Health Committee on April 25th, 2022

[The Chair, Liberal, Sean Casey]

Good afternoon, everyone.

I call this meeting to order. Welcome to meeting number 17 of the House of Commons Standing Committee on Health. Today we will meet for two hours to hear from witnesses on our study of the Canada’s health workforce.

Before I introduce today’s witnesses, I have a few regular reminders for hybrid meetings. Today’s meeting is taking place in a hybrid format, pursuant to the House order of November 25, 2021. Per the directive of the Board of Internal Economy on March 10, 2022, all those attending the meeting in person must wear a mask, except for members who are at their place during proceedings.

I have a few comments for the benefits of the witnesses. Please wait until I recognize you by name before speaking. For those participating by video conference—which I believe is all of the witnesses—click on the microphone icon to activate your mike and please mute yourself when you are not speaking. Interpretation is available on the bottom of your screen. You can choose floor, English or French.

I'll remind you that comments are to be addressed through the chair. Please refrain from taking screenshots or photos of your screen. The proceedings today will be made available via the House of Commons website.

In accordance with our routine motion, I am now informing the committee that all witnesses have completed the required connection tests in advance of the meeting.

Today we have with us, as individuals, Dr. David Gratzer, physician and attending psychiatrist, and Dr. Arjun Sahgal, professor of radiation oncology.

From the Canadian Federation of Medical Students, we have Santanna Hernandez, president, and Montana Hackett, director of government affairs.

We also have with us Dr. Anne‑Louise Boucher, director of planning and regionalization, and Mr. Pierre Belzile, director of legal affairs, both with the Fédération des médecins omnipraticiens du Québec

From Health Intelligence Inc., we have Dr. David Peachey, principal, and from Sheridan College, we have Dr. Janet Morrison, president and vice chancellor.

Thank you to all of our esteemed witnesses and panellists for being with us here today and for taking the time to impart upon us some wisdom and advice as we endeavour to make recommendations to the Government of Canada with respect to Canada's health workforce. We're going to begin with opening remarks from each witness in the order they appear on the notice of meeting.

Please limit your remarks to five minutes.

With we're going to start with you, Dr. Gratzer. You have the floor for the next five minutes. Welcome to the committee.

[Dr. David Gratzer, Physician and Attending Psychiatrist, As an Individual]

Thank you, members of the committee, for the invitation to speak today.

“I started watching the clock during the day and thinking more about how many more patients there are and how much time is left in the day. I knew I'd get through it, but I didn't know how I'd feel at the end of the day. Then it just started getting earlier and earlier, and one day, five minutes into the meeting, I was thinking, “Oh boy, it feels like I've been here for a while. I have a long day to go.””

These are comments that a physician colleague recently made to me. When we speak about the recruitment and retention of health care workers, we need to think about several things, and they include the psychological needs of our workers.

My name is Dr. David Gratzer. I'm a medical doctor and attending psychiatrist. I'd like to speak for a few moments this afternoon about burnout and about mental disorders. By way of background, I work at CAMH here in Toronto where I serve in clinical, administrative and educational roles. That said, the views I express today are not necessarily those of the hospital.

Let me take a few moments to talk about burnout, and I'll confess my bias. My roles involve physicians, so I see things through the prism of physician burnout and physician needs, but I think they're applicable across all health care domains.

As you know, physician burnout is a syndrome that is characterized by three things: emotional exhaustion, depersonalization and a reduced sense of personal accomplishment. To be a little bit more specific, emotional exhaustion is feeling used up at the end of the day, that there is nothing more to be offered to patients. Depersonalization is when clinicians no longer view patients as being people but more like objects, and a reduced sense of personal accomplishment, well, that one is clear, but I would add that it is often combined with feelings of ineffectiveness despite years of training and goodwill.

Though burnout has been problematic for years, as you know, everything with regard to physician issues has grown worse with the pandemic. The Canadian Medical Association's national physician health survey, which polls thousands of physicians from sea to sea to sea, suggested that about one in three physicians had been experiencing burnout. That was before the pandemic. As you know, since the pandemic has begun, those numbers have jumped up. The most recent survey suggests that about one in every two physicians, half of our physician workforce, is experiencing some element of burnout. Similar surveys for nursing, occupational therapy and other disciplines of health care have shown something similar. In other words, a bad situation, perhaps not surprisingly, has grown worse.

Let me pivot and talk about the pandemic and mental health disorders. As you know, there's been much attention in recent months to survey results showing that people are more anxious and that their mood is lower. As a psychiatrist, I find this interesting but not necessarily worrisome for most people. Again, I chose my words carefully. Most people have resilience and, as a result, while the pandemic might be stressful, while they might be worried about making rent or about their employment prospects, they will walk away from this relatively emotionally and psychologically unscathed.

