from a doctor like that, but police, fire, and EMS services for sure would be able to benefit from that.
5 p.m.
Conservative
David Wilks Conservative Kootenay—Columbia, BC
In my 20 years as a policeman I came across a lot of interesting things. I just see this as a huge opportunity.
5 p.m.
Conservative
The Chair Conservative Joy Smith
Mr. Wilks, I'm going to take this huge opportunity to tell you that you're out of time.
I'm sorry about that because I love your questions.
5 p.m.
Conservative
David Wilks Conservative Kootenay—Columbia, BC
I'm going to take this huge opportunity to thank you.
5 p.m.
Conservative
The Chair Conservative Joy Smith
Mr. Wilks is a true gentleman. He carried all my bags on the way to committee today. He not only does that for me, he does it for other ladies too—just when they have heavy bags.
It's hard to cut off a gentleman like that, but there you go. I'm a hard-hearted person, Mr. Wilks.
Dr. Carrie, you're up next.
February 14th, 2013 / 5 p.m.
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you very much, Madam Chair, for the opportunity to ask a question.
I do want to thank my colleague Mr. Lobb.
I think you do have a future in consulting.
You know, when I look at the co-op model, I can see how the model would give control to local communities. In Canada we have such diverse communities.
We've heard about first nations communities. Different communities, like first nations, for example, might want aboriginal healers. They might want chiropractors, more natural healers. They may have issues with respite care, home care.
Could you maybe give an example to the committee of how a cooperative model might be very innovative, if these communities decide this is a way they could attract physicians, attract human health resources?
One of the things we hear over and over again is how difficult it is to attract human health resources to these communities. Could you give us an example of how the co-op model would work in a situation like that?
5:05 p.m.
Communications and Programs Manager, Conseil canadien de la coopération et de la mutualité
I am going to try to be as clear as Mr. Lobb.
Let's take Saskatoon as an example. There is a health cooperative there that has decided to offer additional service to aboriginal persons, service that is adapted to their needs, because no public service was doing that. They decided to do so using the resources of the cooperative.
I will give you another example. In northern Quebec, there is a project to serve the needs of the Inuit using cooperatives. The local cooperatives have decided to offer health prevention services that include health education, because this is a considerable challenge among the Inuit. This is being done according to the cooperative model. The public service was not offering such services, and so they used the cooperative model in order to provide these targeted services.
I find your comment about involving citizens very interesting. To express things in the simplest way, the health cooperative model implies that citizens decide to provide additional funding in order to have additional services, or to have greater access to services. Those citizens decide how they will do that. So this is a vector for innovation. Citizens decide to look at the innovations needed to meet their own needs, since the public services alone are not managing to do that. They reinvest and go and get what they need to target the public service to the needs of the community, and they foot the bill.
5:05 p.m.
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you very much.
I have another question.
One of my colleagues brought up the Canada Health Act. I am curious. Do some provinces not recognize co-ops? Are there any challenges as to how this model is interpreted under the Canada Health Act?
5:05 p.m.
Communications and Programs Manager, Conseil canadien de la coopération et de la mutualité
All of the provinces recognize cooperatives in general and they recognize health cooperatives. How is accessibility interpreted? Does the contribution of one member influence that? I will give you a very concrete example.
In Nova Scotia, there is a telemedicine service. Members are asked to pay $10 to cover the costs of the technology. The province accepts this without any problem, whereas other provinces might interpret the situation differently. It is difficult, because cooperatives are managed by volunteers. They have to be able to interpret what is acceptable and what is not properly. There is indeed a grey zone.
In Quebec, as I mentioned, the cooperative movement has led to very specific guidelines, in order to ensure that things are well understood.
5:05 p.m.
Conservative
Colin Carrie Conservative Oshawa, ON
I have a real quick one.
I was curious about working with physician assistants. I've heard a lot about them and how they can really be helpful. You said they don't have the autonomy; they do have to work under supervision.
Is there a way they are remunerated, or do they have to be remunerated through the family physician? Are they able to bill provincial programs?
5:05 p.m.
Assistant Clinical Professor of Surgery, McMaster University; Adjunct Professor of Otolaryngology, University of Western Ontario, As an Individual
Very briefly, the forces remunerate our Canadian Forces physician assistants. It's a model that has slowly started to percolate into the civilian sector. Manitoba, in rural medicine, is using physician assistants. In Ontario, they're getting contracts through separate contracts with the Ministry of Health.
In Kirkland Lake, in the emergency room, we have one of the physician assistants I trained from Borden, who now works in the civilian sector. He provides a model of practice for the other civilian physician assistants. There's a program at McMaster University in civilian physician assistants, so he provides a model for young physician assistants.