Health Committee on April 25th, 2022

[The Chair, Liberal, Sean Casey]

Thank you very much.

Mr. van Koeverden, you have six minutes, please.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Mr. Chair.

Last week ministers Duclos and Khera co-announced $379 million for the safe long-term care fund. Standards have been released and much progress has been made. The challenge that persists is workforce-related, and that's something we need to address. The feedback we've received so far will guide us in those deliberations. I thank everybody who came today to provide us with that insight.

My question will be brief, but I'd like to be able to get to more than one witness. I have only five and a half minutes remaining.

I would ask you, Dr. Morrison, with a shout-out to Halton—I grew up really close to Sheridan College—if you could answer this question first and then provide enough time for others to tune in as well. My question is related to the qualifications for foreign-trained and -educated medical professionals in this country. In looking for solutions to attract more talent in the upstream for students who are currently in high school or are perhaps doing an undergraduate degree, it's good to address this problem years and decades from now, but we have a challenge right now. I know that in my diverse community of Milton, we have a lot of people who are qualified to be physicians' assistants, doctors, nurses and personal support care workers who are doing other jobs. They're far more qualified than that.

How can the Ontario but also cross-Canada post-secondary network assist us in training up foreign-trained medical professionals to ensure that we can address this challenge now?

[Janet Morrison]

Thank you for your leadership and community presence. You're certainly well known across our campuses.

You know, access is a complicated puzzle. I would suggest to you that we have to make it financially viable for learners. We have to think about the red tape. We have to think about regulatory processes in particular. Particularly for learners for whom English is not their language of origin, the obstacles in terms of the service they can provide and the multilingual capacity they have to deliver in communities, particularly across the GTA, are huge, but we have to figure out how to reduce obstacles to those learners being trained locally. You need to deliver at night. You need to deliver on weekends. You need to provide English-language supports, particularly in areas of pharmacology, for example. If you still need to study that, think about studying it in a second or a third language.

I think there are lots of opportunities. We need to be purposeful and we need to think in very broad terms about access. This is low-hanging fruit that I think we can better deliver on.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Dr. Morrison.

President Hernandez, I saw you nodding along quite a lot. Can I ask you if you have some ideas to share?

[Santanna Hernandez]

Yes. Absolutely.

Prior to my medical education, I did a lot of work in my undergraduate degree in the province of B.C. through the BC Federation of Students. One of the big surveys and studies we did was around fairness for international students. I met with students on a regular basis who had the exact training that you talked about but were unable to make that next step in bringing those qualifications forward.

I think some key things need to be looked at within immigration policy. Oftentimes, we bring them here and we train them in certain fields, but when it comes to getting the immigration points that they need to be able to transition, they have higher immigration points by being a manager at McDonald's than they would by being a teller at a bank or a health care aide or some of these other components. The way the immigration scale works in order to give them those points to become Canadian citizens is more fruitful in other areas.

The other thing we could do is work with our post-secondary partners to create bridging programs that build in some of that English-language competency but also transitions them to meet the accreditation standards we have within our programs that theirs may be missing. There are some differences in care that we are learning, but there are some really practical solutions. We have leaders across this country in both undergraduate and medical education who want to see this work come forward. Unfortunately, if we do this work, we don't necessarily have the ability to implement it without some changes taken by the federal government to ensure that we can do that in a good way.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, President Hernandez; and thank you for your years of work in this field.

With about one minute and 20 seconds remaining, are there any other witnesses who have strong feelings they could share about foreign credentials qualifications...or if the feelings are not strong? They can be medium feelings as well.

[Dr. Arjun Sahgal]

I would just say it's very important to bring in the appropriate professionals, but it's not necessarily just about bringing them in and them going into the workforce. We have to have a system that can train them so that no matter where they are, patients and communities are receiving the same level of care as if it was a trained physician as a Canadian, going through the Canadian medical system. There are differences. We do see systems where patients are underserviced because of the lack of training of the professionals.

If you want a system where we bring in more health care professionals, which we need absolutely, it has to balance out with the increased training that's provided to them so that we're all at relatively the same standard of care.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you very much.

I'll cede the remaining time to the chair.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. van Koeverden.

Go ahead, Mr. Garon. You have six minutes.

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

Thank you very much, Mr. Chair.

I'd like to thank all the witnesses for their very informative testimonies.

Dr. Boucher, what's interesting is that we're in Ottawa, the seat of the federal government, which does not manage hospitals or the health care system. The federal government has no functional jurisdiction over the management of health care services. You talked about increasing the Canada health transfer, or CHT. This is an additional unconditional transfer that would be paid to Quebec and the provinces.

There is a great need for doctors, especially in the remote areas of Quebec. How would a significant increase in the CHT help you to promote the profession of general practitioner?

[Dr. Anne-Louise Boucher]

Thank you for the question.

Let me mention one important element, and that is transfers within medical schools. In a way that varies from faculty to faculty, the undergraduate curriculum exposes students to family medicine in different areas of practice and in different regions of Quebec, whether they are in remote or intermediate regions. If universities had the funds to systematically include introductory family medicine internships in their curricula, all students could be exposed to family medicine at the undergraduate level.

The broad outlines of the curricula are common to the four faculties of medicine in Quebec, but there are still some differences with respect to certain internships, particularly with respect to exposure to family medicine. This may contribute to the fact that exposure to different models of family medicine is not optimal.

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

What you're telling us is that decentralization and significant regional factors interfere with the type of training of family doctors, and that essentially, it's the people on the ground and the provinces who are best positioned to put in place training that meets the needs.

Is that it?

[Dr. Anne-Louise Boucher]

Yes, that's exactly it.

