Health Committee on April 25th, 2022

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Peachey, we've heard from various witnesses before this committee that in Canada we appear to be drowning in data, but we don't seem to be able to marshal it on a national scale when it comes to managing the health care professional human resource crisis in this country.

Do you have any insights or advice to give this committee on how we can better use data to more efficiently deal with this issue?

[Dr. David Peachey]

I think the issue is this: there are really good data out there, but, as you indicated, the data frequently don't get used. Sometimes the data holders are not aware of how good their data are. As data start to get used, people start to get excited about them.

On the question about where we go from here and how the data are used, I think you can look at it in a variety of ways. Go back to the patient-centric care question that came up earlier. The data would suggest, by all sorts of parameters, that it simply isn't happening. The reality is, when we started this several years ago, we only did physician resource plans, until we realized that just perpetuates the medical model. Now we turn down physician resource plans and only do clinical and preventative services plans, and 50% of that work—it takes six to nine months at the start of a project—is based on acquiring and looking at the data. It's not purely a metric exercise, because you have to have a qualitative component, as well.

The data are generally better than most people think. They're just not being used. You can say that about services planning or how we analyze physician compensation. It goes everywhere. You're absolutely right. The data are sitting there almost begging to be used.

[Don Davies, NDP, Vancouver Kingsway, BC]

You've probably seen a bit of the problem we face. Some people are fixated on health care being delivered provincially, but, of course, the federal government plays a role in this. It's almost like squeezing a balloon with water in it. If we fix a human resource issue in one part of the country, we could end up affecting another.

What's the role of the federal government in coordinating a national approach to addressing this issue?

[The Chair, Liberal, Sean Casey]

Please answer as succinctly as you can.

[Dr. David Peachey]

I think the approach is to undertake the analyses required to use a single methodology across jurisdictions. Using that single methodology would enable us to bring the information together and start to look at it nationally. As long as we have 13 autonomous health care systems, that's not going to happen.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Davies.

Next, we have Ms. Goodridge for five minutes.

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

Thank you so much.

Thank you to the witnesses for their testimony today. It's always spectacular to have such a different perspective on some of these issues.

I don't see Ms. Hernandez on the screen. I think she might have dropped off, which is unfortunate. I was going to plug—and perhaps, Montana, you can share this with her—the brand new hospital on the 4 Wing Cold Lake base. If that's something she is interested in, we have an amazing brand new health centre on the 4 Wing base. I would love to have her come back a bit closer to home.

You were talking about the residency seats, and about how so many residencies go unfilled. My riding is Fort McMurray—Cold Lake. I have a lot of rural, northern and isolated communities. We would absolutely love to have residents learning first-hand in our communities. I know there are some challenges with that.

Have you any thoughts on how we could improve and increase the number of residents in some of these rural communities?

[Montana Hackett]

Absolutely, and, yes, Santanna had to step out. She actually had to get to another space to talk about this exact issue.

When it comes to engaging residents and medical students in more rural areas, ultimately if you look at it from the perspective of “as early up in the pipeline as possible”, of course, the best way to recruit people to a region is to recruit the people from that region, so the opportunities for people from rural locations to matriculate into medical school has to be looked at.

From the perspective of the federal government, that's about lowering the barrier in terms of cost, in terms of opportunity for people from that region to get the required education to be able to apply and then get in. We've seen medical school admissions start to look at this, but upstream there need to be much more work on this as well.

In terms of getting current residents in these spaces, ultimately it's about investing in having the education available in those spaces.

Santanna mentioned one of the big things about rural medicine is they are quite often playing short-handed in that they don't have the same resources. For example, I did one of my clinical rotations up in Wiarton, which is not too rural compared to places in northern Ontario, but there were still decisions we had to make in management where we didn't, for example, have a CT scanner that we could use immediately, or all of the things in blood work that we can normally do.

