Health Committee on May 9th, 2022

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

Thank you very much.

I have a question for Mr. Guest.

We have talked a lot about immigration. We have to do more to attract health care workers to Canada. I have talked with some Liberal colleagues about this. I know this is very important to all my colleagues around the table.

Quebec is unique in that it selects its own economic immigrants. I know this is a priority for the Quebec government.

I would like to know if the approach you are suggesting today to the federal government to attract health care workers to Canada was also suggested to the Quebec government. Did you approach the Quebec government to stress the importance of this issue since it is within its jurisdiction?

[Tim Guest]

We have had communication with all of the provincial and territorial departments of health. We've included the communication that we've sent to the federal government to all 13 provinces and territories, recommending the same approaches to them all.

I would say that when there's a need for us to reach out, we do. We tend to focus at the national level in a federal way and support our colleagues at the Quebec Nurses' Association to advocate locally with the government and the Province of Quebec. We tend not to interfere in those processes, but we had very much provided information to all of the provinces and territories related to our recommendations long before the road map was in place.

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

Mr. Guest, you are not the first person to say that we need better information and data in order to implement our health policies.

What kind of data collection mechanism do you have in mind? Are you thinking of something more collaborative, with the provinces collaborating with each other, or something highly centralized in the federal government? What is your main idea?

[Tim Guest]

Thank you for the additional question.

We are not as specific in recommending the final outcome of how the data collection occurs. What's more important is that it be expeditious and there be national standards in the data that's collected, so that we have information that tells us something.

Currently we see siloed information. It doesn't have the same meaning, and it's very difficult for us to make informed decisions across the country with respect to what our needs are.

We suggest a number of options. We supported recommendations that have already been put forward. It could be a new organization that the federal government creates. It could support a not-for-profit organization similar to the Canadian Partnership Against Cancer.

Largely, we don't have a specific recommendation as to what the structure should be; it's more about the outcome and that the outcome happens quickly.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Garon.

Thank you, Mr. Guest.

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

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you, witnesses. Happy National Nursing Week, and happy Indigenous Nurses Day.

I want to congratulate and thank all of you for bringing solutions to the table. I think we've had a really good description of the problems during this study. What we really need to focus on is how we can address the problem that I think everyone is very well apprised of now.

I'm going to start with you, Dr. Bouchard. In your view, how would national licensure help with improving access to primary care? I know that it would help doctors move, but how would that actually help with the issue before the committee?

[Dr. Brady Bouchard]

I think it would help in a number of ways, a few of which Dr. Smart touched on already.

One of them is certainly around locum availability. We hear that from our members constantly, that current disparities in staffing across the country often leave them unable to take a break from their practice—to get a locum in to cover their practice while they're away. A national licensure would certainly provide mobility to allow that to happen. These are short-term locums specifically right now. It can take a long time, in addition to the money, to get registration in a particular province.

The other one that we often hear about is regarding border towns. We have a number of communities across the country, some closer than others to borders, and some particularly far away from their tertiary referral centres, where getting locums could happen maybe an hour down the road, versus trying to get somebody from elsewhere in the province. That would help with that.

My hometown, Lloydminster, is cut right in half on the Saskatchewan-Alberta border, and right now you need two licences to practice there on a daily basis. It's not just locums.

Those are two that I would mention for sure.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks, Dr. Bouchard.

Dr. Smart, I'm going pivot to you to elaborate on that. I know we've spoken before about virtual care and how that might play into national licensure, so I'm going to ask you to comment on that.

Furthermore, you mentioned that a mental health strategy would be a key component to dealing with this. What should that consist of?

[Dr. Katharine Smart]

I'll start with the licensure issue first.

With regard to access to care, we know that one of the things that's really challenging right now too is also streamlined access to specialist care. That also impacts primary care providers as well, because a major source of burnout for family doctors is being unable to get their patients the care they need in a timely manner. I think we can support family physicians by streamlining the process they need to go through to access those consultations and collaborative care for their patients.

