Human Resources Committee on Sept. 21st, 2006

[The Chair, Conservative, Dean Allison]

We'll get this meeting started.

Pursuant to Standing Order 108(2), the committee will now commence the study on employment in Canada.

We have five witnesses today. Because of the limited amount of time, we ask that you limit your presentations to seven minutes. We'll try to give you a one-minute warning, and then we'll cut you off so that the others can make their presentations. Then, of course, the committee will ask questions after that.

I understand you have organized yourselves in the order that you're going to present, which is very impressive.

We're going to start with HEAL, followed by the Canadian Pharmacists Association, the Canadian Medical Association, the Canadian Nurses Association, and, last but not least, the Canadian Healthcare Association.

First of all, I want to thank you all for taking the time to be here today.

We look forward to your comments. We'll get started with the organization HEAL.

[Pamela Fralick, Chief Executive Officer, The Canadian Physiotherapy Association, Health Action Lobby]

First of all, thank you.

Thank you for this opportunity to speak to you today.

Our intent is to reflect the concerns of the health system vis-à-vis the issues under scrutiny by this committee and to bring that whole arena to your attention. We have both common messages, supported by all--

[The Chair, Conservative, Dean Allison]

Sorry, apparently we're having a translation problem.

Let's start again. Sorry

[Pamela Fralick]

We are presenting common messages that are very important to all of us--

[The Chair, Conservative, Dean Allison]

Let's just hold. We're getting someone else's committee meeting. That could be problematic.

[Technical difficulty--Editor]

[The Chair, Conservative, Dean Allison]

Thank you for your patience. Now that those voices have gone away in my head, we can start again.

Ms. Fralick, if you'd start again, there are about two minutes left. No, no, you have the full seven minutes.

[Pamela Fralick]

Thank you.

For the record, please let me thank you once again for the opportunity to speak with you today.

The intent of those of us in front of you today is to bring to your attention the concerns of the health system vis-à-vis the issues under scrutiny by this committee. We have some common messages that are supported by all who are here before you, as well as some additional messages specific to the constituents being represented.

I'm going to open this briefing with a presentation--very brief, of course--from the Health Action Lobby. And in the event that you're not familiar with HEAL, it is a coalition of 30 national health associations, including those here today in front of you.

Collectively, I must tell you, they have identified health human resources as a key priority, and for most of the members I would say the priority issue of the day. The biggest problem, however, is that we don't know enough about it, and that is why we want especially to bring it to your attention in terms of the interests of this committee. We don't have the data, the information, that we need. The limited efforts that have taken place in Canada in this area have, by and large, been uncoordinated, not connected with one another, and many of the key players, we feel--and referring here to health providers--have not really been valued as significant contributors to both understanding and solving the problem. So HEAL wants to contribute to that understanding and to finding the solutions.

We did circulate to you a document in advance, and I'm going to highlight just a couple of points from that in the event that you've not had a chance to review it with all the many materials you're receiving.

There are three broad recommendations that HEAL feels are critically important for this country to consider if we are to make a dent in the issue of health human resources.

The first is a recommendation around the establishment of an ongoing mechanism to support and promote the exchange of information and policy capacity building among national health organizations on cross-cutting health human resources policy issues and data collection. This speaks to the limitation of the current situation that I referred to a moment ago.

The second of the recommendations is a need for the establishment of a mechanism to provide for routine consultations and exchanges between national health organizations and the federal government on health human resources policy and related issues. It simply isn't happening to the sufficient levels that we need.

And the third of these critical recommendations that HEAL has made calls for the establishment of a fact-finding task force to carry out a rapid assessment of the trends, the prospects, the key issues of the various health disciplines, and this includes the capacity of the educational infrastructure to absorb increased enrolment at both the entry or undergraduate levels and post-graduate levels as well as the availability of practicum opportunities.

HEAL has gone further in its work to bring some concrete contributions to this discussion, and that is all contained in the report you've received. We feel that there are three themes that must guide this country's approach to a healthy, vibrant, and effective health workforce: patient-centred care, planning, and the career life cycle. Moreover, we've agreed on 10 key principles that must underpin these three themes. Again, you've been provided with the detailed information, but I would like to make brief reference to three of these principles.

The first is the number one principle in the document. It refers to needs-based planning--population needs-based planning. In this country we've focused on the supply side of the equation, the number of personnel or equipment that is needed. However, today we must look at things differently. Planners must adopt a needs-based approach, which is not looking at costs but rather investments to the health system. It should anticipate the current and emerging health service needs of the populations that are determined by demographic, epidemiological, cultural, and geographic factors and that take into account the evolving delivery models and technological change. There is, of course, also that very important interface between the publicly funded health system, the private health system, and the public health system.

