Health Committee on Feb. 16th, 2022

[The Chair, Liberal, Sean Casey]

Good afternoon, everyone. I call this meeting to order. Welcome to meeting number eight of the House of Commons Standing Committee on Health.

Today we will meet for two hours. Because of the late start, that will take us to 6:14 eastern to hear from witnesses on our study of Canada's health workforce.

Before I introduce today's witnesses, I have a few regular reminders for hybrid meetings. We are meeting in a hybrid format, pursuant to the House order of November 25, 2021, with members attending in person in the room and remotely using the Zoom application.

I would like to remind those who are participating virtually not to take screenshots of your screen. The proceedings will be made available via the House of Commons website.

All public health advisories as well as the directive of the Board of Internal Economy of October 19, 2021, are in force and will be observed.

To begin, each organization has five minutes to make their opening statements before rounds of questions for the remainder of the two hours.

We are very pleased to have with us this afternoon the following witnesses: As an individual, we have Bacchus Barua, the director of health policy studies at Fraser Institute; from the Canadian Association of Radiologists, Dr. Gilles Soulez, president; from the Canadian Federation of Nurses Unions, Linda Silas, president; from the Canadian Medical Association, Dr. Katharine Smart, president; from HealthCareCAN, Paul-Émil Cloutier, president and CEO; and Elaine Watson, chief human resources officer, Covenant Health.

Thank you all for taking the time to be with us and to testify today.

We will proceed in the order listed on the notice of meeting.

Mr. Barua, you have the floor for five minutes. Welcome to the committee.

[Bacchus Barua, Director, Health Policy Studies, Fraser Institute, As an Individual]

Thank you very much.

Good afternoon and thank you for the invitation to contribute to the committee's study on Canada's health workforce. It is an honour to be here, and I hope what I have to say is of some value to the esteemed members.

I should state up front that, although I am the director of health policy studies at the Fraser Institute, a non-partisan Canadian think tank, the organization does not hold any positions. Therefore, my testimony is based on my own views and published research.

My understanding is that my job today is to try to set the stage by providing information that may be pertinent to the committee's subsequent discussion on the matter. As such, I would like to focus on three areas: first, highlighting Canada's relative scarcity of key medical resources; second, decoupling the impact of COVID from structural issues; and third, looking through the lens of supply and demand to identify potential solutions.

First, let's take stock. Canada has a relative scarcity of key medical resources, including human and capital resources. Our most recent report on health care performance found that in 2019, out of 28 high-income countries with universal health care coverage, Canada ranked 26th for physicians, 18th for nurses and 25th out of 26 for curative care or hospital beds. Canada also ranked 22nd out of 24 for MRI units and 24th out of 26 for CT scanners per million population.

This relative scarcity existed despite the fact that Canada ranked sixth highest for health care expenditure as a percentage of GDP and the 10th highest for health care expenditure per capita in the same year.

Second, it's important to acknowledge the pressures of COVID in the current context, but to not conflate them with larger structural issues. I provide three quick examples.

The data I mentioned are from 2019. That's a year before the pandemic. Canada's relative scarcity of physicians spans decades. Physician density began to diverge in the mid-1970s and deepened following the Barer-Stoddart report of 1991. While there has been an uptick since the turn of the millennium, projections from a 2018 report I co-authored suggest Canada will still have fewer physicians per 1,000 population in 2030 than the OECD average way back in 2018. It is worth noting here that Canada's relative scarcity is more prominent for specialists than it is for family doctors.

Wait times have certainly gone up during COVID, but have been increasing for decades. The Fraser Institute's survey reports an estimated 25.6 week wait between referral from a family doctor to getting medically necessary elective treatment in 2021. However, in 2019, a year before the pandemic, the wait time was still 20.9 weeks. Similar observations can be made with other international surveys, such as those by the Commonwealth Fund in 2020 and 2016.

The takeaway is that context is important. COVID has exacerbated but is not the cause of the current challenges with the health care workforce. Moreover, the combination of backlogs due to surgical ramp-downs, potential long-term effects of COVID and an aging population will ensure these challenges persist long after the pandemic has passed. The obvious question is, what can be done?

We need to start by understanding that the imbalance between demand and supply of medical services manifests in a number of ways that includes things like: overflowing hospitals, which we also had before the pandemic; overburdened staff, which we're currently grappling with; and rationed care for patients, which Canada has struggled with for decades. Any solution, therefore, lies in reconciling this imbalance between supply and demand through increasing supply, tempering demand and better aligning incentives.

