Health Committee on March 2nd, 2022

[The Chair, Liberal, Sean Casey]

Sure.

Mr. Villeneuve, go ahead.

[Michael Villeneuve]

Thank you.

We don't know the exact number. We hear through anecdotal reports across the country that there are many in the pipeline waiting to get in, but I can look that up for you and would be happy to report it back.

About 9% of the nursing workforce are internationally educated, if that's of any help, but that's been a long-standing pattern of individual migration.

[Don Davies, NDP, Vancouver Kingsway, BC]

We know that it's a problem, for instance, with foreign-trained doctors, who I know have a really hard time getting credentialed in Canada. Can you give us a sense of how serious an issue that is, if it is at all, with respect to nurses in the country?

[Michael Villeneuve]

Go ahead, Gail.

[Dr. Gail Tomblin Murphy]

I can answer that, Mr. Chair.

What we have learned is that we haven't done a very good job. There are some provinces and territories that have taken this seriously, definitely the federal government as well, to find innovative ways we can actually spend more time with our workers prior to their coming to Canada: for instance, working at the country level and offering distance learning, English while in country, and moving towards the credentialing opportunity while in country.

We have also found that some of the innovation here is actually preparing communities, whether it's for children in school or the employers, businesses, universities, colleges and—

[Don Davies, NDP, Vancouver Kingsway, BC]

Sorry, I'm getting a sign and I want to get one question in, if I can, to Dr. Kassam.

Dr. Kassam, the OECD provides a breakdown of various categories. They say that Canada has the second-highest proportion of generalists in 2019 but was below the OECD average for the proportion of specialists.

I'm interested whether it's your experience that we're having difficulty getting specialists. If so, what categories of specialists are most needed in Canada? Where is the deficiency for retention and recruitment most acute?

[Dr. Adam Kassam]

I think it's a hard question to answer because it is highly regionalized. You might not need a dermatologist in downtown Toronto, but you might need one in northern Ontario. It really is matching supply and demand, and need, with the appropriate service to be provided.

Generally speaking, we have a very good understanding that there is a broad shortage of both family doctors—primary care—and specialists in northern and rural communities, at least at is pertains to Ontario. This is why we need not only an urban and suburban health human resource strategy, but also a rural and northern strategy as well.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Kassam and Mr. Davies.

Next we have Dr. Ellis, please, for five minutes.

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

Thank you, Mr. Chair.

If I may, Dr. Pichora, I have an interesting question, perhaps, to start. You talked about doubling your ICU capacity during the pandemic. How were you able to do that?

[Dr. David Pichora]

In the early phases of the pandemic, as you know, emergency departments really closed down. People stopped coming. There was lots of capacity in regional hospitals, our local post-acute care hospital, rehab and [Technical difficulty—Editor] and there was capacity in long-term care. You can argue in the end whether it was a good idea to move so many patients into long-term care in the province because of the consequences, but nevertheless, that happened.

Hospitals had a lot of empty beds. Our occupancy was the lowest it's ever been. Our ALC rate was the lowest it's ever been. We were able to redeploy staff, reconfigure facilities and bring in additional monitoring and ventilator equipment to create additional ICU beds. But for every one of those beds we created, we had to close five acute-care beds. Fortunately, those beds were empty at the time. We had to redeploy the nurses and other health care workers who were staffing those beds. We were able to do that last spring. We could not do that today, because of staffing shortages. The hospital is full. We have the highest number of ALC patients we've had in two years. We have about a hundred nurses off today with COVID-related...either they're infected or their family members or kids are infected.

In terms of the ability to ramp up that level, we're still running more ICU beds than we ever ran before the pandemic, but to get back to that double rate where we were in May and June, we would not be able to do that today.

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

Dr. Pichora, is it fair to say that your hospitals generally run at 95%, 100% or 130% capacity, as we do in Nova Scotia?

[Dr. David Pichora]

Most Ontario hospitals run in those ranges, yes.

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

Dr. Pichora, I have a couple of other questions. You talked about maximizing the scope of practitioners. Do you think that will require alternate payment schemes for physicians?

[Dr. David Pichora]

That's one of the options. We do have an alternate payment plan here at Queen's that has protected physicians from the ebbs and flows of the ability to bill fee for service during the pandemic.

With the nursing shortages and others, we've hired and trained a lot of nurses, as many as we could, but as you've heard, hiring and replacing all of those nursing vacancies in the next few years is a daunting challenge. We've been hiring extenders and trying to train new classes of workers to support our nurses: OR techs to support the OR nurses, for example, or mobility aides who can get patients walking so nurses can practise at the top of their skill. We've done a lot of that to extend the capability of our existing staff while we continue to try to hire regulated staff.

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

Dr. Pichora, we've talked a bit about virtual care, and certainly there are issues around virtual care, such as how it's done and which cases you should choose, but that doesn't take into account the Internet and all those types of difficulties, such as difficulties that elderly people may have using the technology.

What kinds of challenges do you see on a regular basis? We heard from Ms. Vance. She talked to her doctor on the phone, which, of course, for diagnosis of shingles is not helpful. I find those examples hard to take as a physician. What do you think we should do about that?