Virtual care is a tool to allow for that. It's also a tool that creates more flexibility in who can be providing the care to whom, so that we can better leverage different availabilities and wait times from across the country, which we don't do now. I think good access to virtual care is also important for family physicians in their ongoing continuity of care for their patients. It gives them more flexibility in how they meet the needs of their patients and in what context, so that they can better utilize their time and their patients' time. This means that if something doesn't need to be done in person, a lot of people prefer it to be done virtually. There's also an impact on the patient who has to take time off work, park and wait in your waiting room versus having a quick virtual appointment. Sometimes for those ongoing things between the longer appointments in a patient-doctor relationship, it can be quite efficient.

I think there are ways of utilizing virtual care to improve the doctor-patient experience to allow family doctors to deliver the right care through the right mode at the right time for their patients, which strengthens that doctor-patient relationship and then also access to specialists. Utilizing virtual care, I think, can make things easier for family doctors and also get them the support they need, given the increasing complexity and aging population, to continue to do their work.

That's particularly relevant for those of us who practice in rural and remote parts of the country, where the burden of travel for families can be substantial to access that care. Often the same things can be achieved collaboratively in utilizing virtual care. I think there are lots of pros to that. The other aspect of that is that increasing access virtually can also support continuing professional development for physicians, which is another challenge when you live in rural and remote places. There are many aspects to it that are positive.

With regard to the mental health piece, we know that the mental health of physicians has dramatically declined during the pandemic. We're hearing that over 50% of physicians have severe burnout; it's almost doubled from the beginning of the pandemic. A significant portion of physicians are reporting clinical mental health concerns.

I think we need to have more access to mental health care for doctors so they can address those issues. We need to destigmatize that. We do have some ongoing challenges where those types of health issues need to be reported to regulatory colleges, which can be a barrier for doctors seeking that care. We need to destigmatize mental health and recognize physicians are people and that they have these issues, just like anyone in the population. We need to normalize that and support them, and then make sure that those supports are readily available where they are and in an easy way so that it's not a barrier to their reaching out.

The government could be supporting those programs and making sure that they're available to doctors so that we can access that care and be in our top form so that we can continue to care for the patients when they need us.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks.

Dr. Bouchard, I have a quick question. Is there a viable IT solution to the data problem you described?

[Dr. Brady Bouchard]

Not currently.

[Don Davies, NDP, Vancouver Kingsway, BC]

And, Mr. Guest from Nurses Association?

[The Chair, Liberal, Sean Casey]

Give a quick answer, if possible.

[Tim Guest]

No, there isn't. Each province and territory is collecting information separately, and we find that we have to sometimes go facility by facility. For individual provinces, some of them don't even know what their workforce data needs are. I think this is more difficult than just a simple IT solution.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Guest and Mr. Davies.

Next is Mr. Lake, please, for five minutes.

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

I'm going to continue on the mental health path here. Last week was Mental Health Week and I had the chance to meet with several stakeholders. I've had the chance to meet most of you individually as well. This is a great panel.

I've been thinking about mental health as it relates to what we're talking about. In my head, I've organized it in three different areas. There was what Dr. Smart talked about a few seconds ago, which is the mental health, directly, of medical experts or medical professionals. But first, of course, you're dealing with the mental health of the broad population as well, and the impact on health broadly. Then you're dealing with the mental health of individuals who are coming and interacting with you, and I can imagine that right now that's particularly difficult in many circumstances. Then, of course, you're dealing with the mental health of professionals.

Is that a good encapsulation? Is there a part of the equation that maybe I'm missing there? Would anyone like to comment?

[Dr. Katharine Smart]

I can comment on that if you like.

I do think that is a good framework. I agree that those things all interact with each other, absolutely.

I think, again, burnout really directly relates to mental health for many providers. The more you're burnt out in your work, the less joy you find in your work. The more the people around you are burnt out, the more negative those normal interactions we have with each other as colleagues can become. All those things just drive your mental health not being optimal.

