Evidence of meeting #18 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was palliative.
A recording is available from Parliament.
President and Chief Executive Officer, Association of Faculties of Medicine of Canada
We are currently midway through the match for this year, but we know that there is a gap of at least 100 positions at the moment, and that's without any increases in the number of medical school positions.
We could certainly, again, provide you with an accurate number based on the match that's under way right now, which will be completed by the end of May. We could add that information to a subsequent package that is forwarded to the standing committee.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Great. Thanks, Dr. Moineau.
To be clear, for perhaps those people who don't understand the system, that means there are 100 medical students trained in Canada who now cannot become physicians because they don't have a position as a resident.
President and Chief Executive Officer, Association of Faculties of Medicine of Canada
Upon their year of graduation.... That's correct.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Do we have any idea of how many of those types of individuals—I'll use that terminology—are in Canada now and perhaps have given up on the match?
Is that kind of data available?
President and Chief Executive Officer, Association of Faculties of Medicine of Canada
These are graduates of Canadian medical schools, so they are in Canada.
The issue is that there's a wastage of time in their not graduating and moving on to residency in that year. Many of them eventually match, but just to have to delay that by a year is really very unfortunate, both for the health care system, because we want those individuals to be able to finish their training and to become independent practitioners, but also for those trainees as well.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Understood, and thanks for that. Is there any idea of how many of those individuals have never been matched? Are there 50 of them or a thousand of them over the years? Are there a hundred a year over the last 10 years?
President and Chief Executive Officer, Association of Faculties of Medicine of Canada
There would definitely be more than 50 over the last several years. That information is a little harder to obtain, but we can certainly give you a range if that would be helpful to you.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
That's great. Thanks, Dr. Moineau. I appreciate it.
I have a question for the palliative care group, Pallium, if I may.
It's interesting, you know. Palliative care certainly is an institution that's near and dear to my heart, as a family doctor, and is certainly germane in terms of things like MAID, etc. There was a commitment of about $6 billion in funding over 10 years in budget 2017.
Can you talk more about how much money organizations like Pallium have received and what is the difficulty in deploying that money and educating people around palliative care?
Chief Executive Officer, Pallium Canada
Thank you, Dr. Ellis, for that question.
The short answer to your question is very little. We've actually done some homework to understand just how much of this investment has been spent on palliative care.
According to the Office of the Parliamentary Budget Officer, when the officer was asked to identify federal investments in palliative care and MAID since Canada legalized medical assistance in dying in December 2020, this is what was shared. As we know, based on a common set of principles on shared health priorities, the federal government subsequently signed bilateral funding agreements with each province and territory, and each province and territory developed an action plan. That's usually appended to the bilateral agreement and specifies how the federal transfers would be used. However, only six provinces identified initiatives specific to palliative care: B.C., Alberta, Saskatchewan, Manitoba, New Brunswick and Newfoundland.
According to the provinces' bilateral agreements, the total funding for palliative care initiatives for these six provinces was estimated at $170 million, and that's to the end of 2021-22, but we're not given any details on how these funds were spent. Unfortunately, the specific amounts allocated to palliative care are not available for the remaining provinces and territories, because health is a provincial jurisdiction. As we know, Health Canada doesn't have access to or the authority to request program-specific accounting.
The long and the short of it, Dr. Ellis, is that we simply don't know how much and how exactly this money has been spent, which is disappointing.
Dr. Pereira, would you like to add anything to that?
Liberal
The Chair Liberal Sean Casey
Very briefly, Dr. Pereira, please, as we're well past time. Please be succinct.
Scientific Officer, Pallium Canada
Thank you.
We visited about eight provinces and territories between 2019 and early 2020, and the response was always, “It's important and it's part of our strategic plan, but we don't have funding to support it.”
Liberal
The Chair Liberal Sean Casey
Thank you.
Thank you, Dr. Ellis.
Next we have Dr. Powlowski, please, for six minutes.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
We're here to examine the health care workforce shortage and what we can do about it now. As somebody who graduated from medical school in 1986, I've been doing this a long time, and you know what? Nothing has changed. We had a shortage of people, particularly in under-serviced areas, 35 years ago. We still have that shortage.
