Evidence of meeting #15 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was doctors.
A recording is available from Parliament.
Chief Executive Officer, Speech-Language and Audiology Canada
It's very, very high. It's probably 85%.
Chief Executive Officer, Speech-Language and Audiology Canada
No, it's a little bit less. It's more male-dominated in the audiology sector. It's probably half-and-half.
NDP
Don Davies NDP Vancouver Kingsway, BC
Okay.
The federal government's Canadian occupational projection system has estimated that over the period of 2019 to 2028, the number of job openings for audiologists and speech-language pathologists is expected to total 3,800, while the number of job seekers is expected to total 2,800.
You've already spoken to the rather shocking discrepancy between SLPs in Canada and the U.S. I'm wondering if you could explain to us the primary reasons for the shortage of SLPs in Canada.
Chief Executive Officer, Speech-Language and Audiology Canada
I may ask my learned colleague Dr. Rvachew to speak to this, just from her standpoint.
Chief Executive Officer, Speech-Language and Audiology Canada
I can expand, if needed.
Full Professor, Speech-Language and Audiology Canada
The first issue, I think, is going to be the number of schools and the number of seats in Canada for training speech-language pathologists. The number of audiologists is actually equivalent in the United States and Canada. I'm not going to speak to whether it's enough, but it's equivalent.
For speech-language pathologists, there just aren't enough being trained. There are 12 schools, and we're training 450 students per year. That number has actually doubled in the past six years, approximately, so we've been increasing the number of students being trained, but it's clearly not fast enough to double the number of speech pathologists in the country.
The needs have been increasing because of the aging of the population. Initially, speech pathology was very carefully directed at children. Now, with the aging of the population and an increase in the number of people with swallowing disorders—for example, people in long-term care homes, post-stroke survivors and so on—there are huge needs in the aging population.
So the needs have expanded, and the capacity to train speech-language pathologists has not expanded fast enough.
NDP
Don Davies NDP Vancouver Kingsway, BC
Ballpark, how many people apply to get into SLP programs every year? You mentioned that you graduate 400-and-some a year.
Full Professor, Speech-Language and Audiology Canada
Well, there's a weird thing with that. The number applying is actually going down because it's so hard to get in, and people are like.... There are all of these other health care professions where there are huge needs. Everyone is competing for the same pie.
However, that being said, I'm at McGill. Every year we have at least 200 applicants, and sometimes 250 or 275 applicants. We accept 30 students. The number of applicants per the number of students accepted is very high—it's many, many, many, and the requirements to get in are very tight. The students in our program have grade point averages that are very close to 4.0. So there is capacity to expand the number of students we take into our programs.
NDP
Don Davies NDP Vancouver Kingsway, BC
Now, this is a bit of a no-kidding question, but I wonder if you could expand a little bit on the impact of early intervention for children, particularly on health outcomes, but also just as importantly on downstream costs.
Full Professor, Speech-Language and Audiology Canada
I should have looked up that number because there is really good data on that. The main thing has to do with literacy. What's often not recognized is that in the prevention of literacy delay in school, the time to prevent that is in the preschool area. The predictors of a child's not learning to read are deficits in language skills, speech perception skills and speech production skills, and what's called “emergent literacy”. All of that is happening between the ages of 3 and 5.
If a child starts school and their speech and language skills are not within normal limits at that point, at age 5 and age 6, there's then a heightened risk of a whole bunch of bad outcomes. These include their being bullied at school, social and emotional problems, conduct disorders, ADHD—anxiety disorders in girls skyrocket—and not learning to read. There's about a 60% probability that the child will have a reading disability in grade 3. Then the chance of school failure increases the probability of boys—not girls, but boys—coming into contact with the justice system and so on.
The early intervention is absolutely essential and we are really falling down on that.
Liberal
The Chair Liberal Sean Casey
Thank you very much, Dr. Rvachew.
Okay, 15 seconds. Go ahead. If you think you can get a question and answer in 15 seconds, go ahead.
NDP
Don Davies NDP Vancouver Kingsway, BC
I will do my best.
We hear a lot from other professionals about burnout and people leaving the profession. Are we experiencing that in the SLP/audiology world?
Full Professor, Speech-Language and Audiology Canada
There aren't studies on it, but we are women. I think it's actually higher than 85% now. What people are doing is leaving the publicly funded health system and going into private practice, reducing their caseload size, because there's a big need in private practice. Quite frankly, I did that before I became a professor. There's the attitude of, “I just don't need this.” Because of the rationing of care in the public system, you would rather have a job where you feel like you're making a difference to your patients.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Davies and Dr. Rvachew.
Next we're going to go back to Dr. Ellis, please, for five minutes.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thank you, Mr. Chair, and through you, sir, if I might I will preface this.
I don't need the road map, but I have heard that the College of Family Physicians and the Royal College both have a road map. I will call it a “road map to recovery for the health care system”.
I will start with you, Dr. Lemire. Is that true? That's the question. Is it something you would share with this committee?
Executive Director and Chief Executive Officer, College of Family Physicians of Canada
I suspect the road map you're referring to is the rural road map.
Dr. Bouchard, correct me if I'm wrong. I'm not aware that we have another road map kicking around.
Certainly, the road map does speak to rural recruitment and retention of family physicians in rural and remote areas in Canada. Certainly, if you would like us to share this with you, we will be pleased to do so.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Yes. Thank you.
Certainly, we know that rural areas are perhaps more particularly affected in Canada for family physicians.
A second question, Dr. Lemire, is do we think we need to pay physicians differently? Certainly, there are a lot of models out there now on how to remunerate physicians. The world I came from was fee for service. Do you think it's time to make more broad strokes with respect to how we pay family doctors?
Executive Director and Chief Executive Officer, College of Family Physicians of Canada
The college is on the record recommending or suggesting that we need to take another look to broaden our horizons with regard to how we pay physicians.
Many of the patients we look after in family practice are people who have comorbidities, several medical conditions going on at the same time. Many have chronic conditions. The proportion of frail elderly in our practices is rising. Therefore, looking after these people well, we feel, requires a broadening of how we look at this.
Some of the models, which I described earlier, have a model of payment that is what we refer to as a “blended funding model”, where a physician gets a fee or the practice gets a fee per patient per year to look after them, and then there are some services within this that are provided where there's a fee-for-service component.
This is a model that we would suggest is the preferred model, and certainly might facilitate a more comprehensive and proactive caring for patients.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thank you, doctor.
I only have a couple of minutes left.
Dr. Lefebvre, is it fair to say that similar things would apply to specialists?