Health Committee on Nov. 4th, 2025

[The Chair, Liberal, Hedy Fry]

Thank you.

You have one minute, Ms. Silas.

[Linda Silas]

I want to thank Baljinder for his expertise on our committee and highlight to all of us that when you have been a practising nurse in another country and it takes seven years and having to go through the U.S. to get a licence before getting a licence in Nova Scotia, it is a shame. We hope this committee will bring strong recommendations to the federal government.

Thank you very much.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

I now go to Dr. Shazeen Suleman, associate professor at Stanford, who is appearing as an individual.

You have five minutes.

[Shazeen Suleman, Clinical Associate Professor, Stanford University, As an Individual]

Thank you, Madam Chair.

I'm grateful to be here to speak with you all today. The views that I express today are my own and do not represent Stanford University or any other organization.

By way of introduction, I'm a pediatrician. I'm from Cambridge, Ontario, and I am a child of refugees. As you heard, I am an associate professor at Stanford, but I am also an affiliate scientist at the MAP Centre for Urban Health Solutions at St. Michael's Hospital in Toronto, which is where I practised and taught medical trainees before moving to Stanford three years ago. It is also where I built the Compass Clinic, which cares for children and youth who live at the margins, including children with disabilities and refugee, immigrant and indigenous children. As a clinician scientist, my lab develops and tests interventions with these children and their families to reduce their health disparities.

There are three points I wish to share with you today. The first is that I ask you to remember that no child chooses to be an immigrant or a refugee. These are choices that are made for them. By 2036, nearly half of Canada’s children will be these children, as either first- or second-generation immigrants, yet they are poised to suffer the consequences of decisions made by adults.

The second is that, like yourselves, as a Canadian pediatrician, my work is bound by the UN Convention on the Rights of the Child, which was ratified by Canada in 1991. It unequivocally recognizes the rights of every child residing in Canada, no matter where they live or what their immigration status is, and especially that they all have the right to health care, yet there are many children in Canada who do not have reliable access to health care and programs that support their health. These include children who live in rural or remote settings, many of whom are indigenous, who may need to take multiple flights just to get to a facility. They include children with developmental disabilities who wait years to access specialized therapies that they need. They also include children who cannot access the Canada child benefit or are separated from their parents, despite the children themselves being citizens of this country.

They include refugee children who can't find a provider that accepts the interim federal health program, or IFHP. When we survey all pediatricians in Canada, less than a quarter knew what the program was, and only 16% knew how to use the program. As a result, many people with IFHP don't know how to use the program themselves and are reluctant to access care until they're in dire straits and end up in our emergency rooms for what could have been preventable.

This brings me to my third and final point. As a signatory to the UN convention, Canada has an obligation to ensure that all children living in Canada have the same access to quality health care, independent of where they live or their parents' immigration status. We can learn from the Province of Quebec, which has provided access to public insurance for all children who live there, independent of their parents' immigration status, under Bill 83. Children in every other province are left without any access to care.

To a pediatrician, it is unacceptable and distressing to see children suffer. Our broken system harms all children in Canada and, in doing so, our future. Having practised in both the U.S. and Canada, in urban and rural settings, I am ashamed that I have been able to provide better care for immigrant children and youth in the United States than I ever could in Canada, because of better access to public health insurance programs and easier processes for internationally trained providers.

There is no denying the shortage of primary care providers in our country. Allowing qualified internationally trained clinicians, including returning Canadians, to practise in Canada is an attractive strategy to fix this.

I said I had three points, but I would like to add a fourth. It is that the children of refugees and immigrants are just like me. They are proud of their country and determined to make Canada better for all. We owe them the opportunity to do so.

Thank you for your consideration.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

We will go to the question and answer segment. The first round is six minutes. The six minutes include the questions and the answers.

I shall begin with the Conservatives and Mr. Mazier for six minutes, please.

[Dan Mazier, Conservative, Riding Mountain, MB]

Thank you, Chair.

Ms. Lake, you mentioned that internationally trained physicians could be tested on their competencies prior to their arrival. This is something we've heard from internationally trained physicians, who feel that they became trapped in a broken system once they arrived in Canada.

Can you explain how pre-arrival competency assessments could help prevent bottlenecks?

[Deidre Lake]

We provide navigation support. One of the things we often recommend is that individuals consider doing some of the assessments they are able to do abroad, before coming to Canada, to speed up the process. Certainly that is one aspect.

Then it's looking at what tools are needed to measure the competencies needed and align those with health care demands.

[Dan Mazier, Conservative, Riding Mountain, MB]

Thank you.

Ms. Lake, do you believe Canada should implement a national licence for health care professionals, so that doctors can practise across provinces without barriers?

[Deidre Lake]

I think that eliminating the barriers, particularly for individuals who are here or anyone who is coming, is definitely something that we would support.

[Dan Mazier, Conservative, Riding Mountain, MB]

Are you aware of any barriers? Do you have personal knowledge of people who have challenged these barriers, and can you elaborate on those?