But there are groups at risk. I can think of three. First are people who have had a history of mental health problems. Second are those with direct exposure to the virus and illness and third are those who have survived the illness. Many of our health care workers—too many of these health care workers—fall into all three categories and are thus at risk for or experiencing major depressive disorder, post-traumatic stress disorder and anxiety disorders.

The literature suggests that, long after the physical manifestations of SARS ended, there were the psychological manifestations. I think we're going to see something similar with COVID-19. The point is that our problems with COVID-19 will continue after the last patient is discharged from an ICU.

In my closing few seconds, I wish to sound a note of hope. I would suggest that there are thoughtful and practical things that can be done and that are being done. Regarding burnout, a rich literature has developed over the last decade or two, suggesting steps that can be taken.

I think about some of the excellence at my own hospital and some of the work done by people like Drs. Wilkie and Tajirian, who are setting up a peer support group that's been highly effective for doctors. Of course, the treatment of mental health disorders, my goodness, that's my life's work. Never have we been able to do more for people who have mental health disorders. The key, of course, is to recognize these problems and then to take the appropriate actions.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Gratzer.

Next we have Dr. Sahgal, who is appearing as an individual.

Welcome to the committee. You have the floor for five minutes.

[Dr. Arjun Sahgal, Professor of Radiation Oncology, As an Individual]

Thank you very much, Mr. Chairman. It is an honour to speak to you today.

I am Dr. Arjun Sahgal. I work at the Sunnybrook Odette Cancer Centre of the University of Toronto. Today I am representing myself, as a Canadian physician and professor of radiation oncology, subspecialized in the treatment of brain and spinal tumours.

To provide context, those of us in this field deal predominantly with incurable cancers like glioblastoma. Cancerous brain tumours are the most difficult to treat, and I have been privileged to treat these patients and to try to extend their lives. I have treated patients from those with absolutely no resources to Canadian icons like Gord Downie. It is always humbling that, no matter where they are in the world or whatever their background, the disease indiscriminately takes the patient’s life.

The nature of this work is highly stressful and it presents a major emotional burden. Resources were already limited as we all faced challenges of practising in a constrained and publicly funded health care system, but the past two years of practising during the pandemic have only exacerbated the potential for burnout—and system-wide burnout. From the early days of having shortages of PPE while seeing patients; dealing with the potential of exposing ourselves, our families and other patients to COVID; and triaging patient care based on COVID risk to the current reality of working in an overextended health system and trying to catch up while still managing the increased number of patients with COVID needing care, burnout is being fuelled at all levels of the medical profession.

Moreover, patients and caregivers themselves are burning out, and therefore the realities of limited resources that we face extend to not only the medical practitioners but also the patients themselves. Every facet of care is challenged by the lack of human health resources.

We are short nurses, allied health professionals, personal support workers and doctors. Many have simply retired, quit or looked for another profession as the environment is just overwhelming and under-resourced.

In addition, the system really hasn’t provided additional supports to care for the workers who are at the front line. The system is trying new strategies on the fly, but the question is what can make that difference to help health care workers now? It is not simply recognition.

I often reflect on a system that would improve the efficiency in which we practise through better modernized electronic health record systems, seamless access to imaging tests like MRI and CAT scans, better approval processes for new life-saving drugs and tests, and specialist care and staff to help the administration of health care. More and more, these tasks are being put on doctors, and that is stressing the system and increasing the burnout. In other words, we need to let the doctors be doctors and ensure that clerical staffing is provided by the system so that doctors can look after patients instead of cutting down on patient care to allow time to enter orders and transcribe notes. This would be a major boon for staff retention, especially in northern and rural settings, and would combat what seems to be an increasing proportion of young doctors who are burning out.

I am not an expert, nor do I practise in a rural or underserviced community, but as a specialist I do care for patients from all over Ontario who have rare tumours. I can say, from my northern colleagues, that this problem is much more difficult to deal with in remote centres since there is a much smaller pool of workers and some core services have had to be restricted.

The acceleration of virtual care is helpful in managing the current crisis as we can do more virtually, but we need a fair system and access to resources that span not only hospitals but all care settings, including remote care offices.

Immediate attention needs to be given to new health care models to manage the limited resources that are becoming even more scarce due to the workforce answering with burnout from the constant pressures of understaffing and over-administration.

I do believe that increasing the staffing levels will make a major difference, but this will take time. Accelerated programs for recruitment of nurses and long-term care workers from other countries may be a solution, but we need to train more young Canadians and make it attractive again to go into the field of caring for the sick and needy.

It would go a long way for rural centres to have modernized resources so that the staff could work proudly in that setting, be retained and be able to recruit new staff by offering the latest medical care resources—as they would in downtown Toronto—so that they could do their jobs the way they were trained to do. This could have a positive impact on the burnout rate in patient care.