[Dr. David Pichora]

It's complicated. There are opportunities. In my own domain, doing certain follow-up visits by virtual care or by telephone can be quite effective and save patients from having to travel long distances. On the other hand, doing consultations and providing urgent and emergent care in orthopaedics and many other specialities requires hands-on care. I think we have to find the balance; it's not all or none.

Dr. Kassam could probably speak to this better than me. Because of the nature of family practice and the size of the offices, the size of the waiting rooms, the staff and the availability of PPE, they really had to resort to telephone care and virtual care more than any of them would want. As a consequence, I think that has contributed to building the backlog of patients needing referral. Certainly in our own orthopaedic practice, new referrals to my colleagues fell like a stone during the first few stages of the pandemic, and it's starting to come back now as care is returning to the office setting, so I think that's something we need to learn from.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Pichora and Dr. Ellis.

Next is Mr. Jowhari for five minutes, please.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair.

Thank you to all our witnesses.

My question is going to go to the CNA: Mr. Villeneuve and Ms. Tomblin Murphy.

Welcome to our committee; it's good to see you both once again.

In your advocacy, in the documents you provided, you've noted that the crisis requires a multipronged solution. Can you elaborate on this and define what factors play into the solution that you're recommending from the short term to the medium and long term?

[Michael Villeneuve]

I think I'll start. Thank you very much, Mr. Chair.

There are a couple of dynamics at play. One is that different waves of COVID have impacted different sectors. We know the terrible outcomes that happened in long-term care, for example, in the first wave. We've just heard Dr. Pichora talk about critical care, and in the third wave, critical care was pretty badly hit. Maybe it was the fourth wave; I'm losing track of the waves at this point. It really hit long-term care. We really stressed critical care, and this last one has really pushed all the buttons in medical-surgical units, in general hospital units. There are still some people going into ICUs, but hospitals are full, so we have three major sectors of the health care system that have really impacted nursing.

At the same time, older folks like myself, who might have been lured into staying a bit longer before retiring, are saying they can't do it anymore, so their retirement phase, which might have been five years or something, is being compressed because of the COVID experience, and we're seeing them saying they're going to leave the profession.

A Canadian Federation of Nurses Unions study showed us that, in most recent polling, it was the nurses at the beginning of their career and mid-career who wanted to leave or intended to turn over. You hit three big sectors; you hit new-career, mid-career and late-career nurses, and we're in a pickle.

The things that are going to help retain a nurse, for example, who's 63 are very different from those for a nurse who's 25. That 25-year-old nurse might be delighted to stay for a return of service if the student debt was cleared, for example, but that's not going to make a difference to nurses in their sixties. That's the kind of thing we need when we talk about a need to look at a very multifaceted approach to how we're going to treat the problems, not just the problem.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Ms. Murphy, do you have any comments before I ask the next question?

[Dr. Gail Tomblin Murphy]

Thank you.

I would agree 100% with Michael. Clearly the evidence tells us that some of the incentives are pretty simple. It might be helping to reduce the debt from tuition, for instance. It could be incentives that would be, again, looking at working to maximum scope and providing regular hours, which means that we have the appropriate staffing in place.

Also, right across the board, in the sectors that Mike talked about as being hit hard, I think many of our nurses who felt inexperienced were put in situations that were stressful for them. I think what we need to do is have investment in ongoing professional development, so that we can teach on the fly, which was learned in COVID, but in a way that nurses as well as other team members are feeling—

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you. I have one quick question and about a minute and 15 seconds left.

Another one of the recommendations that were made by the association seems to demand the creation of a national health care workforce body that collects data and supports health workforce planning at the regional level. We heard similar recommendations from CMA.

Can you please explain the key benefit of such a data collection tool, both at the provincial level and at the federal level?

[Michael Villeneuve]

First I want to give you the fast answer. We collect data across the country. For example, we know there are 349,000 nurses, and the areas where they work. What we don't do is articulate that and make it interoperable with what the physicians are doing, the needs in communities and whether those 349,000 nurses are doing the right thing.

If someone asked me today whether there is a nursing shortage, I'd say, well, there are 350,000 nurses and 95,000 doctors, so I don't know. Tons of them are working part time. What if they were working full time? There are a lot of what-ifs. Our plea for an agency or a structure where we bring data together, planning together, is to talk about what society needs, who can best meet it, and then how many of them you need.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Villeneuve and Mr. Jowhari.

Next, we have Mr. Lake, for five minutes, please.

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

Thank you, Mr. Chair, and thank you to all the witnesses. This has been a great meeting.

We heard a lot about how the funding situation needs to be resolved. If you take a look at the platforms of our respective parties, I think we all recognize that.

I'm pulling up a chart here of funding for the last 30 years. We've been on a solid trajectory, since about 2003-04, with the growth of transfers being faster than the growth of the economy. But with the devastating cuts, if you take a look at the chart from 1993-2001, is it fair to say that we've never caught up from the impact of those cuts?

I'll maybe ask Dr. Kassam to start.