Many successful universal health care countries, including Switzerland, the Netherlands, Germany and Australia, do this in three ways. They embrace the private sector as a partner or pressure valve on the supply side. They employ patient cost-sharing on the demand side to temper demand, with supports for vulnerable populations and exemptions. They encourage competition and incentivize treatment through activity-based hospital funding, which contrasts with Canada's global budgeting approach.

In the absence of these types of reforms [Technical difficulty—Editor] improving efficiencies at the margin. However, these will cost the government money and be limited in scope.

Supply can be expanded in a number of ways, including: increasing domestic enrolment and residencies, which are also very important for physicians, as an example; promoting immigration of foreign trained physicians or other important health care staff, such as nurses; and increasing the adoption of new technologies, such as telemedicine, otherwise known as virtual care.

Each of these face unique challenges, but they're not insurmountable. For example, it takes a while to train doctors domestically, and virtual care may eventually face challenges from the Canada Health Act. There's no point having more doctors if their services are not funded, or if they can't find employment, both of which are documented problems under Canada's global budgeting approach for hospital remuneration.

In summary, there is a documented relative scarcity of key medical resources. This scarcity is structural and will persist in the postpandemic world. Solutions do exist within the current framework, but in the absence of potentially significant reform, they will likely be expensive, limited in scope and only temporarily successful in nature.

I hope these comments have been of some value to the members of the committee.

[The Chair, Liberal, Sean Casey]

Thank you very much, Mr. Barua.

Next we're going to hear from the Canadian Association of Radiologists.

Dr. Soulez, you have the floor for five minutes.

[Dr. Gilles Soulez, President, Canadian Association of Radiologists]

Thank you.

Mr. Chair, members of the committee, fellow panellists, good afternoon.

My name is Gilles Soulez, and I am the president of the Canadian Association of Radiologists, associate professor in the Université de Montréal's department of radiology and interventional radiologist at the Centre hospitalier de l'Université de Montréal, or CHUM, in Montreal. It is an honour to be here with you today, unfortunately under dire circumstances for Canadians who need care.

Our workforce is burned out and insufficient in number. We need short, medium and long–term investments today to remedy the situation.

As you know, medical imaging is our health care system's gateway for diagnosing diseases, but it is also needed to assess the effectiveness of treatments and to guide minimally invasive treatments in interventional radiology. Whether you have a stroke, cancer, trauma or back pain, medical imagery will often be necessary a number of times in your care pathway.

In the time I have allotted, I will speak to three issues: excessive and growing wait times; the need for health human resources investment; and the need for the latest equipment and information technology to allow for these human resources to be optimized.

Let's first talk about wait times. Canadians are waiting too long for diagnostic imaging procedures, and the pandemic has made this worse. Originally from France, I came to Canada in 1991. At the time, Canada was among the top countries in terms of wait times for medical imaging. After 20 years of underinvestment in health care infrastructure, wait times are again exceeding the P3, priority 3, 30‑day wait time across the country.

Prior to the pandemic, patients were waiting on average 50 days for CT scan diagnostics and from 69 to 89 days for magnetic resonance imaging, or MRI, diagnostics, which is already much too long. These numbers have continued to grow owing to a drop in test productivity during the pandemic. At the height of the crisis, we noted a 50% to 70% decrease in radiology services across the country.

At this time, the activities have unfortunately not returned to normal. Our health care system is not currently equipped to handle these volumes. If this situation persists, we are at risk of leaving many patients undiagnosed and untreated.

In 2019, the Conference Board of Canada estimated that the cost of these excessive wait times resulted in a loss of $3.7 billion in gross domestic product, or GDP, and $400 million in lost tax revenues in 2017. The costs will certainly be much worse in 2022.

The second issue has to do with health human resources. Excessive wait times have led to a situation where medical radiation technologists and sonographers are working overtime to try to keep up with the demand. Many of these front–line workers are burned out, getting sick—including from COVID‑19—and exacerbating an already dire situation for patients. But the human cost of nearly 24 months of overtime has had a pervasive impact on these front–line health care workers. It is our responsibility to put forward a plan to improve their lives and to take better care of Canadians.

