Thank you so much. It's such a pleasure to be here.
I'm an emergency physician and trauma specialist here in Toronto and with Médicins Sans Frontières. I've worked in epidemics before the COVID-19 pandemic and I intend to afterwards.
First, I'd like to say that the response overall by Canada and Canadians has been remarkable and exceeded my and so many peoples' expectations. I just wanted to extend my thanks as a citizen and a clinician for feeling so well supported...having mitigated the worst of this for all of us.
Normally, I speak about issues of global equity, particularly knowledge translation through critical care and emergency medicine to the global south. Today I want to speak about issues that are particularly relevant to the Canadian context in the emergency landscape that the COVID-19 pandemic has made so clear. I will focus my testimony today on how we might continue these lessons from the pandemic to create a stronger, more robust and safer health system for Canadians. In particular, I will focus the discussion today on the topic of national licensure for doctors, nurses and other health care professionals in our country.
As you likely know, provincial licensure is what health care professionals require to gain the ability to treat patients. It's only in the confines of their province. Should you want to move to another province, either in times of disaster, pandemic or otherwise, you require an emergency order to do so. That process is cumbersome, ineffective, risky and really unsafe.
I believe we are the last remaining Commonwealth country—I wasn't able to go through the whole list, but we were the last—that doesn't have national licensure. It prevents more equitable distribution of health care resources, particularly as we move into greater virtual care opportunities. What's happening now is that I can't treat a patient in Iqaluit without a special reciprocal licence between our provinces. I think that needs to change.
As you can see, the nature of this pandemic, like all disaster, is one of asymmetry. This means that it doesn't just happen demographically; it happens geographically. You're seeing Manitoba going through a crisis right now that Ontario's just coming through to the other side of. You're seeing patients being transited from Manitoba to Ontario. That's dangerous. It's risky for the individual because if you're a sick person, it's much more risky to send you to Ontario than send a healthy nurse, doctor or RT to Manitoba. I think that through national licensure, we can start to equilibrate some of these resources.
While mathematical modelling can help predict something with the COVID-19 pandemic, it certainly can't predict an earthquake on the west coast or how high the Red River will rise. Giving physicians, nurses and other health care professionals the ability to move freely throughout the country would be an easy way to start redistributing these resources in times of emergency, and also overall.
I think, as you'll see in the coming months, we're about to face a crisis of a different kind. We're about to face a crisis of burnout. Pretty much every doctor I know, as they look to the future of their whole careers perhaps wearing the mask and shield, is thinking about doing something else. This is real.
I bring up this issue of national licensure because it's close to my heart. It initially came up when working in Inuit, Métis and first nation communities as a way to distribute health care resources there. Now I see it as a way to respond to a need in our health care community, which is the freedom of mobility to allow doctors and nurses to do what they love to do best, which is treat patients no matter where they are.
It's safer for Canadians, it's better for doctors and 91% of physicians want it. More than half of them say that it would increase the likelihood of their working in remote communities.
If we don't take this step, virtual care is going to move into a private sphere and we're going to miss an opportunity to keep it affordable for the average Canadian. With President Biden moving to insure up to 40 million Americans, there's no reason to stop a doctor in Alberta from now treating Americans using virtual care. We have to get ahead of that, in my opinion, and a national licence is the way to do that.
Reciprocity for this licence and allowing greater training is one thing that would encourage it as well, particularly as these people are committed to working in remote and indigenous communities or with those populations that have been made vulnerable by systemic inequity.
I would suggest that the federal government consider immediately establishing a reciprocal arrangement, or encouraging a reciprocal arrangement, between provinces that allows freedom of mobility of health care professionals during the COVID-19 pandemic. Then it should look to develop a plan to extend this reciprocal licensing arrangement between provinces, territories, indigenous and federal governments, allowing these health care professionals licensed in one to work in other provinces and territories.
The requirements are all the same. The training is the same. The fact is there is this expanse in the hurdles to jump over. It is kind of redundant. It makes the system vulnerable, because if someone has malfeasance in their past, it's less easy to track because they can go to another provincial college. They are siloed organizations.
Luckily, as Canadians, we haven't endured the big crimes that we've seen in the U.K. and Australia that allowed doctors to operate truly unqualified and hurt people. We're just waiting for that. Maybe that will never happen, but having a national autonomy and licensor is one way to do it.
In conclusion, there are two ways I think it can be done. One would be to start to focus on health care as administered through federal bodies, like indigenous, Métis and first nations communities. That is something that could allow them certain types of autonomy with registration, regulating who comes in and certain types of accountability.
The second and more robust way to do it would be to have the provinces, which have mandated to the college the licensing authority, mandate that authority to a national body. It wouldn't change the machinery of the provinces necessarily, but it would allow national licensure to be possible. I think ultimately it would be a good step not only to buoy the spirits of the health care workers who have been working very hard during this time, but also to encourage harmonization of health care in the country, improve accessibility to care and universality of care.
That is what I think is possible. It is what I imagine would be a positive step for the health care of Canadians.