Health Committee on April 4th, 2022

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

We have about a minute and a half left.

Dr. Maguire, could you speak to the necessity of creating a welcoming environment for families of physicians coming to Canada as well, please?

[Dr. Hugh Maguire]

The goal is to get doctors to come and then to get them to stay. For the family in question, typically when a doctor arrives, we'll make sure that we've made connections for their families, such as activities and plans. For example, the daughter of one family who came is involved in horseback riding. We arranged for that to happen when she arrived.

Also, we make sure that we have lots of professional support in the workplace when introducing the doctor to the new environment and how the system works, and engaging them in social activities. Providing that welcoming environment is key, in fact.

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

Finally, Dr. Maguire, if I might, I know that you're a practising psychiatrist who is working in an emergency room as well. How essential would it be to have a pan-Canadian electronic medical record that you could access in the emergency room?

[Dr. Hugh Maguire]

That would be helpful. It would be terrific. I think we're a long way away, but if we could start the process of getting there, that would be really helpful.

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

Thank you, Dr. Maguire.

Thank you, Chair.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ellis.

Next is Dr. Hanley, please, for six minutes.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much.

I'm thinking about that dream of a pan-Canadian electronic medical record.

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

You can do it.

[Brendan Hanley, Liberal, Yukon, YT]

Let's do it.

Thank you very much to all of the witnesses. Like my colleague opposite, I have also recently joined the dark side from the medical profession.

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

The Liberals aren't that bad.

[Voices]

Oh, oh!

[Brendan Hanley, Liberal, Yukon, YT]

Both of those are on the record.

On that note, I'm going to go first to Dr. Lemire. She may or may not remember that my first ever work experience as a family physician was, in fact, in Corner Brook, Newfoundland. My first whitewater canoeing experience was with Dr. Lemire and her family. It's good to see you again.

Dr. Lemire, my question is about the team-based approach. I'm wondering if you could expand on it. I was really interested in your talking about the administrative support that family physicians are asking for as part of the team.

How does that work? Are there some good examples? Who else is on the team? Who are the important players on the team?

Thanks.

[Dr. Francine Lemire]

Thank you, Mr. Hanley.

I do remember that canoeing experience quite well, actually.

The team-based model of care is one that we're trying to promote at the moment, and it is already in place in some provinces. Family health teams in Ontario, groupes de médecine de famille in Quebec and PCNs in Alberta are some examples of models of care where there is access to a family physician for every person in the practice but where the family doctor also has the opportunity to work with other providers.

We have pharmacists in this virtual room today, and a pharmacist is an important member of the clinical team. We also have social workers, nurse practitioners, clinical nurses, dietitians and physiotherapists. The decision as to which providers we privilege as members of a team depends in part on the population that is served. For these models I've described, there is generally an analysis of who it is that a practice is serving, and then, based on some demographic information, there's a decision made as to which types of providers might be best suited to offer support in providing the best care for that patient population.

For myself, I worked for several years in such a model in Toronto when I was in clinical practice, and that was an example of this, so I had fairly close interaction with the clinical pharmacist in that team, particularly for the frail and elderly patients I was looking after those who were on more than six medications. Every year, the pharmacist would review those patients, and we'd have a conversation about whether all of the drugs were appropriate, whether we could trim one or two or whether there were drug interactions to be mindful of.

Of course, in that practice, we provided immunizations, and clinical nurses were important providers to help us with administering immunizations and identifying people who were due their immunizations who had not had them, so working closely with nurses is very important.

We often don't talk about the receptionists. Certainly, every practice has a receptionist, and having enhanced roles for the receptionists also helped to streamline that care.

I could go on, but these are some examples. In the team I was on, we had a social worker, and the social worker was really quite critical for patients who were dependent on funding from social services, in terms of identifying some potential sources of funding and working with those patients on some of these applications and forms to fill out.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much.

Dr. Lemire, I have one minute left, and I'm going to take as much advantage possible of my time, but that was great, thank you so much.

To the speech and language expert who spoke, I really appreciate that you highlighted the difficulties of recruitment for northern and rural areas. Is there any role for a locum service, a rotating service, virtual care or some of the other potential ideas for servicing northern and remote areas?

[Dawn Wilson]

Susan, I'll let you speak to this.

[Susan Rvachew, Full Professor, Speech-Language and Audiology Canada]

Thank you, Dawn.

Certainly, there is some room for that. I think we have to consider that there is a massive shortage of speech-language pathologists in Canada, with the number of speech-language pathologists per capita half of what it is in the United States, for example. We could have locums, and we could have virtual care, but there are just not very many speech-language pathologists, so that's an issue.

We are using virtual care quite a bit, and one particular way in which we're using it is to send students into northern communities and supervise those students from the city using Zoom and other technologies. So there is an opportunity for that.