To summarize, I would say that every health care worker—from the support staff maintaining clean surroundings and security personnel who protected us when protests were happening to technicians, nurses and doctors—strives selflessly to provide only the best care for our patients.

That I believe in and I do believe it's time to protect us from burnout. I thank this committee for this opportunity.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Sahgal.

What a perfect segue to our next group, the Canadian Federation of Medical Students.

Welcome.

[Santanna Hernandez, President, Canadian Federation of Medical Students]

Mahsi cho .

Thank you to the Standing Committee on Health for taking the time to hear from the Canadian Federation of Medical Students. We are an organization that represents over 8,000 students from 15 medical schools across the country and the future of the health care system.

My name is Santanna Hernandez. I am the president of the CFMS and here on the traditional territories of the Treaty 7 peoples of southern Alberta and home to Métis Nation of Alberta Region 3. I'm joined by Montana Hackett, our director of government affairs, and our president-elect, who is joining from the Township, Treaty 6 territory in London, Ontario, as well as Treaty 2 territory.

As medical learners, we bring a unique perspective to this conversation and are strong advocates for learners and the broader medical educational community. We are aware that our partners at the Canadian Medical Association had the opportunity to speak to you previously and we hope that our information and asks will build on the information they shared as we echo the incredibly important issues on the health and human resource crisis, the need for investments on a national health and human resource strategy, and national licensure.

[Montana Hackett, Director of Government Affairs, Canadian Federation of Medical Students]

Perhaps there can be confusion on how those issues impact students and what components are missing that impact us as learners, so I want to take a few minutes to break this down for the members of the committee.

One thing that is top of mind for all medical learners is the residency matching process. Each year we see trained medical doctors going unmatched to a post-graduate program. Government plays a key role in deciding residency seats at the varying provinces since those seats are often determined by educational funding and resources to build programs across the country. Only a few weeks ago we concluded the first round of the 2022 residency match and it was a landmark year for all of the wrong reasons. This showcases the urgent need for action from the federal and provincial governments, both from the standpoint of medical student burnout, prevention and retention, but also resource allocation in a health care system that is bleeding workers.

There is a significant need to align the current residency system with the needs of the patient population and the desired career prospects of its future physicians to prevent burnout. This includes government investments in human resource projections and adequate program funding.

[Santanna Hernandez]

Secondly, there is an urgent need for national licensure. Currently, the application process for medical licensure requires physicians to submit separate applications to each of the 13 provinces' and territories' medical regulatory authorities that license physicians. This limits physicians from providing services in multiple jurisdictions without going through a separate licensure process for each province and territory. This poses a challenge to residents and staff physicians, who strive to deliver care to patients easily and flexibly. This includes significant patient safety risks and delays in care as administrative burden takes physicians away from their primary focus of patient-centred care.

Practising outside of their own province and territory would allow residents to expand their practice to include underserved rural and remote communities. As future physicians, the burden of these applications in the context of all of our other duties and responsibilities is significant. National licensure would alleviate this issue, while also making patient-centred care more flexible and directed to those who need it most.

We released a joint statement with the Resident Doctors of Canada, the College of Family Physicians of Canada, the Royal College, the Canadian Medical Association, and the Society of Rural Physicians of Canada, advocating for exactly this several years ago and there is an increased urgency for this change now more than ever.

[Montana Hackett]

Finally, both preventative and reactive mental health supports need urgent funding. In our 2017 CFMS member survey, it was reported that around 37% of Canadian medical students meet the criteria for burnout. This is a staggering figure, and even more frightening is that it is a prepandemic one.

Wesley Verbeek, who was a medical student in 2017, said it best. Another problem is that students training to care for the mental and physical health of others don't have time to tend to their own health. Wesley Verbeek said, “You have to learn and do so much in a short period of time. There is a lot of pressure to keep going, keep going, keep going, because the more you can continue the status quo, the more likely you are to get matched to the residency you want.”

As our former president, Dr. Franco Rizzuti, explained, “Medical students tend to be high-functioning and highly resilient, but the accumulation of many stressors leads to anxiety, depression and burnout".

Time-crunch pressure, lack of sleep, 70-hour weeks during clinical rotations, witnessing patient death for the first time and personal issues add up, and “even the best coping mechanisms can start to fail,” said Rizzuti. With burnout among residents and staff physicians estimated at 50% or above, the emotional struggles of medical students represent “the beginning of the pipeline,” said Rizzuti. “How are we going to improve overall health and wellness in the general physician population if our trainees—without the stress of running a business, without some of the on-call requirements—have high levels of burnout and depression?”

So the combination of the long wait times and inaccessible mental health supports with trainees, who due to the demands of their learning have limited opportunity to access them, creates a crisis.

[Santanna Hernandez]

We have three key recommendations.

A national integrated health and human resource plan, that has an intergovernmental approach spearheaded by the federal government, is urgently required.

