Health Committee on April 4th, 2022

[The Chair, Liberal, Sean Casey]

I call this meeting to order. Welcome to meeting number 15 of the House of Commons Standing Committee on Health.

Today we're going to meet for two hours to hear from witnesses for our study of Canada's health workforce.

Before I introduce today's witnesses, I have a few regular reminders for hybrid meetings. Today’s meeting is taking place in a hybrid format, pursuant to the House order of November 25, 2021. Per the directive of the Board of Internal Economy on March 10, 2022, all those attending the meeting in person must wear a mask, except for members who are at their place during proceedings.

I have a few comments for the benefit of witnesses and members. Please wait until I recognize you by name before speaking. For those participating by video conference, click on the microphone icon to activate your mike. Please mute yourself when you are not speaking. For interpretation for those on Zoom, you have the choice at the bottom of your screen of the floor, English or French. For those in the room, you can use the earpiece to select the desired channel. Please don't take any screenshots or photos. That isn't permitted. The proceedings today will be made available via the House of Commons website.

In accordance with our routine motion, I'm informing the committee that all witnesses have completed the required connection tests in advance of the meeting.

We are very pleased to welcome our witnesses here today. Thank you for your patience while we fulfilled our democratic duty. That did cause a bit of a delay to our meeting, so thank you for sticking with us. We'll still have the full two hours with you.

We have with us today, as an individual, Dr. Hugh Maguire, head of psychiatry, Nova Scotia northern zone, and assistant professor at Dalhousie University.

We are also hearing from the representative for the Association des chirurgiens cardiovasculaires et thoraciques du Québec, Dr. Louis P. Perrault, president and cardiac surgeon.

From the Canadian Pharmacists Association, we have Dr. Danielle Paes, chief pharmacist officer; from the College of Family Physicians of Canada, Dr. Brady Bouchard, president, and Dr. Francine Lemire, executive director and chief executive officer; from the Royal College of Physicians and Surgeons of Canada, Dr. Guylaine Lefebvre, executive director, membership engagement and programs; and from Speech-Language and Audiology Canada, we have Dawn Wilson, chief executive officer, and Susan Rvachew, full professor.

Thank you all for taking the time to appear today.

We're going to begin with opening remarks in the order that our guests appear on the notice of meeting. We're going to start with Dr. Maguire for his opening remarks.

You have five minutes, Dr. Maguire. Welcome to the committee. You have the floor.

[Dr. Hugh Maguire, Head of Psychiatry, Nova Scotia Northern Zone, Assistant Professor, Dalhousie University, As an Individual]

Thanks very much for inviting me to speak today.

I was nervous enough, and then I saw that with Speech-Language and Audiology in the room, I need to speak as clearly as I can.

First of all, I want to say I'm grateful to be presenting here today and to contribute to this very important work as we look at Canada's health care resources. It has never been as clear that health care is important as it has been the last two years as we dealt with a worldwide pandemic.

In Nova Scotia we did our best to deal with the pandemic, and we saw an upsurge in our use of telehealth, so we were able to use Zoom technology to see patients in rural and remote areas. We're fortunate in that psychiatry and mental health are particularly well suited to this technology, and it did help us see patients in remote areas on an urgent basis who would not otherwise have been seen.

This brought to light the need for improved access to broadband Internet in rural areas, and if the federal government were to support that, it would be helpful. Also, if we were to support rural hospitals in communities to have improved technology to access those services, that would be very helpful.

Even though telehealth is a burgeoning field, it's not the same as in-person sessions, so we still need boots on the ground.

Today I would like to mention the importance of the recruitment and retention of health care workers to Canada, especially rural areas. My experience is with physicians, but I believe my comments would apply to other health care workers as well.

Essentially we're trying to get doctors to come to a rural areas, to stay, and then to be happy that they stayed. Part of the process of getting doctors to come to rural areas is training doctors at home, and we're doing good work in our medical schools across the country to try to find doctors well suited to rural practice and help them tailor their studies to best allow them to do that. We also bring in doctors from overseas, and I wish to speak today to the importance of streamlined immigration.

We have had a number of doctors agree to come to rural Nova Scotia whose arrival here was delayed considerably by challenges with the immigration process. One of the things that came up during the pandemic especially was that we had an inability to effectively communicate with Immigration Canada to troubleshoot some of these problems, resulting in one physician arriving in Canada three weeks before his family, who had to pay for a hotel in London, England for three weeks while waiting for things to get sorted out.

