Health Committee on Feb. 16th, 2022

[Linda Silas]

That's just as old as me, because I've been around as long as Paul-Émile Cloutier.

[Don Davies, NDP, Vancouver Kingsway, BC]

Yes, that's right, as long as me.

Dr. Smart, perhaps I can turn to you now. I remember when, as long ago as 2007, Jack Layton, the former leader of our party, was crusading for more family doctors. I think the figure at that time was that five million Canadians didn't have access to a family doctor.

I'm going to fire three quick questions at you, and you can answer all of them.

First, you talked about burnout. I'm just wondering if there's any appetite from your members to move from a fee-for-service type of pay structure to more salaried positions as part of the solution to maybe helping doctors who feel that pressure of seeing a lot of patients. Is that something that's worth exploring?

[Dr. Katharine Smart]

It's a great question. Again, I think it relates back to what some of the structural issues are that are impacting health care delivery. There's no question that some of the existent payment and structural models for primary care are preventing people from choosing longitudinal family practice. We have many examples of successful team-based primary care in Canada that could be scaled. We have experts who are primary care providers themselves who have done research in this area suggesting that different models of payment and working together in a team can better serve Canadians with better health outcomes.

We definitely think these things need to be explored and linked to this $3.2-billion investment in primary care. Part of the need for the integrated health workforce planning is understanding what the barriers are to our new family doctors choosing to provide longitudinal family practice opportunities for patients.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks.

I want to give you a chance to expand a bit more on what I think is a very creative and novel solution, which is this idea of national licensure for practitioners. Can you give us the 30-second elevator pitch on why that's something the federal government or governments across the country should do?

[Dr. Katharine Smart]

There are many reasons why a national licensure could be a huge benefit to Canadians, but I think primarily it relates to access to care. As we're learning more about virtual care and how it can be deployed, a pan-Canadian licence suddenly allows any practitioner in the country to be available to any patient. It also provides opportunities for health workforce mobility to provide support in rural and remote parts of the country.

I think there are many, many benefits for physicians and for patients that will improve access, sustainability and retention.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Mr. Cloutier, I have a number of questions that I want to ask you, but I don't think I'll have time.

One question is on what the federal role is. I presume that the workforce shortages occur across all provinces and territories and across all professions, as you pointed out. You also mentioned the importance of data.

I'm going to lead you a little bit. Do you see the federal government playing a convening coordinating role for helping all the provinces, who are clearly suffering from the same issues, to gather data and help plan a national vision to deal with this problem? If so, I guess I want you to tell us what you see as the federal role in helping address this issue.

[Paul-Émile Cloutier]

Certainly. That's an excellent question to be asked.

Believe me that data across the country is not uniform at all. There's no standard plan as to what you're getting and what you're getting it for. I think the federal government's role would be to be a convenor, a facilitator, in getting that kind of data and working with the provinces, the regulators and the major national health associations that collect certain data. At the end of the day, what you want is a system that is standardized across the country so that you know exactly where there's a gap in nursing, physicians or technicians.

When we talk about burnout—and I need to say this, and I know this has nothing to do with your question, Mr. Davies—I was speaking with some of our CEO members. There's a big scare at this moment that, following COVID, many of our managers, who are leaders within the hospitals, the research hospitals, will all say, “Hasta la vista, I want to go home. I've had enough of this.”

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Cloutier.

Do you want to finish your thought? We're well past time, but go ahead.

[Paul-Émile Cloutier]

My closing point is that the stress is not just at the clinical level; it's across the system, from the front line right up to the leader of any institution.

To answer your question, the government should be a facilitator and bring all of this information together.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Cloutier and Mr. Davies.

Next we have Mrs. Kramp-Neuman for five minutes, please.

[Shelby Kramp-Neuman, Conservative, Hastings—Lennox and Addington, ON]

I'm Shelby Kramp-Neuman, MP for Hastings—Lennox and Addington.

I'd like to start by thanking all of you for joining us. I'm not a doctor by any means, so I am pleased to be surrounded by your level of expertise. This is my first term in office and my first time on the health committee. I'm thrilled to be here.

I'm going to start by jumping into something that has already been spoken about, , and that is the issue of burnout, workload, stressors and anxiety.

Years ago, becoming a nurse was a very sought-out career. It should still be the case, but when you are a nurse during a pandemic, it's the last place you want to be. We should work to try to regain that and encourage people to get into the workforce. I'll speak a little more specifically.

Excessive workloads due to insufficient human resources in the health workforce were happening before COVID, and if anything, they've been heightened by COVID. The additional stresses and the anxiety that has been brought on by the pandemic have resulted in additional burnout. Mental health is huge, and the consequences we're all seeing in our colleagues, in our neighbours and our friends, especially in the health field, are anxiety and depression.

You've already spoken to some of the levels. There's 50% burnout and 45% want to resign. This has already been spoken about, but do you see a role for any specific supports the federal government could provide health care professionals and providers within their respective organizations? What role do you see for us in providing that level of resolve with regard to mental illness, stressors and anxiety? It's a big question.

[Linda Silas]

I'm not sure who you are addressing your question to, but you said “nurse”, so I'll jump in.

Welcome to this committee. You'll see it's the best committee on the Hill. It's very productive.

The federal government did it before, and we have to remind ourselves of that. The last crisis in health human resources was in 1997. There were round tables established by the federal government from 1997 to about 2008. Then we hit a recession and everything went down the drain. We had nursing sector studies, medical sector studies and allied health sector studies. We are way too small a country to expect 13 jurisdictions to have all the data, all the best practices and all the experts. That's where the federal government can come in: They can fund these projects.