We need to eliminate barriers for medical professionals, by enabling the adoption of a national licensure system. Medical professionals need to be able to move from province to province to territory to help deliver care where it's needed.

Finally, we need to increase accessibility for mental health supports, given that medical trainees are facing a mental health crisis.

We are at the beginning of a lifetime of service to our communities, so implementing these measures now translates into better patient care for all. Working with Blackfoot elders here in Mohkinstsis, the Blackfoot name for the city of Calgary, I have been privileged to have many teachings about the importance of walking a parallel path. That is what we must do now. We need to work together to create a health care system that fosters wellness and sustainability, and takes a proactive approach to ensuring patient safety.

We urge you to take action now before it's too late. Our educators need you, and we need you. This is a non-partisan issue. Canadians need you on their team.

Mahsi cho. Thank you to the Chair and the committee for hearing our witness statement.

[The Chair, Liberal, Sean Casey]

Thanks to you both. I'm sure there will be questions, when we get to that part of the program.

We'll now go to Dr. Boucher of the Fédération des médecins omnipraticiens du Québec.

[Dr. Anne-Louise Boucher, Director, Planning and Regionalization, Fédération des médecins omnipraticiens du Québec]

Good afternoon.

I'm a family doctor, and I represent the Fédération des médecins omnipraticiens du Québec, or FMOQ.

First of all, I'd like to thank the House of Commons Standing Committee on Health, and in particular Mr. Luc Thériault, member of Parliament for Montcalm, for allowing us to make a few comments on the state of the physician workforce in family medicine in Quebec.

The FMOQ is a professional union representing some 10,000 family doctors practising in the Quebec health care system. It is a representative body recognized by the Quebec government to negotiate the conditions of practice with the minister of health and social services. However, it isn't only a union, but also an important player in the planning and organization of general medical care in Quebec, as well as the largest continuing medical education enterprise in family medicine in Quebec.

The FMOQ and its members play a central role in the smooth operation of Quebec's health care system. We saw this during the health crisis related to the coronavirus pandemic. We demonstrated that our organization is an indispensable and necessary partner for policy‑makers and network managers.

The pandemic revealed that FMOQ and its members responded to all levels of intervention. They were able to proactively and with great initiative reorganize front‑line services quickly, while actively supporting second‑line care for patients and the various services offered in institutions. Whether in front line medical clinics, emergency rooms, hospital units, intensive care units, long‑term care facilities, local community service centres, home care, palliative care, whether in home or in institutions, or in work related to medical assistance in dying, whatever the practice setting, Quebec family doctors have risen to the occasion. They continue to be so today and will do so tomorrow. They stand in solidarity with the needs of the people.

In Quebec, family doctors cover both primary and secondary care. Across Canada, they are more likely to practise secondary care. The additional effort required by the state of health emergency for family doctors has certainly had an impact on them. This effort has resulted in an increase in the number of days worked and, consequently, in palpable exhaustion in the field. It has been physically, psychologically and professionally stressful to deal with a steady pace of work and to be constantly adapting, both in terms of the coverage of care, where the demand was constantly changing with the pandemic, and within the medical teams, where the unexpected absence of staff due to isolation because of COVID‑19 put all professionals in rapid adaptation mode on a constant basis.

The practice of medicine during the pandemic was in some respects disrupted. To give just one example, the rapid introduction of telemedicine into everyday practice has brought about lasting and rapid changes. Unfortunately, to support all these efforts with the public and to coordinate all these changes professionally, our workforce is not at an optimal level. On the contrary, many are missing. As we have said many times in recent months, there is currently a shortage of more than 1,000 family doctors in Quebec to meet all the needs.

There are many reasons for this shortage. In addition to the upheaval and fatigue that the pandemic has caused in the workforce in recent years, there has been a significant increase in the burden of medical‑administrative tasks. This has led to a decline in the attractiveness of the profession for new aspiring doctors.

For your information, the Canadian resident matching service promotes a system for applying for, selecting and matching postgraduate medical training positions across Canada. Again this year, graduates are turning away from family medicine in favour of other medical specialties, and this is very important in Quebec. Just over 90 family medicine positions in Quebec remained vacant after the first round of matching. We must never forget that an unfilled position in family medicine can have a negative impact on access to primary care for more than 30 years. For us, this situation is as sad as it is alarming. Family medicine in Quebec urgently needs to be valued by medical students. Too many people, including some at the highest levels, have unfortunately denigrated this profession over the years, which has produced the results we know.

In terms of workforce, there is a shortage of at least 1,000 family doctors in Quebec. That's a significant shortage. Over the past seven years, including the last two years in particular, several positions have remained vacant.

In addition, there is less primary care activity in Quebec than in the rest of Canada. Family doctors in Quebec are more versatile than family doctors elsewhere in Canada. About 50% of them work in at least two practice settings. The number of family doctors per 100,000 inhabitants is lower in Quebec than in the rest of the country.

