Health Committee on April 4th, 2022

[Dr. Francine Lemire]

We need more family doctors. We need family doctors not only to look after the 4.6 million who do not have one. We need more family doctors in this country.

I think I'll ask Dr. Bouchard to respond to the rest of your question, because he is on the ground. He is providing care in a particular clinical area, mainly because that care is needed in his community.

Dr. Bouchard.

[Dr. Brady Bouchard]

Thank you, Dr. Lemire.

Certainly, there were significant adaptations throughout the pandemic from physicians stepping into areas where they don't traditionally practice or haven't traditionally practised. They have done their best to provide a high quality of care to Canadians, but that's certainly leading to burnout as well. You mentioned the idea of being overextended.

I mean, this is a complex issue. One issue that was touched on previously was models of remuneration. Particularly in some of our urban areas across the country, with inflation and overhead and staff salaries, the administrative overhead for a practice has astronomically increased, particularly postpandemic. Part of that is just to try to make a living in a fee-for-service practice, for example, where what you can bill and what you can earn into your practice is a set rate that is not changing. Physicians are trained to do their best, and sometimes that may lend itself to limiting to one issue, although we certainly don't endorse that approach.

The other part of that is just the complexity of Canadians. Canadians are aging. They have more medical conditions. They have complex care. There are more therapeutic options available to them. They're waiting longer for specialist consultation. They're waiting longer for surgeries. All of that is certainly contributing to burnout, but it's also contributing to how many patients I can effectively manage in my practice.

I hear from colleagues across the country who have practices. They may have 1,000 or 1,200 patients that they've had for their career, and they're not going to let those patients go. They're not going to fire patients, because there is no other provider, but they do feel overextended for those reasons that I mentioned and many other reasons.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Bouchard and Mr. Barrett.

Next is Ms. Sidhu, please, for five minutes

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair, and thank you to all of the witnesses for your testimony.

We all heard Dr. Lemire say that 4.6 million people do not have access to a family physician. Dr. Bouchard said we have a shortage of family physicians. You hit the nail, Dr. Bouchard. The aging population needs complex care, and that means we need more doctors.

We heard before that Canadians who attend medical school here have difficulty finding residencies. Sometimes they have to go to the U.S. What can be done to increase the number of opportunities for those students?

[Dr. Brady Bouchard]

The obvious answer is that we need to increase medical school enrolment and residency places across the country, and we have to make the practice environment enticing to learners. We're only going to entice medical students and residents to train in family practice when they can see that their preceptors or teachers are thriving and enjoying their practice environment.

I trained as what we call a Canadian studying abroad, so I went to Australia for medical school and then came back to practise. I'm from Saskatchewan and I practise in Saskatchewan. For that reason, there are not enough spots in Canada. I was lucky to be able to come back. There were four spots for my residency site and there were 700 applicants, so it is not at all easy.

[Sonia Sidhu, Liberal, Brampton South, ON]

Dr. Lefebvre, do you want to add to that?

[Dr. Guylaine Lefebvre]

I agree. We have the same reality. When medical students choose to be residents, they have the choice of The College of Family Physicians and a variety of specialties at the Royal College. Increasing access is absolutely part of the solution. Of course, nothing is easy in that, because as you increase access you have to increase the number of teachers, and teachers are somewhat smothered right now in a system that is overburdened. Again, it's about having those multiprofession conversations on how we address the issue.

As much as we need doctors, I think we also need a system that respects that we support doctors to be doctors. One of the problems we see right now is that we have physicians who will tell us that 30% of their day is spent on administrative tasks. If we could lighten up that load, our doctors would have a better quality of practice and we would be able to expand the reach.

[Sonia Sidhu, Liberal, Brampton South, ON]

Dr. Lefebvre, you have spoken several times about the need for better data collection to inform decision-making. As it stands now, which organizations are collecting useful data, and in what areas do we need better data?

You also said that for centralized data, there's some concern about privacy. What specific recommendation do you have on improving data?

[Dr. Guylaine Lefebvre]

We have limited access to data as a whole for the entire system. There is an opportunity, I think, through the Canadian Medical Association, to look at creating a national dataset that could go beyond only physicians and include our colleagues as well.