Finally, investments in health human resources must be made now. We need to implement a strategy for increasing health human resources in medical imaging by hiring more staff, implementing new training programs and expanding on existing programs.

A survey of our members indicates that 70% of radiologists see the staff shortage as the most significant barrier to addressing wait times. For example, in the Gatineau region, close to you in Parliament, 25% of technologist positions are vacant. Health human resources are also hindered by aging and often insufficient equipment and by a glaring lag in the integration of information technologies. Those technologies help optimize the organizational process and the work flow with fewer repetitive human actions. They also help ensure the relevance of examinations in a prescription and decrease the number of unnecessary examinations.

We need to work smarter to improve our performance while protecting our staff.

Investment in medical imaging equipment is necessary. In 2019, the Conference Board of Canada estimated that approximately 30% of our diagnostic medical imaging equipment is 10 years old or older. Investment in diagnostic imaging equipment across the country is at a 20‑year low. Newer imaging equipment—specifically for MRIs, but also CTs—helps reduce examination times by providing better diagnostic performance and less radiation exposure for patients.

For example, the use of artificial intelligence in recent units and new rapid frequencies make it possible to reduce the time of an MRI examination by 30%.

Our aging equipment also exposes us to more frequent breakdowns than before, which unfortunately makes the problem worse.

In 2003, the federal government, under Paul Martin's leadership, injected $1.5 billion in medical imaging equipment. This really helped Canada ensure equitable access to medical imaging for all Canadians.

The time has come to once again invest in efficient medical imaging equipment and to develop a health human resources strategy for radiology to avoid crippling our health care system and to ensure patients are receiving the right test at the right time, ultimately saving lives.

To summarize, excessive and growing wait times in medical imagery are reducing efficiency across our health care system, as our action is critical in the patient care process. Investments must be made quickly to foster the recruitment and retention of human resources in medical imaging. We need more efficient imaging equipment and information technologies to once again optimize the operational process while preserving our human resources.

A $6‑billion investment was included in the 2021 Liberal election platform to reduce wait times, and MRI was specifically referenced, as that is really the area with the most delays.

Investing $1.5 billion in human resources and equipment will not only benefit our front-line and second-line staff, but more importantly—

[The Chair, Liberal, Sean Casey]

Dr. Soulez, I'm sorry, but your time is up. Could you wrap up your presentation please?

[Dr. Gilles Soulez]

Okay.

That investment will ensure reasonable access to the care our patients need over the long term.

I would be happy to answer your questions.

Thank you very much.

[The Chair, Liberal, Sean Casey]

Thank you.

As you know, Dr. Soulez, you will have an opportunity to speak further to those topics. I am sure questions will be asked about this.

From the Canadian Federation of Nurses Unions, Linda Silas, you have the floor for five minutes. Welcome.

[Linda Silas, President, Canadian Federation of Nurses Unions]

Good afternoon, everyone.

I'm calling from Ottawa, the beautiful land of the Algonquin and Anishinabe people.

Mr. Chair and committee members, thank you for inviting me to present to this committee on behalf of the Canadian Federation of Nurses Unions. As stated, my name is Linda Silas. I'm the national president.

I want to congratulate the health committee for undertaking this important study. In my world, we would call it retention and recruitment, because if you can't retain your nurses, you will never be able to recruit any.

Prior to the pandemic, nurses were exhausted and burnt out. A University of Regina report on nurses' mental health, which surveyed over 7,000 nurses, found that nurses screened positive for symptoms of PTSD, anxiety and major depression at similar or higher rates than public safety officers. In 2019, 29% had symptoms of severe burnout. Today, it's 45%.

The health workforce accounts for more than 10% of all employed Canadians, over two-thirds of all health care spending and nearly 8% of Canada's total GDP. Nurses are the largest group of regulated professionals in Canada. We have over 450,000 nurses who are responsible for much of the direct, hands-on care provided in Canada's health system. CFNU proudly represents most of these workers, who are at their patient's side 24-7, either in ICUs or in long-term care.

The Conference Board of Canada recently reported that by 2026, Canada could lose 20% of its health care workers due to retirement. Let's remember that over 50% of the health workforce is made up of nurses. In fact, Stats Canada reports that over a two-year period, the number of vacancies for nurses more than doubled. CFNU surveyed nurses across Canada just prior to the omicron wave, and 80% of nurses said there was not enough staff scheduled to meet the demands of patients or residents in long-term care.

