Evidence of meeting #14 for Health in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was spots.
A recording is available from Parliament.
Liberal
The Chair Liberal Hedy Fry
I am resuming the meeting with the witnesses who are here.
Once again, we have witnesses present in the room: Ms. Amber McPherson, who is an emergency medicine physician; Dr. Marie Dagenais, from the National Dental Examining Board of Canada; and Dr. Meredith Irwin, pediatrician-in-chief, department of pediatrics, SickKids hospital.
I will just run over the process quickly. You each have five minutes to present. I will give you a one-minute yell, and then a 30-second yell so that you can wrap up. If you can't finish what you need to say, it will actually, hopefully, come out when you're getting into the question and answer sessions.
I will now begin with the opening remarks.
Dr. Amber McPherson, you have five minutes, please.
Dr. Amber McPherson Emergency Medicine Physician, As an Individual
Thank you, Madam Chair and members of the committee.
My name is Amber McPherson. I'm a U.S.-trained, board-certified emergency medicine physician with 12 years of experience prior to moving to Ontario earlier this year.
I came to Canada because I was increasingly frustrated by practising in a system where patients are routinely bankrupted by life-saving or even routine medical care. I wanted to work in a country where access to basic health care is a right, not a privilege.
I'm not alone. Many U.S.-trained physicians feel this way, especially recently. A growing number of American physicians are seeking to leave a system where evidence-based medicine is becoming increasingly politicized. We want to practise in countries where science, equity and public health are supported not only by professional organizations, but by government policy. Canada, as our nearest neighbour, is a natural first choice.
Unfortunately, Canada's licensing and immigration processes are so burdensome, disorganized and inconsistent that many physicians give up before even arriving. In my own case, I spent months in back-and-forth communications with British Columbia's licensing bodies, trying to determine whether I qualified for a licence. I had connections on Vancouver Island and a likely job offer, but the answers I received were inconsistent and ultimately inconclusive. I eventually shifted my attention to Ontario, where I was finally able to obtain my certificate to practise.
Once licensed, I was able to secure a job almost immediately, and I chose to join the Waterloo Regional Health Network, where I am happy practising today.
Like any immigrant, I hope to obtain permanent residency to reduce long-term uncertainty and build a stable future in Canada, but the pathway is far from straightforward. For example, Ontario has a provincial nominee program with a specific stream for physicians, yet the program currently excludes most U.S.-trained specialists.
The issue is a terminology mismatch. The College of Physicians and Surgeons of Ontario issues what is called a “restricted certificate” even though it allows full independent unsupervised practise with no time limit. The only restriction is that we must practise within our specialty—in my case, emergency medicine.
Why would the provincial nominee program create a pathway for physicians that is effectively inaccessible to nearly all immigrant physicians? It's almost certainly unintentional, but it represents a significant and unnecessary barrier for physicians who simply want to live, work and contribute permanently in Canada.
This reflects a broader pattern across the country. Regulatory bodies, immigration programs, provincial ministries and federal frameworks operate in silos. Their requirements do not align and internationally trained physicians get stuck in the gaps.
Until I obtain permanent residency, my legal status is tied to a single work site, preventing me from providing locum coverage elsewhere. Locums are an effective way to support rural and remote communities. Many physicians, including me, enjoy providing part-time coverage in high-need areas, but delays in immigration status limit our flexibility, as does the lack of reciprocity between provincial licensing bodies.
It's important to emphasize that the clinical differences between the U.S. and Canada are minimal. We follow the same science and evidence and similar standards of care, yet licensure pathways vary dramatically between provinces, and the process can be opaque even within a single province. Several of my colleagues in the U.S. are interested in practising in Canada but cannot obtain a clear answer about eligibility.
In contrast, in the U.S., while licensing is state-based, the criteria are transparent. If you meet objective requirements and have no history of misconduct, you know you will qualify before you invest extensive time and money in the process of applying. Given the rigorous standards of U.S. medical training and board certification, there's no reason why Canadian provinces should not implement reciprocal or streamlined licensing for most specialties.