We cite four strategic directions that we feel can contribute to advancing this particular issue. We need an in-depth analysis of population surveys and epidemiological data--there is some out there, but it needs to be used and we need more--benchmarking based on regional variations, a review of the specialty mix within and between disciples, and the development of leadership for system change.

The second principle I want to cite briefly refers to a need for inclusive policy planning and decision-making processes and it supports the comments I've just made.

Policy planning and decision-making in the area of health human resources must include representation from all stakeholders involved. Yes, with governments, but also regional health authorities, educational and regulatory authorities, and of course practising professionals. The strategic directions we suggest that might support that include the establishment of some kind of a Canadian coordinating office for health human resources, distinct and at arm's length from the government, bringing neutrality and objectivity to the issue.

We recommend the provision of exchanges between the provider community and the FPT, federal-provincial-territorial advisory committees. We also recommend the promotion of provider representation at regional and institutional governance bodies. Finally, we recommend the promotion of inter-sectoral discussions on healthy public policy.

The final note I'd like to bring to your attention before passing on to my colleagues is a call for healthy workplaces. We speak especially in the healthy workforce of the difficulty of recruiting and retaining people, of worker morale. It is a difficult field to attract people to despite the advancements that have been made in the last couple of years. Health care administrators and decision-makers must recognize the importance of healthy workplaces and collaborate with health care providers to implement strategies to support their health and safety.

We do recommend the need for some best practice approaches, educational programs, and the need to promote a cultural shift to encourage help-seeking behaviours among health professionals themselves.

I know you'll have many questions, but at this point I will end my comments and turn to my colleagues from the Canadian Pharmacists Association for the next presentation.

Thank you. Merci.

[The Chair, Conservative, Dean Allison]

Thank you very much.

You've set the bar high. You are under your seven minutes. We'll see if everyone else can do that.

We'll move on to the Canadian Pharmacists Association.

[Brian Stowe, President, Canadian Pharmacists Association]

Thank you.

Good morning, ladies and gentlemen. Thank you for the opportunity to present to you today along with our G4 and HEAL colleagues.

My name is Brian Stowe. I am president of the Canadian Pharmacists Association and an independent pharmacy owner here in Ottawa, at Carleton University. I am joined by my colleague, Janet Cooper, who is our senior director of professional affairs.

The Canadian Pharmacists Association, or CPhA, is the national voluntary organization of pharmacists. We are committed to providing leadership for the profession of pharmacy and to improving the health of Canadians.

You have been provided with a brief that outlines our recommendations and key issues. CPhA is involved in numerous initiatives to address HHR challenges, in particular those faced by pharmacists and pharmacy technicians.

Before I focus on the recommendations, let me give you some brief background.

Canada's 29,000 pharmacists represent the third-largest health care professional group. More than one-third of our pharmacists are under the age of 35. International pharmacy graduates, or IPGs, are a significant part of the pharmacy workforce, estimated at 20% to 30% of all pharmacists practising today.

Pharmacists are the medication experts of the health care system. The roles of pharmacists and pharmacy technicians are evolving to better meet the pharmaceutical care needs of Canadians, and in particular with respect to primary care.

Licensing standards for pharmacists assure Canadians of appropriate and safe practices. The Pharmacy Examining Board of Canada assesses the qualifications of both Canadian and foreign graduates. Pharmacist mobility across Canada is facilitated by a mutual recognition agreement.

International pharmacy graduates specifically must meet the same standards of practice and have the knowledge and skills of Canadian-trained pharmacists. A key challenge for IPGs is learning how to “be a pharmacist” in Canada.

In the late 1990s, shortages in the pharmacist workforce became evident. It is now estimated that Canada has an unfilled demand for between 1,500 and 2,500 pharmacists in our current workplace.

This is at a time when concerns about the safe, appropriate, and cost-effective use of medication is at an all-time high, and when numerous reports, including those of Romanow and Kirby, have pointed to a role for pharmacists in optimizing pharmaceutical care.

The FPT governments have identified pharmacy as one of seven health professions to receive priority HHR action.

Work is now under way to improve planning in the pharmacy sector. A new study titled “Moving Forward—Pharmacy Human Resources for the Future” is a joint initiative led by CPhA and funded by HRSDC. As well, CIHI is developing a database of licensed pharmacists in Canada.

Today we offer you the following recommendations to support a coordinated approach to health human resources and to address specific challenges facing the pharmacy profession.

