Health Committee on Nov. 20th, 2025

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

Okay.

I would think that you don't do a high volume of patients. If you were a doctor practising in Nova Scotia, trying to make a decent salary, you'd see lots of people. As a result of seeing lots of people, you would make lots of money. With this PACE centre, they're paying more, I would think, because you're teaching people, so you don't have to see nearly as many people.

I'm just wondering about the efficiency in addressing the health care shortage. The efficiency and the point is to train people, not to see a lot of people.

[Dr. Keri McAdoo]

It is a different model than a typical clinic, for sure. The funding model is based on the number of assessors in the clinic, and the assessors oversee the work of the internationally trained physicians. We expect that the team would see as many as a full-time family physician would for the funding model. It's not the volume that you would expect in a typical clinic because there's time built in for the assessment work, both for the assessor and for the international trainee.

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

Maybe Dr. Nickerson can chime in here. Why do you need PACE? Why couldn't you just have doctors in the community playing the same role, supervising somebody doing a practice-ready assessment?

I think the answer, and maybe Dr. Nickerson can address it, is that it's hard to find a number of people who are willing to do the assessment for PRAs. Is part of why you exist due to the difficulty in getting people to do PRAs in the community?

[Dr. Keri McAdoo]

Yes. There are definitely challenges in recruiting and retaining assessors in the traditional practice-ready assessment model. In the previous model that other PRAs operate with, physicians are asked to provide an assessment every year or two and may not be doing it regularly. Therefore, they may not maintain their confidence to provide that assessment work. With PACE, the assessors are providing assessment work on a regular basis and feeling confident with that work. They also have extensive training with the Medical Council of Canada, so they're feeling confident that they have the skills they need to do that work.

With this centralized model of PACE, they have developed a community of practice so that they provide support to each other and are able to work together to build their skills, and they are compensated as well.

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

Is your program, PACE, open to physicians from any country, or is there some sort of decision that certain countries are going to produce higher-level graduates? Is it all comers?

[Dr. Keri McAdoo]

It really is based on the competency that we expect to see in the clinic. We have eligibility criteria that are set by the College of Physicians and Surgeons of Nova Scotia and then selection criteria on top of that. We don't identify specific countries. It really is looking at who would be most successful.

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

Dr. Nickerson, I know that in Manitoba they've been doing PRAs for a while. My understanding is that it's fairly limited numbers. My guess is that it was about 30-something per year in Manitoba. Why don't they do more?

Is PACE perhaps the answer? Perhaps Manitoba ought to do something similar, so it could get a lot more people out through that kind of approach.

[Dr. Peter Nickerson]

It's a great question.

We actually launched doing PRAs back around 2000, initially without quite the standardization that you've heard from Dr. McAdoo. We found that it didn't necessarily meet the needs of the internationally trained physicians, so we moved to a one-year program where we essentially give them rotations through various areas—emergency medicine, family medicine and pediatrics—to give them a broader orientation to the Canadian health care system. We found that one-year program to be highly successful. Over the years we've had 20 per year go through that program. We've ramped it up now to 30.

We are ramping up a PRA program in Manitoba that's very similar to what Dr. McAdoo is doing. We are spending time, though, getting the assessors well trained through MCC and developing the same kind of community of practice in Manitoba.

Like Dr. McAdoo, I think it requires some screening for who's eligible for the PRA because you only have three months generally to do the PRA. That really requires that you have a wholesome assessment, so that you can really sign off that they're ready to practice.

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

I wanted to get in what I think is a really important question.

[The Chair, Liberal, Hedy Fry]

I'm sorry. I've been so interested in this question, Marcus, that I have let you go. You have nine seconds left.

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

I understand there's a group of facilities that offer PRAs that meet and try to set national standards. They're interested in a CaRMS kind of program for PRAs nationally.

Is this something that perhaps the federal government should look to fund?

[Dr. Keri McAdoo]

I think you're referring to the Medical Council of Canada. I'm not sure if that's what you're describing, but they do have a national assessment collaborative through the MCC that brings various PRAs together. I think that's what you're describing.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

Ms. Larouche, you now have the floor for six minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Madam Chair.

I would like to thank the three witnesses for being here with us. Their comments are very enlightening.

My first question is for Dr. Nickerson.

Correct me if I am wrong, but in one of your answers, you said that in your opinion and that of the Association of Faculties of Medicine of Canada, retaining those who work in Canada should be a priority.

