Evidence of meeting #8 for Health in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was programs.
A video is available from Parliament.
Conservative
Burton Bailey Conservative Red Deer, AB
This seems very bureaucratic and onerous. In order for you to be an anaesthetist and do the same job in multiple provinces, you carry licences in each of those provinces. I am having trouble with that.
How many licences do you carry with that $20,000? I should get that clarified.
Physician, As an Individual
I recently got my Saskatchewan licence, and I was reimbursed by its health care authority. There are so many inefficiencies across the country with regard to this. In Ontario, I paid for my CMPA myself. In Alberta, the Alberta government reimburses me for the CMPA insurance costs, so some of that is recouped. There are annual renewals in all of these provinces. Some of those are reimbursed, and the government wastes money on that, and some of them come out of my own pocket.
Conservative
Burton Bailey Conservative Red Deer, AB
The cost of this process of licensure is obviously a barrier to entry for many medical professionals.
Physician, As an Individual
It's an inconvenience, for sure, and I think it dissuades people. For example, I gave up my Manitoba licence. In that practice, I was going to serve indigenous communities with pediatric dental care. The travel was a lot and I didn't want to keep my licence up to date, so I discontinued paying for it. It was a barrier that made me give it up.
Conservative
Burton Bailey Conservative Red Deer, AB
Thank you.
I'll share my time with my colleague Dr. Strauss.
Conservative
Matt Strauss Conservative Kitchener South—Hespeler, ON
Dr. Anand, you made in your opening statement a very interesting remark about it being common practice to charge insurance for refugees who are receiving health care five times more than for a public-pay Canadian citizen. Can you tell me more about that? That seems kind of crazy, if I'm being honest.
Physician, As an Individual
Of course. For federal programs, including prisoner and other federal programs, physician fees are not covered by the province, so you submit invoices to Blue Cross. The AMA publishes a fee guide. They actually suggest that doctors bill between two and five times more than regular fees for those programs that are considered uninsured.
Conservative
Matt Strauss Conservative Kitchener South—Hespeler, ON
It seems to me that if you have hundreds of thousands of asylum claimants in Canada receiving health care and the physician is receiving five times more, that's a significant drain of resources.
In the last hour, we had some conversation about capacity versus funding for training seats. Anaesthesia is a really interesting example, because it seems to me that you either have an anaesthetist willing to take a student into the OR that day and teach them or you do not, irrespective of funding. Can you reflect on that for me? It becomes relevant when we talk about—
Conservative
Matt Strauss Conservative Kitchener South—Hespeler, ON
I'm looking for whatever reflections you have on that, please.
Physician, As an Individual
I agree with your statement. For example, we have paramedics who have to come to Red Deer all the time. I don't get paid anything for that, actually. I'm asked to volunteer for that, just to help the community.
Irrespective of funding, depending on whether there's availability to take on students, that is an infrastructure question fully. Of course funding can play into some of that, but I think as physicians we're here to contribute to and help support the Canadian health care system.
Liberal
The Chair Liberal Hedy Fry
Thank you very much.
People, I will have to ask you, if you're going to share, don't give the other person only a minute, because it goes over time.
For the Liberals, we have Ms. Sidhu.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you, Madam Chair.
Thank you, witnesses, for joining us today and for your insight.
I'm from the riding of Brampton South in the community of Peel. We are feeling a gap in our resources of 220 people. That's why this meeting is very, very important. It's a shared responsibility, of course.
There's one thing I really want to put on the record. The federal government has expanded support for foreign credential recognition to help internationally trained health professionals join the workforce more quickly. Through the working together bilateral agreements, the federal government is providing $25 billion over 10 years to support shared priorities so that we can work together with provinces and territories to bring more health resources to Canadians.
Mr. Barnum, I know that you're working on data collection a lot. What additional data is needed to support national planning for internationally trained health professionals? How can this information be collected consistently across Canada and across jurisdictions?
Senior Manager, Data, Canadian Post-M.D. Education Registry
That's a great question.
One of the challenges we run into at AFMC and CAPER is that we get our data directly from the medical faculties themselves. Unless a physician, particularly an internationally trained physician, has some sort of contact with our medical faculty, we simply don't know they exist. Getting data on how many physicians are coming into Canada who are maybe trained outside the country would be absolutely amazing for our needs.
I'm not sure about the mechanics of how we would actually get that data, per se, but it would be some sort of data connection between us and the immigration department. We don't even need to know who they are, necessarily. We just need to know how many there are and what area of medicine their specialty is in. Is it family medicine? Is it surgery? Is it psychiatry?
Does that answer your question?
Liberal
Sonia Sidhu Liberal Brampton South, ON
Yes.
A previous panel was talking about how many others have a registry. We all know there's a gap. What changes would you recommend to make it easier for Canadian medical graduates trained in the U.S., or in Sydney, as we heard, or in any other country so that they can come back? They're Canadian but they went to study abroad. While maintaining high professional standards, what can be done? How can we fill that gap?
Senior Manager, Data, Canadian Post-M.D. Education Registry
That's outside my area of expertise as a senior manager of data. Reflecting on what I see in the data, I would suggest some sort of system.... I'm sorry. This is really outside my area of expertise.
Advisor, Canadian Medical Foundation, Internationally Educated Health Professionals in Canada
I'm sorry. I'll need you to repeat the question, please.
Liberal
Sonia Sidhu Liberal Brampton South, ON
It's a shared jurisdiction. What steps can be taken so that more IMG doctors and international students can easily come to the country?
Advisor, Canadian Medical Foundation, Internationally Educated Health Professionals in Canada
I don't know that the issue is having them at the front and what we need to do more to get them to come. I think the issue is that we have people already in the country who need support, and because they haven't been adequately supported since arriving and getting into the practice, we are seeing these gaps.
A lot needs to be done before immigration to inform people of some of the challenges, some of the barriers and some of the processes they need to undertake. That would be extremely helpful.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you.
Dr. Anand, you were talking about longer wait periods and a mismatch within the system's capacity. Can you elaborate on that? What can be done?
Physician, As an Individual
This may tie into your last question. There are multiple layers.
Number one, for university planning with residency spots, is that we train orthopaedic surgeons and they can't get jobs afterwards. Just within our own management of Canadian-trained medical practitioners, there should be better human resources planning, rather than having residency positions just to support big academic institutions.
Number two is having a pathway for practice-ready assessments for Canadians who have been internationally trained so that they can come back and integrate into the system in a streamlined approach and a way that's consistent across the provinces. This would probably be beneficial.
Number three is that we could utilize IMGs, who are non-Canadian citizens who have trained internationally, in a clinical assistant or associate division program so that they can be supervised indirectly, work with Canadian-trained physicians and get extra training. It would be a kind of top-up. They'd eventually go to a practice-ready assessment or another formalized program where they can be given an okay, and then they could go and help underserved and rural communities.
A multipronged approach is probably the way to go about solving a complex problem.