Health Committee on April 25th, 2022

[Santanna Hernandez]

Yes, he definitely raised the point.

On average recently, we've seen about 70 medical students a year go unmatched after the second iteration. Oftentimes we have many family medicine seats that are available, especially in the province of Quebec. They do a better job of making more seats available.

Oftentimes this becomes a political issue. As you might see in the province of Alberta, our physicians don't actually have a contract, so there is a lot of variation in what their compensation can look like. That definitely has an impact on people wanting to match to family medicine here in Alberta. This year, 26% of our family medicine seats went unmatched at the University of Calgary, which is the highest we've seen.

As somebody who wants to match here in the province of Alberta, because my family is here and my ancestry is from the Cold Lake First Nation up in northern Alberta, I would love to be able to stay here and practise here in my province. Unfortunately, there is a political aspect to medicine, as you see here as we're representing to you today, because there are political pieces that support our ongoing success and governments decide residency spots. Therefore, we need to work with them to develop programs that have seats for students, to be able to continue to train them.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, do I have any time left?

[The Chair, Liberal, Sean Casey]

You have about a half minute.

[Don Davies, NDP, Vancouver Kingsway, BC]

Just quickly, then, Ms. Hernandez, you mentioned coming from a rural area. We know that Canada already lags behind the other member countries in the OECD in numbers of physicians per thousand, but that's particularly acute in Canada's large rural areas. Despite 19% of Canadians living in rural areas, they're served by only 8% of physicians.

Are there any suggestions you might give us about how we can attract young medical students to practise in underserved or rural areas?

[Santanna Hernandez]

As somebody who had to travel 27 hours to deliver my third child because I lived in Fort Nelson, B.C., at the time, I think a key piece of that is giving rural communities access to the resources they need to provide care. I had to travel to Burnaby to deliver my child because that was the only place I could afford to stay with family.

If we had access to resources there such as anaesthesia, ultrasound and things like that....

I had to travel four hours for my ultrasound.

Doctors don't necessarily want to provide care where they don't have the resources to provide care to their patients. They constantly feel like they're failing those individuals because they can't do things in an adequate timeline and have to depend on urban partners to desperately take some of their patients in a reactive manner instead of a proactive manner.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, maybe the record can reflect Mr. Hackett's enthusiastic head nodding.

[Montana Hackett]

Yes, very enthusiastic head nodding. Thank you.

[The Chair, Liberal, Sean Casey]

Actually, I'm glad you got that last question in. That was an extremely good exchange, very valuable to us. Thank you both.

Next will be Dr. Ellis, please. You have five minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Mr. Chair; and thank you to all the witnesses.

Certainly as someone who was a family doctor for 26 years and has been intimately involved with this system from a matter of all aspects of family medicine, this is an opportunity that's near and dear to my own heart.

The real premise for me is that I'm not entirely certain the Canadian population understands the precipice at which we all sit as Canadian citizens, with the looming disaster, and that frightens me.

That said, Dr. Gratzer, you talked a lot about physician burnout, perhaps half of physicians being burned out at the current time.

It's a gross generalization, but if physicians are going to recover from burnout, could you maybe, in a brief amount of time, tell us how that might happen, and how long does it take if it happens?

[Dr. David Gratzer]

Every individual is different and everyone's experience is different, but we do see over the last decade the literature growing much more thoughtful and mature, which is a fancy way of saying other people are looking for answers and I think there are some.

They include, first of all, a culture of wellness making it possible for physicians to get care and get timely care and making it acceptable for physicians to want that. We see as well that empowerment can be useful. While I am very grateful to be a physician, like others have commented today there are incredible frustrations including some very modern frustrations with regard to electronic medical records and the like. Addressing that sometimes with very simple steps can be useful.

Of course, one can also think about ways of physicians supporting each other just like other health care workers. One thinks about peer support and the like.

What I'm driving at is that while burnout is a very common phenomenon, there are very reasonable steps one can take to address it. The key is to do that, and to move away from the thinking of not so long ago across North America and across the west, which is doctors don't get sick and we don't need to worry about doctors getting sick.