The answer has always seemed clearly to me to be in front of our noses: foreign graduates. There have always been a lot of foreign graduates in Canada. I've certainly known enough of them in my time who find it very hard to get licensed in Canada. There has been this mismatch. There's been a need and there's been a desire of foreign-trained doctors to work in under-serviced areas. What is the problem?
I've asked this of a few people here, I think. I'm not sure what the problem is.
Certainly, I have some suspicion that it's medical protectionism. Organizations like the CMA and the OMA are dominated by doctors from big cities. When you work in big cities, which I've done a little bit—I've done far more work in under-serviced areas—you want patients. You're competing for patients. You want to maintain your salary. I somewhat suspect that the problem is doctors not wanting to make it easy to license foreign-trained doctors.
The other possibility is that the provinces realize that more billing numbers equal higher health care costs.
I throw that out there as two possibilities. I wanted to ask Ms. Lefebvre from the federal regulatory authority for her views on this matter. What has been the barrier to licensing more foreign graduates?
Executive Director and Chief Executive Officer, Federation of Medical Regulatory Authorities of Canada
Thank you for that question, which I knew was coming, so this is good.
We have been asked this several times before. There are two things. First of all, I cannot speak on the payers' approach to this. The regulatory authorities do not issue billing numbers. They issue a licence to qualify physicians. IMGs, as I said, come from all over the place and from very different training systems. Canadian graduates undergo really thorough assessments in real life with patients in real, live health care situations.
Our approach to this is that IMGs, in order to come to Canada, for the most part—and not all of them—have to undergo a similar kind of in-practice assessment. It is expensive to run, and it's a competitive process. There are probably many more qualified IMGs than those who actually secure a spot for that. Once they had gone through that 12-week process, they would then get a provisional licence under supervision, and there are steps to move them from a provisional to a full unrestricted licence.
You have had presentations from the CMA and the Royal College. The Royal College is developing different mechanisms with the hope of getting these people assessed a little bit faster.
Medical education is a complex and very expensive system. I think it's time to ramp this up, but in order to ramp it up, you must also have the capacity to do the assessments, and right now that is quite challenging.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Can I interrupt you there?
This is the first I've heard of this 12-week assessment. Excuse my ignorance, but what is that? Do all colleges of physicians and surgeons across Canada allow this option or only some? How does this work exactly?
Executive Director and Chief Executive Officer, Federation of Medical Regulatory Authorities of Canada
More than half of them do. It's called the “practice-ready assessment”. It was designed primarily for physicians who had come into Canada to work either as general internists or as family physicians. In order to assess the specialist and the subspecialist physicians, you almost need a specially designed program for them, and that's again quite a bit more challenging.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Do I get you right that there are not enough positions for these practice-ready assessments, so a lot of foreign graduates don't get to enter into the process to be evaluated?
Executive Director and Chief Executive Officer, Federation of Medical Regulatory Authorities of Canada
That's correct. Because of resources, it is a competitive process, so we have way more applicants who would probably qualify if there were an unlimited number of assessment positions.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Do you know how many positions there are in Canada each year?
Executive Director and Chief Executive Officer, Federation of Medical Regulatory Authorities of Canada
I could find that for you. I don't have it at my fingertips. It's relatively modest, but it depends on the jurisdiction. Approximately 25%—and I would say over 25% but I think I will stick to 25%—of practising physicians in Canada are international medical graduates, so many of them do get through.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
When you say modest, just give me a ballpark figure. Are we talking thousands or hundreds?
Executive Director and Chief Executive Officer, Federation of Medical Regulatory Authorities of Canada
It's hundreds.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Could you get us that information?
If the federal government were to put more money into opening more practice-ready assessments, do you think we would be able to do that rapidly in order to evaluate the skill of foreign-trained doctors and get a lot more people out there quickly?
Executive Director and Chief Executive Officer, Federation of Medical Regulatory Authorities of Canada
It would be wonderful to be able to say yes to that, but because the other resources it requires are human resources—practising physicians assessing incoming international medical graduates—I think that other side of the coin would have to be factored into this. It would involve some discussion, but I would be hopeful.