Nurses also routinely report 16- to 24-hour shifts in some jurisdictions. This isn't safe. What does it mean to start your shift at 7 a.m. and think you're done by 3 p.m. or 7 p.m., just to be told you are mandated to stay because they are short-staffed? This happens to nurses like Pauline, who's a single mom with two kids. Who does she call at 7 p.m. to come and take care of her kids? What about Yvette, who needs to wear full PPE that looks like a haz-mat suit for her whole shift? Yvette can't even get a glass of water because all the break rooms are too small or simply closed. She is then asked to please stay a little bit longer.

One in two nurses says they are considering leaving their current job in the next year, and I'm pretty sure you're not wondering why. The reality is we can expect that even more nurses will head to the doors unless immediate actions are taken.

Before I finish today, I will share with you two more comments from nurses who are working today while I'm on Zoom speaking to you on their behalf. One said, “Nursing is my life and I have loved being one for 20-plus years. I hate feeling like it’s the worse job ever now and that no one even cares what we are going through.” Another one shared with me, “I am making an exit strategy.”

Please hear their voices now and commit to immediate funding for innovation projects to retain both our experienced nurses and the new nurse graduates who will not survive in their job unless things are radically changed. Please, let's not play the political football of whose responsibility it is. You represent Canadians in every part of this country. That includes Canada's nurses and Canada's patients.

Now it's time for us to discuss solutions such as funding for students, bridging programs, initiatives for late-career nurses and new grads, safe nurse-to-patient ratios, safe working conditions free from violence and mandatory overtime, permanent full-time jobs with respectful salaries and benefits, and a national body or agency to provide the best data and strategies to the provinces and territories.

This is a critical moment for nurses and the people whom we care for. Today's crisis has been years in the making. If we don't act now, we risk suffering a system-wide failure of our treasured universal public health care system.

Once again, thank you to the members of the committee.

I'll answer your questions later.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Silas.

Next is Dr. Katharine Smart, president of the Canadian Medical Association.

The next five minutes are all yours.

[Dr. Katharine Smart, President, Canadian Medical Association]

Thank you, Chair and committee members, for the opportunity to appear before you today.

I'm Dr. Katharine Smart. I'm speaking to you from the traditional territory of the Kwanlin Dün First Nation and the Ta'an Kwäch'än Council. I'm a pediatrician based in the Yukon.

As president of the Canadian Medical Association, it's an honour to represent physicians and medical learners from all jurisdictions. Every one of us has felt the impacts of a health care system stretched beyond its capacity.

For health workers, the pandemic has been unrelenting. We're burnt out, exhausted and demoralized. In caring for patients in an already broken system, we've been pushed to breaking and beyond. Each wave submerges us under deeper layers of backlogs and with even greater workforce and systems impacts. Our health workforce is in the biggest crisis we've ever seen.

Last fall, the CMA and the Canadian Nurses Association co-hosted an emergency summit to learn from nearly 40 health organizations representing nurses, physicians, respiratory therapists, personal support workers, psychologists and educational institutions. They all agree: It's an unprecedented crisis.

There's no question that the CMA is grateful for the federal government's integral part in the pandemic response, but it's not over, and even when it is, health care will feel the repercussions for many years. Health care workers are relying on the leadership of the federal government to support a way forward. By aiding medical professionals, you are helping every Canadian now and in the future.

Chair, having this committee study Canada's health workforce is welcome. There is more to learn of the crisis, but let me tell you what's happening now. Physician burnout is at an all-time high. More than half of physicians report high levels of burnout—nearly double prepandemic levels—and nearly half told us that they are likely or very likely to reduce clinical hours in the next 24 months.

The repercussions of this could be devastating. Already more than five million Canadians don't have a regular health care provider. Only 40% of them can get an appointment within 48 hours. Rural and remote communities and marginalized and at-risk populations are even more disadvantaged.

Over time, we've also created barriers for doctors and nurses practising in a new province or territory. It is why the current regulatory licensing frameworks need to move to a pan-Canadian licensure model. This would allow health professionals to work where they would like to and where the needs are the greatest. It's time to remove these unnecessary regulatory obstacles.