Making these places more attractive for physicians of different stripes by making sure these resources are available to them is one piece, and also partnering with the medical schools and investing in more spots maybe in those places would be one fantastic thing to do as well. Ultimately, they are trying to allocate spots in the residencies the best that can based on the regions that they occupy. At the end of the day, we only have so many medical schools and only fewer spots.

Those are a couple of things we can do.

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

Fantastic.

I have heard from some of my friends who studied medicine that because the medical schools are in bigger centres, once students get used to the fact that you can visit any kind of restaurant at any time of the day, moving back to some of those rural communities becomes a little less attractive, but I'll put in a plug for my community that Fort McMurray has direct flights from Toronto so you can get home very regularly.

Dr. Sahgal, I saw you nodding along. Do you have anything you would like to add?

[Dr. Arjun Sahgal]

I would just say the point that was brought up was that equipping these rural communities with services so that physicians can do their jobs will reduce the stress on the physicians and that will improve burnout rates. We have to remember that if the system is not providing that CAT scan, it's still the physician who has the medical responsibility for the patient. If something goes wrong, it is not the hospital or the system that may be blamed, but we get blamed. It's not just a matter of a lawsuit. It's our own moral blame that we put on ourselves. That stress is something that most professionals don't really understand, when we couldn't get a test and a person died right in front of us.

[The Chair, Liberal, Sean Casey]

Thank you very much, Dr. Sahgal.

Ms. Goodridge, you do an amazingly effective job of recruitment and selling your riding. Well done.

Mr. Jowhari, please, for five minutes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair.

Thank you to all the witnesses.

I'm going to start with Mr. Hackett. Many of us over the last hour or so have talked about the residency match. Can you briefly explain how the matching process works? How is it distributed among graduates from our own universities, internationally accredited individuals who come here, and a lot of my friends who go to the U.S. and get their medical degree and come back here and have to do the residency? Who sets these targets? How are these targets set? Who plays a role, from a government point of view, in setting up these targets? How can the federal government help?

[Montana Hackett]

I can absolutely answer the six questions, yes. I appreciate it.

When it comes to how the actual residency matching process works, essentially in our final year of medical school we go through an electives process where we choose specific locations and programs that we want to visit and rotate through. We accumulate the different pieces of our application and then submit a final rank order of our preferred programs in those specific locations and then apply to the places we want to apply to.

We then hopefully get interviews at those places, interview, then submit our final order of preference and then the programs also submit their final order of preference for candidates.

Those orders, as well as our applications, go to an organization called CaRMS, the Canadian Resident Matching Service. They do a great job of running an algorithm that matches the student and the program, based on those factors that I outlined.

When it comes to the role government plays—I believe that was the next part of your question, with how government—

[Majid Jowhari, Liberal, Richmond Hill, ON]

Your testimony indicated that it is the government that determines the number of spots. Which level of government makes that decision?

[Montana Hackett]

That is at the provincial government's discretion. Essentially how it works is there is supposed to be a health and human resources allocation for these spots where they look at the needs of the communities, the need for specific types of physicians in those places as well as predefined spots that determine the specialists, and those spots are then available to make application to.

Unfortunately, my understanding is that this doesn't happen as much as it needs to, so oftentimes we're applying to processes that are out of date, and the positions we're applying to are not necessarily ones that represent the need at that particular time. How government is implicated in that is through running that model but also funding the spots based on the needs of the community.

That is the provincial context, but, as was mentioned before, the federal government has to look at the needs of our pan-Canadian system in a way that the provincial governments can't always do in their own contexts, so that they're leading what we need as a country and giving the provinces the tools they can use to fill their specific needs based on the context that the federal government is working in.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

Would you recommend that the federal government tie some of its transfer funding to setting some of those targets specifically in support of the provinces opening up some of these slots?

