Health Committee on Oct. 28th, 2025

[The Chair, Liberal, Hedy Fry]

We are now 30 seconds over.

[Luc Thériault, Bloc, Montcalm, QC]

Isn't labour mobility an important element to consider in addressing this problem?

[The Chair, Liberal, Hedy Fry]

Thank you.

I will now move to Mr. Strauss for the Conservatives for five minutes, please.

[Matt Strauss, Conservative, Kitchener South—Hespeler, ON]

Thank you, Madam Chair.

Mr. Barnum, thank you for being here. You look after the Canadian Post-M.D. Education Registry. You have this fantastic report and have compiled lots of data about what sorts of doctors are being trained in Canada.

I take it from this data that we can have a pretty good analysis of what the health care workforce is going to look like in Canada, at least as far as physicians are concerned. It's a terrific report with terrific data.

I'm curious. When the immigration ministry decided to bring about a million more newcomers to Canada this year, did they consult with your office? Did they read this report? Did they ask you any questions about it?

[Geoffrey Barnum]

Not that I'm aware of.

[Matt Strauss, Conservative, Kitchener South—Hespeler, ON]

That seems like a crying shame to me.

In looking at the report, of interest to me is table B5i, which is about visa trainees in Canada. For one thing, I note that anaesthesia has the highest number of any discipline for visa trainees in Canada. I also note that it's increasing rapidly. Does your office have any idea of or opinion as to why that might be? It has gone from 113 in 2020 to 185 in 2024 for anaesthetists being trained.

[Geoffrey Barnum]

I think we actually took a look into that number at one point, just because—you're right—it is a bit of a data anomaly, and that set off my alarm bells to go and make sure it's being accurately reported. It's being primarily pushed by clinical fellowships. Those are the short little ones that are coming in. I remember going back and looking at the residency data. Don't quote me on this number, but I think only eight are actually in a residency position.

[Matt Strauss, Conservative, Kitchener South—Hespeler, ON]

I see.

Likewise in psychiatry, the visa trainee positions have doubled over that same period. That's on the next page, about seven rows down.

[Geoffrey Barnum]

Yes. That has gone from 32 in 2020 up to 67 in 2024.

[Matt Strauss, Conservative, Kitchener South—Hespeler, ON]

I just draw the committee's attention to this. The overall totals, likewise, have massively increased. They've increased by 50% over the last five years.

At the back of the report, section C talks about IMGs in Canada, but the tables there exclude visa trainees. From the report, we don't know if these visa trainees are staying in Canada. Is that because they aren't? As a rule, do visa trainees go back to their home countries?

[Geoffrey Barnum]

Legally speaking, yes, they should be returning to their home country after the conclusion of training.

There is a study out there that I did with Dr. Maria Mathews, I think it was, where we did try to look up some of these visa trainees a couple of years down the road. It was a very small percentage that we were able to find again and who had gone through the legal immigration process to return to Canada and practise medicine.

[Matt Strauss, Conservative, Kitchener South—Hespeler, ON]

I see.

Since anaesthesia is such a big part of it, I'd like to ask Dr. Anand some more questions about visa trainees and anaesthesia, since he's an expert and he's here.

I have a quick story. I did a critical care fellowship with a gentlemen from Egypt who was an anaesthetist. He came here and did a fellowship in cardiac anesthesiology. They liked him so much at Western that they asked him to stay, but the requirement was that he redo his whole training, that he go back to PGY-1 in anaesthesia.

Do you have any reflections on that? That seemed crazy to me. It seemed, frankly, that he was being taken advantage of.

[Arun Anand]

Was that Ashraf Fayad?

[Matt Strauss, Conservative, Kitchener South—Hespeler, ON]

No. It was Ahmed Hegazy. He's a professor at Western now. He's a fantastic guy.

[Arun Anand]

Yes, and you know, I think that is a bit ridiculous. My experience in Ottawa was that there were foreign-trained people who came and did the year fellowship. They were phenomenal and went through a different pathway to receive licensure in Ontario. The University of Ottawa had to say that there was some special need for physicians, that they actually wanted to hire Canadian grads into their department, and they had to make some sort of case to hire these exceptional people. Then they came and they became faculty and teachers and some of my mentors.

[The Chair, Liberal, Hedy Fry]

You have one minute.

[Arun Anand]

They're great, but then they're locked into the hospital or program that they're at. They don't have the mobility.