We believe that the reason we are forced to recruit so many foreign workers is because students from here go to study abroad but do not return to the country after their studies because of working conditions.

Have I understood correctly? Should the priority be to keep students here so that they work in Canada?

[Dr. Peter Nickerson]

We should be looking at our Canadian medical graduates whom we train. We obviously want to keep them here in Canada. We've invested heavily in them. Most medical students cost, on average, $430,000 in total to train over the four years.

For those individuals we have enrolled in our residency programs, we would hope that at the end of their residency training, they would stay in Canada and help the Canadian workforce. Absolutely, that's what we should be doing.

[Andréanne Larouche, Bloc, Shefford, QC]

To do that, we would need to be able to offer them good conditions.

In the latest budget, it was announced that funds would be allocated to hospital infrastructure. However, Quebec’s request for an increase in health transfers and the return of annual indexation at 6% after 2028 has not been met. This is not only a request from Quebec, but also from other provinces.

In your opinion, what is the point of having hospitals if we are unable to offer good working conditions to the people who work there? If we want to keep workers here, we have to offer them good conditions. If we kept those who work here, perhaps we would have less need to seek workers from abroad.

What do you have to say about the issue of health transfers?

[Dr. Peter Nickerson]

I think you're making an excellent point in the sense that we've grown the population of Canada significantly over the last several years, so we need to create the infrastructure, both in the medical schools and within the health system, to be able to support both the delivery of health care and the delivery of training.

There's a need to invest in both the university medical school infrastructure and the health system infrastructure to support both capacity and quality in the training environment as well as in the work environment. Why people choose to stay and work in a given area is going to be largely dependent upon the physician group they're joining, as well as the conditions of the health system they're working in.

[Andréanne Larouche, Bloc, Shefford, QC]

That’s absolutely right. If we have new operating rooms, they must not be empty. We need to offer good conditions to people who want to come and work here. Obviously, there must be people in an operating room. Retaining students who could work here is crucial.

I will now turn to Dr. McAdoo, who represents the Physician Assessment Centre of Excellence.

I would like to remind you that the issues of economic immigration and the recognition of qualifications are the responsibility of Quebec, in particular.

The people who work in your clinic, who are supervised by your centre, are waiting for their credentials to be recognized. What difficulties are they experiencing? Are they experiencing financial difficulties? They are here, but they have to take steps to get their credentials recognized. There are costs associated with all of this, but they do not have a salary that allows them to live adequately while they are under your supervision.

Would it be helpful for the federal government to implement tax measures?

[Dr. Keri McAdoo]

The internationally trained physicians who come to PACE receive a weekly stipend during the time they're under assessment and a monthly stipend for accommodation, but it is definitely financially challenging for the physicians to come and do this work. Housing is definitely a challenge for physicians to attend our assessment centre. That's something that needs to be addressed.

[The Chair, Liberal, Hedy Fry]

Thank you.

I now go to the second round. It's a five-minute round.

Ms. Konanz, you have five minutes.

[Helena Konanz, Conservative, Similkameen—South Okanagan—West Kootenay, BC]

Thank you, Chair.

Dr. Burry, when it comes to dental care being administered through the interim federal health program, has the number of dental users increased over the past 10 years?

[Dr. Aaron Burry]

I wouldn't have that information. I'd have to get back to you in terms of that particular program. It's federal.

[Helena Konanz, Conservative, Similkameen—South Okanagan—West Kootenay, BC]

The numbers that the government is giving show that there is a 464% increase since 2016, with more than 110,000 more users.

What kinds of bureaucratic hurdles or delays do that many more users in this health program place on dental offices?

[Dr. Aaron Burry]

That program is a very limited program, primarily focused on very urgent and emergent care, so I think the biggest issue with the program is exactly that: People are arriving with needs that are far greater than the program is designed to deliver.

[Helena Konanz, Conservative, Similkameen—South Okanagan—West Kootenay, BC]

I was wondering about that. My hat is off to the local Rotary club that I belong to. We've been fundraising for local Ukrainian children for their dental service, and I was wondering why they weren't being serviced. The cost has gone up to $256 million, and a decade ago it was only $13 million.

Is there a different process that dentists' offices must take with the interim federal health program dental coverage if services are rendered to a refugee applicant whose application has been rejected by the Immigration and Refugee Board, as compared to services rendered to an approved refugee?