Thank you very much.
I don't need to remind anybody sitting around this table that Canada is a vast country, but I wanted to share with you some specific statistics, courtesy of the Society of Rural Physicians of Canada.
One in seven rural physicians plans to leave their community within the next two years, threatening already underserviced areas.
Of Canada's 10 million square kilometres, 99.8% are considered rural by definition.
Nine million Canadians, which amounts to 31.4% of all Canadians, live in those rural areas.
Towns that account for a population under 10,000 are 22% of Canada, but are served by only 10.1% of Canadian physicians, so they have less than half the ratio they should have.
Larger rural and regional centres—that's between 10,000 and 100,000 population—constitute 15.9% of the population but have only 11.9% of Canada's physicians.
So right there, half of all Canadians are underserviced.
The doctor shortage is a severe problem. Many people are working hard to help. Both Dr. Ballagh and I have sat with Barrie's member of Parliament, Patrick Brown, on a physician recruitment task force, trying to attract doctors to Barrie, but the problem isn't going to be solved overnight. Yet in the meantime, things can be done to help these people. A lot of patients do not have family doctors, and as a specialist I'm concerned that they also then don't have access to specialists such as me, because you need the family doctor to access the specialists, especially in these remote areas.
This problem doesn't have to be as severe as it is, however. With the connectivity of the modern world, allowing everyone to be linked by things like e-mail and text messages, Facebook, Linkedin, Twitter, and Skype, there's no reason that these people can't access their specialist and their family physicians remotely. The technology exists today. This isn't something that has to be developed in the future.
I provide a few examples.
There's simulated training whereby primary care physicians working in rural areas don't even need to have the specialist on hand. They can learn the critical skills they need to have remotely by using simulated patients. These patients will breathe, moan, move, and verbalize, they can be intubated, they can be given medications, they can have tubes inserted into the various cavities in their bodies, and they will respond appropriately. So if mistakes are made, the lessons will be learned. This kind of training allows rural physicians in remote areas to learn the kinds of skill sets they need.
There's also remote video resuscitation. You don't always have to have a physician present. Many places don't have physicians on staff there. These resuscitation teams consist of nurses, maintenance staff, health attendants, and even members of the community—anybody who's interested in participating in that kind of a team.
Cameras can be used and are aimed at both the patient and at the equipment, and the physician from a remote area will offer the advice and the direction of where the resuscitation needs to go.
There's also robotic telemedicine, specifically in Nain, Newfoundland and Labrador, which is the most northern community in that province. There are no physicians on site, but there's a robot named Rosie. She's 165 centimetres tall, so just a little taller, I think, than I am. She has a screen for her face, and she has two-way audio and video capabilities so that a physician in a remote area can use a joystick and have her move from patient to patient; interact directly with the patient; see what she needs to see, whether that's looking at the patient or the pill bottle or the chart; and can offer the needed advice.
Doctor in a Box is something that can be carried to various places, such as the EMS teams when a physician will not be at the scene when an ambulance picks them up. It will be able to see not only what's going on, but will be able to receive the telemetry from the heart rhythms picked up and will be able to provide advice to them directly so that the patient is getting expert care right off the bat.
Surgical robotic systems are another thing that can perform surgery remotely using state-of-the-art robotics. Those types of systems tend to be reserved for large academic hospitals, but less impressive systems can still be employed elsewhere in remote regions where surgeons with expertise can simply monitor what's happening with the OR, using two-way audio and video capabilities. So a surgeon with a greater skill set can instruct and advise a surgeon with a lesser skill set who's physically on the scene. They can see the operative field and they can see what's happening with the patient.
Finally, there are telehealth consults. As a cardiologist, I would say 90% of the diagnoses I make are taken from the patient's history. Although performing a physical exam is helpful, it's not always so critical to be able to offer care to these patients. If I had the ability to interact with them remotely and had an echocardiogram whereby I could see the images done by a skilled technologist, I'd be able to help these patients impressively.
You'll see that most of these technologies have two-way audio-video capabilities.
Rosie and Doctor in a Box aren't as widespread as I think they need to be in a country like this. And nothing I've described here uses any technology that doesn't already exist. This would allow people like me to run remote clinics all over the province, all over the country, and I think all these patients deserve this kind of access. In a country as great as Canada is, but as vast as Canada is, I think one goal for our country is to be able to provide everybody, no matter where they live, that kind of access to care, both primary care and specialist care, and with these sorts of technologies, that can be done.
Thank you very much for your time.