Health Committee on March 2nd, 2022

[Dr. Adam Kassam]

Absolutely. When we think about Canada health transfers and the fact that shared spending is now sitting at close to 22%, at least in the province of Ontario, it simply isn't good enough. That's why we've called for an increase. It's why we stand in solidarity with all of the premiers. I believe at the last council of first ministers, all the premiers were there basically advocating for an increase in Canada health transfers. The reason it's important is that, as this money flows to the provinces, we can address a lot of the issues that we've brought up here in this chamber today.

Absolutely, it has not met the needs of a growing and aging society, which we unfortunately have in this country—and it's a beautiful country—and we need to be able to sustain the level and quality of care by having commensurate investment in these areas.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Dr. Kassam, I'm going to stick with you.

In that vein, we're all inundated, especially at this point in time, with asks for massive new amounts of government spending. The government is going to have to say no to significant good asks given our spending situation, which is pretty challenging in Canada, if we're going to say yes to dealing with this crisis in health.

We acknowledge that we're going to need to spend more. Our party's platform projected $60 billion in additional spending over 10 years. As we do that, thinking about technology, thinking about how to get more with the dollars we are spending, can we leverage technology to improve the quantity and quality of care that is delivered?

I'll ask a second question in parcel with that. Can we also use technology to improve the system to avoid the burnout that all of you have spoken about?

[Dr. Adam Kassam]

Absolutely. Those are very astute questions.

Let me take the first one, which is whether we can use and leverage technology innovation. Can we scale up and level up in this country our ability to deliver service—i.e., health care services—to the people who need it at the time that they need it? Absolutely. We saw what happened during COVID with virtual care.

Yes, we're talking about appropriateness. We, as a profession, need to figure out what is appropriate and what is better served for patients in terms of in-person care. That conversation happens in real time and is being grappled with not only in this country, but, frankly, around the world.

I absolutely believe.... We've seen this take place in a robust way in this province, in Ontario, throughout the past 24 months. One of the things that are important to recognize is that, as we start thinking about a recovery and a rehabilitation in our society post-COVID—and we're still here, still dealing with the aftermath and trying to prevent a next wave—we can't have an economic recovery without a health care recovery. This is where we think that investment is so very important, and using technology to leverage our ability to do so is extremely crucial.

To your second question, which was about using technology to help with system-level change to reduce burnout, I absolutely hope so. We know that technology, in some capacity, is actually a driver of burnout. I'll give you an example. As physicians, we have electronic medical records that are often not connected to one another. Having to click through a bunch of different sites and different areas can actually contribute to burnout if that information is not available to a provider in real time because it's on a different network, for example.

If we can have this integrated, hopefully in a meaningful way, we can reduce burnout and have doctors be doctors, continue seeing patients and see more of them, and also reduce the administrative burden that is a driver of burnout in the sector.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Thank you.

How much time do I have left?

[The Chair, Liberal, Sean Casey]

You have 20 seconds.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

I'm not going to ask a question. I'm going to make a comment to Ms. Vance.

I come from Alberta. I live in that world where I can go to my pharmacist and get help that, if I were in another part of the country, I would have to go to the doctor for, and it is fantastic. Talking about innovation, some of the innovations aren't necessarily technical, but systemic. That's to reinforce some of what you're saying.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Lake.

The last round of questions will come from the Liberals.

Ms. Sidhu, you have five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

I would like to share my time with Dr. Powlowski.

Thank you to all the witnesses for your valuable information.

My question is mainly for the OMA. We heard at previous meetings that the one issue contributing to the worker shortage was the provincial regulatory bodies. They make it difficult to move between provinces and to admit foreign-trained professionals, especially IMGs.

We heard from Dr. Murphy about the nurse shortage of 60,000 by 2022. We have our lab technicians. There are only five medical laboratory education programs in Ontario, and they all have waiting lists. We also have a shortage of PSWs.

Dr. Kassam, you said that in creating residency support and recruitment, we need a multilateral approach. What do you think are the best strategies and best practices, so that we can create more residency places for our IMGs? I know some of the Canadian students, the IMGs, even did Kingston General Hospital electives, but they're waiting for residency spots.

What can we do to fill those gaps?

[Dr. Adam Kassam]

There's no question that there are bottlenecks in being credentialed from an international medical graduate perspective, and this is something that comes up quite commonly in our discourse as we think about a health human resources strategy for the future.

An international approach is very important, where we think about being able to match not only the supply of IMGs, for example, but also the demand for different kinds of physicians and where they are appropriate. For example, it would make absolutely no sense to train more surgeons without a commensurate increase in the ability to have those surgeons operate. Right now, we have a limitation in our ability to have surgeons operate, because of operating room time and the numbers of operating rooms that are available. Simply credentialling more surgeons is not going to make the problem better; it's going to make it worse. You're going to have more unemployed specialists.

It's really a matter of identifying the need and the scope of practice based on the jurisdiction, and then being able to tie that into a minimum threshold of competence. That is the task of a federal body like this, but also perhaps a task force that would be required to better understand [Technical difficulty—Editor].

[The Chair, Liberal, Sean Casey]

Dr. Powlowski, go ahead.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

The problem in my mind is pretty simple: We don't have enough primary care practitioners to work in rural areas. We haven't for the past almost 35 years, since I graduated from medical school. The other problem now is not having enough nurses. It would seem to me the problem could readily be solved by looking at credentialling far more foreign graduates. In my 35 years of being a doctor, I've met so many people, doctors and nurses in Canada, who were trained in other places but were unable, despite all their efforts, to get credentialing in Canada.

It would certainly seem to me that if we want to address the health care shortage quickly, the federal government could give more money to the provinces, and the provinces could then implement more positions to upgrade the skills of foreign-trained graduates so that they come up to the standards required in Canada. That may mean academic upgrading, practical upgrading or more residency programs. Could we do that?

Let me first ask Dr. Pichora. Could you, at Kingston, open up more positions for academic training? I'm thinking for maybe just a year or two, or maybe shorter, depending on where the person has graduated from. Could you provide a tailored, practical upgrading, if necessary, in order to get practitioners out quickly? Presumably they'd still have to write the licensing exams. I'm not thinking of surgeons, because the problem is not OR spots, but I'm thinking of primary care practitioners and nurses.

[Dr. David Pichora]

Yes, we would try to do this and work with the universities and colleges to support it. Primary care is an interesting one, because we have a very large family medicine program here, but it's a distributed education model, and they have placements all over Ontario and beyond. They don't just train in Kingston. We need to take advantage of models like that. We have lots of hospitals in the province where surgeons could go to receive part of their training. We do some of that already with Lakeridge, for example. There's probably a lot more opportunity to do that than we take right now.

The downstream effects are significant. One of the biggest concerns I hear about is in the physiotherapy and occupational therapy training programs, where they just can't get access to enough clinical placements, which they need to finish their training. It's not just physicians; it's nurses and others.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Pichora and Dr. Powlowski.

That completes the round of questions.

I want to offer a sincere thanks to our witnesses. You're all very busy professionals. Your expertise is evident. We will benefit from it greatly in our work on this study. I know that we would like to have you here longer. It's too bad for the interruptions, but we certainly had quality. I appreciate your sticking around and being so generous with your time.

Thank you very much, everyone.

Is it the will of the committee to adjourn the meeting? We have consensus.

The meeting is adjourned.