According to the latest available data for 2020‑2021, there are approximately 9,800 family doctors in the Quebec public system, and more than 7,500 of them offer primary care services. In addition, 3,737 caregivers take care of patients in hospitals, 2,453 work in emergency rooms, 2,303 work in nursing homes and long‑term care facilities, or CHSLDs, and more than 117 work in obstetrics, where there were at least 34,000 deliveries in 2020‑2021. Others work in various sectors, such as palliative care, rehabilitation, and so on.

It's important to consider the versatility of Quebec family doctors, whose contribution to the caseload of family doctors in institutions is between 35% and 40% compared to about 20% in Ontario, if we want to get an accurate picture of the family doctors in Quebec who are available on the front lines. We also want to emphasize that difficulties in accessing specialized investigations and wait times for consultations and surgeries result in over‑consultation. For example, patients may consult with their family doctor several times to adjust the dosage of an analgesic or while waiting for surgery or assessment. This, in turn, increases the workload of family doctors.

Furthermore, particularly in remote areas of Quebec, the state of family medicine doctors, while far from optimal, has been relatively stable in recent years. However, some regions such as Abitibi‑Témiscamingue, Chibougamau and the Magdalen Islands, stand out. In fact, these geographic areas have a harder time recruiting doctors than others.

There are also rural areas, which are currently the worst geographic areas in this regard. Family doctors who practise in rural areas are often late career doctors who have devoted most of their practice to their communities. There is very little medical succession in these rural communities, which are not always so far from an urban centre. Many young doctors are reluctant to start their careers in such isolated settings. Many sub‑territories have significant recruitment issues. With respect to indigenous communities, in recent years—

[The Chair, Liberal, Sean Casey]

Dr. Boucher, I would ask you to wrap up your opening remarks. You will be able to add details during the question period.

[Dr. Anne-Louise Boucher]

I'll conclude by saying that, in our opinion, the federal government must significantly increase health transfers to the Quebec government in order to better support family doctors and give them access to better technical platforms for conducting investigative activities.

Valuing the profession of family medicine in Quebec is also a major aspect to consider within our health care system. Family medicine could be promoted and supported through federal funding to Quebec universities, in particular to increase the exposure of students at the undergraduate level to family medicine.

We also want to make an important point. We believe that the federal government and its corporations could be asked to revisit what unnecessarily complicates the practice of family medicine. I'm thinking, for example, of the red tape involved in applying for tax credits and other forms and regulations of all kinds.

With the current shortage of family doctors, we can no longer practise medicine in the same way. We need to be able to delegate more tasks and work with other professionals. We also need to reduce the medical‑administrative burden. This reorganization of work requires support and change management that will allow family doctors to do what they were trained to do, which is to practise medicine.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Boucher.

Representing Health Intelligence Inc., we have Dr. David Peachey, principal.

You have the floor, Dr. Peachey.

[Dr. David Peachey, Principal, Health Intelligence Inc.]

Good afternoon and thank you for the opportunity to meet with the committee.

I have prepared a brief opening statement to provide context for the nature of our work and some of the lessons that we have learned.

Health Intelligence has undertaken related work with a team of four, constituted by a project lead, a health statistician, a software engineer and a project manager. Each of us has consulted in health care for 20 years or more, with the major thrust over the past 10 years being resource and clinical services planning. With varying degrees of scope and intensity, we've completed resources and services plans in nine provinces and territories.

I do believe that a fundamental aspect of your mandate in this committee is, in fact, this type of planning, particularly in the domains of recruitment and retention efforts, which inevitably founder in the absence of the ability to recruit to a plan.

Health care systems that are unplanned rarely, if ever, reach full potential. Human resources for health are, intrinsically, the health care system. Without question, technology, beds and pharmaceuticals are vital to its functioning, but the ultimate quality of care received by the people it serves starts and ends with the quality of its human resources for health.

Planning human resources for health addresses the challenge of balancing supply, demand and need in a highly labour-intensive delivery system. Understanding the complexity of the workforce, the contributing roles of supply and demand in generating shortages, demographic trends and working conditions are additive in assessing the current and long-term pressures on the workforce.

Resource planning and related policy initiatives are dysfunctional without coordination across the workforce. In the absence of health workforce planning as the basis of health system planning, policy and implementation, the status quo will prevail. Across Canada, the status quo means a largely demand-based system of growth and change in health workforce needs.

On the other hand, clinical services forecasting is a forward-looking projection based on assumptions regarding key determinants of population need and workforce supply. Resource and services planning is the process of shaping the future forecast according to organizational strategy, policy and objectives. As I'm sure you're well aware, the work of such planning is neither formulaic nor necessarily intuitive. Rather, it is navigational, both seeking information and responding to it.