For all of these reasons, I strongly support national licensure standards and a more coherent, streamlined pathway to permanent residency for internationally trained physicians, particularly those from equivalent training systems like the United States.
Liberal
The Chair Liberal Hedy Fry
Thank you very much.
I now go to our next witness, Dr. Marie Dagenais, executive director and registrar of the National Dental Examining Board of Canada.
Dr. Marie Dagenais Executive Director and Registrar, National Dental Examining Board of Canada
Good afternoon. Thank you, Madam Chair and members of the committee, for the opportunity to appear.
My name is Marie Dagenais. I am a dentist and the executive director of the National Dental Examining Board of Canada, or NDEB.
The NDEB was created by an act of Parliament to establish and maintain a national standard for the practice of dentistry in Canada. The NDEB is a not-for-profit organization supported by examination fees. All dentists, regardless of citizenship or country of education, are required to successfully complete our examination prior to licensure.
The dental profession in Canada maintains reciprocal agreements with the United States, Australia, Ireland and New Zealand. These agreements recognize the equivalency of dental education and facilitate licensure for graduates from those jurisdictions. However, internationally trained dentists. ITDs, from countries without such reciprocal agreements must demonstrate equivalency through one of two routes: the completion of a two- to three-year university bridging program or the completion of the NDEB equivalency process, which is a structured assessment pathway.
Global dental education varies widely in curriculum, clinical exposure and assessment standards. Since the establishment of our equivalency process in 2011, over 12,000 ITDs have taken at least one of our examinations, but only 25% have completed all of the examinations and achieved certification. The success rate for our equivalency process varies between 33% and 93% between countries, and 35% and 98% between universities.
The examinations administered by the NDEB are essential safeguards to ensure public protection. Dentistry is a profession in which practitioners often work independently, alone and without supervision. Therefore, a standardized and independent assessment of competence is critical.
Canada is facing significant health human resource challenges and this includes dentists. Although the current number of dentists appears sufficient, there is a problem in terms of distribution, with shortages in rural areas. Effective workforce planning is also necessary to support the CDCP, which funds oral health care for low-income residents.
Enrolment in Canadian dental programs has remained unchanged for a decade, producing fewer than 600 graduates, including ITDs enrolled in bridging programs. The ESDC projects that dentistry is at a strong risk of shortages between 2024 and 2033. The ESDC further indicates that a substantial increase in school leavers would be needed to prevent a shortage.
An important government initiative toward addressing the health human resource challenges has been the prioritization of health-related occupations through the express entry system. While this approach appropriately seeks to strengthen Canada's health workforce, the inclusion of dentistry in invitations for health care professionals may unintentionally create unrealistic expectations among immigrants regarding their ability to obtain licensure in Canada. Prioritizing immigration candidates based on an academic credential in dentistry offers limited practical benefits in addressing Canada's oral health workforce needs.
Health Canada's ethical framework for recruiting and retaining internationally educated health professionals, IEHPs, emphasizes the need to avoid increasing the number of underutilized IEHPs and to support those already in Canada. In alignment with this principle, the NDEB recommends that the federal government remove dentistry from the health care occupations included in dedicated immigration invitations and prioritize permanent residency pathways.
The NDEB also recommends collaboration between governments, regulators and academic institutions to expand seats in accredited dental programs for both domestic and ITDs to increase the support for new dentists and help meet projected population needs.
Finally, the NDEB recommends that a plan be developed to address the distribution issue through collaboration between the government, provincial regulators and academic institutions.
Thank you very much.
Liberal
The Chair Liberal Hedy Fry
Thank you, Ms. Dagenais.
I'd like to now go to Dr. Meredith Irwin, who is the pediatrician-in-chief at SickKids hospital.
Dr. Irwin, go ahead.
Dr. Meredith Irwin Paediatrician-in-Chief, Department of Paediatrics, The Hospital for Sick Children (SickKids), Representative, Pediatric Chairs of Canada
Thank you.
