Health Committee on March 2nd, 2022

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much for that. I appreciate it.

Dr. Kassam, we talked a little bit about some of the solutions, and of course the OMA has presented a very comprehensive picture of that.

I'm wondering about the short-term look at recruiting physicians. It would appear that if I did my math right, we're perhaps around 500 short in Ontario. How might we change that in a very short term? What are one, two or three things you might think of?

[Dr. Adam Kassam]

Thanks for the question, Dr. Ellis. It's a very important question as far as health resources are concerned.

The first thing we need to do is stop the exodus in the profession by shoring up what health care resources we have right now in terms of physicians spread across the province.

As for what we can do immediately, we can fund more medical student spots as well as residency spots. It makes no sense to have an increase in medical enrolment that is not followed by commensurate residency training spots. That just worsens the problem.

Finally, of course, we need to align incentives in a variety of regions. To be very frank, in northern and rural parts of our province, we have trouble retaining and recruiting physicians. Aligning incentives, whether that means financial support of infrastructure or innovation incentives.... These are areas that we believe would actually serve a purpose for retention and recruitment in areas that are under-serviced.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Dr. Kassam.

I have one other question. Has the topic of pensions for physicians come up? What does the OMA think of that?

[Dr. Adam Kassam]

This is an important issue because, as most people on this call and in this committee know, physicians have to self-fund their pensions. Unlike other public service workers, there is no pension for physicians. This is a huge problem for our profession broadly. It is also a challenge as we think about the future of the profession, as far as being able to care for themselves and their families into old age is concerned.

The pension issue is a very live one. It's one that the physician community is very strongly in favour of. It requires attention at both a federal and a provincial level to really move that ball down the field.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Dr. Kassam.

Dr. Tomblin Murphy, we have some numbers here from the OECD: perhaps 8.8 nurses per 1,000 population. In Canada, we're around 10 per 1,000. Can you tell us a bit about why there might be a discrepancy there in the number of nurses we have, which is above the OECD average?

[Dr. Gail Tomblin Murphy]

Thank you for the question.

When we do comparisons between OECD countries by numbers, I think that looking at a number of something by population only gives us one picture. It doesn't give us what the needs of the population are or the care delivery system in which nurses and others are actually participating.

The OECD comparisons are helpful, but I think the better comparator is for us to look more closely across this country by provinces and territories and better understand that. In terms of OECD, we probably are ranking pretty well, but we need to be thinking about more than numbers per population as we look at any provider group.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

I have one quick question, Dr. Tomblin Murphy.

In Nova Scotia, since it's our home province, how many nurses do you think we're short?

[Dr. Gail Tomblin Murphy]

Across the province, we are looking at high vacancy rates. In Nova Scotia Health, the provincial health authority, as you're aware, there are about 800 vacancies right now. We are already working short. We do have many good strategies in place that we are feeling very optimistic about, strategies that have to do with hiring students, for instance, during their programs, which gives students a sense of value and of becoming part of the health care system early, as opposed to at the time of graduation.

We are also looking at ways to precept and mentor nurses much differently, such as by using the pool of retired nurses, who have a lot to offer. As you're very well aware, we are also looking at strategies to better prepare to receive internationally educated nurses by taking it very seriously, in terms of preparing in the province as well as across the country. We need to, so we can successfully integrate these workers in a timely way, in a way that recognizes their credentials and moves them into our health care system delivery through bridge programs for CCAs, LPNs, NPs and others.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Tomblin Murphy.

Next, we'll go to Dr. Hanley for five minutes.

Go ahead, please.

[Brendan Hanley, Liberal, Yukon, YT]

Thanks.

I'd like to add my gratitude to all of you for having appeared and given your time, especially in a somewhat interrupted way, this afternoon.

I have so many questions, and so little time. I'm going to start with Dr. Kassam.

I think you mentioned credentialing in your opening remarks. I wonder if you could give me your views on how we could be more efficient in international credentialing, and also maybe comment on the question about pan-Canadian licensure and whether you would see that as an advantage.

[Dr. Adam Kassam]

Sure. Thank you so much for the question, Dr. Hanley. Given your expertise in your area, I know this is something that's germane to not only your understanding but also the understanding of the committee.

Obviously, we need to have an international strategy for health human resource recruitment, and that will invariably include a pathway to credentialing. This is obviously a very complex situation, because it requires multiple institutions, including the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada, as well as the provincial colleges of physicians and surgeons. A multilateral approach will have to be undertaken, but invariably this will also have to relate to what we are very deeply committed to here in this country, which is quality of care. It's not necessarily quantity of care, but quality of care. How do you ensure a minimum quality of care and competence from places around the world so that Canadians can continue to receive the best and, frankly, highest-quality care that they deserve and need?

This is also a challenge in that space, and there needs to be a strategy for onboarding, whether that means apprenticeship programs or perhaps even a more streamlined approach to being able to stand for and, frankly, challenge the board examinations, which are, of course, necessary in order to proceed through licensing. These are conversations that need to happen at a federal level, and this is where you and your colleagues have a great role to play.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much.

