Health Committee on Oct. 30th, 2025

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

Is that as an independent physician?

[Pantea Barati]

Yes.

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

Is it or is it not the case that we are absolutely crying for mental health physicians in Canada?

[Pantea Barati]

At least in my region, which is Kitchener-Waterloo, the wait time to see a psychiatrist is over a year, and it is offered as only a one-time appointment for consultation, and the follow-up is transferred to the family physician rather than a psychiatrist.

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

You are a Canadian. I imagine you've had experiences with the Canadian health care system. You're working in the U.K. health system. Can you think of any reason that a physician who's working in mental health in the U.K. couldn't do that same work in Canada? Why could we not just recognize U.K. credentials and get you to work tomorrow?

[Pantea Barati]

Unfortunately, I don't have a clear answer to that. There are just rumours going around that we don't want them to work here. Other than the knowledge, everything is similar. Human beings are similar. It's just some culture differences.

The other thing is that the U.K.'s population is much larger than the Canadian population. Their resources are much more limited than our resources. I honestly don't have any clear answer why we in Canada cannot employ a doctor who has worked in another country.

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

I have a couple of questions for the Canadian Nurses Association. I'm an ICU doctor. Over the pandemic, fantastic ICU nurses I had worked with for 10 years up and left. The words they often used were “burnout,” “fed up” or “frustrated.” It wasn't as though aliens beamed away all of our nurses, yet we see emergency rooms shutting down because nurses are burnt out or fed up. Is that about your impression of the situation? Can you tell us what they're feeling that way about?

[Valerie Grdisa]

There are reports about burnout and forced or involuntary overtime, which is a significant issue when you think of someone trying to balance work and life.

Again, there was a massive adjustment post-COVID in almost every position in the health system and in nursing too. We saw a major shift. It goes back to some of the fundamentals we need to have for nurses, like workplace conditions that support choice, such as in scheduling—often they don't have choice in scheduling and they live complex lives— and, obviously, any type of involuntary overtime; once in a blue moon, anybody will stay and do a double shift, but if it's being asked every other day, then they don't feel they have that control in their life.

There's a hidden situation you would know about as a doctor working in the health system. There's a lot of toxicity in the health system because of so many things being out of control. People do leave workplace environments where they don't feel they have any control and/or respect and aren't valued.

That's why we've seen these changes over the last few years with nurses speaking up and speaking out about workplace conditions and increased violence in the workplace. Although there's federal legislation and provincial legislation around no tolerance for violence, there isn't a substantial change in terms of that—

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

What seems so dangerous to me about the situation is it seems like the more nurses get burnt out and leave the workforce, the more the remaining nurses will get burnt out and leave the nursing force. It starts as a snowball rolling downhill that becomes an avalanche.

Would you agree there is a danger to that? If we don't fix this problem and get the nursing workforce optimized, it's going to accelerate.

[The Chair, Liberal, Hedy Fry]

Ms. Grdisa, I have to ask you to answer that in another round. We've gone well over time here. Thank you.

I now go to Mr. Powlowski for the Liberals. You have five minutes, please.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Dr. Grdisa, currently, how many foreign-trained nurses are working in the Canadian health care system?

[Valerie Grdisa]

The rough estimate would be about a quarter. In terms of immigrant nurses, the nurses for whom Canada was not their country of birth, it's almost 50%.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Wow, that's great.

I have to play a bit of politics here. I bring it up because the Conservatives have continued to try to portray this image that the problem with the health care system is the number of immigrants, whereas the reality is a big part of the fact we still have a health care system is because of the immigrants. We owe a big thanks to all the immigrants working in nursing.

Could you talk about agency nurses? I know up around Thunder Bay and in northwestern Ontario this is a big issue and a problem coming out of our lack of adequate numbers of nurses. I certainly hear a lot about it. Not only does it cost the hospitals a lot to be bringing nurses up from Toronto but it creates animosity within the health care facilities when the local nurses are making significantly less than the agency nurses.