Honourable members of the Standing Committee on Health, it's an absolute privilege to provide testimony today on behalf of the Pediatric Chairs of Canada, PCC.
As you've heard, I'm the pediatrician-in-chief and also the chair of pediatrics at the University of Toronto and The Hospital for Sick Children.
PCC is a national network of our academic child health leaders. We are dedicated to strengthening the future of pediatrics by working together to advance education, research and the excellent care of our children, youth and families. We also oversee the training of the next generation of specialized expert pediatric physicians across Canada.
PCC and Children's Healthcare Canada, our sister organization, have been advocating to put children back at the centre of policy-making. Investing in children's health yields measurable social and economic returns.
As you know, Canada's children have a right to health care. Right now, our collective ability to deliver this care in a timely way to children and youth increasingly depends on the strength of its highly specialized pediatric workforce. Today, that workforce is at risk.
Across the country, pediatricians and subspecialists, whose expertise is essential when children require preventative care, specialized treatments or coordinated diagnostics and management of complex conditions, are in very short supply. Importantly, pediatric subspecialists in areas such as cardiology, oncology and neurology are not interchangeable with those who care for adults and are significantly fewer in number.
There are more than eight million children currently living in Canada, and this number will increase by 24% over the next 50 years, yet across many jurisdictions, children now wait longer than adults for essential care, not because their needs are less urgent but because our workforce is too small, aging and increasingly stretched to meet the needs of an increasingly complex population of children.
To better understand the scope, PCC in 2024 conducted a national data collection focused on pediatric subspecialty physicians, the workforce and the trainees who are currently preparing to enter these fields. Our findings showed that shortages are causing delays in access to essential care, jeopardizing the short- and long-term outcomes of our children. Fewer trainees are choosing pediatrics, resulting in a shrinking workforce attempting to serve a growing, increasingly complex pediatric population.
As you've heard, there are insufficient provincial residency spots to train a sufficient number of Canadian pediatric subspecialists to meet the current demand. Finally, and importantly, there are delays in hiring internationally trained pediatric subspecialists, including Canadians trained abroad. This threatens service delivery, teaching and capacity building, as well as research and innovation.
Today, highly trained pediatric subspecialists, many urgently needed to maintain services, face unnecessary delays in immigration, protracted licensing timelines and systemic obstacles, preventing them from joining the workforce in a timely manner.
These barriers are not just administrative. They translate into longer work times, longer wait times for children, increased pressures on our hospitals, closure of programs and lost opportunities.
PCC would like to submit the following recommendations to the committee.
We suggest streamlining immigration processes, such as paperwork, authorizations for work permits and visas, creating faster, clearer pathways for permanent residency for pediatric specialists and other subspecialists.
We feel we need to prioritize pediatric subspecialists in existing immigration streams, such as express entry. We suggest harmonizing and coordinating licensure requirements across provinces and territories to reduce variability, as well as developing national standards for recognizing training from countries with similar standards and, finally, creating and expediting consistent—
Paediatrician-in-Chief, Department of Paediatrics, The Hospital for Sick Children (SickKids), Representative, Pediatric Chairs of Canada
—licensure.
We would support federal and provincial initiatives, including encouraging collaboration with the immigration groups who control that, as well as the provincial ministries of health and medical regulatory authorities.
We need to ensure that the pediatric workforce is counted as part of the broader HHR strategies that our government is putting important focus on, especially subspecialist care.
I want to highlight this is not just about physicians. It's about other specialty health providers who provide expertise care, such as nurses, psychologists and others, for children.
In conclusion, addressing the pediatric workforce requires coordinated, national-level action. PCC believes the federal government has a critical role to play to strengthen this pediatric workforce, both strengthening our domestic training pathways while also modernizing—
Paediatrician-in-Chief, Department of Paediatrics, The Hospital for Sick Children (SickKids), Representative, Pediatric Chairs of Canada
—immigration and credentialing as our way to get physicians here now.