[Deidre Lake]

Even in my speech.... We're limiting access to the competition for people who are here by making residence requirements or limiting their access to seats, and there is a lack of bridging programs or whatnot where people can fill gaps where gaps are identified. That lack of opportunity or being subjected to further limitations certainly creates barriers for people, and we have a lot of people who relocate to different provinces where there are opportunities.

For example, in Alberta, we have associate physician positions. We have one of the largest PRA programs for both specialist and family physicians, and of course there is residency across Canada, but you have to be a resident of Alberta in order to apply for those seats.

[Dan Mazier, Conservative, Riding Mountain, MB]

Ms. Lake, would you support a streamlined national competency-based assessment for internationally trained doctors?

[Deidre Lake]

Yes. I think there is some work being done right now looking to increase competency-based assessments for physicians. We certainly support that. I think the issue right now is that we have a battery of tests and assessments that people have to do before they're even considered or looked at, or, as I said, they may not even be able to make it to the plate to be assessed.

I certainly think there are improvements that we need to make to allow people a fair assessment of their skills upon arrival and then determine at what scope they're able to practise and which assessments they would need to do to fulfill their competencies.

[Dan Mazier, Conservative, Riding Mountain, MB]

Ms. Lake, according to the Royal College of Physicians and Surgeons of Canada, there are currently over 13,000 internationally trained physicians in Canada who are not working as doctors.

Do you think the government should prioritize licensing internationally trained physicians already in Canada before they start adding people to a bottleneck in a broken system?

[Deidre Lake]

I think lot of the changes that are made are benefiting those who are arriving, and I do think there is a large number of people we haven't utilized, people who are underutilized and underemployed and aren't working to their potential. I think any initiative that would support assessing those individuals for their competence and getting them into the health workforce would be of benefit to all.

[Dan Mazier, Conservative, Riding Mountain, MB]

Ms. Lake, do you believe there is a disconnect between immigration policy and health care planning in Canada?

[Deidre Lake]

I'm not an immigration policy expert. I think there are certainly highly educated and highly skilled individuals coming, and I think having that information so that people could land where their skill sets are needed and having better-coordinated services between those demands and the individuals coming would be helpful.

[Dan Mazier, Conservative, Riding Mountain, MB]

Thank you. There are lots of opportunities for that.

Have you talked to any people who have immigrated and are not in the system? Do you have examples right in your own neighbourhood or in your own community of people you could think of whom this would actually help out tremendously? It would help out our system as well, as far as serving Canadians is concerned.

[Deidre Lake]

It would help thousands. I know that during the pandemic there were lots of people sitting on the sidelines wanting to help their fellow colleagues. I think there are lots of people still sitting on the sidelines, like the gentleman I made reference to who is working as an Uber driver and who was employed in Afghanistan working for the WHO. He is simply looking for a job where he could provide public health information or vaccines.

[Dan Mazier, Conservative, Riding Mountain, MB]

Ms. Lake, how can practice readiness assessments help get internationally trained doctors licensed and working?

[Deidre Lake]

I think that an increase in those seats has been a proven model for assessment, so I think expanding upon practice readiness assessment opportunities and associate physician opportunities would be helpful in creating pathways to licensure.

[The Chair, Liberal, Hedy Fry]

I now go to the Liberals.

We have Ms. Chi for six minutes.

[Dan Mazier, Conservative, Riding Mountain, MB]

Thank you, Ms. Lake.

[Maggie Chi, Liberal, Don Valley North, ON]

Thank you, Madam Chair.

Thank you, Ms. Lake, for coming, and thank you to all the witnesses for joining us this afternoon.

My first question is for Ms. Lake.

In terms of your experience, you talked about the process and sometimes the frustration around it. Which part of the process would you think could be better aligned with the Medical Council of Canada and the provincial colleges to streamline the process a little bit more?

[Deidre Lake]

It's a good question.

There was some discussion on modernizing assessment processes. I know there is a demand or a request to move to more competency-based assessments. Again, if we were able to align individual skills, for instance, we would have a urologist who is able to work as a urologist. At the current time, specialists are having to do part one of the qualifying exam, which requires them to essentially go back and study all aspects of medicine, when in fact that might not be the area of medicine or the scope of practice that they are eligible to work in, so it is slowing down their process to be assessed. Again, that is one thing—looking at the tools we need to have in place to assess competencies and to ensure safety of practice and being able to assess individuals upon arrival for their competencies and then look at their skills and training.

The other aspect is that for CaRMS, there are a lot of processes that could be changed. There are individuals who are having to apply to CaRMS on an annual basis, for example, and who have to repeat all the same documentation, such as English proficiency exams, every two years. There are also personal attribute tests, which they do on an annual basis. They do three assessments if they're applying to family medicine across Canada, if there are seats available. There are multiple repetitions of tests they do year after year, which compounds the issue and discourages some people from continuing to apply.