Health Committee on May 9th, 2022

[Dr. Brady Bouchard]

There are a number of aspects to this.

Again, as Dr. Smart mentioned, we have all heard of physicians who have trained abroad and now live in Canada. They are Canadian, but they're unable to enter practice. Increasing resources for the practice assessment bodies—the credential bodies that do those assessments in each province—is certainly one path forward, and we would support that.

I think it's important to recognize that Canada must demonstrate a positive working environment for physicians in order to attract them to family medicine. We've broadly outlined a number of concerns around family medicine that we need to address, as well.

Another aspect of this is the concept of ethical recruitment. Certainly, Canadians who have immigrated from abroad and are now in Canada.... I think that's a clear line, and it includes Canadians who have left to study abroad and come back. There's a pool of resources there. We would support increasing training—

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Sorry, perhaps I could interrupt you there.

Would there have to be more money available for the colleges of physicians and surgeons across Canada? Are they the ones creating the practice-ready assessments? If they had more money, would this open up more positions? Is that part of the roadblock?

[Dr. Brady Bouchard]

I won't speak for the regulatory colleges themselves. Certainly, we know that doing these practice-ready assessments is a resource-intensive process, so I would assume more resources are required. Sorry, I can't be more specific.

[Dr. Francine Lemire, Executive Director and Chief Executive Officer, College of Family Physicians of Canada]

I think the bottleneck, if there is a bottleneck, is in the capacity to assess a physician who has come from another country—working with that physician to make sure they are competent to perform in a Canadian environment. That capacity is one of the limiting factors.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Our government has promised money in order to make it easier for foreign graduates to get licensed in Canada. Is it as simple as having more money available to the colleges to do these assessments? Is that the answer? Or do physicians not want to do the assessments? Do they not have a lot of trainers? Where is the roadblock, exactly? The government does want to address this, I think. Is it just a matter of more money, or are there other things we'd have to do to get more of these assessments done?

Dr. Smart hasn't said anything.

You look as if you want to say something.

[Dr. Katharine Smart]

I can comment.

As my other colleagues have said, I think it's challenging in that it's not just one issue. The funding is one aspect of it for sure, but again there's also the challenge around the capacity of having the physician assessors able to take on more of these folks to help them go through the process.

Again, what you're hearing is that we're layering that on top of family physicians who are already quite overburdened in their practice. That's where it can get very challenging in the system, because we're trying to leverage the same people in multiple directions at the same time, and it's hard to keep adding to that.

We really need to be thinking about what that looks like. What is that process? How do we provide support and make that attractive for the physicians who are doing the assessments so that it's something they can fit into their workflow? Then, how do we make sure that it is appropriately funded? Also, the folks going through that assessment need t be funded so that it's something reasonable for them to be able to accomplish. Sometimes they're having to do that with no financial support, and that's a big barrier.

Absolutely, the finances are one piece, but I think, as you're hearing broadly as a theme today, for all of these issues we're talking about, the dollars are not the only issue in any of these problems. There are really significant structural issues. There are significant capacity issues. If we don't think about those two things in parallel, I don't think we're going to solve the issue. More money for something that's not working isn't going to suddenly make it work.

We need, I think, to understand what's working and what's not. How do we scale the things that are working? What substantial system changes need to be made, and then how do we support those new ways of moving forward so that it becomes sustainable?

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Smart and Dr. Powlowski.

Mr. Garon, you have the floor for two and a half minutes.

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

Thank you, Mr. Chair.

Mr. Guest, I would like to focus on your third strategic recommendation, which I find very interesting. You talked about providing $3.2 billion to the territories, provinces and Quebec to bolster the nursing and medical professions.

What is the time frame for your request of $3.2 billion? Over how many years? That is not indicated in your plan.

[Dr. Brady Bouchard]

To be honest, I don't have the answer to that, but I will make sure that I get back to you.

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

No problem.

In addition, you did not provide any details on how that $3.2 billion would be transferred. I know you are more focused on the needs of Quebec and the provinces than on the terms and conditions.

Can you provide more details about what the provincial governments could do to bolster the nursing profession, for instance, if those amounts were provided to the provinces and to Quebec?

[Tim Guest]

If that question was directed to me, I actually think Dr. Smart would be a better person to answer it, because it's very much focused on primary care. I would defer that to her.

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

Dr. Smart.

[Dr. Katharine Smart]

Thank you for the question.

What we're looking for there is this. We heard in the election campaign this figure of $3.2 billion for improved access to primary care, and I think where we see that making an impact is on really trying to address what is making primary care not work today. I think you've heard from us today about what many of those issues are. We'd like to see those dollars directed at moving towards integrated, team-based care and really changing that model of care so that patients have a medical home with a variety of providers who can meet their needs. This, in turn, will create a better working environment for family doctors, make family medicine more attractive and appealing—therefore, retaining the people who are already family doctors in longitudinal practice. At the same time, it will make it a more appealing area of specialization for our new medical graduates, as well as allowing other health care professionals to work at top of scope in a team, which also will increase their job satisfaction. It builds on itself in terms of the success it would bring in that regard and in improving access to care for Canadians.

That's really where we would like to see that money go. Again, we know that just having more doctors isn't the solution in and of itself, because if those physicians are not satisfied in their work environment, or that work environment is broken, they are going to leave and do other things. That's what we're seeing now. Many family physicians are practising medicine, but they're not practising in a primary care model in a community with a patient roster. Those dollars could go to changing that practice environment so that family doctors actually want to be family doctors, and that people who want to work in these teams providing primary care to Canadians are able to do so longitudinally.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Smart.

