No, it has not.
Evidence of meeting #7 for Health in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was doctors.
A video is available from Parliament.
Evidence of meeting #7 for Health in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was doctors.
A video is available from Parliament.
Conservative
Matt Strauss Conservative Kitchener South—Hespeler, ON
That seems like another crying shame.
Dr. Watling, I'm also a fellow of the royal college. It is my understanding that the vast majority of physicians in this country who write the royal college exam have access to the old questions. Is that your understanding?
Chief Executive Officer, Royal College of Physicians and Surgeons of Canada
It is not my understanding that most have access to old questions. I think anyone trained in a Canadian program has access to a lot of supports to be able to prepare them well for exams, because in a lot of ways Canadian programs are really geared for that.
Conservative
Matt Strauss Conservative Kitchener South—Hespeler, ON
I would characterize it as an open secret. I think everyone knows that Canadian trainees have access to the old questions. It is also my understanding that for most specialities, every year's exam is largely comprised of the old questions. Is that your understanding?
Chief Executive Officer, Royal College of Physicians and Surgeons of Canada
No. That is incorrect.
Liberal
The Chair Liberal Hedy Fry
Thank you, Mr. Strauss. I'm sorry. You've gone over your time now.
We'll move to the next round.
Mr. Powlowski, you have five minutes, please.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
First of all, let me say that I'm somewhat disappointed by some of these Conservative questions, which are using this study as a forum to suggest or to say that the number of immigrants is causing a crisis within our health care system.
As somebody who continues to work, at least a little bit, in the health care system, I can say that most of the immigrants are young. They're not people who require CT scans, MRIs, colonoscopies, surgeries or ICUs, so they are not a big burden on the health care system. On the other hand, if you go to the hospitals, you'll be looked after by a nurse who's an immigrant. You'll be looked after by a doctor who's an immigrant. If you have elderly parents and they go to an old folks' home, they'll be looked after by PSWs who are overwhelmingly immigrants. My rant on that is now over.
Dr. Watling, you talked about PRAs, practice-ready assessments, being underutilized. You suggested that there ought to be a federal program to expand this. Could you expand on this a little bit? How many physician specialist positions are there a year that come through the PRA process in Canada?
Chief Executive Officer, Royal College of Physicians and Surgeons of Canada
I don't actually know, because provincial regulators in a few provinces run PRA processes, and when people succeed in them, they go directly to licensure. I would say that the majority of those people who are specialists don't come to the royal college. We see some people, probably only about 50 or fewer a year, who use that PRA as exam eligibility to then get them to full fellowship with the royal college, but most PRAs actually operate a little bit outside our viewpoint.
The expansion of it that I see as possible relates to opportunities to create some national standards, particularly around PRAs for specialty medicine. There are some really good programs looking at PRAs for family medicine, especially in Nova Scotia and Alberta, but I think we can do more around the specialty area. I think we'd love to be engaged in helping to develop national standards and national assessment tools and being able to get people assessed in about a 12-week period as opposed to the much longer one.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
We know that you have only a very brief time here. However, you can submit something in writing. Specific recommendations on how we as the federal government can help get more people through the PRA process would certainly be welcome.
Chief Executive Officer, Royal College of Physicians and Surgeons of Canada
Thank you.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
On a second topic, you talked about top-up training. I think that's really important. I've worked in many countries as a physician. The quality of graduates from different countries will vary quite a bit. Rather than making everyone go back to medical school to do it all over again, some people may need only months and some people perhaps a year or two.
Which provinces are doing a good job in terms of that top-up training? It would seem to me that this is really underutilized.
Chief Executive Officer, Royal College of Physicians and Surgeons of Canada
I think it is really underutilized. If I have this right, I think Manitoba is doing a fairly good job of this at the moment. I'm not aware of other programs systematically looking at that, but I think there's a huge opportunity there: You have 80% of what you require. Let us fill in the gaps. In six to 12 months, you'll be ready to go.
That would be much more efficient than telling someone to apply for a residency program.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
We'll make recommendations coming out of this study. Maybe I could ask everyone around the table about the top-up training. Should we be doing the same in nursing and the same in anaesthesia? Should there be more programs for top-up training that would bridge the gap and get people into the system quicker?
Maybe I can ask both the anaesthesia people and the nursing school people about that.
président, Société canadienne des anesthésiologistes
Yes, I think it could be a great opportunity. We also need a robust way to evaluate the baseline and evaluate whether they need 20%, 30% or 40%. This is where it gets tricky. It's trying to establish that as well. There we would need to partner with universities and programs to be able to do that. This is often where the roadblock is.
President-Elect, Canadian Association of Schools of Nursing
I would agree. The practice-ready assessment—the competency assessment—is really important. As Dr. Fuda said, a partnership between education institutions and regulatory bodies would be hugely beneficial and efficient there. That forms the basis for the second piece, which is the top-up training that Dr. Watling so nicely articulated.
You need to have a baseline assessment and then determine what percentage and what kind of training is needed. It is not one-size-fits-all, where everybody goes into the same pathway.
Liberal
The Chair Liberal Hedy Fry
Thank you very much. That ends your time, Mr. Powlowski.
I will now go to Monsieur Thériault for two and a half minutes please.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Madam Chair.
I've been listening to all the questions and answers. The worker shortage issue doesn't go back just five or 10 years. It's been going on for at least 20 years. After all these years, why haven't issues around co-operation among various professional associations been resolved? What factors are getting in the way of professional associations' ability to communicate with each other and exchange best practices, always within their areas of jurisdiction, of course? One does not preclude the other. It's been 20 years, and they still haven't managed to do that. Why?
What are your thoughts, Mr. Watling?
Liberal
The Chair Liberal Hedy Fry
I think you may have to direct your answer specifically. It seems no one has the answer, Monsieur Thériault.
Bloc
Luc Thériault Bloc Montcalm, QC
I asked Dr. Watling to answer my question. I don't know if he heard the interpretation.
Chief Executive Officer, Royal College of Physicians and Surgeons of Canada
I may just say that I agree with you. I share that frustration.
I sense at the moment, at least among different medical organizations in Canada—The College of Family Physicians and the Federation of Medical Regulatory Authorities—a much greater will to co-operate than we have perhaps seen in the past. I think perhaps some of the historic territoriality is going away. There's a real desire on our part to work collectively rather than separately.
I feel more optimistic about the next five years than perhaps the last 20 years would suggest.
Bloc
Luc Thériault Bloc Montcalm, QC
Do you think there might be some kind of corporatism that's getting in the way of accelerating the credential recognition process?
Chief Executive Officer, Royal College of Physicians and Surgeons of Canada
I'm not sure. For me, the biggest thing that has been a barrier, particularly with 70-odd specialty disciplines, is a lack of nationally coordinated planning and numbers to help us.
You've already seen, when you ask for data, how challenging it is for us to put forward exact data. I think the thing that would really have driven things forward is nationally endorsed and agreed-upon planning platforms.
Liberal
Conservative
Helena Konanz Conservative Similkameen—South Okanagan—West Kootenay, BC
Thank you.
Dr. Srivastava, in 2022, your organization appeared before this committee and your executive director, Cynthia Baker, said that “In terms of international education, this has...to do with the regulatory bodies that license the internationally educated nurses. The process is slow. There is an evaluation process that is time-consuming.”
Where do these processes stand today?
President-Elect, Canadian Association of Schools of Nursing
As Dr. Watling has said, there's better co-operation, but that certainly is still an area where there's considerable backlog.
Every province does the practice assessment. The regulatory bodies do the practice assessment and then make recommendations around how much of a top-up or further competency support is needed, or what kind of bridging program—