The methodology that we've used for a little over a decade is an adjusted population needs-based model, or APNM, which utilizes a primary model that is population-needs based, but has specific adjustments and modifications to compensate for known inherent weaknesses. The elements and variables in our model constitute the anchor to underpin the complexity of a rolling 10-year plan with a constant repopulation of the data and the qualitative components as well. The outcoming care is equitable, sustainable and based on population health needs.

This patient-centred care, as was referenced earlier, cannot be achieved in the absence of a collaborative, team-based care, which is characterized particularly by the role optimization of all providers in the system with measured outcomes, mutual respect and a shared responsibility for quality.

The methodology itself, as it's evolved over the past dozen years, follows a sequence. It begins with comprehensive data acquisition, collation and analytics followed by comprehensive qualitative inputs based on significant stakeholder engagement and an updating of our literature database. We assess determinants of need and determinants of supply. All of these come together to evolve into a preliminary data catalogue and from there, into a data compendium. The data compendium evolves into an environmental scan and the environmental scan evolves into the genesis of innovative models of care.

Integrating the final qualitative and quantitative elements of need and supply uses our software and the APNM to generate a forecasting model, including scenarios and simulations that are translated into a base case, a low case and a high case in the construct of a rolling 10-year plan.

With this context and summary of our approach as the backdrop, the following is a non-prioritized list of lessons and key points that, if nothing else, have been constants throughout our work.

First of all, if it's not being done for the patient, then why is it being done? We have survived and are coming out of a provider-centric care system. Hopefully, it'll be a patient-centric system.

Recruitment and retention of health professionals are unquestionably bolstered when there is a resource and services plan in place. Recruitment and retention are, however, best addressed as separate entities, since the drivers differ and are distinct.

Rural and remote care benefits from jurisdictional programs, but requires support with the modern tools of digital health.

Recurrent themes across jurisdictions have been collaborative care, mental health and addictions, palliative care, vulnerable populations, public health, maternal and child health, and care of the older adult. These rise to the top in every jurisdiction where we work.

As referenced—and it's important to stress—to be successful, a resource and services plan needs to be navigational, not prescriptive. Planning must be customized to jurisdictional priorities and a needs assessment. For all providers, it's essential to work by using clinical FTEs, including an academic mandate.

The models of care need to be developed with role optimization of all provider disciplines and a shared responsibility for quality. Failure to achieve advances in models of care perpetuates the status quo and marginalizes non-physician providers.

There also needs to be a much greater focus on generalism. That is one of the keys to health care transformation.

Finally, Mr. Chair, this planning that's been described is absolutely not an end, but a beginning.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you very much, Dr. Peachey.

Finally, we have the president and vice chancellor of Sheridan College, Dr. Janet Morrison.

You have the floor.

[Janet Morrison, President and Vice Chancellor, Sheridan College]

Good afternoon.

I am Dr. Janet Morrison, and I'm president and vice chancellor of Sheridan College.

Our campuses are located on the traditional territory of several indigenous nations, including the Anishinabe, the Haudenosaunee Confederacy, the Wendat, the Métis and the Mississaugas of the Credit first nation.

Thank you so much for inviting me to discuss the critical role played by post-secondary institutions like Sheridan in shaping the future of Canada's allied health care workforce.

Before I get started, I want to recognize and thank MP Sonia Sidhu for the role she plays in championing health care both locally and nationally.

Sheridan is one of 24 publicly assisted colleges in Ontario. We have over 55,000 full- and part-time students enrolled in a variety of degree, diploma and certificate programs in the arts and design, technology, business, computing, skilled trades and health. We have three campuses in some of the fastest growing cities in the country: Oakville, Mississauga and Brampton. Our campus in Brampton houses our faculty of applied health and community studies where more than 3,000 learners are currently enrolled in programs such as practical nursing, athletic therapy, kinesiology and personal support workers, among others.

Our graduates play a critical role in frontline care across Ontario in looking after the health and well-being of Canadians, whether they're seniors, youth facing barriers or those living with chronic disease. The applied aspect of learning at Sheridan starts early. Every year we send 1,500 students to field placements in frontline settings, amounting to thousands of hours of service in the community, from hospitals and pharmacies to long-term care homes, shelters, transition homes and sports clinics and, in the private sector, in pharma and health technology.

I want to share a little bit about what we're hearing from our students, alumni, faculty and partners on the ground in the communities on the realities unfolding in their workplaces. Even before the pandemic started, the local municipality of Brampton had declared a health emergency. A lack of qualified and accredited frontline staff to look after the burgeoning and increasingly diverse population of the city was a primary factor. The city, like much of the region around the greater Toronto area, was seeing an influx of new families settling in and an aging population, both of whom needed culturally competent care when a health care workforce was facing a slate of retirements.

Then came the pandemic. For a few very long weeks, COVID infections ripped through the heart of our neighbourhoods in Brampton. This saw record levels of infections and some of the lowest vaccination rates in our province.