The data on physicians that we use often is from CIHI, the Canadian Institute for Health Information. Those datasets are private through the Scott's registry and are really not created to allow us to collect the right data about our physicians. To echo Dr. Lemire, part of the problem in those datasets, which were not created for the right reason, is that we don't really have as part of the data what a person is doing in their practice. A dermatologist working in a cosmetic clinic is very different from a dermatologist who works in an ICU in a hospital, for example, and there are varieties of complexities that way. I do think most of our organizations would be willing and able to contribute to a federally funded dataset.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

If we're talking about the pan-Canadian side, for which other health care professionals, if any, would a pan-Canadian licence model be useful?

Dr. Lemire, do you want to add on there?

[Dr. Francine Lemire]

I just want to be sure I understand the question. Are you asking me which professionals or providers besides physicians would benefit from a national licensure enablement?

[Sonia Sidhu, Liberal, Brampton South, ON]

Yes.

[Dr. Francine Lemire]

I would probably suggest nursing, pharmacy—

[Dr. Danielle Paes]

Could I interject?

[Dr. Francine Lemire]

I think the list could actually be quite long of professions that would lend themselves well to national licensure, which would therefore enable and facilitate those who provide care—and that's pharmacists, nurses, physicians—in some rural and remote communities to get a break and be able to take a vacation. I think that goes beyond physicians.

[Dr. Danielle Paes]

Can I add to that?

[The Chair, Liberal, Sean Casey]

Very briefly, please.

[Dr. Danielle Paes]

National licensure would also promote mobility between provinces. We want to have a national approach to making sure we understand the needs, and right now we don't have any data to support the demands. We know what the supply is, but we really need to look at what the demands are and then collectively work at mobilizing our health care workforce to meet those needs and remove any barriers.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Paes.

Thank you, Ms. Sidhu.

Mr. Thériault, go ahead for two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much, Mr. Chair.

I will address the Canadian Pharmacists Association representative.

Since recently, in Quebec, pharmacists have been able to prescribe antiviral drug Paxlovid. With all due respect to my doctor colleagues, I have always believed that, following a diagnostic, pharmacists were more qualified to prescribe drugs.

What is your approach concerning that new information, the ability to prescribe this drug?

We will then talk about the issues around Paxlovid.

[Dr. Danielle Paes]

Absolutely. Paxlovid is a really great example—nd kudos to Quebec for enabling pharmacists to participate in increasing patients' access to it, getting it into the hands of high-risk individuals and keeping them out of hospitals.

I think it's really about optimizing our education as medication experts. It's a collaborative approach. When it comes to the pandemic, we've seen how pharmacists have stepped up.

We've been involved in testing. We've been involved in screening and administering vaccines. If you're already going to a pharmacist to provide you with the pandemic services that we've had throughout the pandemic, prescribing for Paxlovid is a natural fit.

It's also really important because of the short duration for efficacy. We know that there's a short window—five days. Going to different health care settings to navigate this is very complicated for patients, so making sure that we're removing those barriers and giving access is so important. Pharmacists are well versed in drug interactions. They have a full patient history. It would be lovely if they had access to the medical records, but they can work in collaboration with family physicians and other health care providers to make sure that monitoring and follow-up takes place.

It's a very natural fit for pharmacists, and it makes sense because that relationship is already established with the patients that they serve.

[Luc Thériault, Bloc, Montcalm, QC]

If I understood you correctly, that is a Quebec practice you would like to see adopted elsewhere.

[Dr. Danielle Paes]

Absolutely. This is again about making sure that we are giving Canadians access to the medications and the services that they need, regardless of the postal code they live in. We need to see this type of progressive, creative, “meet the patients where they're at” approach to health care across the country, so kudos to Quebec for demonstrating how this model can work.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Paes, and Mr. Thériault.

Next is Mr. Davies, please, for two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Lefebvre, I get my teeth cleaned every six months by this wonderful person who is a Bulgarian-trained pediatrician who came to Canada and actually did all the requirements she had to do for her schooling but couldn't get a residency. I think this was just touched on.

Would I be correct in speculating that Canada has a real bottleneck? We have too few residencies. Is that part of the problem as well for all those who may be seeking to qualify to practice medicine in Canada?