If we were able to have a streamlined process for immigration and then improve communication between the federal department of immigration and our provincial health authorities, that would be helpful.

The federal government has been doing work to promote national licensure for physicians. This is also helpful with portability in helping rural areas reach out to locums when in need. Aligned with that would be a federal locum program where we can, again, access help for doctors in rural areas.

There are doctors who are challenged by the idea of coming to a rural area because they are, frankly, afraid that they won't be able to leave and that they won't be able to get a break, so a federal locum program would assist those doctors in knowing they would get time off when they so much need it.

When doctors come to a rural area, we need to do everything we can to support them in their careers, which means giving them fulfilling work, offering them the opportunity to have a good work-life balance as well as the opportunity to continue to have their continuing education, whether it be by Zoom in their local clinics or getting away to attend a conference. Support we can give in this area would also be quite helpful.

Another thing that would be helpful is also recognizing the importance of having health care workers who decide to come to a community and stay for the long term, so coming up with incentives for longer-term service, I think, is very important.

One idea that I have pitched locally is the idea of a five-year bursary bonus, where any doctor or health care worker who comes to a rural area and stays five years after buying a house in the community would get a bursary paid out gradually over the following five years to encourage them to stay a longer time.

Finally, I would like to speak to the importance of fostering nationwide positive workplace cultures. If we can create positive, healthy workplaces that are culturally safe, welcoming and inclusive, that would be one of the best ways to encourage our health care workers to choose to live in rural areas and also stay.

I know I'm on a timeline here. I know the committee's time is precious, so I will conclude my comments there and thank you for your time.

[The Chair, Liberal, Sean Casey]

Thank you very much, Dr. Maguire.

You will no doubt have a chance to expand on your comments once we start asking questions.

We will now hear from Dr. Louis Perrault, president of the Association des chirurgiens cardiovasculaires et thoraciques du Québec.

The floor is yours.

[Dr. Louis Perrault, President and Cardiac Surgeon, Association des chirurgiens cardiovasculaires et thoraciques du Québec]

Thank you so much for having me this afternoon to speak on a very important subject for the health care system in Canada.

As mentioned before, I'm the president of Quebec's association of cardiac surgeons. I'm professor of surgery at the University of Montreal. I've been a cardiac surgeon for 25 years, so I've been exposed pretty much to the system day in day out.

My colleague Dr. Maguire raised a lot of very important points. One of the things I wanted to speak to is the fact that our system showed during COVID that it was not on the brink of disaster, but had already collapsed. COVID simply made things evident not only in Quebec but all over Canada. This, in my opinion, is related to chronic underfunding of the health system in Canada.

We saw that we did not have enough beds and not enough personnel. The lessons that we should have learned from the SARS crisis and the Campbell report way back were not either learned or remembered, because all of the necessary tools were mentioned in that very extensive report. I encourage you to read it.

I think that, sadly, a lot of decisions that were made health-wise were with a short-term vision. We do need to look at the way we entice people to become health professionals, doctors, etc. It's all well and good to say we will have immigration, but I think we should have a long-term plan to entice, train and have a sufficient number of health care professionals. That's all across the board. Physicians are part of it, but definitely, they are part of a team. If there's a deficiency in one of the team members in terms of volume, we cannot function properly.

I think to have a proper culture, as Dr. Maguire said, you need to have sufficient team sizes. If you don't have a sufficient size, then people will not stay. They will not come. It's all interrelated, the culture, the workplace environment, etc. That is very important.

I think that the short-term vision should be put aside. There should be some kind of an independent body that would make decisions to look a generation ahead, 20 years ahead, and make sure that we have a health resource plan, also in terms of infrastructure, to be able to take care of the needs of Canadians. We all know that the population is aging, and this is associated with a lot of our health care needs.

The bed levels in Canada are amongst the lowest in, I would say, the occidental part of the world. Beds aren't necessarily always the solution, but definitely they could have been part of the solution during the pandemic. This should be looked at, because there is going to be another pandemic down the road, the same way COVID followed SARS.

I think it's important to have a body that will be accountable, that doesn't just look four years ahead, that makes sure we will get the bang for our buck as Canadians and taxpayers.

