Health Committee on April 25th, 2022

[Janet Morrison]

I do think there are ways to measure what progress needs to be made and I'd go back to the internationally trained professionals. We have experience in IEP advancement, regulatory oversight and the reduction of red tape. We have that in non-health care environments—accounting comes immediately to mind. There are ways to measure that. How many are in the pipeline? How long is it taking? Again, this isn't rocket science. I think it's about concerted effort and about a shared sense of urgency nationally.

[Dr. David Peachey]

If I could add one thing to that, there are a lot of metrics that are very useful and they can be at an individual level across specialty or they can be geographic. One of my favourites is the ambulatory care sensitive condition rates, which are measures of people who are admitted to hospital who likely would not have been admitted to hospital if they had timely access to a primary care physician. It's a pretty good tool to say what's going on.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Peachey.

Next, we're going to go to Dr. Hanley, please, for five minutes.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much. I feel very much like Mr. Lake. This has been excellent testimony from all around the table. It's hard to know where to focus one's five minutes.

I do think I will start with Dr. Sahgal.

I find that even though you are in a hyperspecialized practice, you spoke very eloquently about rural needs. We have almost a dichotomy between the need for super specialization, particularly in our modern age, but also the need for that broad spectrum of practice.

Particularly with our rural and remote lens, how can we best optimize that mix between broad generalists in medical practice and finely honed specialists?

[Dr. Arjun Sahgal]

I think it's new models of care that are important. I think we have to start to look for those ways in which we can balance the specialist being in the big city where we have all the tools to do our work but supporting the rural communities so that care can be delivered there.

The challenge is that we can only do so much and there's a lot of that work that is just part of being the physician but not necessarily remunerated, not necessarily as our physician remuneration but also to the hospital system remuneration. There are a lot of changes that need to be in place in order to do that outreach and maintain that outreach.

I'll give you a quick example of one of my particular areas, which is brain radio surgery, or focused radiation. We went out there on our own and taught all our communities—whether it was Kitchener, Kingston or going up north to Sudbury—and I did lectures with them and I tried to bring technology to them so that they could do the treatments there. When they need the help, we're here when it matters most. They can call in. They can reach me 24-7 and we'll do it, but not all places have physician champions. To foster that model so that rural Canadians have just the same level of access as they could right here takes a lot of work and effort and a new model of care.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

Dr. Peachey, as you may or may not remember, I was in Yukon as a practitioner when you did some extensive data work there that I think shed a lot of light on what the needs were. I wonder if you could talk about some examples of where that deep data search has really clarified the needs around provider mix and how we can really elevate that conversation around the country.

[Dr. David Peachey]

I'll give one example, of which there are many, and I would be very interested if Dr. Gratzer had a comment on it.

One thing we find constantly wherever we go is that mental health and addictions are a real problem, not in just the incidence and prevalence, but also, people who really need to see a psychiatrist often have unconscionable delays and with serious consequences. On the other hand, in terms of the number of people a psychiatrist perhaps needs to see, he or she doesn't have to see everybody who comes through the door just because of a referral.

In the model we took, we looked at the data on that and started to advocate this, I believe in Manitoba, to enhance the use of clinical psychologists not only in positioning in primary care offices, where a patient coming in who needs that sort of assessment can get it the same day, can just go to the next office. Similarly, clinical psychologists can be a filter for those patients who are referred to psychiatrists, and if the patient needs to be seen tomorrow, the patient gets seen tomorrow. If there can be a delay, you can delay it or you can go back to your family physician.

Whatever discipline in medicine you want to look at, the data that underpin those sorts of decisions can be extracted and they can be used.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

Mr. Chair, do I have any room for Dr. Gratzer to perhaps provide a brief follow-up comment in that regard?

[The Chair, Liberal, Sean Casey]

Go ahead, succinctly, please.

[Dr. David Gratzer]

I agree. We have to be smarter about who does what and when.

By the way, I also think that would contribute to better overall well-being if one sees cases that are more aligned with one's skill set as opposed to just anyone who was referred. In some ways, our health care system has not evolved much from the 1950s where a secretary calls a secretary and books an appointment to maybe being replaced by the fax machine, which isn't necessarily replaced by anything just yet, but I think these things are worth considering.

Studies show as an example that nurse practitioners might be able to do better histories than certain specialists, being more available and more thoughtful about detail. These things are good from a system point of view, but also good from a mental health perspective in terms of contributing to well-being.

I remember I worked at a clinic once where they often would ask me to see people who were interested in couples therapy. I had no issues with sitting down with such patients, but we didn't offer couples therapy. It was, in a sense, a waste of their hour to sit with me and talk about these things and it didn't make me feel any better either.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Hanley and Dr. Gratzer.

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

[Jean-Denis Garon, Bloc, Mirabel, QC]

Thank you very much, Mr. Chair.

Dr. Boucher, I'd first like to thank you for being with us today to share with us your expertise and present your perspective.

You are testifying today before Canadian Parliament's Standing Committee on Health. The people listening to you are parliamentarians who have the power to change things and the duty to improve the quality of life of Canadians and Quebeckers.

