Health Committee on April 27th, 2022

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Powlowski.

Thank you, Dr. Lefebvre.

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

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

Thank you very much, Mr. Chair.

I'd like to thank all the witnesses for being here today.

I will start with a question for Dr. Moineau.

Dr. Moineau, you eloquently mentioned that 4.6 million Canadians are having difficulty accessing a doctor or local medical services right now. This brings us back to the need to have better planning and to have a better capacity to train doctors and send them to hospitals in the regions. Not surprisingly, there is the issue of funding.

This week, in committee, we heard from representatives of the Fédération des médecins omnipraticiens du Québec. They told us that, in order to improve the conditions under which doctors practise and to make them more available in the regions, there was an immediate and significant need to increase health transfers to the provinces. Previously, these transfers covered up to 35% of system costs, but this has been reduced to 22% and could well decrease to 18%.

Would this additional funding help the provinces to carry out better long‑term planning?

[Dr. Geneviève Moineau]

Thank you very much for the question.

In fact, it is not within the authority of the Association of Faculties of Medicine of Canada to comment directly on this. What I can say, though, is that it's really important to think about how general practitioners are paid for their work and for the care they provide, if we're going to be able to meet the needs of the population. The provinces should really address the inequity that sometimes exists in health care reimbursements.

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

I understand that this is a provincial jurisdiction. I understand your reluctance. Having said that, I think the issue of the shortage of family doctors is a medical school issue, Dr. Moineau. When the representatives of the Fédération des médecins omnipraticiens du Québec appeared before the committee, they told us that the value of the profession of family doctor needed to be promoted. They said that medical schools sometimes have trouble attracting candidates to general medicine rather than to certain specialties.

It is therefore important to make major changes in technology and practice conditions and to facilitate work in the regions. We were told that better, more sustainable and predictable funding through the provinces could help faculties make this change.

What are your thoughts on that?

[Dr. Geneviève Moineau]

I agree with you that it's important for medical schools to accept students who are ready to become general practitioners. We are looking at this issue a lot. Whether in Quebec or in the other provinces, it's a really important aspect.

In fact, it's the faculties that decide who enters or is accepted into the profession. We need to make sure that we are accepting individuals who are willing to practise general medicine, general practitioner medicine, and practice in the regions.

Let me make a comment on the previous conversation. We believe it's important that young people living in the regions be able to receive their medical education in the regions, in all the provinces of Canada. This will help us ensure that there will be more doctors practising in the regions. There is still a lot of work to be done in this regard, but it's one of our goals for medical schools.

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

Thank you very much.

I'd now like to turn to Dr. Bourgeault briefly.

I read your brief, which is very interesting and contains several possible solutions. That said, I note that several of your proposals are aimed at centralizing the collection and management of health information at the federal level. I remember, for example, the years of the Romanow commission. At that time, the Canadian Institute for Health Information was created. This centralization caused major problems with membership, particularly in Quebec, and ultimately there were delays in the information-gathering process.

Would you be more open to a decentralized approach, one that would be more respectful of provincial jurisdictions, but that could allow for a great deal of co‑operation? I'm thinking, for example, of a working group that would give the provincial and Quebec governments a lot of leeway.

[Dr. Ivy Lynn Bourgeault]

Thank you. I really appreciate that question.

It's important to recognize what we're proposing to be centralized, which is data to be standardized. Right now, the data collected by medical regulatory authorities, even on the medical profession represented by my colleagues here, which Dr. Lefebvre has noted is excellent information, is not data that goes to the Canadian Institute for Health Information. The data collected by the Association of Faculties of Medicine of Canada—and it's extensive—on medical students also doesn't align with the data collected by medical regulatory authorities and what goes to the Canadian Institute of Health Information, so our proposal is to have standardized data.

An excellent way to standardize data would be to have a system of pan-Canadian registration, and this is really important. We are not suggesting that health workforce planning be undertaken at a national level. That's not an appropriate level for that to happen. What we are suggesting is that there would be standardized data collected in the same way that StatsCan collects standardized data through the census on the population, and that then the provinces, territories, regions, hospitals and medical institutions could do some planning.

Right now, the data is siloed across jurisdictions, across organizations within a profession and also across the professions. If we could bring those together, that's what we're talking about with data infrastructure. In our conversation with folks in Quebec, they said they would very much welcome that and the development of tools to help them to do much better planning at a local level, which is the most appropriate place for it.

I hope that has answered your question.

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

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Garon.

Next we have Mr. Davies, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you to the witnesses for your excellent testimony.

Dr. Moineau, I'd like to start with you.

In a 2018 article from University Affairs, you were quoted as saying this: “The deans have clearly identified the unmatched Canadian medical graduate as a top priority.” You've already spoken to this a bit, but I'm wondering what the direction is since that was written four years ago.

Has the number of Canadian medical graduates who are unsuccessful in matching to a residency requirement each year decreased or increased since that article was published?

[Dr. Geneviève Moineau]

Thank you for the question.

As you identify, this was the recommendation that came out in 2018. In fact, we did have a significant positive response to that, in that we had three provinces that actually changed their policy around how the match was structured, which enabled a significant decrease in the number of unmatched.

However, unfortunately, those numbers have started creeping up again. The major issue that remains is that we do not have the appropriate buffer between the number of graduates of Canadian medical schools and the number of residency positions.