I think this is the time when we need to look way ahead. We cannot put aside or put on hold investment in the health care system. Because of COVID, the number of patients that we will have to treat because they were undertreated during the COVID pandemic is going to be enormous. The funding should start now or else we will never get over it.

I thank you for your attention. I look forward to answering questions.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Perrault.

Next, on behalf of the College of Family Physicians of Canada, we have Dr. Brady Bouchard and Dr. Francine Lemire.

Who is going to lead off?

[Dr. Francine Lemire, Executive Director and Chief Executive Officer, College of Family Physicians of Canada]

I will be leading off.

[The Chair, Liberal, Sean Casey]

Okay.

Dr. Lemire, please go ahead.

[Dr. Francine Lemire]

Thank you for inviting us to speak on behalf of the College of Family Physicians of Canada and our more than 42,000 members. I'll be presenting in English. We will be pleased to respond to questions in both official languages.

My name is Francine Lemire. I'm a family physician and executive director and CEO of the CFPC. I am joined today by our president, Dr. Brady Bouchard, a family physician practising in North Battleford, Saskatchewan.

A thriving health workforce is critical in ensuring that Canadians have timely and convenient access to primary care. We'd like to describe the changes that are necessary to ensure that our health workforce can meet the evolving needs of Canadian communities.

There are 4.6 million people in Canada who do not have a regular family physician, and many cannot access the care they need when they need it. COVID-19 has accentuated and exposed existing gaps in care, particularly for vulnerable populations, such as seniors, indigenous populations and those suffering from addictions and mental health issues. Providing care during the pandemic has been challenging. Family doctors quickly pivoted to using virtual care while providing excellent in-person care when required.

The unique foundational value of family physicians is in providing comprehensive care to patients and families across the ages, including preventative care over time in a variety of settings. The evidence is solid: Countries with robust primary care featuring family doctor leadership have better population outcomes. However, in COVID's wake we're concerned about reports of family physicians and other providers feeling burnt out, retiring early, significantly reducing their clinical commitments or leaving the profession altogether.

Every Canadian should have access to quality care close to home in a family practice. Better access is possible if family doctors and their teams spend less time on the things that aren't direct patient care, such as general paperwork and clinic administration; if more family doctors are available, particularly as Canada consistently lags behind other OECD countries in physician numbers; and if family doctors working in teams are more available to their patients and a wider array of services are available through the team. Addressing each of those areas will retain the workforce, maintain well-being and ultimately improve access.

What can we do? The government's commitment to increase the family physician supply is commendable, but doing so will take time. In the short term, we must ease the burden on the frontline family physicians.

First, establish a time-limited fund to incentivize the retention of family physicians and other primary health care providers who are considering leaving the workforce postpandemic or are already on their way out. Second, provide administrative support to primary health care teams through dedicated funding and streamlined administrative processes, creating more time and capacity for direct patient care. A recent survey of our members ranked administrative support as the top requirement to enhance access.

Looking further ahead, we need to consider several systemic issues to make our workforce supply and distribution more resilient, equitable and adaptable. We welcome recent announcements to increase family medicine capacity in some medical schools. There must be consistent, deliberate action to increase supply and enhance capacity with a focus on under-serviced settings and populations.

Now more than ever, we need a robust provincial and national data strategy. Numbers are not enough. We must understand and take into account what providers do—their scope of practice and their career trajectories. We must sustain and expand practice environments that are good for patients and providers. The CFPC promotes the concept of the “patient medical home”, a vision of care that is collaborative, team-based, patient-centred, and strongly connected to the community and health care system as a whole. Further progress on expanding this type of care must be supported through a dedicated primary care transition fund that we've been advocating for in partnership with the Canadian Medical Association and the Canadian Nurses Association.

There's a general sense of lack of appreciation and support among family physicians, who are feeling burnt out and overburdened. Our members continue to serve as a foundation of Canada's health care system and trusted partners to their patients.

It is critical that family doctors and other health professionals get the support they need, both in acknowledging their contributions and through dedicated support from all levels of government.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Lemire.

Next, on behalf of the Canadian Pharmacists Association, we have Dr. Danielle Paes.

Welcome to the committee, Dr. Paes. You have the floor.

[Dr. Danielle Paes, Chief Pharmacist Officer, Canadian Pharmacists Association]

Good afternoon and thank you for the opportunity to be part of this important and timely study.