I look forward to answering any questions and providing examples if they would be helpful.
Thank you.
Liberal
The Chair Liberal Hedy Fry
Thank you very much.
I'm going to go to the question and answer session. It begins with a six-minute session. That six-minute session includes both questions and answers. I will be giving you the call out at one minute and again at 30 seconds so that you can wrap it up. I will not be allowing people to go over time, because we have a time limit on a committee meeting. Thank you.
To begin the questions and answers, I go to the Conservatives and Ms. Konanz for six minutes, please.
Conservative
Helena Konanz Conservative Similkameen—South Okanagan—West Kootenay, BC
Thank you, Chair.
Through the chair, my first questions are for Dr. Irwin.
Thank you for coming in today. Your testimony was really informative and also disturbing in a lot of ways.
Dr. Irwin, the pediatric unit at the Kelowna hospital in my region was forced to close for several months amid a doctor shortage. While it has since reopened, I don't believe it's open to full capacity at this point.
How common is it for pediatric health care to be suddenly unavailable to a community the size of Kelowna, with nearly 200,000 people? This hospital also services the entire interior of B.C., basically, for pediatrics. How common is that?
Paediatrician-in-Chief, Department of Paediatrics, The Hospital for Sick Children (SickKids), Representative, Pediatric Chairs of Canada
I think that in pediatrics, probably like many specialties, the numbers are often fewer than they would be for adult caregivers or adult specialists to serve a similarly sized population.
I don't know the exact numbers in your riding, but I would suspect that the total number of physicians available at that hospital to provide pediatric services may have been under some strain, and perhaps it got to a critical number, such that there were not enough doctors to provide safe health care.
Again, I don't know the details—
Conservative
Helena Konanz Conservative Similkameen—South Okanagan—West Kootenay, BC
Excuse me; is that common? Is that a common thing to happen throughout the country?
Paediatrician-in-Chief, Department of Paediatrics, The Hospital for Sick Children (SickKids), Representative, Pediatric Chairs of Canada
I think it can be.
I can give you some examples from Ontario or from some of the groups that I'm more aware of. I'll give you a very different example.
I'm a pediatric oncologist, so I care for children with cancer—
Conservative
Paediatrician-in-Chief, Department of Paediatrics, The Hospital for Sick Children (SickKids), Representative, Pediatric Chairs of Canada
We in Ontario, in Toronto, provide bone marrow transplants for children essentially east of Ottawa, or from Ottawa and eastward. We have only five physicians, and it took a lot of work to recruit them to provide bone marrow transplants.
If any of those physicians leave, we will not be able to do what we can do. If more than two were to leave, we would potentially have to close the program.
Conservative
Paediatrician-in-Chief, Department of Paediatrics, The Hospital for Sick Children (SickKids), Representative, Pediatric Chairs of Canada
We have not needed to—
Conservative
Paediatrician-in-Chief, Department of Paediatrics, The Hospital for Sick Children (SickKids), Representative, Pediatric Chairs of Canada
—but four out of those five are internationally trained physicians. We were not able to identify Canadians.
Conservative
Helena Konanz Conservative Similkameen—South Okanagan—West Kootenay, BC
What risks are possible in care to our children if a hospital lacks a pediatric unit? If someone says to me, “Oh, well, they'll just go to another unit,” tell me what the risks are.
Paediatrician-in-Chief, Department of Paediatrics, The Hospital for Sick Children (SickKids), Representative, Pediatric Chairs of Canada
That's a really important question.
As I alluded to, we are not the same. We train very differently in pediatrics. We do four years of training in pediatrics after medical school graduation, and then in our subspecialties. For oncology, that's another three years of hematology and oncology.
We take care of different conditions, whether that be in kidney, heart, etc., and so physicians—
Conservative
Helena Konanz Conservative Similkameen—South Okanagan—West Kootenay, BC
Then it's a very dangerous situation.