Health Committee on Oct. 28th, 2025

[The Chair, Liberal, Hedy Fry]

I call this meeting to order.

Welcome to meeting number eight of the House of Commons Standing Committee on Health.

We recognize that we are meeting on the unceded territory of the Algonquin Anishinabe people.

Today's meeting is taking place in a hybrid format, pursuant to the Standing Orders.

I would like to remind participants of the following points.

Please wait until I recognize you by name before speaking. For those participating by video conference, click on the microphone icon to activate your mic and mute your microphone when you're not speaking. At the bottom of your screen, you can select the appropriate channel for interpretation. The options are floor, English or French.

I remind you that all comments should be addressed through the chair.

For members in the room, I'm going to remind you of the little icon here and to put your phones down and speak into the microphone without a lot of disturbance, because it does affect the hearing of the interpreters.

Again, if you raise your hand, the clerk and I will try to recognize you as we see your hand come up.

The meeting is on the impact of immigration policy on health care and barriers to integrating internationally trained health professionals.

Pursuant to the motion adopted on Tuesday, September 23, 2025, we're resuming that study.

I would like to welcome our witnesses for this first hour.

As an individual, we have Dr. Scott Alexander, medical adviser. From the Medical Council of Canada, we welcome Dr. Viren Naik, chief executive officer. From the Society Of Canadians Studying Medicine Abroad, we have Rosemary Pawliuk, president, and Dr. Douglas Munkley, physician.

Each group has five minutes, but you can split your five minutes any way you want. I will give you a one-minute shout-out, and then I'll give you a 30-second shout-out so you know to wrap up. If you don't finish what you're saying, you can probably include it in an answer to a question.

Yes, Helena.

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

Madam Chair, are we going to be able to get the full hour? I know we have some witnesses from B.C. Will we get the full hour?

[The Chair, Liberal, Hedy Fry]

We have until one o'clock. If we need more than five minutes or so of further time, we're going to have to ask if we have the resources to do that.

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

Will this hour go until 12:10?

[The Chair, Liberal, Hedy Fry]

Everyone would have to agree they can stay. If not everyone can stay, we won't be able to go past one o'clock.

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

This hour—

[The Chair, Liberal, Hedy Fry]

Basically, you're asking for this. That means if we go beyond this hour, we're going to be cutting short the next hour if everyone is not in agreement to stay afterwards.

[Dan Mazier, Conservative, Riding Mountain, MB]

Chair, with all due respect, we have witnesses who came here all the way from B.C. I think the least we could do is allow them the first full hour and full second hour to be here.

[The Chair, Liberal, Hedy Fry]

We can cut the people in the second hour short. Is that what you're saying?

[Dan Mazier, Conservative, Riding Mountain, MB]

No, we're going for the full two hours.

[The Chair, Liberal, Hedy Fry]

We have to get agreement, Mr. Mazier, to stay in this room until after one o'clock. We have to get agreement from every one of the members of this committee to stay after one o'clock. It's not up to one person to do that.

[Dan Mazier, Conservative, Riding Mountain, MB]

Call the question, then. Do we have agreement from the committee?

[The Chair, Liberal, Hedy Fry]

I will ask the committee.

Do we have agreement to stay after one o'clock?

Clerk, do we have resources for after one o'clock?

Okay, we do. All right. That's good.

[Dan Mazier, Conservative, Riding Mountain, MB]

Thank you, Chair.

[The Chair, Liberal, Hedy Fry]

It's always going to require consent from the committee. It's not just one group or one person who can say so.

I hear what you're saying, Mr. Mazier. I'm trying to get it done according to process. Thank you.

I will begin with Dr. Alexander.

You have five minutes. I shall give you those shout-outs like I said.

[Scott Alexander, Medical Advisor, As an Individual]

Thank you very much, Madam Chair, and everyone in the committee, for having us here.

My name is Scott Alexander, and I was born and raised in North Vancouver, British Columbia. I graduated from the University of Queensland school of medicine in 2017 and returned to Canada with the intention of completing a residency and practising here, but I'm now a non-licensed physician in Canada because I was unable to obtain and secure a postgraduate residency position.

I discovered my calling for medicine after transitioning from the University of British Columbia to Simon Fraser University, where I studied biomedical physiology and kinesiology and fell in love with the science of the human body.