Prior to this pandemic, our health care system was ailing. Today, it finds itself with more cracks than ever. Worse, those who work and care for Canadians are exhausted, burnt out and leaving. The result will affect every single Canadian and put at risk their health and ability to access their health system. This crisis has ballooned past what any jurisdiction can manage alone.

We know that the premiers are focused on an increase in unconditional federal dollars. We believe that more strategic federal investments are required now to support rebuilding health care delivery in Canada.

First, we need federal leadership for pan-Canadian integrated health human resources planning. An intergovernmental approach led by the federal government is now required.

Second, it's time to deliver on the promise to increase patient access to family doctors and primary care teams by delivering on the $3.2-billion commitment. As part of this commitment, the CMA recommends that $1.2 billion over four years be dedicated to a primary care access fund and $2 million to undertake an assessment of interprofessional training capacity of family physicians and other professionals in the area of primary health care. Scaling up collaborative interprofessional primary care is central to increasing access to care.

Third, we need to eliminate barriers for medical professionals by enabling the adoption of pan-Canadian licensure. Medical professionals need to be able to move from province to province to deliver care where it's needed.

The past decades have witnessed remarkable advances in medical science, but we are still reliant on health workers. Just as they have stood at the front lines, it's critical that the federal government create pathways that will stand for the protection of health and medical professionals. We need the federal government to finish this long shift with us.

Thank you, Chair.

[The Chair, Liberal, Sean Casey]

Thank you very much, Dr. Smart.

Last but not least is HealthCareCAN.

Paul-Émile Cloutier, will you be speaking for the delegation?

[Paul-Émile Cloutier, President and Chief Executive Officer, HealthCareCAN]

Yes, I will.

[The Chair, Liberal, Sean Casey]

Very good. The floor is yours for five minutes. Welcome.

[Paul-Émile Cloutier]

Mr. Chair, members of the committee, my fellow presenters, thank you very much for the opportunity to speak to you today.

I am joined by my colleague Elaine Watson, who is the chief human resources officer at Covenant Health in Alberta, one of Canada's largest Catholic health care providers. Ms. Watson is also the co-chair of HealthCareCAN's health human resources advisory committee, and will be available to answer many of the questions that you will have.

As a national organization representing hospitals, health research institutes and health care organizations, what we repeatedly hear from health leaders is that human resources are the number one challenge facing us and that it must be addressed as quickly as possible.

There is a serious issue because health care is a people business, and health care workers are the foundation of our health system. I commend the committee for taking the time to study this important issue that has been neglected for far too long.

Health workers are more than nurses, physicians and personal support workers. They also include support, custodial and administrative staff. They also include researchers, lab techs and leadership teams. All of these people are needed for the health system to function and deliver quality care to Canadians.

When we look to develop health workforce solutions, we must consider all of these people rather than take a siloed approach by profession. It has to be a multi-professional approach. The exhaustion and burnout felt by too many health care workers due to the pandemic has made a previously tenuous situation far more critical today. There are job vacancies throughout the entire system and likely more to come once the pandemic subsides. Many health care workers are choosing to retire earlier, move to less demanding roles in the health system or leave the system entirely.

While the waves of the pandemic increase demand on the system, health care needs remain even as the worst of COVID-19 recedes. There is still heightened demand on the system as health care workers deal with medical procedure backlogs, caring for people who have delayed treatment and who come in sicker, and treating a population that is living much longer, often with more complex and chronic conditions.

We must rethink our entire health system. Addressing health human resources challenges must be central to this to ensure a more resilient system that can respond to people's care needs.

We need innovative short–term and long–term solutions to address health care professionals' concerns. Having the right mix and number of health care workers, in the right place at the right time, to meet the needs of people across Canada is paramount.

HealthCareCAN would like to make certain recommendations to the federal government through your committee.

The first recommendation is to improve the immigration process to better leverage the skills of newcomers to help meet existing health system needs over the short and medium terms.

The second is to collaborate with other levels of government, regulators and educational institutions to increase the number of Canadian-trained health care professionals in the right roles to meet long-term needs.

The third one is to collaborate with provincial and territorial governments and health care organizations across the country to support the health, wellness, safety and resiliency of the health care workforce. This could include increased federal investments in mental health and wellness research, and programs and resources specific to health care workers.

