Good afternoon.
Thank you, Mr Chair and members of the committee, for inviting me to speak to you today as you explore the role of the federal government in the practice and training of health care professionals.
Before speaking to the topic at hand, as the representative of the Canadian Federation of Medical Students, I would like to take a few moments to introduce our organization.
The CFMS represents more than 8,000 medical students from 14 Canadian medical schools coast to coast. We represent medical students to the public, to the federal government, and to national and international medical organizations. As the national voice of medical students, we connect, support, and represent our membership as they learn to serve patients and society.
I am here today in my capacity as president of the CFMS. I'm also a fourth year medical student at McGill University in Montreal.
I would like to start by reviewing the current process by which physicians in Canada are trained.
A potential doctor in most provinces in Canada is required to complete an undergraduate degree prior to being accepted into medical school. Medical students usually then complete four years of studies before graduating as doctors. They then complete additional training, referred to as residency, in their specific field of interest. Residency in family medicine is an additional two years, whereas specialty training is usually five years. Additional sub-specialty training is often required for a physician to be hired in an academic centre.
The implication of this system is that medical students can study in one province, complete their residency training in another province, and ultimately be hired as staff physicians in yet another province. As a result, there is an opportunity for federal leadership in the development of a robust supply-and-demand model for health care professionals.
The CFMS would like to commend the federal government for its ongoing support of the Physician Resource Planning Task Force, PRPTF. Through the work of this group, the government is helping to address an imbalance of unemployed or underemployed specialist physicians against a continued shortage of family physicians, especially in rural, remote, and northern communities. The CFMS believes there is a need for ongoing modelling of physician supply-and-demand projections in order for medical students to make informed career choices that best serve the Canadian population.
We support the recommendation of the PRPTF for the establishment of a pan-Canadian physician resources planning committee for continued collaboration on this issue. The CFMS also commends the Government of Canada for its support of the transformation of medical education through the Future of Medical Education in Canada projects. These programs, if realized to their full potential, will result in better physicians who are more responsive to the health needs of Canadian society and better equipped to improve health, enhance quality of care, and secure a sustainable health system.
While there has been progress towards a more equal distribution of physicians across Canada, there are still significant challenges. In 2012, the Canadian Institute for Health Information reported that 18% of Canadians live in rural and remote areas, while only 8.5% of physicians work within these regions. These distribution issues underlie the 2014 Commonwealth Fund finding that placed Canada last in terms of timely access to care when compared with 10 other OECD nations.
The Government of Canada has made positive steps towards correcting the maldistribution of physicians across the country. An example of this progress is the Canada student loan forgiveness for family doctors and nurses program. This initiative allows family doctors or family medicine residents in a rural or remote community to benefit from up to $8,000 of federal loan forgiveness per year to a maximum of $40,000. As of November 2013, this program had enabled more than 1,150 family doctors and nurses to receive some loan forgiveness.
While this program represents a positive step towards providing rural Canadians with better access to care, the CFMS believes that this program is not operating at its full potential. The barrier to maximizing the number of new family doctors taking advantage of the program lies in ensuring that they have outstanding federal government loans when they are in a position to take advantage of the program. That means that you still need to have Canada student loans at the end of your medical training.
It is helpful to know that medical trainees are required to begin payment of principal and interest on federal loans during their residency. The interest rate charged on loans through the Canada student loan program is significantly higher than that charged by major financial institutions for other professional student lines of credit. For instance, the interest rate on Canada student loans is currently set at prime plus 2.5%, whereas a medical student line of credit would be set at prime.
As a result of this difference in interest rates, most medical residents choose at the start of their residency training to consolidate their Canada student loans to a line of credit from their financial institution. This shift of debt significantly reduces the incentive that has been created to draw new doctors to rural and remote communities. Simply put, residents and family physicians who no longer have outstanding debt on a Canada student loan are no longer eligible for the debt relief program.
The program would be significantly improved if the federal government were to delay repayment of principal and defer interest accrual on Canada student loans until after the end of residency. As a result, many more physicians would be able to participate in the Canada student loan forgiveness for family doctors and nurses program, and Canadians in rural, remote, and northern communities might enjoy better access to care. Furthermore, this proposal would better align federal and provincial policies, as several provinces already offer loan forgiveness for residents who remain within the region.
The CFMS appreciates Ottawa's important role in supporting skills development of health professionals. Two areas in which the Government of Canada can tackle physician maldistribution are long-term projections of physician supply and demand, and improvements to the Canada student loan program. These solutions have the potential to be important levers to improve the federal role in skills training of health professionals.
Thank you for your time and your attention. I look forward to our discussion.