Even now for some of my mentors who I'm trying to get out into Alberta, even though they've been practising in Ontario for 20-some years, they're having difficulty getting licensure into Alberta. I'm bringing them in for some initiatives here, and there's a freeze and some roadblocks with the CPSA.

[Matt Strauss, Conservative, Kitchener South—Hespeler, ON]

In the little time that's remaining, there are 185 visa trainees who are training in anesthesiology and going back to their home country after, as they're legally required to.

In your view, how great is the anesthesiologist shortage in Canada right now and how much could 185 extra trainees help to ameliorate that, qualitatively?

[Arun Anand]

I think the 185 trainees would help substantially. There is still a continued worldwide shortage of anesthesiologists, as I'm aware. I think we need to be innovative in some of our approaches, whether we use clinical assistance, anaesthesia care teams or different models to improve the delivery of care in innovative ways and improve our training and output of qualified professionals.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

I will now go to the final questioner. That's for the Liberals.

Mr. Eyolfson, you have five minutes, please.

[Doug Eyolfson, Liberal, Winnipeg West, MB]

Thank you, Chair,

Dr. Anand, I was listening to Mr. Bailey's comments about having to apply and pay for a licence in every province if you want to do that. I agree completely. I used to have an Ontario licence. I was doing some locums in Toronto. First of all, just to get that second licence, I had to jump through a lot of hoops. Then I had to pay the licence fee. When I wasn't doing that work, I wasn't allowed to pause it; I had to actually cancel it. If I wanted to go back, I had to start from square one. I agree with what Mr. Bailey said. It's an absolutely absurd process.

The federal government has tried over the years to establish pan-Canadian licensure. We always get the same response. We get the provinces pushing back, saying that this is provincial jurisdiction, so stay in your lane.

Should your colleagues be advocating en masse to your provincial authorities to say that you need this to improve access to health care in Canada?

[Arun Anand]

There are separations between federal and provincial jurisdictions probably for a reason. That's a little bit outside of my expertise, but I definitely think that colleges can all communicate, coordinate and create processes and agreements amongst themselves, similar to what we see in the Atlantic region, so that we can utilize our workforce more efficiently.

[Doug Eyolfson, Liberal, Winnipeg West, MB]

Absolutely. I agree with that as well. I find the frustration.... From the federal government, I would love to see this happen, but we get push-back from the provinces saying that it's none of our business.

I do agree with you that this is something we need to do. We need to talk with our provincial counterparts the way they have in Atlantic Canada. There's now affordability of the licensure through the Atlantic provinces. I would certainly be an advocate for our colleges to establish the same throughout Canada.

In regard to medical training, we've talked about this before. I talked about it in the last round. There were changes to medical training back in the early nineties. I graduated from med school in 1993, which is pretty much when they made those changes. There was the opportunity for the general practice, the GP licensure.... You did an internship, which was one year. There was advocating for doing this for two years, which many agreed with. Then they switched gears and said there's no such thing as a GP. They used to have people who, if they didn't get matched to a residency to do their internship, could work as a GP for a few years and then go back into anaesthesia, surgery and these sorts of things or some people just liked it and decided to stay as that.

Do you think that in the medical profession there would be any opportunity or any appetite for restoring that kind of system where you have that so-called third pathway to licensure?

[Arun Anand]

I graduated medical school in 2012 and finished residency in 2017. I had heard about those programs, especially within the context of having ICU extenders and things like that in the residency program. I think that trainees welcome those opportunities; however, with what we have currently, where you have a GP who can do additional training and become a GP anesthesiologist or a GP OB or whatnot, I think that there are limitations in that. In Alberta I saw that we had a lot of GPs become GP anesthesiologists, and then a GP was lost in the community.

I would advocate more towards innovative care delivery models where you have anaesthesia care teams, for example, and have anaesthesia assistants and one anesthesiologist running two rooms, for example. That's a more efficient way than taking a GP out of a community to become an obstetrician or to become an anesthesiologist in a rural community.

I think that they can also provide additional service and complement the system, but taking away from Peter to give to Paul doesn't make a lot of sense.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

That ends this particular round and ends this meeting.

I'm sorry for some of the interpretation problems. It's technology again.

Witnesses, I want to thank you for coming, for giving us your time and for helping us to understand even further and dig deeper into this issue.

Thank you very much.