Medical schools have the power to develop elements of their curriculum. It's important to understand that before the selection and matching of family medicine or specialty medicine residents, doctors don't make their choice in the last two or three months of their undergraduate training. They do it several months before that.

These programs sometimes require more funding because there must be family doctors and settings available to receive them. Second, you have to get out of the hospitals if you want family doctors to gain experience in primary care and not limit their training to the hospital setting. You need to think outside the box. Of course, there's a certain cost to that, because it takes infrastructure, staff and family doctors. They need to free up or at least adapt their patient care duties to mentor learners.

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

Thank you, Dr. Boucher.

During the pandemic, the federal government had to make emergency injections of over $30 billion into provincial health systems. The Minister of Health has bragged a lot about this, by the way. Now there is offloading, surgeries have had to be postponed, and a one‑time amount of $2 billion is being offered to the provinces and Quebec. From what I understand, the situation in the hospitals is critical. You say that the lack of training in family medicine could have negative consequences for 30 years.

How does this approach of making conditional, one‑time and poorly planned transfers without having a long‑term vision prevent us from training family doctors to help people on the ground?

[Dr. Anne-Louise Boucher]

We are still facing this crisis. Even though the pandemic is running out of steam again, there is still some catching up to do not in terms of providing care, but also in terms of making the environment attractive for caregivers and learners.

One‑time transfers allow us to catch up, but we need to take a medium‑ and long‑term view. When a family medicine position is left vacant, it represents 30 to 35 years of reduced access to primary care in Quebec. If you multiply that by 1,000, I'll let you do the math on how many people won't have access to care. If they do have access, the delays won't always be acceptable.

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

Dr. Boucher, the Bloc Québécois and others had suggested holding a national summit on health care, where stakeholders could have discussed these issues on the ground directly with the Prime Minister, directly with Ottawa. I know that Dr. Amyot, your president, has been supportive of this approach.

Why is it important to make Ottawa aware that it is the people working on the ground who are best placed to understand the reality of the environment?

[Dr. Anne-Louise Boucher]

Canada is a very large country. Each province, each region, has its own reality. When broad pan‑Canadian principles are established for the quality or direction of health care, applicability on the ground becomes a major issue, whether it's in the provinces or in the regions. They are in the best position to know the reality on the ground and the local or regional characteristics based on the type of population, ethnicities, urban realities versus the reality of intermediate and remote regions.

Canada certainly has a role to play in establishing principles of equity, basic care and access to free health care, but their applicability needs to be assessed by people on the ground. There are too many different realities from coast to coast. You can't have a one‑size‑fits‑all rule.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Boucher and Mr. Garon.

Next is Mr. Davies, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Ms. Hernandez and Mr. Hackett, I'd like to address some questions to you first.

It's infamous now that Canada has a shortage of family physicians. The last number I saw was some five million Canadians who don't have access to a primary care physician, which is pretty shocking for a country that claims to have public, universal access to medicare.

Can you give us a bit of a snapshot, representing medical students and the next generation of doctors? What is the feeling in medical schools among your colleagues about whether they are going to go into family medicine? If not, what are some of the reasons that your colleagues don't go into family medicine?

[Montana Hackett]

I can speak to that. It's a fantastic question.

I am someone who wants to go into family medicine, so maybe I'll be biased towards this. Santanna is as well.

It's a very good question and something that, as we've been talking about, is very specific to the region and to the people who are entering medical school. The conversations around career prospects at medical schools are that you very much need to find the thing that is going to bring you the most joy and the thing that you're going to be the best at. Ultimately, being a physician, and different types of physician, is a very personal thing.

Ultimately, medical schools are about teaching us to be generalists. We graduate having all of the core competencies to be a physician from a generalist perspective, but the way we've seen care change over the last 20 or 30 years is that because of the quality of care and the expansive nature of health care specialists, more and more hyperspecializations are required.

At the same time, you mentioned that family medicine is deeply needed in this country. As someone who is currently on his clinical rotations, this is something that I see quite consistently. It's immeasurable how many people come in the emergency department or the hospital who do not have a family physician. The impact on them—not only from systemic factors, but also preventative medicine in terms of being able to access care—is quite devastating for those individual patients.

From a medical student perspective, it's something that we all have to consider that we need as individuals and that the populations we're trying to serve need as well.

[Santanna Hernandez]

Unfortunately, there is this hidden curriculum within our educational agenda that we are taught by subspecialists. A big part of that comes from how compensation of our preceptors is given.

One thing we hear from our folks in Quebec, from the FMEQ, the student organization that represents the Quebec students, is that our family physicians are actually not compensated the same way as the specialty positions are in the province of Quebec, so there's less incentive for them to be part of teaching us. If we're not being taught by family doctors, how are we supposed to get excited? How are we supposed to get students excited about wanting to be family physicians?

As someone who loves family medicine, it's the only thing I've ever wanted to do, and as a military medical student I'm fortunate enough that I get to continue on that pathway. However, we need to support our physicians to be able to teach us, to get us excited about it. That's what we're not seeing, the support of our physicians who are out on the floor who are our educators.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Switching more to the residency, Mr. Hackett, I think you talked about this.

I'm curious about how many graduates, approximately, from Canadian medical schools do not match a Canadian residency position and are therefore unable to practise as physicians in that area.

[Montana Hackett]

If you want to explore that question, you can ask Santanna.

[Santanna Hernandez]

Yes. As somebody who sits on those committees, I probably have more numbers at the top of my head.

[Don Davies, NDP, Vancouver Kingsway, BC]

Please, Ms. Hernandez. I thought it was Mr. Hackett who raised it.