I started later than many applicants to medical school and faced some early setbacks, which unfortunately included playing junior hockey. With a master's degree, I tried to strengthen my application, but it did not gain me admission to Canadian medical schools. I then self-funded my education in Australia at a personal cost of over $250,000 Canadian, intending to return home to practise here and raise my family.

After graduation, I did return to Canada and started my family, and I did apply for residency positions in both family medicine and psychiatry. However, two unsuccessful applications were followed by some retroactive changes to the exam requirements that declared the exams I had taken, the MCCEE and the NAC OSCE, were no longer acceptable, and I was required to take resident-level examinations, the MCCQE part I, before entering residency, and an updated NAC OSCE with a new format.

These changes effectively erased my progress towards licensure, as was the case for many internationally trained Canadians like me, and prevented me from applying to residency in further years. Therefore, I had to pivot, and I moved into medical affairs in the pharmaceutical industry.

For the last eight years, I've worked to bring innovative medicine to the patients in Canada and scientific education to the physicians across the country. I take real pride in improving patient care, but on a different scale than I had expected. This career change was not in my plans, and it does reflect some of those systemic barriers that prevent qualified Canadians trained abroad from practising at home.

I'm very fortunate that I have a physician-facing role and that I get to engage with doctors across Canada and build relationships with them. One of the icebreakers that I typically do when introducing myself is to share my story. Almost without fail, there is shock and sympathy, and immediate offers of help with things like observerships, preceptorships or letters of recommendation are given my way.

However, these offers come from the individual physicians themselves. In discussions with them, I've come to understand that a lot of the programs do not have the capacity to take on more training. One of the bottlenecks I've heard about does happen to be the foreign-trained visas. While they don't directly compete with residency positions, they do limit the number of supervised training positions available because of the constraints on teaching capacity and the limited hours that physicians have for supervision. It was not something I had considered as a barrier before having these conversations with the doctors, but on speaking with them, while they're burning out and struggling with their patient care, it seems to come to the front presently.

The medical school I attended was one of the largest international institutions, with a student body of 250 international students. There were 60 Canadians in my year. When I graduated in 2017, only two students tried to come back to Canada. Fifty-eight of my Canadian colleagues decided to stay in Australia and are now serving the Australian population as fully trained consultants.

Many of my peers would like to return, but they tell me that the barriers are prohibitively high and that the process lacks transparency for them. This frustration and loss of trained clinicians to other health systems is a problem for Canada.

In conclusion, I'd just like to say that while I would like to acknowledge that Canada invests in its people, we should not, through this unclear and inconsistent process or through retroactive changes, be losing Canadians who have already trained and been invested in.

[The Chair, Liberal, Hedy Fry]

I'm sorry to interrupt. You have 37 seconds.

[Scott Alexander]

My personal thoughts are to remove some of these bottlenecks that come from the visa programs and capacity constraints, to restore predictability in the assessment and licensing and to expand supervised clinical training capacity so that qualified internationally trained Canadians can complete the final steps that are required here at home. Doing so will restore fairness to individuals and their families, deliver trained clinicians where they are desperately needed and strengthen health care for all Canadians.

I ask this committee to recommend concrete time-bound measures to help make that happen.

I thank you all very much for your time.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

Now I will go to the Medical Council of Canada and Dr. Naik.

[Viren Naik, Chief Executive Officer, Medical Council of Canada]

Good morning, Madam Chair and honourable members.

Thank you for the invitation to appear today.

My name is Viren Naik, and I am the CEO of the Medical Council of Canada. I'm also a practising anesthesiologist helping with the shortage here in the nation's capital, which you heard about in previous weeks.

Canada is absolutely in a crisis, and you've heard testimony and staggering figures to that effect. This isn't just a Canadian problem; it's a global problem. The World Health Organization has predicted that we will be short 10 million health care workers by the year 2030.

The Medical Council of Canada was enacted as an act of Parliament in 1912 to serve regulation and licensure by setting the national standard for the competencies we expect of physicians.

In crises, we do see erosions of the standards. I don't think that today is the day to lower or remove standards, but we absolutely do have to modernize those standards, making them efficient, effective and relevant. The national standard needs to evolve, just as medical practices evolve. If we do that right, we can maintain patient safety and keep the public's trust. Our licenciate and our examinations are good measures of whether someone is ready to enter supervised practice.