My name is Danielle Paes and I am the chief pharmacist officer for the Canadian Pharmacists Association. Today, I am joining you from the traditional and unceded territory of the Confederacy of the Three Fires of first nations: the Odawa, Ojibway and the Potawatomi.

The CPhA represents Canada's 47,000 pharmacists who, along with their teams of pharmacy technicians and assistants, have worked tirelessly throughout the pandemic to support us all.

I want to spend a few moments highlighting the role of pharmacists during the pandemic.

When the pandemic started, pharmacies were one of the only community health care providers to remain open to the public, when most others closed or transitioned to virtual care. They did so amidst great uncertainty, not knowing how to protect themselves or their staff, while also trying to manage drug shortages and disruptions. The pandemic has truly highlighted the essential role that pharmacists and pharmacies play in health care.

Pharmacists have been an important source of COVID-19 information for the public, and have had to navigate a consistently changing environment, in some cases, with little or no advance notice. In many parts of the country, pharmacists distribute and administer COVID-19 tests, and they are the leading providers of COVID-19 vaccines, with over 17 million administered in pharmacies today.

Although COVID has dominated the last two years, the opioid crisis hasn't gone away. Through an exemption provided by the federal government during the pandemic, pharmacists were able to extend care to patients using opioids and other controlled substances. This was especially important, because they helped those individuals struggling with addiction to maintain their treatments.

The pandemic, however, has come with a toll, due to the relentless demands placed on all health care workers within a system that was already stretched. Over the past few weeks, you've heard many common themes from witnesses who have appeared. Our own experience, supported by a national survey that we recently conducted, reinforces the point that the mental health of our pharmacy workforce has been significantly impacted by burnout, labour shortages and patient harassment. It saddens me to share that during the pandemic, almost half of respondents experienced abuse or harassment from patients at least once a week, and some even daily.

Like our physician and nursing colleagues, the pandemic has had a major impact on the supply of pharmacists and their support staff. We're seeing an alarmingly high number contemplating leaving the profession. It's been heartbreaking to listen to the stories of my frontline colleagues, who are exhausted. For most, the stress and pressures they're under at work, coupled with the challenges they face personally, have put them at a breaking point.

We believe urgent action is needed to address this impending catastrophe. The federal government can play an important role in providing direct support to health providers, as well as indirect support through the provinces and territories. This includes targeted mental health resources to help pharmacy teams cope with the struggles they've faced over the past two years, as well as strategies and funding to ensure that we have the appropriate supply of pharmacy professionals, particularly in rural and remote areas.

Financial incentives, loan forgiveness for health care workers and subsidies for employers providing practical experience to students and internationally trained health-care workers are just a few of the recommendations that we believe could help avert a future health care workforce shortage and emergency.

As the committee considers strategies to improve the recruitment and retention of health care providers, I would be remiss if I did not talk about the lack of consistency with our scope of practice in Canada. Many committee members here today are able to get a flu shot at their local pharmacy, but there are still some territories that haven't enabled pharmacists to provide this service. Similarly, in some parts of the country, pharmacists can prescribe for common ailments, like UTIs and skin rashes, but others cannot. This demonstrates clear inequities to care within our existing system.

When it comes to recruiting and retaining pharmacy professionals, the ability for us to work to our full scope, regardless of where we live, is so important to our personal and professional fulfillment. The lack of scope can also disincentivize pharmacists from practising in rural and remote locations. While health and the scope of practice remain mostly provincial jurisdiction, we believe the federal government should provide targeted funding to the provinces to further extend scopes of practice for pharmacy professionals, so that they can deliver better care to patients.

I'd like to acknowledge again the incredible work and sacrifice of all health care workers over the past two years. We owe so much to them.

Thank you to the committee for allowing me to share how pharmacists and their teams across Canada have contributed to and been impacted by the pandemic. We look forward to seeing the positive outcomes from your dedicated efforts.

[The Chair, Liberal, Sean Casey]

Thank you very much, Dr. Paes.

Next we have the Royal College of Physicians and Surgeons of Canada represented by Dr. Guylaine Lefebvre.

You have the floor.

[Dr. Guylaine Lefebvre, Executive Director, Membership Engagement and Programs, Royal College of Physicians and Surgeons of Canada]

Thank you, Mr. Chair.