We spent an enormous amount of time today talking about how to get more people in the health care workforce, very reasonable conversations, and they impress upon us the importance of retaining those individuals, and making sure that they work in an effective and efficacious manner as well.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Great. Thank you for that. I appreciate it.

Through you, Mr. Chair, to Dr. Sahgal, you are certainly working in a very subspecialized area of brain and spine radiation treatment. How are we going to catch up with respect to the numbers of physicians we're short?

You talked about electronic medical records and reduction of administrative work, but also we need more people to do the work. How are we going to get them quickly into the Canadian system?

[Dr. Arjun Sahgal]

I will say one thing we have noted during the pandemic as a result of the delays is that cancers are much more advanced than they ever were before. The things we see are horrendous and we never saw those.

We're all trying to work to catch up. The hours are really quite long and we need more staff. Part of it is not just to hire more staff but actually have the hospitals allow for those staff to work.

This is what happens. A certain number of physicians can do a certain amount of work, but now we don't have the nurses or the clerical support. The hospitals try to reduce their budgets by reducing the amount of help that is given to the physicians and to the allied health force, and that increases our burden. The burden is always on us because we are not employees of the hospital but our own individuals working within the hospital care.

At the end of the day we do need to increase the number of physicians to combat the burden, but the system has to ensure that they give us the levels of support to work because, as was mentioned before, we do everything that we do but we don't have the support now to fulfill our mandate of caring for patients.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

I appreciate it.

We have about 30 seconds left.

Mr. Hackett, you made one comment I thought was interesting. You said it was a landmark year for all the wrong reasons. Notwithstanding COVID, I assume you were talking about something else. Perhaps you could enlighten us on that.

[Montana Hackett]

Yes, absolutely.

It was in regard to the point about unmatched graduates in our country. That is a significant piece of burnout for students.

Imagine going through all of the necessary stages to get into medical school, being in the single digits of people who get in, and then going through medical school learning everything you need to know, getting your clinical rotations finished, building an application to apply to the position you want to serve your community within, and then not getting it, not being matched at all to anything.

I cannot even begin to describe to you how traumatic that is for people. Santanna and I have talked to numerous students this year in particular who have gone through this and it is a humongous source of burnout for students in the medical profession. Obviously, it's a waste of resources when it comes to these are people who are trained doctors at that point who are not getting into the system.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Hackett, and Dr. Ellis.

Next, Ms. Sidhu, please, for five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Thank you to all the witnesses for being with us.

My first question is for Dr. Sahgal. Thank you for the hard work you do at Sunnybrook. I just want to echo my colleagues.

Many families have been coping with delays in surgeries and cancer screening. Postpandemic, we are expecting to see an increased rate of cancer. With the recent federal investment of $2 billion to tackle this issue.... Off the top, what recommendation do you have?

You also said that to combat this burden.... What do you think? How fast can we increase the resources? What kinds of resources can we provide?

[Dr. Arjun Sahgal]

Thank you very much, MP Sidhu.

I think one issue is the ICU beds. We definitely have to increase the ICU capacity and then the surgeries can happen. Alongside the increase in ICU capacity, we need the staffing. That's where we're starting to fail. We don't have the nurses and the staff to manage the patients post-surgery. It's a very delicate balance right now.

I would just impress upon the committee overall that the disparity in various health systems to allow for budgets for clerical and nursing staff to try to manage the pressures that are on the hospital system is not necessarily helping the backlog of COVID cases. That's where cancer patients are suffering. It's harder for us to get tests when we know we need them. It's harder for us to get surgeries. We don't have nursing supports the way we used to. Again, we're being overloaded with the administrative tasks.

Whatever transfer payment comes, if you can ensure that certain amounts are there to allow for those services so that we can do our jobs, that would be very positive for the burnout rate.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

The next question is for Dr. Morrison.

Dr. Morrison, thank you for your leadership.

We heard a lot in these meetings about foreign-trained health care workers not having their training and credentials recognized. What role would you like to see colleges playing in resolving this issue and ensuring skilled professionals are in the right jobs?