The other thing is to have communication disorders assistants in those communities that communicate with speech pathologists who are spread further apart and are thinner on the ground.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Rvachew and Dr. Hanley.

Mr. Thériault, go ahead for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much, Mr. Chair.

I thank all the witnesses for their valuable testimony.

I will put my questions to Dr. Perrault.

Denial is a refusal to take into account part of reality. Yet the federal government is stubbornly waiting for the pandemic to end to provide structural, recurring and substantial funding to address the part of reality it does not seem to be taking into account: patients who have not contracted COVID‑19. So it has adopted a piecemeal approach and provided one-off investments to address a part of reality.

Can you talk to us about the consequences of such stubbornness in a living environment as critical as cardiology? Can you remind us of the consequences of waiting like this?

We are in the sixth wave of the COVID‑19 pandemic, but from the first wave, we have been seeing this same reality, that the system was too fragile and that there would be very long–term repercussions on patients.

[Dr. Louis Perrault]

Thank you for your question.

Your analysis of the situation is good. As my colleague from the Royal College of Physicians and Surgeons of Canada mentioned, all the pandemic did was expose pre-existing problems, such as waiting lists.

At the beginning of the pandemic, we saw that cardiology and cardiac surgery patients tended not to access the health care system out of fear of ending up in hospitals. That not only led to all sorts of new complications, but it also revealed that some problems that may have been detected earlier and treated with due care remained unaddressed, on the one hand, owing to limited access to hospital resources and, on the other hand, owing to patients' completely normal concern over being examined in contaminated environments. Those complications have had a number of consequences. One of them is that patients came to hospitals in a worsened condition, a potentially unstable one.

Imagine the situation. We are in the 21st century; we have the treatments, the diagnostics, the doctors and the team, but we do not have the means to receive patients. This clearly adversely impacts their recovery.

Another thing that is really unfortunate is that, if we wait too long, the accumulated backlog will really have undesirable consequences on all patient cohorts. I am preaching for my own parish, but that backlog has not been noted only in the cardiovascular community. It is also in oncology, where patients have received subdiagnoses, their diagnosis was delayed or they received a diagnosis of more advanced diseases.

The situation was urgent before the pandemic, but it is now critically important to adjust the level of funding, potentially in the form of transfers, and to assure us that the rebuilding and resumption of activities start now. We will not be able to cope with this kind of a situation for many more years.

If I may, I will make a comment to echo the comments of some of my colleagues and other witnesses. Planning is crucial for all health teams right now. One of the things we are seeing is that, in some provinces, like mine, the number of surgery residents has dropped by half over the past 10 years. So if someone needs surgery, it will be difficult for them to get treatment.

Like my colleague from the Royal College said, independent, long-term workforce planning, using evidence-based data, is extremely important for the future, not only for doctors, surgeons, and so on, but for all health care professionals.

I will give you an example. We have had a critical shortage of perfusionists for 20 years, and nothing has been done so far. So we are dealing with issues that have been known for two decades without any solutions being adopted.

[Luc Thériault, Bloc, Montcalm, QC]

So what we have to understand is that the provinces and Quebec need predictability to be able to increase the robustness of their networks, including critical living environments like yours.

[Dr. Louis Perrault]

That's true for our environment, yes, but if I compare speech pathologist rates in Canada with those in the United States, the difference is ridiculous. So if there was planning and an identification of needs, standards and benchmarks to determine that we need a certain number of speech pathologists per 1,000 inhabitants, and so on, if we had forecasts, we could at least try to reduce the gap between the current number and the desirable number of speech pathologists for all Canadians.

[Luc Thériault, Bloc, Montcalm, QC]

The Fédération des médecins omnipraticiens du Québec and the Fédération des médecins spécialistes du Québec have joined us in calling for a summit to be held to discuss health care funding transparently.

I assume that you are joining your voice to those of your colleagues and that you want to participate in that kind of an exercise, so as to optimize financial resources and set priorities. After all, you know what your priorities are, since you are on the ground.

[Dr. Louis Perrault]

Yes, I would be interested in that.

That is a key exercise we must all carry out. I don't want to disparage anyone, and we ourselves have used short-term solutions in our cardiac surgery work, including by bringing in doctors from abroad. But those are reactive and temporary solutions, and we need substantive ones.

We need to engage in long-term planning. We should not plan for the next four or five years, but rather for the next 20 years.

For example, we know that it takes 10 years to train a surgeon. So, if a decision was made in five years, shortages for that type of specialist would be very severe. A massive effort must really be made to review the funding and completely overhaul workforce planning.

[The Chair, Liberal, Sean Casey]

Thank you Dr. Perrault and Mr. Thériault.

Next is Mr. Davies, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you to all of the witnesses for being here.

To Ms. Wilson, please, from Speech-Language and Audiology Canada, what percentage of speech-language pathologists are women?