I put it to you that we support the national standard in three ways. One is through credential verification. Thankfully, in today's day and age, we see the incidence of fraudulence to be low, but it's not non-existent, so this is an important check to test medical knowledge and, more importantly, the ethical and cultural considerations we'd want to see in our doctors. Recognizing that no single test is going to tap all these competencies, importantly, professionalism and communication, we are leaning into assessor tools and training so that we can bring valid and defensible decisions to workplace-based assessment through the practice-ready programs you discussed.

I said it's a global crisis. Well, inherently, that means it's also a global competition. We are going to have competition in our provinces and our territories, but we cannot allow that competition to increase the complexity and confusion with heterogeneous pathways and heterogeneous processes. We have to recognize that all recruitment needs to be ethical, but if we can do this right, given this global crisis, we can have Canada as a destination of choice for physicians who choose to migrate.

More importantly, for those who are already here, we can bring clarity, as opposed to confusion, to the pathways that are accessible to them.

We know from our exams that we leave a thousand candidates every year on the table after they've demonstrated the competencies that show they're ready for supervised practice and potentially for moving on to licensure. That's because they can't access enough residency and PRA positions.

My recommendations to this committee are threefold.

One, let's bring clarity, not through a provincial and territorial lens, but through a national lens, about the requirements for international medical graduates and set expectations so that the migrating doctor can make an educated decision on whether Canada is a destination, but more importantly, so that we can navigate those who are already here, as opposed to having them try to understand the system.

Two, we need to expand opportunities for supervised placements that can lead to licensure. That includes bridging programs and clinical assistant positions to address recency of practice, increasing our residency spots and dramatically expanding our PRA programs, which we know are the most efficient way to bring people to licensure.

That includes the innovative Physician Assessment Centre of Excellence in Nova Scotia that you've heard about, of which we are a partner. That innovative program directly addresses the bottlenecks and capacity issues that we see in this program.

Finally, I think we do need to build upon digital platforms like the National Registry of Physicians so that we have a single source of truth for credentials, for practice locations and for scope of practice. If we have that information, then we can remove the redundant credential checks throughout the system. We can facilitate mobility between our provinces, and probably most importantly, do the HHR planning so that we don't end up in a situation like this in generations to come.

I look forward to your questions.

Thank you, merci and meegwetch.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

I now go to the Society of Canadians Studying Medicine Abroad.

I'm going to call on Dr. Pawliuk. Are you going to be the speaker?

[Rosemary Pawliuk, President, Society for Canadians Studying Medicine Abroad]

Actually, we're going to split it. Dr. Doug Munkley will speak first, and I'll speak second.

[The Chair, Liberal, Hedy Fry]

All right.

Dr. Munkley, you have two and a half minutes.

[Douglas Munkley, Physician, Society for Canadians Studying Medicine Abroad]

Thank you, and good morning.

I'm Doug Munkley, and I have been a full-time emergency physician in a high-volume community hospital in Niagara for over 30 years. I've also worked in walk-in, urgent care and primary care settings. As well, I'm the medical director for Niagara EMS, the ambulance service that provides care to over 500,000 people in our region.

Niagara is a wonderful place to live and work. However, we too have an acute lack of family physicians, and we're designated as such by the Ontario Ministry of Health. That lack of physicians, both GPs and specialists, is felt in a number of ways. Clearly, to those individuals who do not have access to primary care, there are adverse health effects from lack of disease prevention and delayed diagnosis and treatment. For those awaiting specialist consultation or surgery, those delays also have profound effects.

However, there are other consequences of the lack of family physicians or after-hours physician services. Patients often have nowhere to go except the emergency department. Provincial telehealth services, which are risk averse, will direct patients to the ED, as will doctor's offices. These factors are part of a systemic issue causing widespread emergency department overcrowding. When EDs are overcrowded, ambulances cannot offload their patients and, therefore, they are not available to respond to emergency calls.

What are some of the solutions to this doctor shortage?

There are 3,500 Canadian students studying in highly respected medical schools around the world. We need to provide a fair and equitable process for Canadian medical students studying abroad to obtain residency positions, and we need to remove the licensing barriers to enable these physicians to come home to practise in Canada.

[The Chair, Liberal, Hedy Fry]

Thank you.

Ms. Pawliuk, go ahead.