Health Committee on April 4th, 2022

[Dr. Guylaine Lefebvre]

Thank you.

Yes. My husband is a family doctor and I can tell you that there are a lot more similarities than differences between specialists and family physicians when it comes to these issues.

I really do think that the solution, as you've heard from many of my colleagues, is to work together. Better data means better planning. We really need to plan and support in an integrated way that reflects the way we deliver the care.

We are already collaborating closely, through the Canadian Medical Forum, with Dr. Lemire and the College of Family Physicians of Canada. We're looking at, for example, the rural and remote realities. The integration of primary care specialists with other specialists will be key, and with other providers as well.

We hear from our fellows right now about how they would love the resources to better support the system as a whole. We've referred to the administrative staff, the nursing, the patient at the centre and the team that we need to support it, and we really don't have that data.

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

We have about 30 seconds left, Dr. Lefebvre.

Is it fair to say that my pie-in-the-sky idea of a pan-Canadian electronic medical record would really be essential to...? It would speed up care, in my mind, and make care better and more comprehensive. Is that fair?

[Dr. Guylaine Lefebvre]

Having a system with the patient at the centre and where we can all talk to the same reality definitely does seem to be an advantage.

The implementation of this, making sure that the physicians and other health care workers who deliver the care have access to that, and the implications relating to privacy and so forth are some of the challenges that stand in the way.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Lefebvre.

Thank you, Dr. Ellis.

Next we have Mr. Van Koeverden, please, for five minutes.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you very much, Mr. Chair.

I believe I should start, as many of my colleagues have, by declaring a bias or a conflict. My girlfriend is a speech-language pathologist, so my questions will probably focus mostly there today.

Dr. Rvachew, Emily Wood says hi. She's my girlfriend and you taught her at McGill. She said you'd probably remember her.

[Susan Rvachew]

I do indeed.

[Adam van Koeverden, Liberal, Milton, ON]

She's doing a Ph.D. now at the University of Toronto. She'll probably reach out to you at some point and discuss her research.

Over the last couple of years, and actually because of the onset of the pandemic, she started a study on telehealth, so I was hoping to focus a little bit on speech-language pathology specifically, but it could expand to other modalities as well.

Telehealth provides us with an opportunity to look at how some of the challenges with respect to availability of SLPs and audiologists in remote northern communities could be applied. Obviously there are other challenges around connectivity there.

Could you speak briefly about some of the potential outcomes for SLPs who could reach people who otherwise wouldn't have access to one?

[Susan Rvachew]

Yes. Speech-language pathologists switched over to telehealth extremely fast. Through the professional association nationally, the SAC, and the organization in Quebec, and at the provincial level all across Canada, many different types of supports were offered to speech-language pathologists to help them do that, learn how to do it, find out what kind of equipment they needed and so on. It's been two years and we actually have quite a lot of experience with it. We're teaching our students how to use that model, and they're getting more and more of their clinical practice hours in telehealth. We're quite excited about it.

There are many issues, which Dr. Maguire spoke to. The first one is the integrity of the Wi-Fi you have and connectivity issues, because for speech-language pathology, it's especially important that you have good-quality sound. Sound delays can be devastating when you're doing speech therapy, so you need to have good-quality connectivity.

The other thing that makes a difference for the equity of the service is that the patient or client has to have equipment as well. Not everybody has the equipment or they might not have good enough equipment, so we have to provide those people with the equipment.

The third thing is that the speech pathologist has to have skills, and not everybody is equally skilled. Then this has to work for the very many different kinds of things that speech-language pathologists do, because we're treating different disorders in different ways. Right now, it's not clear that this works for everything. In our school, we have speech pathologists and students providing that service for different kinds of disorders, and it seems to be working quite well for certain kinds of things. However, we did a study in my lab, for example, on a very severe kind of speech disorder called apraxia of speech and it didn't work. It wasn't good, so it works well for some kinds of things, but not well for other kinds of things.

I'm a bit worried about what will happen. People may decide to provide interventions that are suited to the modality, rather than providing treatments that are suited to the problem the patient has—

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Doctor. I'm sorry, but I have a limited amount of time and I have another question.

One of the things I've learned from Emily is that undiagnosed hearing impairments often lead to really negative future health and societal outcomes for people, particularly young people. That was touched on earlier. I represent one of the largest deaf populations. It's in Milton because Milton has the largest deaf school.