The last recommendation is to establish a pan-Canadian health workforce agency responsible for strategic and standardized health workforce data gathering, research and planning, to help us better understand the current workforce and its future needs. This agency could work with provincial and territorial governments, regulators and health care stakeholders and use the information it collects to develop and implement strategies to address systemic health workforce concerns.

Canadians expect the federal government to show leadership and to address these issues in collaboration with provinces, territories and all health care stakeholders.

The status quo is clearly no longer an option. Failing to act now will lead to lower quality care, longer wait times and worse health outcomes.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Cloutier.

Before we begin with the rounds of questions, I want to make sure that I haven't improperly spoken for the committee. I indicated at the outset that we would be sitting until 7:14. What I should have said is we have the support of the fine folks at the House of Commons for the full two hours, if it is the will of the committee to sit for the full two hours.

Oh, I'm back on Atlantic time, and I'm in Ottawa.

Do we have the support of the committee to sit until 6:15?

There is consent in the room and on the screen. Excellent.

We will now begin with rounds of questions, starting with the Conservatives.

We have Dr. Ellis for six minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Mr. Chair.

Thank you to all the witnesses for appearing. It's a daunting task and certainly one that I have experienced first-hand as a family doctor who provided all aspects of care. Thank you for coming and attempting at some point to ameliorate this situation.

This question is for our first witness. Thinking about the current funding model and the 7,500 health care workers promised by the Prime Minister during the election and repeatedly during question period, can you tell me how many of those health care workers have been provided to our current system?

[The Chair, Liberal, Sean Casey]

The question's for you, Mr. Barua.

[Bacchus Barua]

Thank you for the question.

I don't think I commented on that, and I won't be able to answer that question.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much.

Dr. Smart from the CMA, I would ask you that same question, if you don't mind answering.

[Dr. Katharine Smart]

Thank you for the question.

I think at this point we don't have the data to know how many additional primary care providers have been added to the system. What we know is that there are major barriers right now for people providing a longitudinal family practice type of care, as well as many barriers to providing integrated team-based care. This partly is what underlies our desire to see integrated health workforce planning. We feel we need to understand the direction we're headed in terms of providing integrated team-based care, why some people are choosing not to provide that type of care, and the number and types of providers needed to make sure every Canadian has access to primary care. That work has not yet been done, and we feel that is critical as we move forward.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you.

From the CFNU, Ms. Silas, do you know if any nurses have been recruited from these 7,500 promised by the federal government?

[Linda Silas]

Good afternoon, Dr. Ellis. Hello from another Maritimer.

No, we don't know. Dr. Smart was very clear that this is one of our asks, that the federal government take the lead on getting the proper data. Where we know there's been an increase is in the personal care worker workforce. You've seen that in Quebec, Ontario, a little bit in Alberta. That's about it where we have concrete actions for increasing staff.

If you read the last Stats Canada report, you find that there are over 118 vacant positions in the regulated health care workforce, and that does not include personal care workers.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you.

Mr. Barua, I'll go back to you. Do you have any idea of the number of health care workers Canada may need to help fill any of these vacancies?

[Bacchus Barua]

I'll narrow the question down to physicians, because that's really what we've looked at quite a bit.

What I can say is that in 2019, as I mentioned, Canada ranked 26 out of 28 for the number of physicians per 1,000 population. I don't have the data right in front of me, but I believe that equated to about 2.8 physicians per 1,000 population compared to the OECD average of about 3.8. I may have my decimals a bit mixed up. The calculations would be based on that.

Of course, it's really, really important to narrow down exactly what the questions are. For example, as I mentioned, Canada actually does about the same, or relatively a little better, when it comes to family doctors per 1,000 population and is significantly worse when it comes to specialists. Even though that's the case, the demand for a family doctor seems to be a significant issue right now. In my opinion, that really represents a bottleneck, such that people are trying to get into hospital, trying to get treatment, but have to be treated by family doctors in the meantime.

With those ratios, as I said, I don't know what they translated into numbers, but that gives you a rough idea of how far away we are from the OECD average. That's not counting the [Technical difficulty—Editor].

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

That's great. Thank you.

By my math, that means we're short about 38,000 doctors compared to the OECD average, and 7,500 would be a drop in the bucket.

It's interesting. I wonder, Ms. Silas, if you have any idea of how many nurses we're short. I understand we have 450,000 nurses in Canada. We're talking about losing perhaps 26% of the 50% of health care workers that nurses make up. Do you have any idea of the number?