Then the other side of that, as you alluded to, is that when our patients are really struggling and we don't have the resources to help them, that is also very challenging.

I think as the needs of Canadians have become more complex, in terms of both an aging population with more complex medical needs and the growing mental health crisis across the country, which is incredibly prevalent—at least one in four Canadians is dealing with concerns with their mental health—and then we're downloading that onto this broken system, that doesn't support people in the way they need. That burden, again, is often borne by individual physicians and other health care professionals who are very distressed at the fact they can't get patients the care they need.

I think those three things all do interact. I think they're circular. I think they build on each other, and if we're not addressing them holistically, I don't think we're going to solve that problem.

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

Dr. Smart, you mentioned the $4.5 billion Canada mental health transfer promise. As I was having conversations with stakeholders last week, more and more concern was raised about the fact that the money hasn't been delivered.

The promise specifically was for $4.5 billion over five years, but for the last fiscal year $250 million was promised, and for this fiscal year it was over $600 million. Of course, in the budget we just didn't see that.

Taking away the whole $4.5 billion, and just thinking about almost a billion dollars that was promised eight months ago in the election campaign for allocation by this point in time for a Canada Mental Health Transfer, how important would that $900+ million be at this point in time to addressing some of the significant issues we're facing?

[Dr. Katharine Smart]

I think it would be very important. I think we're starting to see growing alignment on what the priorities are and what the challenges are, but it is very difficult to move from this conversation to the action without the resources. I think that next phase of funding and providing the fiscal supports to drive these changes is essential.

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

Dr. Bouchard or Mr. Guest, do you want to weigh in on that? Again, a clear promise was made, a commitment to spend this money right now, almost a billion dollars just last year and this year alone? How important and how far would that money go to addressing some of the concerns we're facing on the mental health side?

[Dr. Brady Bouchard]

Thank you.

Yes. I will expand on that. Dr. Smart, of course, mentioned that without resources we cannot move either provincially, federally or collaboratively.

I just want to emphasize for the family physicians that we need the resourcing both for ourselves and for our patients, particularly around coming back to team-based care. We can't address patients' medical health and we can't address our own mental health in the five- or ten-minute visits that family practice has traditionally involved. We need that team-based transformation to address mental health as well. It's all interconnected. It's certainly not just the mental health of providers.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Lake and Mr. Guest.

Next—

[Tim Guest]

As my colleagues did, I would say it's vitally important. I think the one thing I have to add, though, is that the additional money is not going to be the only solution when we are looking at a mental health system that also has vacancies.

Over the last two years with registered nurses and registered psychiatric nurses alone, there has been an over 100% increase in the number of vacancies, so we need to be careful that we don't assume that the additional dollars are going to be the only thing that's going to be needed for a solution to this issue, because we would be sadly mistaken.

[The Chair, Liberal, Sean Casey]

Thank you.

Next we're going to go to Dr. Powlowski for five minutes.

Go ahead, please.

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

Thank you.

I want to thank all of our guests for their recommendations. There's certainly a lot here.

In my mind, the key to getting more doctors into under-serviced areas and getting more nurses across Canada is recommendation 6: training and licensing for international medical graduates and internationally educated nurses. It's the “Action plan to get internationally trained doctors, nurses, and nurse practitioners to work”.

Certainly, in under-serviced areas, people don't really mind where you come from as long as you can do the job. I say that having worked in six different countries and all kinds of places in Canada that are under-serviced.

Policy recommendation 6 says to “increase opportunities for experienced foreign-trained IMGs to complete Practice Ready Assessments”. I want to ask both Dr. Smart and Dr. Bouchard about this recommendation.

We talked to a witness earlier in this study who suggested.... They thought there were only a couple hundred such positions available across Canada per year. Would having more opportunities for foreign graduates to take part in these practice-ready assessments allow us to get more foreign-graduated doctors licensed?