Could you speak briefly about the opportunity that exists in applying some of these assessments earlier in life, potentially through a new national universal early learning and child care program? We might be able to assess some of these challenges earlier in children, providing better outcomes later in life.

[Susan Rvachew]

I'm very excited about the national child care program. There are so many opportunities associated with national child care programs.

With regard to hearing loss, the universal hearing screening programs across the country are the most important thing because for a lot of hearing loss, babies are born with it. I think that's really important. There are also hearing losses associated with otitis media, which are very common in the indigenous population, for example, so having screening in preschools is very important. Then there's the opportunity to provide early interventions through preschools to children, families and so on. I think it's a very important opportunity that we should take advantage of.

My daughter has autism. She's 33 now, but when she was really young, we were receiving her services in the day care for a while and it was marvellous. They were very good. Then, for some reason, the Government of Alberta decided that wasn't a good thing to do and just withdrew the services. It was quite devastating. I really look forward to the possibilities.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Doctor. I'll tell Emily you say hi.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. van Koeverden.

Mr. Thériault, you have two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

My question is for the Canadian Pharmacists Association representative.

There have been drug shortages throughout the pandemic. That put a burden on patients, but also on health care providers.

Has the situation improved? Is Health Canada more vigilant right now when it comes to drug supply? Are the necessary steps being taken to prevent those shortages?

[Dr. Danielle Paes]

Thank you for the question.

Drug shortages are a part of the daily life of community pharmacists. The pandemic made it more stressful. It made the pressures more significant.

It ebbs and flows. I think the reality is that pharmacists and the government need to have conversations. We need to be involved in the planning. We need to be ahead of the game as much as possible. We would welcome any opportunities to continue the dialogue to ensure that we set up our pharmacies with the resources, the drugs and the medications they need to help the patients they serve.

[Luc Thériault, Bloc, Montcalm, QC]

Does that cause specific anxiety or stress among providers and pharmacists?

[Dr. Danielle Paes]

Absolutely. Just imagine what it's like to be the face that is delivering that message to your patient: You're not going to be able to continue with the therapy that you've been on because it's just not available.

It requires us to become creative problem-solvers. We need to collaborate with our other health care providers. As you've seen here, there are huge opportunities for us to work interprofessionally to establish the best plan moving forward—whether or not we need to substitute, whether or not we need to modify medication based on availability. I think there's a lot there to discuss and unpack.

The bottom line is, yes, it is a huge source of stress and anxiety for our profession.

[The Chair, Liberal, Sean Casey]

Merci, Monsieur Thériault and Dr. Paes.

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

[Don Davies, NDP, Vancouver Kingsway, BC]

Well, while we're outing ourselves, I am married to a speech-language pathologist here in Vancouver.

[Voices]

Oh, oh!

[Don Davies, NDP, Vancouver Kingsway, BC]

Sheryl Palm works at the children's hospital, and I just wanted to give her a shout-out. She's on the cranio-facial team. It's caused me to have a lifelong deep respect for the work that SLPs and audiologists do, and I want to thank you for being here.

I have two quick questions.

First, to the College of Family Physicians of Canada, at present, what's the estimate of how many Canadians lack access to a family doctor?

[Dr. Francine Lemire]

It's 4.6 million.

[Don Davies, NDP, Vancouver Kingsway, BC]

Is that getting better or worse?

[Dr. Francine Lemire]

I guess the jury is out on that, at the moment. If our concerns about upcoming retirements for family physicians prove to be true, we will have more Canadians without a family doctor.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Lefebvre, it's notoriously difficult for foreign-trained doctors to practice in Canada. There are public jokes made about it, such as that the healthiest place to have a heart attack in this country is in a taxicab.

Why is this, and what can be done?

[Dr. Guylaine Lefebvre]

That's a great question. Thank you.

We of course want to have the best physicians possible to look after the population of Canada. The processes that we require for both Canadians and physicians outside of Canada to join need to be equitable in a way that, when you see a physician anywhere in this country, whatever the province, whether you're in a rural area or in the city, you can trust that the standards are there. There are processes, of course, to ensure that.

There's a complexity when a physician comes from out of country—linked to their background, their culture, the immigration and so forth—that has to be respected. I think at the same time that we as a population are mindful of the fact that it takes a lot of energy for a country to train a physician to become a physician. We shouldn't be seen as people who make it too easy to actually grab from poorer nations to bring them into the country.

It's that fine line of, absolutely, if you're going to be a physician in this country, I'd rather have you as a physician than a taxi driver, but let's do the best we can to train the number of physicians we need in this country right here.