Sheridan College stepped up to live out our commitment as an anchor institution by hosting mass vaccination clinics at our Bill Davis campus in Brampton. While we were happy to provide the space, overcoming vaccine hesitancy among local residents required a united effort of social service organizations from the South Asian, Black, Latin and Filipino communities.

The combined interprofessional effort of so many concerned citizens, Sheridan employees who volunteered their time and organizations helped deliver 35,000 doses into arms and enabled Brampton and Peel region to overcome what had seemed to be an insurmountable challenge. That clinic was a huge success, but it also taught us some really key lessons.

First, the pandemic has taken a toll on the amazing health care professionals who serve on the front lines and the system as a whole—nothing you don't know. Health care needs in the community are rising just as the workforce is finding it hard to attract new talent and retain existing professionals with so many either retiring or switching professions. It's anticipated that Ontario will be short 20,000 nurses and personal support workers by 2024. That was before the pandemic. One local doctor told me that he's lost a quarter of his nursing staff in the emergency room.

Second, we saw first-hand and heard from so many that looking after the well-being of a growing and diverse population is an increasingly complex task that requires more one-on-one outreach, trust-building along cultural or faith lines, and intentional and coordinated interprofessional networks of care. This point was further stressed during a round table discussion hosted by Sheridan in January that brought together leading voices from across Peel region, including hospitals, public health units, long-term care centres, commercial laboratories and health care associations.

Third, many internationally trained professionals continue to find it hard to break into the labour market. Given the lessons I've already shared, this makes no sense. Rather than doing odd jobs to make ends meet in order to support their families, many qualified health care professionals could be working to serve on the front lines, helping to address the crisis.

While I speak from the experience of our place in Peel region, I suspect the situation is similar in other parts of Canada. I don't think these challenges are insurmountable, though, so let me share just a few ideas on what the federal government could do.

First, we know that one of the reasons the pandemic hit certain communities harder than others was the prevalence of chronic illness in those communities. In Peel alone, rates of diabetes, osteoarthritis, cancer and heart disease have been rising for years. We need to focus on future-proofing our communities from the next pandemic by addressing chronic disease. Public post-secondary institutions can play a huge role in that work through our research and our applied approaches to teaching that involve field placements in a diversity of settings, community and industry partnerships, and the use of technology. I know post-secondary education is a provincial jurisdiction, but there are many examples of how the federal government has supported academic institutions in areas like skills development, research and tech innovation.

Second, we already attract a lot of international talent to Canada through the post-secondary educational system and through the skilled workers point system of immigration. In both cases, publicly assisted colleges like Sheridan are often a path to a new career and a new life in Canada. Many of our graduates earn work permits and, eventually, Canadian residency.

Internationally trained immigrants also come to us for upskilling through micro-credentials so that they can meet the requirements of Canadian employers, but far too many fall through the cracks. The key pitfall is the lack of consistent and accurate information being provided to individuals in their country of origin by unregulated and often unscrupulous agents before they arrive in Canada.

I urge this committee to engage public colleges to be part of the solution in strengthening the channels of communication for prospective visa applicants, whether they're students or skilled immigrants.

Another area of great stress for graduates who are preparing to enter the health care workforce is housing. Our campuses are located in cities where housing affordability is a huge concern for most people. Solutions that are being discussed have often ignored the student population. Whether they're an international student or a domestic student, limited supply of on-campus and near-campus housing that's safe and soaring rents in suburban neighbourhoods are causing many to live in crowded, unsafe rental units.

At Sheridan, we want to address housing affordability for students, whether they choose to live on campus or off. While we'd like to be able to afford more options, building and operating new units in the GTA is not financially viable for us without government support. Therefore, we ask that post-secondary institutions be made eligible for capital grants under the housing accelerator fund.

Finally, we need to address the critical supports that students need as they transition to the workforce postgraduation. Whether a student is international or domestic, we need to provide the same level of enriched education in theory and applied practices. Both international and domestic students graduating from our programs are ready to help meet the demand for skills in the workplace, and those workplaces, like the health care sector, urgently need them. The federal government can help here by accelerating their careers, making all international students enrolled at accredited post-secondary institutions eligible for the Canada summer jobs program, for example. Doing that would address gaps and needs in local labour markets, it would provide international students with the critical Canadian work experience they need, it would help them build their path to residency in Canada, and they would be fairly compensated for their work placements.

Let me assure you, from what I've seen from our international student learners, they're precisely the kinds of citizens Canada needs to help strengthen our social fabric and our health workforce. Sheridan is hosting a summit on the international student experience later this summer, open to residents, students, post-secondaries, policy-makers at all levels of government and more. We would be happy to share the recommendations from that summit with the committee.

