Mr. Chair, committee members, thank you for this committee's work on this very important topic, and the opportunity to present today.
The Royal College, as Marc Lalonde called it a number of years ago, is one of the best-kept secrets in the country. We're trying to open our kimono and share our perspectives and the expertise of our more than 40,000 members, where we support their continuing professional development and set the standards for their training in 65 medical and surgical disciplines.
We were founded by an act of Parliament in 1929, and since then we've overseen the certification of medical specialists in Canada. We also support health system innovation nationwide, and we participate in a number of pan-Canadian initiatives, such as being a member of the FMEC PG consortium, which Dr. Moineau described.
Much like the College of Family Physicians, we've also embarked on a major transformation of how we train doctors in this country. Ours is called competence by design, where we're moving away from a time-based educational system, to a more competency-based system set with milestones, which will cover medical education from residency to retirement. We're confident that this will better ensure that our future specialists are nimbler in order to meet patient health care needs, and indeed, adapt to the ever-changing health care environment that this committee is currently trying to tackle.
We know that scopes of practice of health professionals are constantly changing, including those of physicians, in response to numerous factors such as health workforce shortages, increasing patient needs, and scientific and technological discovery. We know that roles are constantly changing. It wasn't until the 1950s that nurses at what was then called the Ottawa Civic Hospital right near here could carry out tasks like taking blood pressure, giving intramuscular injections, or even administering intravenous antibiotics. Only a physician could do those things.
Because health care delivery approaches are in constant evolution, new professions are also emerging, such as physician assistants, as our interprofessional care models. As the scope of health professionals outside medicine expands to encompass a wide range of roles in varying levels of clinical judgment in the diagnosis and treatment of patients, the Royal College supports and believes they are playing an important role in patient care and helping to improve access.
While we all benefit from these new ways of doing things, we also recognize that precautions have to be in place to ensure the safety and well-being of patients, as everyone has mentioned so far. This is particularly important because there are so many different definitions in the scope, admission, educational requirements, and regulatory oversight among health care professionals in Canada.
While there are many pan-Canadian standards for medicine, as described by my colleagues today, such is not the case for many other health professions. For example, pharmacists can order and interpret lab tests in Alberta and Manitoba, but not in British Columbia and Saskatchewan. They can initiate drug therapy in Ontario and New Brunswick, but not in B.C., Prince Edward Island, and Newfoundland.
Even with the emerging physician assistant profession where there are honest efforts to establish pan-Canadian standards, the University of Manitoba offers a graduate degree, but McMaster University offers an undergraduate degree. Physician assistants are a regulated profession in Manitoba, but not in Ontario.
Better coordinated approaches to the regulation of health professions not only helps assure pan-Canadian standards for education and practice, and hopefully safer, high-quality care. The very act of regulating a profession also supports data collection that can inform quality improvement and planning.
The scope of practice of every health professional should always be consistent with quality skills training and education throughout the continuum of practice. So we have to be mindful of evaluating the quality of the educational programs that lead to entry to practice and throughout their continuing professional development.
The scopes of practice of all health professionals should be the subject of not only high standards of education, but we also have to have the regulatory oversight, because this is all the more important because of the mobility of the workforce across the country. We don't want a health professional trained in one jurisdiction to arrive in another jurisdiction with slightly different skill sets. It's not in the interests of patients and it just makes the system so much simpler to control.
Understanding the nature of scopes of practice will not only help us assure patient safety, but it will also help us better understand the impact on care, health outcomes, and how we plan our workforce in our health system. We've conducted some research that showed that interprofessional practice models and changing scopes of practice are having a direct impact, not only on health care delivery but the number of physicians we need in this country. Conversely, there's likely that ripple effect across other health professions. More disconcertingly, as we have seen the evolution of different health care roles, we are now seeing—and are continuing to see because our research is ongoing—that there is an increase in the unemployment and underemployment of physicians. This is not necessarily a bad thing if we can better assure that we're training the right people to do the right things.
I'll give you an example. With the introduction of anesthesia assistants, who are increasingly in demand by anesthesiologists, we can see that the number of anesthesiologists we need in the country could be reduced by half. There was a study carried out in 2010 of physician assistants working with orthopedic surgeons in an arthroplasty or joint replacement or repair clinic in Winnipeg, and PAs helped reduce wait times and increased the number of surgeries that an orthopedic surgeon could do. But we haven't translated that into a more cohesive approach to planning our services and the number of workers we need.
New roles have also been emerging among advanced practice nurses, which substitute or complement the work of physicians. Nurse practitioners not only play various roles in primary care, they're also practising in acute care settings in hospitals and they assume a wide range of roles such as providing care for acutely critically ill patients with complex conditions. Advanced practice nurses can also specialize their focus within a particular disease or medical subspecialty, such as neonatology, cardiology, psychiatry, and palliative care, among others.
Evaluation of scopes of practice should be built into appropriate territorial and provincial regulation to ensure that these changes are actually having the intended impact, such as improving care, more efficient cost-effective delivery of service, and positive patient health outcomes. But we don't know that. Sharing of knowledge and research on these and other performance measures among all of us is crucial to continued advancement of quality in Canada's health care system and the judicious use of our human and financial resources, and here, the federal government could play a role.
Building on its research about physician employment challenges, the Royal College has begun planning with other health professional organizations and researchers further research about scopes of practice in medicine and in other health professions, notably nursing. This is a large-scale endeavour and its contribution to building a body of evidence and information to inform public policy and health system planning will only accrue with proper financial support.
When we think of the way forward, I see unemployment among physicians, as we recently observed through our research, as symptomatic of ongoing inadequacies in health workforce planning in this country, including planning and properly educating who does what. Although there are many constructive efforts to improve our approaches to plan and regulate the workforce in Canada, gaps remain. Our research and that of others has shown that planning at the profession-specific level will only perpetuate current problems that hinder timely access of Canadians to high-quality and safe care. This also impedes, as I said earlier, letting workers work to their fullest potential.
We must not only look at the number of health care professionals and population health needs, which are usually the predominant elements in how we plan health services in the health workforce in this country. We've learned that, when planning health care delivery and its workforce, it's equally important to understand and consider the effects of interprofessional health care delivery models and the availability of resources such as OR time, but also the changing scopes of practice, and how they're educated and regulated throughout their professional life cycle.
We have a number of pockets of excellence, such as those emerging from the physician resource planning task force. We have a growing body of data and evidence and a keen interest by many to collaborate, but there's no locus to bring us together. The Royal College and so many others, if you go back to all of the submissions to this and other committees, have long hoped for a national human resources for health strategy and federal leadership to convene, facilitate, and support the gathering and analysis of data and to help with knowledge translation at a pan-Canadian level to support provincial and territorial endeavours in health and workforce planning and development. The long-standing call for a pan-Canadian or a national human resources for health institute or agency would serve to garner the benefits and strengths of the learnings, evidence, and experiences from provinces, territories, professional agencies, and researchers.
The interest of the Standing Committee on Health in scopes of practice of health professionals is heartening. We truly appreciate the opportunity to share our research findings and our recommendations on the way forward.
Merci beaucoup.