[Valerie Grdisa]

I do want to recognize the Canadian Federation of Nurses Unions for bringing forward a report that clearly outlines the risks related to any health system or organization when a certain percentage of your workforce is not actually the permanent workforce. There's such a significant compensation differential.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Could you send that report to us? We could, then, possibly include it.

[Valerie Grdisa]

Definitely. I can ask my colleagues at the CFNU.

When you're a nurse, and you're committed to your organization or your unit, and you're working, and someone beside you comes in under an agency staffing model at a higher price point, they're bringing home more money and there's not that continuity for the patients and families, that is not the model of care that should exist anywhere, in any jurisdiction, in Canada. We should have staffing models that actually staff to what we anticipate the population health needs are for communities, and then we should create the conditions within those organizations, with the right price point—meaning the right compensation models—to keep nurses in place. That's what we're struggling to do in Canada right now, retain our nurses.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

My wife went to nursing school in the Philippines. We are still in contact with a lot of the people she went to nursing school with. A number of them came to Canada. It certainly impressed me...the variability of requirements from province to province and time to time. Sometimes they couldn't even get in and licensed in certain provinces, but then in other provinces they were in there within a couple of days after they applied. The same goes for the United States. Is there any kind of homogeneity of requirements among the provinces, or is it just a catacomb of different requirements?

[Valerie Grdisa]

I think it's important for everybody to understand the regulators actually set, for the four types of nurses, the entry-to-practice competencies. They actually accredit the nursing education programs to deliver the education that meets those competencies. Then, there's a nursing licensure exam, the NCLEX. It's a national exam, at least for the registered nurses, for example, and there are exams for the other three types.

You would think that, when the entry-to-practice competencies are set on a standard level, the accreditation's on a standard level and, at least for the RNs and the nurse practitioners, there is a national licensure exam that has the same consistency, there wouldn't be these problems we're facing in terms of harmonization across the 13 jurisdictions.

[Valerie Grdisa]

That's what we are appealing to, as the Canadian Nurses Association. We have all of the components but, for some reason, we still have this fragmentation.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

You said that federal money went to the Canadian school of nursing to help create bridging programs. How much money went into that? How many people have actually gone through those bridging programs? I know you're not going to get to it, so could you make written recommendations as to what we should do in terms of more funding and creating more such positions?

[Valerie Grdisa]

I'm sorry, but I don't have those exact numbers. I can definitely get them from the Canadian Association of Schools of Nursing, about the success of the program. I have seen reports. I just don't have them with me.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Yes, and also recommendations as to the need for more funding and the number of people who have gone through the program.... Thanks.

[The Chair, Liberal, Hedy Fry]

I want to thank the witnesses for coming and for giving us their time and expertise to help us understand this complex issue.

Now I will suspend so that we can bring in the next hour's witnesses. Thank you.

[The Chair, Liberal, Hedy Fry]

I call this meeting to order.

I thank the witnesses for appearing. We have two witnesses and we have a one-hour meeting.

I would like the witnesses to know that you each have five minutes to speak. I will give you a one-minute and a 30-second warning, so you can wrap up. Sometimes you don't get to finish, but during the question and answer period you will get an opportunity to expand on what you want to say.

The second thing I'd like to say is you need to speak through the chair.

Third, turn off your microphone while you are not speaking; otherwise, it creates feedback for the interpreters, which actually harms their ears.

Mr. Powlowski, please do not turn on your microphone until you're ready to speak. It creates feedback, as I'm told by everyone here. Thank you very much.

We have with us two witnesses.

From the American Canadian School of Medicine, we have Dr. Andrew Padmos, executive vice-president. As an individual, we have Dr. Sandra Rao, who is an emergency room physician.

I'll begin with Dr. Padmos. You have five minutes, sir.

[Andrew Padmos, Executive Vice-President, American Canadian School of Medicine]

Thank you, Madam Chair, for the opportunity to speak.

It wasn't my intention, but I happened to listen to yesterday's meeting and thought that I had some things to contribute and misunderstandings to correct. I have distributed notes, because I have quite a few things to explain about a very complicated system of education, training, licensure, certification, residencies, fellowships and the difference between various categories of physicians that we need badly in Canada.