Thank you so much to the House of Commons Standing Committee on Health for inviting me to provide this deputation today. I applaud you for all of the tremendous work you're doing to improve the lives of all Canadians. I'd be happy to answer any questions.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Morrison.

We're going to proceed directly to questions now, starting with the Conservatives.

Mr. Lake, you have six minutes.

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

Thank you.

Thank you all for taking the time to share your experience with us.

I'm going to start with Santanna and Montana. First of all, there is probably a joke in there about my daughter being a big fan about 12 years ago. As I think about my daughter, who is 22 now and in her first year of law school, I see the pressure that she's under. It's hard when I'm trying to figure out what advice to give her about how much of the pressure is a kind of good pressure and how much of it is too much pressure. At times, it can absolutely be overwhelming, and it's clearly too much pressure.

To what extent is the pressure early on in residency in medical school seen as part of the preparation for the future? Where is that line in that amount of pressure?

[Santanna Hernandez]

You raise an incredibly important point that we face as medical learners.

One thing that academia does a really great job of is adding things without ever evaluating whether or not we need to continue to keep some of the things that are still pieces of the puzzle.

What we've seen in medical education over the past many decades is our understanding in science. We continue to make new advancements in health care and in how we can provide that care, and we never look at the scope of practice for what we're trying to achieve.

As Dr. Peachey mentioned, we need to really re-evaluate the amount of time that we're spending on things and the things that we're prioritizing. A key thing we see in the way we've done our evaluations is that some of the details we're trying to look at don't necessarily achieve what we need to do. For instance, they integrate antibiotics or pharmacology into our curriculum, but as we know, pharmacology is always changing. The research is always changing. There are a multitude of apps that give us that information at the drop of a hat.

Is this where we need to be spending our time, or do we need to be developing these skills about how to provide patient-centred care in a good way?

When we're thinking about the pressures being put onto us, it comes down to the evaluations and the level of content that we're trying to deliver, but also the pressures and the experiences of those who are teaching us. They're under their own burdens as health care providers in this system. When something like the pandemic is happening, it is just an added layer on top of their responsibilities to provide the training for future health care providers and to continue to support the health care system that is needed to ensure we are successful and we have healthy Canadians.

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

I'm going to jump in. You mentioned Dr. Peachey and the patient-centred care.

Dr. Peachey, you brought up something that made me write a quick note here, which I want you to explain further.

It seems that you were saying our system has been a provider-based system up until now and it needs to change. Can you elaborate on that a little bit?

[Dr. David Peachey]

Thank you.

Over the years, without calling it provider-centric care, it has clearly been provider-centric care. That is because of the nature of how health systems evolve through looking for evidence.

I go back to wise words of Steven Lewis from Saskatchewan, many years ago. He asked two questions. He asked how you would know if you're giving patient-centred care and how you would know if you were receiving patient-centred care.

One of the themes that comes out of that—and has certainly been perpetuated through the work we've done—is that, at the end of the day, you have to ask this: If it's not being done for the patient, why is it being done at all?

I think that's the transition that must go forward.

It's interesting because in the sort of work we do, we often come against resistance in the early stages, but as it goes on, people embrace and welcome change and, in fact, carry change forward.

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

Dr. Gratzer, I'm going to come to you next and ask if you want to elaborate on that or anything else that you heard because you went first in the testimony and then all the other witnesses went.

I don't know if there's anything you want to specifically zero in on, or if you want to address the question about the pressure and how much of that is part of the preparation.

[Dr. David Gratzer]

Maybe I'll do all of the above, briefly.

There has been a certain common theme running through the different testimonies about how the nature of pressure has changed with regard to health care. There's more information to know than ever before. That's a good thing. We're able to help patients in ways that we weren't able to help them five or 10 years ago.

There are higher expectations as the consumer revolution that has transformed other aspects of the economy now transforms the health care sector.

With it then comes the challenge of balancing out what we want of our health care workers and what we can reasonably expect of them. I think when we talk about physicians—and of course physicians aren't the only health care workers—things become even more challenging because we've been taught for so long that we shouldn't get ill, we should simply muddle along and so on, as though physicians were somehow no longer human and above that.

When we think about what we want in a health care workforce, I think we need to balance these things out and also recognize that while COVID will come and go, health care has fundamentally changed. I think for a moment of the way people practised in the 1970s, when Marcus Welby, M.D. was the most popular TV show in North America. Roughly one in four households tuned in to this American show. If somebody had a heart attack, Marcus Welby would suggest bed rest because there wasn't really that much else to be done. Certainly, one didn't read a lot of papers in order to prescribe four or six weeks worth of bed rest.

Today, of course, we have clot-busting materials. There is good evidence that antidepressants for people at risk would help in the post-MI era. All these things come together.

What am I driving at? There has been a common theme of recognition of burning out and mental health disorders, but also a common place for us to need to find innovative solutions as well.