Health Committee on April 4th, 2022

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Lefebvre and Mr. Davies.

Next we have Ms. Goodridge, please, for five minutes.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you so much.

Thank you to all of the witnesses for spending some time here with us this afternoon. It's really been remarkable; the more witnesses we hear, the more commonalities we seem to hear all across a variety of different spaces and places.

Dr. Maguire, I'm going to start with you. You really hit something that I think rings true to me. I was wondering if you could expand a little bit further on how you would see a federal locum program working. If you could design it, what would your dream program look like?

[Dr. Hugh Maguire]

The reason I speak to the importance of locums across the country is so that rural doctors will know they can get a break when they need it. They're already developing national standards around licensure and encouraging the provinces to work together for licensure. I think that's great work and it would be great if that would continue.

I would love to see it happen so that there would be a registry. When we know in advance that a doctor is going to need time away, we could contact that registry, which would put us in touch with interested doctors. It's a great way for doctors to help out colleagues across the country to see how different systems work across the country. I think the more we know about the practice in different parts of the country, the better our health care system gets overall.

That's what I see. I would see it as a standardized licensure process and then having something where there would be a degree of reciprocity. A province would see that a doctor is already licensed in another jurisdiction in Canada that has very similar standards to its own and they could extend temporary licensure quickly to that doctor to allow them to come to help out.

Those are some of the components I would see as being part of that.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Fantastic.

Whether it be in Cold Lake, Lac La Biche or Fort McMurray, I regularly hear from people with concerns over lack of care. My understanding is that we grosso modo have the right number of doctors; they're just not in the right spaces across the country.

Is that accurate?

[Dr. Hugh Maguire]

Speaking for psychiatry in Nova Scotia, we certainly could use more distribution of psychiatrists from the city out to the more rural areas. As a general trend, I think there might be some truth to that, actually.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Excellent.

Dr. Lefebvre, I'm curious to hear your thoughts on having a federal locum program. I'm wondering if you could expand upon that a little bit?

[Dr. Guylaine Lefebvre]

Thank you.

I'll be a bit of a broken record on the fact that we don't have data.

Regarding your previous question of whether we have enough doctors, I don't know. Do we have the right kind of doctors? Could we actually use that dataset to inform our medical students to help them choose which profession they go in?

There's been a trend in my own career. When I graduated from my residency, every one of my colleagues wanted to have an office and a position and had in mind that they would have this for life. That's no longer the truth. We now have residents who see themselves graduating with the flexibility to have locums and not have the burden of an administrative office and so forth.

I think it goes both ways in looking at what our graduating physicians are looking for to meet the needs of the populations and starting with what the population needs.

Absolutely, we've heard—

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

I'm sorry. I have about a minute left.

You touched on the next point I was going to get to. Super quickly, I hear that doctors of my generation want work-life balance. They want flexibility.

Are there any studies on that? If so, could you table that with us in the committee?

[Dr. Guylaine Lefebvre]

There is more data coming out.

I will actually put forward that this generation of physicians is actually teaching us to be wiser about things. They're looking at the rate of burnout we're seeing and saying that they don't want to be in that position. They want help to not be there.

Absolutely, the work-life blending that physicians hope to have is a reality and should be an important question as we look at not only the number of physicians we have, but what those physicians are willing to do. The physician who puts in 150 hours week and the rural person who ends up having to be on call one day in two are unsustainable.

When we look at issues like rural and remote, work-life balance is an important consideration in that equation.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Lefebvre and Mrs. Goodridge.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you.

[The Chair, Liberal, Sean Casey]

Next up is Dr. Powlowski, please, for five minutes.

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

Thank you.

We're all here trying to address the problem of shortages in the workforce in health care. Certainly, Dr. Maguire has talked about the possibility of using more foreign graduates.

I guess I'm the old man here of the group of doctors. I graduated 36 years ago. Do you know what? Absolutely nothing has changed in 36 years with respect to licensing foreign graduates. They've been around and a number of us have worked in areas.... I've worked most of my life in under-serviced areas and there have always been a lot of foreign doctors in Canada who we could, should we wish to, provide with a pathway to upgrade their skills if necessary, so they can practice in Canada.

Why hasn't it happened in 36 years?

I'm looking across at a couple of other doctors here who are in a similar situation. They, too, have worked in under-serviced areas. I'm frustrated with this. We talked about differences. Dr. Lefebvre, I think, talked about bringing people to the right level, but she's an obstetrician. I've done Caesarean sections myself in developing countries. I know there are a lot of foreign grads who can do better Caesarean sections than Canadian doctors.

If necessary, we can train people, get them up to the required level in order to practice in Canada. What has been the problem?

I would suggest that—and I want to ask a whole bunch of you—there are a number of possible problems.