In closing, I'd like to know what message you'd like the members to take away from your time before the committee.

[Dr. Anne-Louise Boucher]

Thank you for the question.

Among the takeaways is the importance of supporting medical practice, which Dr. Sahgal mentioned often. There is no doubt that non‑medical, administrative and manual tasks that could be performed in an automated manner must be performed by professionals other than doctors.

Next, technology must be harnessed to provide care to people in rural or remote areas. If this technology were available to specialized doctors who wanted to do telemedicine, it might also encourage students to go into family medicine. Family doctors will consider going to work in the regions if they know they will get support. They won't feel alone and helpless. One stakeholder also mentioned the fear of people complaining to the college.

I am convinced that people in the regions and provinces are more aware of local and regional needs than those who write centralized pan‑Canadian guidelines. Of course, we need to have Canadian guidelines and directions, but we really have to leave it to the people in the regions, on the ground, to determine the needs.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Thank you.

In closing, I take it from your brief that your organization is also calling for an increase in the Canada health transfer so that funding is unconditional, stable, predictable and sustainable.

Thank you very much for appearing before the committee.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Garon.

The last round of questions will come from Mr. Davies, please, for two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks.

Dr. Peachey, Wayne Gretzky famously said that the trick was to go where the puck was headed. I think the corollary to that is that it's important to know where we have come from in order to avoid problems from the past.

I note that in June 2010 this committee tabled a report entitled “Promoting Innovative Solutions to Health Human Resources Challenges.” In 2011, the federal government launched the health human resource strategy to “attract, prepare, deploy and retain highly skilled health care providers to give Canadians access to appropriate, timely, effective care now and in the future.” That was 11 years ago.

In addition to the federal role in providing funding for health care, the government also provides support to the federal/provincial/territorial committee on health workforce. In 2005, it launched the pan-Canadian health human resource strategy that—

[Jean-Denis Garon, Bloc, Mirabel, QC]

A point of order, Mr. Chair.

There is no interpretation.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Garon.

Mr. Clerk, can you check and see if this is something that we're going to be able to resolve fairly quickly? We're almost at the hour.

[Jean-Denis Garon, Bloc, Mirabel, QC]

The interpretation has been restored, Mr. Chair.

[The Chair, Liberal, Sean Casey]

Great.

Go ahead, Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks.

Dr. Peachey, for my francophone colleague, in June 2010 this committee tabled a report entitled “Promoting Innovative Solutions to Health Human Resources Challenges.” In 2011, 11 years ago, the federal government launched the health human resource strategy to “attract, prepare, deploy and retain highly skilled health care providers to give Canadians access to appropriate, timely, effective care now and in the future.” Seventeen years ago, in 2005, the federal government launched the pan-Canadian health human resource strategy.

Can you give us any insight as to why basically the last 15 years have been unsuccessful in our dealing with the issue of human resources in the health care sector? What advice would you have going forward to avoid the problems?

[Dr. David Peachey]

I expect the main reason is that there are complexities, as there always will be when it comes to dealing with people and energies, and determining supply and determining need. It can be expensive. The reports that you have listed have fundamentally not gone anywhere, which is why we're still dealing with these things today. I think at the same time there is an enthusiasm to make change and people are not afraid of change anymore.

One of the better committees I have been involved with is a committee on health workforce at Health Canada, which has really strong representation. They have been sideswiped by the pandemic, but their reporting line is to the Conference of Deputy Ministers of Health. I think when there's an opportunity for their voice to be heard, they have many things that can be said. If the CDM can grab it and run with it, then I think we will see change.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Peachey and Mr. Davies.

That concludes the time we have for questions, but I would ask my colleagues not to run off. We're going to thank our witnesses and then there are a couple of administrative matters I want to deal with very quickly.

To all of our witnesses, as has been said several times in this session, this has been an extremely thoughtful and informative discussion. We very much appreciate the way you have handled the questions, the depth of your experience and your willingness to share that with us. We are rapidly approaching the end of the witness testimony part of this study. As a couple of my colleagues have indicated, we could do this for another 10 hours, as every time you peel back the layer of the onion, there's something else there. Thanks again for being with us and for a very productive and interesting meeting.

Colleagues, there are two matters I want to raise with you. One, the committee has passed a motion with respect to the 988 suicide prevention line. The passage of that motion is on the record. Therefore, we are now in a position to receive briefs from the public, but we haven't done what we usually do, which is to specify a limit on those briefs. Traditionally our limit is 2,000 words. Is it okay with everyone if we let it be known that the limit for any briefs to be submitted with respect to that item is 2,000 words?

Mr. Barrett.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Thanks, Mr. Chair.

I would defer to the analysts, based on the limited amount of time that we have. If your recommendation is informed by the same, we support that. There's not a ton of runway before the end of June and there are lots of reports being prepared concurrently.

[The Chair, Liberal, Sean Casey]

That's exactly where the suggestion came from, Mr. Barrett. That's why I put it out there.

Do we have consensus in the room?