Honourable committee members, I thank you for the opportunity to appear today before this committee to discuss the critically important topic of health workforce recruitment and retention.

My name is Guylaine Lefebvre. I am the executive director of the Office of Membership, Engagement and Programs at the Royal College of Physicians and Surgeons of Canada.

I join this meeting today from Ottawa and the traditional, unceded, unsurrendered territory of the Anishinabe Algonquin nation.

I have been a specialist physician for 30 years. My specialty is obstetrics-gynecology. I have participated as an educator and a leader at many levels of our health care system.

The Royal College, its governing council, our president Dr. Richard Reznick and our CEO Dr. Susan Moffatt-Bruce remain committed to physician burnout and wellness issues. I offer regrets from our CEO who cannot join today. Dr. Moffatt-Bruce is committed to this important work in her capacity as a clinician-researcher as well as her position of CEO at the college.

We represent more than 50,000 physicians and surgeons across the country.

Health care, at its core, is about people. Healthy, supported health workers will result in healthier patients and healthier communities across Canada.

I am grateful to this committee for its commitment to addressing issues relating to recruitment and retention in the health workforce. I'd like to share with you what we've heard and what we know from our fellows, our residents and their colleagues in the health workforce, and what we're doing to support them.

I am also grateful to the government for the passage of Bill C‑3, which protects health care workers from intimidation that they increasingly face in the course of trying to provide care for patients.

While the Royal College represents 50,000 specialist physicians and surgeons across Canada, we're not working alone on this issue. We're working in collaboration with other key stakeholders in health care including the membership of the Canadian Medical Forum with its physician resource planning working group and HEAL—Organizations for Health Action—which represents health care workers from over 40 organizations and disciplines.

We cannot work independently from a system that relies on a team of health care workers, from nurses in the operating room and in recovery to environmental teams that maintain the hospital rooms and clerical staff that look after the entire patient journey. Our physicians are only one piece of the care puzzle, which should always have the patient at the centre of the team.

One in two physicians shows signs of advanced burnout. In late stages of burnout, physicians often lose a sense of professional accomplishment and can contemplate leaving the profession. That's a red flag for all of us.

Throughout the COVID‑19 pandemic, health care workers have stepped up. They have come out of retirement, delayed retirement, worked extra hours, all to keep our families, friends and neighbours healthy.

In a recent story published by CTV, an internal medicine and COVID-19 unit physician explained, “We're going to get to a point where we have skeleton crews everywhere, which is not the way a health-care system can survive.... I would argue that we're not surviving now. We're just barely getting by.”

The reality is that we haven't paid the full price of the COVID pandemic and that day is coming.

Burnout, exhaustion, delayed retirements and harassment of health care workers will all result in people leaving these professions and leaving us short of health care workers at a time when there is a tremendous backlog of procedures and care to be provided.

The demands on the health workforce will only increase and we may not have enough people left to provide the care.

We must also recognize that those who remain in the health care sector are stressed, exhausted and have experienced moral distress and moral injury. During the pandemic, health care professionals have been forced into challenging conditions and have had to make impossible decisions. The pandemic has brought to light many issues that already existed in our health care system and have been exacerbated in the last two years.

This means they're worn so thin that it becomes challenging to offer the type of compassionate care that we all want for ourselves and our families. Health workers who are exhausted and burnt out also don't find the same joy and gratification in seeing their patients do well.

As a surgeon, I am intimately familiar with the hardship of knowing that a patient is suffering and needs surgery, but there is no availability of OR time to proceed. The empathy we carry for the patient's pain, the workload of exploring options for care and the challenges of keeping waiting lists all contribute to the moral distress we see with our physicians. Access to care and waiting lists through COVID have gotten even more difficult to manage, but they have been troublesome for years.

In March 2020, Dr. Mamta Gautam, a psychiatrist, offered to hold daily Zoom calls to offer peer support to colleagues across the country. She had approximately 2,000 physicians contact her to join the group. In the first few weeks, between 30 and 50 physicians on average would tune in to the Zoom call each day. That number sometimes reached 80. In addition, according to a recently released survey by the Canadian Medical Association, nearly half of physicians are presently contemplating reducing their workload.