One is protectionism. Organizations like the CMA and OMA represent all doctors. Yes, doctors in rural areas want to attract more foreign graduates, but I've also done a little bit of work in big centres like Toronto. Do you know what? They don't have enough patients in those places, so they're trying to get people in. If you're a doctor in a big centre, you may not want to license a lot of foreign doctors because that's more competition for you and a possibility you will earn less income. So, I'm suggesting maybe there's some protectionism amongst the medical profession in not making it easier for foreign doctors to get work here.

The second thing is the possibility that the provinces don't want to have more billing numbers because that means higher cost. Third is the problem of colleges and the real kind of problem in that they don't meet the same standards as we do. Fourth is the problem with us and the federal government in immigration.

Dr. Maguire, maybe I can start with you and then I'll pass it on to the College of Family Physicians of Canada and the Royal College. I note that neither of those two bodies mentioned increasing the use of foreign doctors.

Dr. Maguire, maybe we can start with you.

[Dr. Hugh Maguire]

Doctor, could I just ask you to clarify the specific question?

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

My question is what is the problem?

Do you think there is protectionism in the medical community that is hindering us licensing more doctors or is the problem that the provinces aren't willing to issue more billing numbers? What's the problem in not licensing more foreign doctors?

[Dr. Hugh Maguire]

That's a good question.

Dr. Lefebvre spoke to some of the differences in where doctors are trained and how they're trained. When we bring a new doctor to Canada, we also need to consider their ability to transfer those skills to a different culture. I think there's probably a fair bit of work that could be done to look at some of those barriers and try to remove them. I think it would be a good idea.

By the way, Doctor, I just want to mention that before I did psychiatry, I did my family medicine north residency training in Thunder Bay.

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

Can I ask the same question, then, of the College of Family Physicians of Canada and also Dr. Lefebvre and the Royal College?

What's the barrier to foreign doctors to be able to practice in Canada? Is medical protectionism involved in not licensing more foreign grads?

[Dr. Francine Lemire]

Brady, did you want to speak to this?

[Dr. Brady Bouchard, President, College of Family Physicians of Canada]

If you wouldn't mind, Dr. Lemire, I will.

There are multiple parts to that question, of course. The IMG assessment programs that I'm familiar with are provincial, so there's certainly provincial responsibility there. One obvious structural barrier is that after a certain number of years of not practising in Canada, IMGs are, to my understanding, generally not eligible to enter retraining and assessment programs.

To your second point around protectionism, I'm willing to acknowledge that this may be happening. We are so desperately short of family physicians—where I practice and everywhere that I've heard from colleagues—that I can't see anything but welcoming arms to have additional colleagues, foreign-trained or not, working in our communities.

I would be remiss if I didn't reiterate Dr. Lefebvre's point as well about the ethics of making it perhaps too easy to immigrate and practice in Canada. There are a lot of resources that go into training a physician. Perhaps there are some ethical issues in bringing them from overseas, where the effort has been put into training them.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Bouchard and Dr. Powlowski.

Dr. Lefebvre, we won't get to you, as we're well past time. You are more than welcome and encouraged, if you're so motivated, to drop us a note to augment any of your testimony, including an answer to this question.

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

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Thanks very much, Chair.

Thanks to all the witnesses for being here today.

Dr. Lemire, I believe it was you gave the number of Canadians who don't have a family doc. Did you say it was 4.7 million?

[Dr. Francine Lemire]

Those are the data that we have. Yes.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Okay. How many doctors would it take to fill that gap?

[Dr. Francine Lemire]

It depends on how you calculate it. We would say that a family physician should be the most responsible provider for about 1,000 to 1,200 people. That is if this person is doing this solely as their scope of work. Many family physicians also will have certain clinical areas where they spend more of their clinical time. If that happens, then obviously the number of people that the family doctor can look after would be less. It would probably be between 500 to 1,000.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Right.

Building on that, I want to ask about the level of care. Based on the calculations that are done on how many doctors we need, in the context of a strained health care system, where we have doctors who specialize in areas that they like or are most proficient at, and they also then lend themselves in areas where they're needed—they do extra rotations in hospitals or, in the context of COVID, they're working at COVID centres—are the doctors providing the level of care that Canadians need and that doctors want to be able to provide to Canadians?

We hear an awful lot about Canadians who are frustrated that they don't get an annual physical or that they can have only one issue per visit. I hear that all the time, that the docs only have time to deal with one issue per visit. There are delayed routine screenings and delayed or cancelled care appointments. This stuff was happening before COVID, and it was exacerbated during COVID.

This list is not a.... It seems that these are all symptoms of doctors who have too many patients and are doing too many things. So is the number of doctors that we need really more than just to serve 4.7 million? Do we have an awful lot of Canadians right now who are on the list at a physician's office, but that doctor can't provide the level of care that they would like to provide or that the individual would like to receive?