Health Committee on April 4th, 2022

[Dr. Guylaine Lefebvre]

Obviously I'm not in a position to comment on that individual's circumstance.

[Don Davies, NDP, Vancouver Kingsway, BC]

Yes, right, nor on the state of my teeth.

[Dr. Guylaine Lefebvre]

I'm sure they are great. It's funny how life diverts us sometimes.

We have a lot of specialties in Canada, and at the Royal College we continuously talk to members about what additional competence they need and what subspecialties we build. Again, what's missing is the data capture. Where are we missing individuals and how do we release that? Do we have a little too many here and not enough over there? That has not been the purview of the Royal College. The access to speciality exists, and how it gets managed in the field is something we are definitely keen to collaborate on.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

My last question is for Ms. Wilson. I'll give the last word to you. What would you recommend to the federal government to help address the shortage of speech-language pathologists and audiologists in Canada?

[Dawn Wilson]

What we need to do is consider creating more spots for speech-language pathologists in schools. We need to consider more funding for jobs. Speech-language pathologists are subject to funding cuts and have been throughout this pandemic, so the government needs to be accountable for health care transfers that go to the provinces to support the vital funding that we need to support the jobs that are being cut. Lastly, we need to ensure that we have people coming into the profession by providing the right supports. Right now speech-language pathologists in particular are not the most well compensated, so with the move to private practice because there's a loss of jobs in the public sector, the government could look at supporting the right mixture of employment for speech-language pathologists.

We are losing people every day based on caseload, burnout and poor wages. This really is a concern, and once people go into private practice, they are faced with the same types of issues because there's a lack of funding for people in the community for the services they need. That also falls onto the other side of things in terms of how services are funded for the people who need them. For the public like you and me and our children, how do we manage insurance coverage? How do we manage the right supports so that people can manage access to services? There are a number of things.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Wilson and Mr. Davies.

Next is Mrs. Goodridge, please, for five minutes.

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

Thank you so much.

This question will be for Dr. Bouchard. You touched briefly on how inflation really impacts doctors in a fee-for-service space. I'm wondering, with the record-breaking inflation that's currently at 5.7%, if you guys are feeling the impact of that on practices in your area.

[Dr. Brady Bouchard]

Absolutely. As I mentioned, although it's not my personal experience, our urban areas—Vancouver and the greater Toronto area—are certainly feeling it the most, but we're feeling it across the board. I want to emphasize again that in the fee-for-service setting where family physicians are running a business, they need to pay for a medical office administrator, a clinical nurse and salaries within their clinic. They need to pay overhead. They need to pay for medical supplies. They need to pay for utilities. Absolutely, they're feeling the hurt. That's part of the uniqueness as well. Other businesses can increase prices. We're certainly not advocating for that for family physicians. We strongly believe in a publicly funded medicare system, but it does limit how you can make a living.

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

Effectively you're saying that this rising inflation is making it more difficult for doctors to just do their job?

[Dr. Brady Bouchard]

Absolutely. That's why we see physicians moving out of practice. That trend was there prepandemic as well. They're moving out of comprehensive office practice and moving into areas such as hospice care, obstetric care and emergency medicine—areas where they do not need to carry the burden of overhead and staff salaries. We need to reverse that trend.

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

That's wonderful. I hope my colleagues opposite have heard the fact that continuously printing money has some consequences on public health, as we're currently hearing.

One other question I have for you highlights the fact that you had to study abroad. Do you think there is a space for universities across the country to have more space for students from rural communities to get into med schools?

[Dr. Brady Bouchard]

Yes, absolutely.

That's part of the rural road map that Dr. Lemire mentioned before, which we've collaborated on with the Society of Rural Physicians of Canada. The key to recruiting rural physicians to practice rurally, whether that's family physicians or specialists, is to recruit medical students from those communities. People who have ties to a community already are much more likely to go back to a community to practice and more likely to stay there. I think it's a clear, smart strategy going forward.

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

Fantastic.

Do you have any other suggestions on how we could recruit and have more rural physicians?

[Dr. Brady Bouchard]

Certainly, the advent of virtual care has made it easier for patients to access specialist care across geographic barriers. That's certainly a barrier for rural physicians. I practice rurally. An additional contributor to burnout of rural physicians is the moral injury of trying to get patients access to care that they might have been able to access in a more urban setting.

Really, we need rural health equity. Certainly, as mentioned by everybody else here, we need data nationally around the distribution of physicians, where we may be over resourced, whether we are maldistributed or just do not have enough.