[Janet Morrison]

When we hosted the health care summit at Sheridan in late January—that was a convened round table, as I said—I was quite impressed by the discussion and the solutions. They're not particularly mind-blowing. The problem is one of talent. We heard that it is one of scope of practice and ensuring that the full scope of professional practice is duly leveraged. It is about model of care—the right care at the right time and the right place.

A lot of the solutions that came to the table from partners focused on many of the themes we've talked about today, such as collaboration, the use of technology, outreach to underserved communities and the use of data to inform where we're going and what needs to happen.

I'm compelled to just underscore that I've worked in medical education for about half of my post-secondary career. The challenges of ensuring that we have the right talent in ancillary services to position physicians and more specialized talent to do their jobs is critical. An absence of focus on PSWs, practical nurses and administrative medical support staff.... I think that deserves our focused attention right now.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

You mentioned the idea of future-proofing ourselves against the next pandemic by focusing on chronic disease. As you know, many chronic diseases are a huge concern in many communities across Canada, including Peel region.

How can government promote the role of the post-secondary education sector to help meet our shared goals?

[Janet Morrison]

That's a great question.

I'm always taken aback when I hear some of the data in this space. You and I are very conversant with the facts that half of adult residents in Peel report living with a chronic health condition, that South Asians in particular are 15% to 20% more likely to develop diabetes and that the diabetes risk amongst Black women has skyrocketed over recent years.

There is programming within the post-secondary sector at both the college and the university level that's really focused on education and awareness campaigns, on adjusting perspective but also lifestyle. Across the continuum of care, we need to get people moving. We need to support people in exercising. Our programs in kinesiology, athletic therapy and osteopathy, for example, are all really intended to support residents before they're diagnosed with chronicity, or certainly afterwards.

I think that colleges, institutes, polytechnics and universities can work collaboratively to make sure we have the right talent to be proactive and upstream in resourcing the system—hopefully, before it becomes overburdened.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Morrison and Ms. Sidhu.

Go ahead, Mr. Garon. You have two and a half minutes.

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

Thank you very much, Mr. Chair.

Dr. Boucher, the Canada health transfer used to account for 35% of the costs of the system. This percentage has decreased to 22%, and it will decrease further to 18%.

I grew up in a small town near Senneterre, Abitibi. Today, people no longer have access to a family doctor, and the hospital is closed. They no longer have access to delivery rooms. In fact, access to health services is very difficult for families.

In your opinion, if the Canada health transfer were restored to a level that would cover 35% of the system's costs, what would the impact be in terms of actual services for Quebec families living in the regions?

[Dr. Anne-Louise Boucher]

That's an excellent question.

I think we will have to be imaginative, because investing money won't necessarily make it possible to get the necessary labour. However, it could facilitate continuing education, as Ms. Morrison mentioned.

There are also other factors to consider. We are in the 21st century, and we must adopt modern ways of doing things.

I am thinking in particular of telemedicine and networking. Doctors can travel to the regions, but the structure of the health care system must allow citizens to have access to care and specialists. We can't ask a number of specialists to move to Abitibi or to sparsely populated areas, because they won't be able to keep their skills up to date if they aren't exposed to certain cases.

However, online medical consultations as well as telemedicine networking and access to specialists by telephone, both for doctor‑patient consultations and for doctor‑to‑doctor consultations, are factors that would improve service delivery in rural and remote areas.

However, there are costs associated with that. An increase in health transfers to the provinces would allow for better access in all regions, while taking into account workforce needs. You don't create the workforce, and you can't multiply the existing workforce. However, new doctors can be trained through programs. The problem of workforce shortage isn't only in the health care sector, but also in many other areas.

We need to have systems that allow access to health care. At least we need to have support for health care professionals, specialists and other stakeholders.

Through modern computer, technological or robotic means, doctors can perform remote auscultation, ultrasound, medical manipulation and surgery. However, it's important to bear in mind the costs of these new ways of doing things. This would require, among other things, an increase in health transfers.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Boucher and Mr. Garon.

Next is Mr. Davies, please, for two and a half minutes.