I think Paul-Emile Cloutier said it well. We have to have accountability. Yes, the federal government needs to increase its share from 22% to 35%, but there has to be a plan, from long-term care to mental health to acute care.

[Shelby Kramp-Neuman, Conservative, Hastings—Lennox and Addington, ON]

Perfect. Thank you very much for that.

My second question is a complete curveball. We were talking about mental health and burnout, but I'm going to talk about recruiting new doctors and nurses.

The federal and Quebec governments have jurisdiction over immigration. An option for recruiting health care providers is to accept internationally trained people. Again, this pandemic has highlighted the need for this.

Can any of you speak to what initiatives have been implemented to encourage individuals from other countries or who have studied elsewhere to become part of Canada's workforce or to get on the roster here in Canada? Of those, which professions have been the focus for these initiatives? In your view, have these initiatives been successful?

[Dr. Katharine Smart]

I can comment on that. Thank you for the question.

We know there are huge barriers right now for international medical graduates to be able to practise in Canada. There are many physicians who were trained in other countries living here and not working in the health care system. There are many barriers that could be addressed with initiatives from the federal government.

On issue is the ability to have people trained and assessed within our system, and the cost and the barriers to that. That area could be supported by the federal government.

The other piece is the assessment and licensing process. I'm referring back to the need for pan-Canadian physician licensure. We have that same process where each province and territory has its own way of assessing credentials, training and licensing international medical graduates. That creates a huge bureaucratic barrier.

We feel there are certainly opportunities for the federal government to support international medical graduates to be able to better access the system, the training, the supervision and the assessment that they need to enter our system. There's also the side of making sure that the licensure process is more transparent and clear and that there aren't barriers there.

There are, of course, ethical concerns with Canada not creating enough human health resources within our own country and taking those resources from other countries. We do believe that in the long term, we need to be self-sufficient in creating enough of the resources here. However, there are many physicians, nurses and other health care professionals who are already here in Canada and are not currently able to practice.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Smart.

Thank you, Mrs. Kramp-Neuman.

[Shelby Kramp-Neuman, Conservative, Hastings—Lennox and Addington, ON]

Thank you.

[The Chair, Liberal, Sean Casey]

Mr. Jowhari is next, please, for five minutes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair. Thank you to our witnesses.

Before I get into my question, on behalf of myself, my colleagues on this committee, as well as all the 338 members and all Canadians, please accept our gratitude to all your members. We thank you and your members for what you have done over the last two years and for what you continue to do despite all the uncertainty and unknowns. Thank you for keeping us safe.

[Some hon members]

Hear, hear!

[Majid Jowhari, Liberal, Richmond Hill, ON]

Once again, thank you for your testimonies.

I was listening to the testimony. It looks like virtual care is emerging as one of the ways that we may be able to address the gap. I talked about the gap.

For my first question, I want to start with Mr. Barua.

You talked about the OECD. You talked about what I perceived to be the gap between the funding and the delivery. It looked like we were number six or seven when it came to the amount of investment that we do in health care. That puts us in the top 20%, yet we rank 25 or 26 out of 38 when it comes to delivery or capacity.

How do you explain that gap? If we want to close that gap based on the current funding, where would we be? How could we benchmark against those who are sixth and seventh and whose delivery is at the top 20%?

[Bacchus Barua]

You're absolutely correct. There is a fundamental imbalance between how much Canada spends on health care and what it gets in return. As you mentioned, we rank sixth highest in the OECD in terms of health care spending per GDP. If we stop to adjust that for age, we actually end up ranking second highest.

I'm stressing this point because when the conversation starts to revolve around more money being pumped into the system, we have to understand that we're already one of the highest spenders. We have a federal government that is deeply in debt. We have provincial governments that are not going to be balancing their budgets for a while in many cases. We have to really understand why this money isn't translating elsewhere.

It's not just in terms of resources. We also have the longest wait times in the developed world. We rank mediocre when it comes to utilization. We have a mixed record when it comes to—

[Majid Jowhari, Liberal, Richmond Hill, ON]

My apologies. How do we address the gap?

[Bacchus Barua]

There's a fundamental imbalance between the two.

[Majid Jowhari, Liberal, Richmond Hill, ON]

I apologize for interrupting you, but how do we address the gap? You've told us we have the money, but you've told us from a capacity point and delivery point of view we are not there. Mr. Cloutier talked about a structural investment and a long-term investment, flexible and collaborative. How can we address that gap?

[Bacchus Barua]

I'll reiterate the three points that I made in terms of differences of policy. That's what qualifies a more successful health care system from a less successful health care system.

There are three things that these other successful health care systems do. They partner with the private sector either as a partner or as a pressure valve. These are countries like Australia, Switzerland, the Netherlands, Germany. Importantly, they also temper demand. They expect patients to share in the cost of treatment, which is a vital strategy in almost every other universal health care country. Importantly, they fund their hospitals based on activity, which is very different from how Canada does this. This way of funding hospitals incentivizes hospitals to treat patients and ensure that hospitals get paid whenever a patient comes in. That takes away the entire process of having this sort of budgeting that we have.

The last thing I will just mention is in terms of virtual care. Because you mentioned that, I wanted to talk to that point. It's that I think virtual care will absolutely help, and in many cases it has already been taken up. However, it's important to understand that virtual care so far is only really in the realm of GPs and physician services. It's not going to provide—