The good news is that together we can effect change. Studies have shown that to reduce the incidence of burnout, improve resilience and ultimately improve patient outcomes, a health system must identify and prioritize a commitment and dedication of resources to support health care professionals. Our colleagues at the Canadian Medical Association have created a physician wellness hub, which is one such resource to support physicians in prioritizing their own health.

Data is a resource that governments can use to understand the current composition of its health workforce to move our system forward from the pandemic. There are existing health workforce datasets, but these are typically limited to a single jurisdiction, based on self-reporting or for-profit databases that were not designed for health workforce planning.

There are also critical data gaps in existing workforce datasets, such as a lack of information related to equity, diversity and inclusion. Cultivating a health care workforce that is representative of the population it serves is critical to ensure the best health care for all Canadians.

[The Chair, Liberal, Sean Casey]

Dr. Lefebvre, I'm sorry to interrupt. Can I get you to try to wrap up, please?

[Dr. Guylaine Lefebvre]

The timing is perfect; I'm right there.

The Royal College represents specialist physicians, but our fellows and residents work in teams. To that end, we offer the following recommendations.

Collect and analyze data at a national level, ensuring that we have robust data for all jurisdictions and all professions within the health care workforce and continued, sustainable investments in programs, policies and supports for the entire health workforce.

The Government of Canada has stepped up during the pandemic to support health care workers, but we must recognize that the challenges faced during this pandemic will continue. Let's continue investing in it.

I thank you for your time, and am happy to answer questions when we get a chance.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Lefebvre.

Next is Speech-Language and Audiology Canada, Dawn Wilson and Dr. Susan Rvachew.

Who is going to speak first?

[Dawn Wilson, Chief Executive Officer, Speech-Language and Audiology Canada]

Mr. Chair, I am going to speak first.

[The Chair, Liberal, Sean Casey]

Go ahead, Ms. Wilson. You have the floor.

[Dawn Wilson]

Thank you so much, Mr. Chair and members of the health committee. I am joined here by my colleague, Dr. Susan Rvachew, and we just want to thank you on behalf of Speech-Language and Audiology Canada for the opportunity to speak to you today about our professions.

Our members focus on prevention, assessment and management of communications, swallowing, hearing and balance disorders across the lifespan. We represent over 7,000 members, who are often assisted by communication health assistants and work in a wide range of settings, including schools, hospitals, early years centres, long-term care facilities and in private practice.

In particular, early intervention from our members set up success for children in the critical ages of zero to six through detection of hearing loss and therapies for speech and/or language delay. Our services are integral to the care, dignity and quality of life for people living in long-term care facilities due to the high prevalence of communications, swallowing, hearing and balance disorders in seniors. These difficulties affect personal and caregiving relationships and are also associated with loss of autonomy, isolation and caregiver stress—and I know, as we can all attest, the ability of residents and facility staff to effectively communicate is paramount for everyone's health and safety.

During the peak of the COVID-19 pandemic, many of our members working in health care settings were redeployed to assist with pandemic response, further contributing to burnout. Moreover, our members play an important part of COVID recovery as many SLPs help patients with speech or swallowing issues post-ventilation.

As a result of the pandemic closures, many infants missed their newborn screen test. According to the Ontario Ministry of Health, two out of every one thousand babies have hearing loss at birth and two more develop it by age five. As a result of hearing impairment, children have difficulty with their speech and language, which can lead to academic, behavioural and emotional issues. Closing schools and day cares impacts the language and literacy of children and has added to the burnout and heavy caseload of school-based SLPs. Already, we know that 45% of indigenous children are missing their literacy benchmarks and that Canada lags behind other developed countries.

Currently, the number of SLPs and audiologists within Canada is not meeting the needs of the population, in particular the growing aging population. Although Canada's population totals around 12% of the U.S. population, the number of Canadian SLPs is around 3% of the number of U.S. SLPs. This poses an issue because the number of SLPs is too small to provide quality treatment to the large and growing number of people with communication and swallowing problems in Canada.

Recently, Northwest Territories Health Minister Julie Green said that adults must wait 19 months to see an audiologist in the Beaufort Delta and 26 months in Yellowknife. There are currently only two audiologists in the Northwest Territories. According to the Health Sciences Association of B.C., early intervention therapies, including SLP therapies, have the longest wait times of any child development centre program. Currently, it is not unusual for children never to end up having access to an SLP before entering kindergarten or to wait months or years before accessing service.