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

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Mr. Guest, you spoke of the crisis as being one more of retention than recruitment, and I take that at face value, but you also mentioned that workloads were a problem. I'm putting together a vision in my mind from what I've heard, namely that as hospitals have cut cleaning and support staff and admin staff, a lot of those duties have been thrust upon nurses, so I can see that adding to their workload if they're spending a couple hours of their shift doing cleaning and administrative work. I see how bulking up the administrative and cleaning staff would help, but does it also not speak to the fact that we need more nurses on shift as well? If so, can you help me quantify that?

[Tim Guest]

I think it's all of that. To add some context, we've added a number of things to nurses' work environment, some of which are related to their doing non-nursing-related tasks. We've seen examples of that. As some organizations have implemented new electronic health records that are more integrated, some of them have reduced clerical supports as physicians do more of their physician orders themselves, and yet there have been tasks left behind that those clerical people were doing that get downloaded onto nurses.

As an example, I hear of nurses needing to clean beds in some facilities at night for admissions because there are no cleaning staff in facilities. There are a couple of examples. Some of the others we're hearing about are that many hospitals across the country are over capacity, which adds to the workloads that nurses are experiencing. What makes it more challenging is that they are sometimes coming into work that day when the workplace is short-staffed already. That's part of the challenge when you have a system that has a significant increase in vacancies that you're not able to fill, yet you haven't adjusted the work with the workforce. We've continued to operate many of our facilities full blast, yet we have a workforce that's depleted and isn't at 100% capacity and are expecting them to continue to do the same work volume.

There needs to be some balance there. Part of that challenge is that it creates additional stress and more of those workers choose to leave because they don't want to come into work not knowing if they're going to have the five patients they should have, or 10, or if they're going to get to go home at the end of the day, or they're going to have to work 16 hours because there's no one coming in to relieve them. Those are the challenges. It's not just about needing to have more of a workforce; it's about needing to look at all of the issues and balancing them all out together.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Guest.

We're going to go to Mrs. Goodridge, please, for five minutes.

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

Thank you, Chair.

Like many of my colleagues, I would like to start by thanking all of the spectacular nurses who make our health care system run. Here I give a special shout-out to a friend of mine, Katie. You do amazing work and we are very proud of all the work you do for our community.

Specifically, I was reading an article last week from CTV Vancouver, which was talking a little bit about how there are an unknown number of patients in B.C. who can't find a family physician. Yet, in Alberta, because of some of the boards that we have, with the College of Physicians and Surgeons of Alberta having a directory that allows them to show how many doctors are accepting new patients in Alberta, they can give a precise number. Often, at this committee up to this point, we've heard a lot about statistics and how the statistics are haphazard across the country, and I'm wondering, perhaps starting with Dr. Smart, if there any jurisdictions who are doing the statistics piece better or worse.

[Dr. Katharine Smart]

I don't have a direct answer for that, because I'm not familiar with exactly how each jurisdiction is collecting statistics. I think we see different jurisdictions reporting different numbers and different things at different times, and some things, on the surface, at least, seem to be better than others. It would be hard for me to say exactly where you would want to be looking to for best practice.

I think what needs to happen for sure is standardization across the country in terms of data reporting, and also to make sure that we're talking about the same thing. As an example, when we're talking about surgical backlogs, some of the ways the provinces are generating those data are varied that the data are not always reflective of the on-the-ground experience of patients or physicians. I think part of getting good data collection is really standardizing what we're talking about when we're discussing different data points and making sure that it's reproducible and that we're talking about the same things—an apples to apples comparison.

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

Fantastic.

Perhaps Dr. Bouchard has an answer for that same question.

[Dr. Brady Bouchard]

Yes. All I would say is that every province is doing it differently. That's why we need some unification around this. Certainly, some provinces are relying on fee-for-service billing data.

I would emphasize on that point as well that a family physician is not a family physician. There are provinces that have made it clear that they think they have enough family physicians, and yet there is a significant proportion of patients who are unattached. Obviously, those both can't be true at the same time. We really need to capture how family physicians, how all health care workers, are practising, whether it's comprehensively or a focused practice in emergency, addictions, etc., in order to know what we need and where we need it.

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

To follow along that same line, if you could design a system, what system would you design to help make sure we had a handle on our health resourcing?

[Dr. Brady Bouchard]

Thanks for the question. I don't think we would be so prescriptive other than to say that it needs to be national in scope. It needs to be standardized. It needs to be shared data as well in order to inform health workforce planning into the future.

As Mr. Guest said, there are many ways to accomplish this. The issue right now is that we don't have the data, and where we have the data, it is collected in very different ways, in different forms, in different places in the country.

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

Fantastic.

Moving on to a different space, Mr. Guest, I'm wondering if you have any thoughts when it comes to some of the data you're seeing and if there are any jurisdictions that you might be able to point to that are doing it better.

[Tim Guest]

I haven't directly had the opportunity to observe how each province and territory is actually collecting data. I can tell you, based on my personal experience, that Nova Scotia has done some really good work in this area, particularly on the non-physician side of the health workforce. They work very directly with their advanced education colleagues. Government is heavily involved in the process. They work collaboratively with the regulators. So there is an example of some that are, I think, doing a fairly good job and where we could replicate some of those processes.

I think Dr. Bouchard's comment was the key: We have 12 or 13 approaches to how we do things. It's not so much about everyone having to do the same things, or someone taking over and doing this for the provinces and territories. It's about the provinces and territories and the federal government coming together and agreeing on a standardized nomenclature for how the data is going to be collected, with a centralized place collecting it for them, so that everyone can access it for better decision-making. I think that's what we believe is the important approach.