[Montana Hackett]

It's a tricky question. I think, ultimately, it's something that should be looked at, but it also depends on how that's done. The provinces in and of themselves know their context best, or should, and they should be collaborating with the specific regions, the communities and the medical schools in those regions. At the end of the day, like I said, if there is an opportunity to establish some national priorities, and if those priorities have to be fulfilled by attaching that to a transfer, then I think that's something that should be looked into, but of course, the devil's in the details when it comes to something like that.

[Majid Jowhari, Liberal, Richmond Hill, ON]

With 30 seconds left, I'm going to quickly go to Dr. Sahgal.

Thank you very much for the great work that you and your team are doing at Sunnybrook. I have a very good friend, Dr. Pirouzmand, who is also at Sunnybrook.

You touched on technology, and I know you've been working on a newer technology, MR-Linac, which is supposed to expedite the process of imaging. Can you touch on that and say how it is going to help us clear some of those backlogs?

[Dr. Arjun Sahgal]

The MR-Linac technology was one we brought here as the first in Canada to try to gain a technological platform to reduce the number of treatments. Instead of six weeks of radiation, now we can do it in one week.

What's important here is how we got that technology. We had to raise money through philanthropy. We had government grants. We basically went to our hospital system and begged them for some money, and they were totally happy to provide innovative funding. It is a conjunction of philanthropy, government grants and hospital budget that brought it together. There are not that many places that can do it like Sunnybrook did, so although we did do something amazing here at Sunnybrook, it's not something that can necessarily be emulated all across the country, which is where the fairness comes in in terms of resource allocation.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Sahgal and Mr. Jowhari.

Next is Mr. Lake for five minutes, please.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Thank you, Mr. Chair.

This is a great meeting, and I wish I had a 10-hour round to ask questions right now.

We've been talking a lot about problems and challenges over multiple meetings on this, and I feel like sometimes we don't spend enough time talking about potential solutions, and I'm thinking a little bit about measurability and what success looks like.

Maybe I'll ask that as a fairly broad, open question starting with Dr. Gratzer. What might success look like? Can you give any examples of success?

[Dr. David Gratzer]

You have two questions here, and one is how we would measure it. I think that's an excellent question because, if we don't have metrics, how do we know if what we're doing is meaningful? I would suggest that, over time, national metrics on burnout would be appropriate, which would also bring accountability to the federal government and the provincial ones.

You're also asking where we can look for ideas and experimentation, and here's something important to consider when we think about burnout. We don't necessarily want to be too creative or too innovative; let's plagiarize ideas from our jurisdiction and other jurisdictions where they found innovative ways to help people, particularly physicians.

Again, I've touched on a couple of these things, and I don't want to use up all of your time, but communities of practice and finding ways for physicians to feel more efficient are good examples. Make it easier to access care as well, given the stigma, particularly within physician bodies, to accessing care.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Dr. Sahgal, you talked about efficiency and I wrote down, tools to “let the doctors be doctors”, which just seems like it was echoed throughout the conversation today.

What examples might you point to in that way? Where are the most egregious examples of doctors spending time on things that doctors shouldn't be spending time on?

[Dr. Arjun Sahgal]

I can tell you just even in terms of my own family life, as my wife works at Women's College where they have an electronic medical record system. She's up for hours just inputting patient medications, making sure she faxes the note to the appropriate physicians and typing in the fax numbers. Our system here at Sunnybrook is a bit different. We don't have that. We use various different strategies that are efficient so that I don't have to spend those four hours after my clinic doing administrative tasks.

If you could tie in part of the funding that gets allocated towards supporting the key initiative of electronic medical records, because it is a key initiative to improve the flow of communication in patient care all across the country, but make sure that there's budget within the system to help us manage the electronic medical records, this will be a huge positive development in the health care for patients across the country.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

I love the fact that when I talked about efficiency, you brought up your wife and sending faxes. That's awesome.

I was going to go to a different question, but I'm wondering, Dr. Morrison, because you were nodding along, if you have anything to add or if Dr. Peachey has anything to add.