We need to know who's doing what practice and where, because a family physician is not a family physician, and a Royal College specialist is not a Royal College specialist.

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

Wonderful.

Dr. Maguire, are there any jurisdictions in Canada that are doing better that we could perhaps look to?

[Dr. Hugh Maguire]

Yes, there are actually a couple of schools in Canada. Memorial University is doing a lot of work in the area of recruiting rural students, as are areas of Ontario, with some of their more rural and remote training programs. Those are all really worth looking at. There's some good success happening there that could certainly be copied in other parts of the country.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Goodridge and Dr. Maguire.

The last round of questions is going to come from Mr. Jowhari, for five minutes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair. Thank you to all our witnesses. Specifically, thank you to my colleague, MP Don Davies for opening the opportunity for me to acknowledge all the oral health workers, especially the restorative hygienists. I would like to acknowledge my wife.

[Voices]

Oh, oh!

[Majid Jowhari, Liberal, Richmond Hill, ON]

I looked at all of my colleagues, and I didn't want to go home on Thursday night and not have acknowledged my wife. She's amazing. I attest to that as do all the patients for whom she's been working for the past 22 years.

Here you go, Homeira. You're amazing.

I also would like to go to Dr. Paes.

I have a very good friend, Dr. Akil Dhirani, who is a pharmacist. He has a number of pharmacies across the GTA, and one of them is in my riding. We often engage in very deep conversation about various skills that pharmacists can bring to the table when it comes to oral health. He talks about the utilization of other capabilities as they relate to the pharmacists.

We talk about national licensure, which we have also talked about here today; opportunities for actually forming a patient-centric care, where all the health care providers come together and provide an integrated care; and partnerships with various levels of government, as well as prescribing capabilities.

In your opening remarks, you talked about lack of consistency in the scope of services, and fragmented funding.

Can you please expand on this lack of consistency and the implication of us, one day, being able to move into virtual care?

[Dr. Danielle Paes]

The lack of consistency is a huge area of frustration to the profession because, depending on where you're practising, you're able to do things...and the funding and support to be able to offer the services that we are capable of giving to our patients is limited. There's a huge opportunity for us to rethink what health care looks like.

When you enter the doors of a pharmacy, you're not just entering the doors to see your pharmacist. You're entering the doors to Canada's health care system. I think there needs to be a shift to incorporating pharmacists into the greater health care system, and rethinking how we can utilize our skills and our knowledge in collaboration with the other health care providers and the other systems in place so that we're not only being efficient, but we're also being effective.

Right now, there's no way of showing the impact that pharmacists' interventions have on the prevention of hospital room visits. We want to be able to triage patients and make sure we catch their conditions. We want to make sure their health conditions are managed early on, not later on, when the implications are.... As we heard earlier on, the delay in treatment, or even in identifying therapy, has severe consequences for the patient and for the health care system.

So leveraging pharmacists is a really smart thing to do, and it's what we want to do. We want to provide care. But I will say that the system needs to be supportive of that. That includes funding and that includes a reduced administrative burden. There are so many barriers or system constraints that prevent us from being able to deliver the care that we want to and that we're capable of doing.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

You talked about the barriers as being system-specific. To go back to virtual care, can you highlight some of the opportunities that exist there for us to be able to move even faster, if and when needed, into virtual care?

[Dr. Danielle Paes]

You know, virtual care is double-edged. It's wonderful, because it gives access to patients in the comfort of their home. That being said, not everybody has access to technology, such as in rural parts of northern Ontario. I spoke to a pharmacist who said he had to set up a kiosk in his pharmacy to help his patients download their QR code to show that they were immunized.

There's a whole group of patients and a demographic that virtual care may not be the right method for, but it's a multimodal system. In some cases, access to virtual care would be a phenomenal asset to individuals, especially if you wanted to do a medication review or to consult on a drug-related question or query. I think there are a lot of opportunities there. Technology can be an enabler, but it is not the solution for everybody. Knowing that 95% of the population lives within five kilometres of a pharmacy, you have access points already in place.

Let's rethink how we leverage and utilize our existing workforce so that we can care for Canadians the way we know how and want to.

[The Chair, Liberal, Sean Casey]

Thank you very much, Dr. Paes and Mr. Jowhari.

Thank you to all of our witnesses for being with us today. This has been a fascinating and informative discussion. Thank you for the work you do on behalf of patients and on behalf of your colleagues in your respective professions. Thank you for your articulate presentations here today. We are extremely grateful to you. It will aid us greatly as we put together a report for Parliament.

With that, is it the will of the committee to adjourn the meeting?

[Some hon. members]

Agreed.