I have a question for Dr. Pichora.

You gave fascinating opening remarks. Thank you very much for all your work and your vision.

I'm wondering what a postpandemic hospital looks like, or should look like, versus a prepandemic hospital. In other words, what have we learned from our experience with respect to what we can do and what we maybe do not need to be involved in? Where are the efficiencies? Maybe give a quick synopsis on that.

[Dr. David Pichora]

Well, apart from the fact that everything has changed, it's a little hard to give you one or two examples. We're learning how and where digital and virtual care is most effective. It's not useful everywhere, but it's highly useful in selected places. We have a lot to learn about how to integrate virtual care into our traditional and future planning with regard to how we deliver care.

Just as we've been talking about maximizing the scope of practice for various health care workers—the Americans talk about “practising at the top of your licence”—we need to do the same thing in hospitals. Our main site is a highly intense critical care site. It's a trauma unit with cardiac surgery and neurosurgery. Our Hotel Dieu site is an ambulatory site where we deliver day surgery, short-stay surgery, highly effective hip and knee replacement, cataracts and bariatric surgery.

We need to have those sorts of strategies when it comes to how to build out the ambulatory system. We've learned that we have to partner a lot more effectively across the health care system in every way. For example, we're working with an independent health facility around assisting and delivering our cataract volumes. I can see the potential to do more of that as we get better integrated and more effective and efficient at doing it. With distributed networks, we're spending a lot of time assisting other hospitals, larger and smaller. There needs to be more of that as well.

Those are just a few examples of many things that have changed. Some things we need to restore from the past, some things we need to continue doing that we've learned from COVID, and other opportunities are yet to be developed.

[Brendan Hanley, Liberal, Yukon, YT]

Mr. Chair, do I have any more time?

[The Chair, Liberal, Sean Casey]

You have about 20 seconds.

[Brendan Hanley, Liberal, Yukon, YT]

Okay.

Mr. Villeneuve, rural versus urban in 15 seconds....

[Michael Villeneuve]

We need more nurses in rural.

[The Chair, Liberal, Sean Casey]

Well done, and thank you.

Mr. Thériault, you have two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Dr. Kassam, I appreciated the fact that your association said that it supports the requests made by Quebec and the provinces concerning the chronic underfunding over the past 30 years and that it agrees that health transfers should be increased by 35%. This amounts to $28 billion, including an additional $6 billion for Quebec. I haven't done the calculations for Ontario. I liked the fact that you provided figures for your needs.

What would you do with an extra $6 billion in Ontario?

[Dr. Adam Kassam]

Well, I wish I had $6 billion in my bank account. It would be a lovely dream to be able to have that.

As for where we think investment is required, we obviously think about the backlog of service that unfortunately expanded during COVID and now exists for a shocking number of 21 million health care services in the province of Ontario. It's probably much larger across the country. Getting through that backlog of care and reducing wait times is the key number one priority.

Number two is investment in mental health and addiction services. We know that over the past two years with COVID, we've seen an escalation, unfortunately, in opioid-related deaths and overdose deaths as a result of the exacerbation of COVID and the pandemic on these populations. Investment in mental health and addiction services would be number two.

The third area of investment would be trying to make community care, home care, and retirement and long-term care more robust.

Finally, it would be pandemic-proofing our future by investing in public health to ensure that we are better prepared for the next one.

[Luc Thériault, Bloc, Montcalm, QC]

I appreciate your response. A number of stakeholders argue that targeted investments would be required to pull the system out of the current situation. They claim that the people working in the system wouldn't be able to identify the priorities and take the necessary steps with the increase in health transfers. I really appreciate your response.

What's the main reason for the 11‑month wait for an MRI scan and the fact that 502,476 people are waiting?

[Dr. Adam Kassam]

Unfortunately, we know that smaller problems become larger problems. People have been waiting for a variety of different care. It could be primary mental health and psychiatric services. It could also extend to cancer screenings, of course, such as colonoscopies and mammograms. It also extends to procedures and surgeries that people have been waiting for: hip or knee replacement surgery, cataract surgery or cancer removal surgery. It runs the gamut of our health care system.

What we have found over the past 21 months within this pandemic is that we have seen an escalation, unfortunately, in terms of late presentations of pathology, which means advanced stages of disease and of course perhaps the worst prognoses. When we think about a system-level perspective, this actually costs more to deal with.

We know that the pandemic has had a significant impact on the ability not only to provide service but to provide service in a timely way. It is now our task as a country to think about the future.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Kassam and Mr. Thériault.

Next we have Dr. Davies, please, for two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Ms. Tomblin Murphy, do you have any general idea, just ballpark, as to how many foreign-trained nurses there are in Canada right now who are unable to practise because their credentials aren't recognized?

[Dr. Gail Tomblin Murphy]

I actually wouldn't have that number. I would defer to Michael Villeneuve on that number.