We know that when we have a buffer of at least 10 positions—so again, for 100 graduates—there is the opportunity for about 110 residency positions, and these are positions in all specialties, in family medicine and all the other specialties. That allows a match for just about everybody. Back in 2009, we had 11 unmatched Canadian graduates across the country. We're really hoping to be able to get back to those types of numbers and not the nearly 100 that we have now. It really requires the provinces to be able to get to that ratio. We're hoping that your committee and the federal government will support encouraging the provinces to get to that level of residency numbers in each jurisdiction.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

In terms of graduates overall, which you've commented on, we know that Canada graduated about 7.5 medical students per 100,000 in 2020. That was in the bottom five of OECD countries—I believe there are 38 OECD countries—so we're not doing well internationally. What advice would you give this committee about how we can increase the number of seats in medical schools?

[Dr. Geneviève Moineau]

Again, we would seek your support in encouraging provinces to increase their numbers, both of medical school spots—positions for students—and, as well, of residency positions. You have to align those, and we suggest an alignment of 1:1.1. There are some provinces that have made some announcements already that are in the right direction, but we really need to see this across all provinces that currently house medical schools.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Bourgeault, perhaps I can turn to you. In an op-ed from May 2021, which you co-authored with CFNU president Linda Silas, you said the following:

Most Canadians probably don't realize that we lack data on the most basic components of our health workforce.

We lack data about the scope of work of health care workers, and about the diversity of the workforce, such as Indigenous or racial identity and language of service. We don't know how different health teams work together or how can they be recruited, trained and retained where they are most needed.

In some critical sectors, such as home care, long-term care and mental health care, we don't even know how many workers there are.

You've spoken about data being siloed and about provinces and territories operating independently. What's the problem with provinces not knowing what's happening in the province next door, and how do you think national data collection, which you've described, would assist in that?

[Dr. Ivy Lynn Bourgeault]

Thank you for that question and for quoting from the article.

I think moving towards pan-Canadian coordination of the collection of data would allow us to plan across different sectors. We're having a conversation about professions, but professions work in sectors. Physicians work in palliative care, as my colleagues have noted here. Folks work in long-term care and mental health care. The types of dashboards they're creating in other OECD countries are looking at this with an interprofessional and sector focus.

Those types of data enhancements would really help local decision-makers in a variety of different organizations. It's not just the provinces, territories, regions and hospitals, and so on. They would want to have access, to say, “Do we have enough?” and “How should we go about planning different models of care?”

We have no idea. I cannot tell you how many personal support workers there are in Canada. I can't tell you how many addictions counsellors there are in Canada. We absolutely need to have that information.

Here's the data story. The Canadian Institute of Health Information gets data on physicians from a for-profit company. They don't get it from the medical regulatory authorities. For all of the other professions, they get it from medical regulatory authorities for a select number. The Canadian Institute of Health Information has to negotiate data-sharing agreements with dozens of regulatory authorities for the different professions that are regulated. Then they have to collect all of that data, none of which aligns. They have to match that all up, so they spend all of their time negotiating data-sharing agreements and then all of their time trying to make a mountain out of the mess that there is.

The data we have is on gender as binary—male or female—as well as age and province. You cannot do any health workforce planning with that type of data. We can do better than this. We have the amazing Statistics Canada, an agency that collects things nationally, on a pan-Canadian basis. What's very interesting about the data from StatsCan is that it's based on the national occupational codes, and none of that aligns with regulatory authority data.

I'll give you just one example. I know the Canadian occupational projection system—COPS—has been noted in this committee. COPS suggests that there are 75,000 family physicians in Canada. We know there are about 45,000 physicians in Canada, so an error of 30,000 is pretty remarkable. Federal funds go into the COPS system. Federal funds go into a national occupational code that doesn't work at all for health workers. I'm not a decision-maker, but I can't imagine what it must be like making decisions when you have absolutely no tools.

Given the questions the committee has asked our colleagues here, that should be readily accessible. We should have early warning systems for unmatched medical graduates and for shortages of personal support workers.

[The Chair, Liberal, Sean Casey]

Ms. Bourgeault, this testimony is absolutely fascinating, but well past time.

Please, wrap up.

[Dr. Ivy Lynn Bourgeault]

I'll conclude there. I could speak on this for hours.

[The Chair, Liberal, Sean Casey]

Do you know what? We'd love to listen to it.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, perhaps we could remind the witnesses that they are able to provide written submissions, because I think this is really riveting and relevant information. I think all committee members would benefit from any additional written information the witnesses might provide.

[The Chair, Liberal, Sean Casey]

Mr. Davies is absolutely right.

In fact, I've already heard from some members who aren't going to get a chance to ask you questions that they might like to correspond with you. If the committee is okay with written questions and answers to supplement what's been said today, there clearly is an appetite for that in this room. I see there are heads nodding all around.

It is absolutely fascinating. It's too bad that we don't have more time. However, we do have a little more, and the next person to pose questions is Ms. Goodridge, for five minutes.

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

Thank you so much to all of the witnesses for your testimony and for being with us today. I think I can speak for all members of the committee in saying that the passion you have shared and your testimony are definitely important.

To Ms. Bourgeault specifically, some of what you were getting at with the data is really succinct, and anything you can provide to us in writing would be very helpful. In my own home province of Alberta, I think AHS had at one point over 1,300 different databases, and not all of them talked to one another. That is kind of ironic for a province that has one unique health system.

I was wondering—

[The Chair, Liberal, Sean Casey]

I'm sorry, Ms. Goodridge. I have to interrupt. The bells are ringing, and the rules require that we get the unanimous consent of the committee to continue the meeting.

Is it the will of the committee to at least have Ms. Goodridge finish her round, if not further? What's the feeling in the room?

[Some hon. members]

Agreed.

[The Chair, Liberal, Sean Casey]

Ms. Goodridge, go ahead.

You have your full five minutes and then we're going to wrap it up.

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

Fantastic. I will speak a little bit faster.

Dr. Bourgeault, do you have any jurisdictions in Canada you could point to that are better with data compared to others?