My own story is that I attended McMaster University a long time ago, in the first class of their medical school. I stayed there for my training in internal medicine and hematology. I practised first in Calgary, but while I was there, several colleagues were going off to Saudi Arabia to a fabulous hospital. My wife and I and two young boys left for what we thought would be a year or two but turned out to be 15 years of a marvellous experience. I was the only hematologist in Saudi Arabia when I went. I had recruited 12 into the department by the time I left, and we were very busy with a program for the whole kingdom.

I returned to Canada in a quasi-administrative role in Kingston at the cancer centre there. I moved to Nova Scotia as the head of cancer programs in the province. I then moved to the Royal College, where I was the CEO for almost 15 years. Since I sort of retired in 2020, I have been building a medical school at Toronto Metropolitan University in Brampton on an interim dean basis. Then I will hand it over to Dr. Teresa Chan. I'm now working with the American Canadian School of Medicine, the only not-for-profit private medical school in the Caribbean.

Visa trainees are a particular interest of mine because, in 1978, when I was newly at King Faisal Specialist, the first four Saudi graduate physicians from King Saud University came to the hospital to ask about Canada and doing their training there. I told them what I could. They asked about Winnipeg, Toronto, Vancouver and other places. The first one actually turned out to take his training in Halifax. They liked it very much. They were treated very well, and many of their colleagues started following.

By 1990, there were literally dozens of Saudi trainees in Canada. That program then started a visa trainee program, which now has 1,100 Saudi physicians taking training at various stages in Canada. However, it's a misconception to think that those positions the Saudis are filling, if vacated, would provide spaces for Canadian students or those who are immigrating into Canada with an MD. These positions for visa trainees are extra and in excess of those provided through provincial funding, which is matched against what are the perceived needs in Canada.

If those 1,100 positions disappeared, we wouldn't actually have any new positions for other trainees, including Canadians studying abroad, unless the provincial government provided salary support for those positions. In which case, those visa trainee positions would disappear, because they're offered by the universities in terms of having excess capacity only. Currently, out of the 1,100 visa trainees in Canada, only about 120 are in entry-level positions. Twenty-five or so are in family medicine, but even there, they're in their second or third year of training, so, again, their absence or disappearance would not actually create some space.

I'll turn to the problem of our workforce. Our problem in respect of Canadians studying medicine in Canada is that we don't have enough medical schools. I participated, as I said, in opening a school in Brampton that took in 94 students this September and 105 resident positions in postgraduate training. That's only the 18th school.

In comparison, Saudi Arabia, which has the same population, has 38 medical schools. Many of them are private. I have a consulting position to help a new medical school start up in Saudi Arabia, and they're looking for their colleague physicians who did their training in Canada, because they're so highly regarded in that country.

Our problem for Canadians studying abroad in the Caribbean or Australia, as you heard yesterday, is that they can't or even don't apply for residency positions because they feel they won't get them.

That's not as true as it was 10 years ago. Provinces are making designated positions available, and in the match this year, something like 638 international medical graduates were given residency positions at the entry level.

It isn't quite the same problem as it was. Those who apply from outside Canada actually have an 80%-plus chance of getting a residency. The problem is, in the Caribbean, Canadian students—there are 3,500 around the world and about 1,200 to 1,500 in Caribbean medical schools—don't even apply because their schools give them clerkships in U.S. hospitals. The U.S. hospitals find them residencies nearby, because they want them to practise there, so they feed the U.S. hospitals with patients. In Canada, we don't tend to view patients as a revenue source. We see them as a cost and try to reduce the number, but not in the U.S.A.

Many of our Canadian students, who pay their own way to medical school, end up practising in the U.S. I think that's unfortunate. It could be reversed if we provided clinical clerkship positions in Canadian hospitals where those undergraduates would be able to find a clerkship and residency in Canada, because they would audition and create a network that would help them do that.

Thank you.