This lack of service for pre-school age children is particularly acute for indigenous children, with devastating consequences for their literacy levels, hearing health, school success, social and emotional health and their vocational outcomes.

As well, according to the Canadian occupational projection system, over the period or 2019 to 2028, the number of job openings arising from the expansion of demand and replacement demand for audiologists and speech-language pathologists is expected to total 3,800 while the number of job seekers is expected to only total 2,800.

As with many of our health care professions, rural and remote areas across the country face issues with recruitment and retention of their workforce. Therefore, we implore the government to recommend and endorse the following initiatives.

We must ensure that speech-language pathologists and audiologists are eligible for the Canada student loan forgiveness program, in particular those who set up practice in rural and remote communities.

We implore the government to provide funding for provinces that will work with partners to create, implement and manage innovative short and long-term strategies and programs that support the recruitment and retention of SLPs and audiologists.

We would ask the that government provide incentives or support to universities to expand or create SLP or audiology programs.

We must invest in telehealth infrastructure as a means of improving access to SLP and audiology services, particularly in rural and remote communities, including our indigenous communities.

We would also like to mention that we support the recommendations provided to HESA by the Canadian Health Workforce Network, who are doing such important work in this area.

We thank you for your time today and we encourage any questions you may have.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Wilson.

We're going to move right to questions now, beginning with Dr. Ellis for six minutes.

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

Thank you, Mr. Chair.

I want to thank all of the witnesses for their statements and being with us today for this exceedingly important study we're doing that affects all Canadians and, probably most acutely, Canadians who live rurally.

Just for full disclosure, I have been a family doctor for 26 years and recently am one of those defectors who have come here to work instead, perhaps for a multitude of reasons. Who knows?

As my colleagues here know, my wife is a pharmacist. I'll give them a shout-out especially because my wife is awesome, but all pharmacists are.

[Voices]

Oh, oh!

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

Thank you. No answer is required

Dr. Maguire, thanks for coming. There are a couple of things that you specifically mentioned, in particular broadband Internet and immigration, that have affected your ability to deliver care and to look at solutions for our very acute problem of the lack of psychiatrists.

Maybe you could give us a bit of a story around the immigration issues that you talked a bit about with the family of a psychiatrist being left in a London hotel for three weeks.

[Dr. Hugh Maguire]

The doctor in question showed up at the London airport to start his new life in Canada, and when they checked in at Heathrow, he was informed that he was allowed to get on the plane but not his family. His wife and teenage daughter, with their pet dog, had to find a hotel at a moment's notice in London, England.

At the time, I was aware of the problem. We were desperately trying to troubleshoot this so that the family could make it onto the plane and board. We just hit one dead end after another in terms of trying to speak with Immigration or to speak to somebody who could allow the family to board the plane.

The family ended up going to the hotel, as I mentioned. Again, we were trying to reach out through appropriate channels, which would have been through health care in Nova Scotia, through the Department of Health, and then we tried to reach out to Immigration to try to make sure that this family could join their father and husband as quickly as possible. In fact, we just found one delay after the other, and the family was just so frustrated.

They ended up having to spend three weeks in that hotel in London before they got to come to Canada. Meanwhile, the physician had to do his quarantine period in Canada for two weeks alone, without any access to his family. Of course, when they arrived in Canada, they had to do the two-week quarantine as well.

It was a pretty tough start to their life in Canada. We're lucky that this is a resilient family they have settled into this country and made Nova Scotia their new home, but it sure was a rocky start and a fairly emotional one at times.

If we had a way to improve our ability to troubleshoot when those issues arise, that would be incredibly helpful to avoid any future problems like that happening.

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

Dr. Maguire, through you, Mr. Chair, do you think it's important that, as part of our short-term solution—especially in rural health care and, perhaps more importantly, in rural psychiatry—we make immigration and attracting physicians from abroad a significant part of that strategy?

[Dr. Hugh Maguire]

I think so. I think that applies to physicians and any kinds of skilled workers. If there's a way to streamline the immigration process, so that those important workers could be in Canada and providing care while they're finished being vetted, for example, that would be super helpful.

In fact, we had one psychiatrist who agreed to come to join us in early 2020. That doctor has still not arrived and has, therefore, given up on his wish to come to Canada.