1. A pan-Canadian HHR strategy must emphasize patient safety and quality care and take a population needs-based planning approach.

2. A pharmacy-specific human resources plan must be developed to ensure a strong pharmacy workforce to meet the present and future pharmaceutical care needs of Canadians. This plan must be integrated into overall HHR planning.

3. Research and better data are needed. The “Moving Forward” study and the CIHI database will greatly improve this situation.

4. We all need to be open and committed to interdisciplinary care, with pharmacists contributing their expertise.

5. Current licensing standards for pharmacists need to assure Canadians of appropriate and safe pharmacy practice; a bar must not be lowered in an effort to license foreign-trained pharmacists.

6. Further initiatives are, however, needed to support qualified international graduates to become licensed and to integrate into pharmacy practice in Canada. This includes expanding the availability of bridging programs for these students.

7. In the longer term, Canada must become more self-sufficient in meeting its health workforce needs and should not depend on international graduates to make up our shortfall.

8. I would now like to speak on behalf of my colleagues from G4 and HEAL.

Health care providers must be at the table to support needs-based HHR planning. We want meaningful and ongoing engagement to exchange information and to support best practices and capacity building among governments, health professionals, and other stakeholders on cross-cutting HHR issues.

Finally, a permanent national HHR body such as an agency, institute, or centre needs to be set up to support a truly integrated approach to meeting the needs of Canadians. All stakeholders need to be involved. Such an organization would address a broad range of issues, including scopes of practice, integration of internationally trained health professionals, and healthy workplaces. This body should also support research on population health needs assessment and planning.

Thank you for your attention. Janet and I will be pleased to answer any questions you might have.

[The Chair, Conservative, Dean Allison]

Thank you, Mr. Stowe and Ms. Cooper, for the presentation.

We're now going to move on to the Canadian Medical Association, and I believe we have Mr. McMillan.

[Dr. Colin McMillan, President, Canadian Medical Association]

Thank you, Mr. Chair.

Ladies and gentlemen, good afternoon.

It's a pleasure, as a full-time practising physician from the province of Prince Edward Island, to address you today on behalf of the Canadian Medical Association, with our fellow professionals.

I have with me today Mr. William Tholl, our secretary general, and it is our understanding that our colleagues will deal with a variety of other issues in relation to the mandate of your committee.

What I hope to do today is to concentrate on three areas. One is national standards for medical education and the practice of medicine in Canada. The second is the integration of international medical graduates into the medical workforce. The third is the recognition of foreign medical credentials.

Before expanding on these areas, however, I want to briefly update your committee on the current status of the workforce of physicians in Canada. Accompanying our submission to the committee is what we refer to as the GAP graph. This graph shows Canada's physicians-to-population ratio in comparison to other areas, particularly the OECD average. At present, Canada ranks 26th out of 29 OECD countries in the physician-to-population ratio. For the past decade, Canada's ratio has stood at 2.1 physicians per 1,000, one-third below the OECD average of 3.

This gap tells us that poor human health resource planning in the 1990s has led to an inadequate supply of physicians currently. While there have been some improvements, our projections show that a significant gap will be maintained when it comes to physician-to-population ratios.

As a general rule, Canadian physicians tend to be older than the general working population and a good proportion of them will be retiring. Adding to this are the increased demands of an aging population. Advances in technology could create a perfect storm with respect to our physician supply.

Therefore, Chair, I would submit that physician shortages will continue to undermine any and all efforts to improve timely access to quality care from physicians. The lessons of the past show clearly that there is a need for effective pan-Canadian health human resources planning, as our other colleagues have indicated.

As to the three major issues of the day, one is national standards. We believe that medicine has worked hard to maintain national standards for both medical education and the practice of medicine in Canada, and while the application of the standard is open to interpretation, it has provided both transparency and uniformity in what is required to practise medicine in our country at all levels.

These standards will help ensure that all Canadians have access to the highest quality of medical care, no matter where they reside.

The second area I would like to touch on with you is the area of international medical graduates. To begin with, I would try to address a couple of common myths. The first is that Canada is a closed shop to foreign graduates, and secondly, that the Canadian medical community is a barrier to their integration.

Ladies and gentlemen, the facts are otherwise. International medical graduates comprise at least one-fourth of our active physicians in many parts of the country. Each year at least 400 international medical graduates are newly licensed to practice in this country.

At present, we and other groups, including the licensing authorities--the faculties of medicine and other groups--all support improvements to integrate the international medical graduates into the Canadian medical workforce.

We have historically relied, and will continue to rely, on the tremendous contributions of international medical graduates, and the medical community has consistently called for, and will continue to call for, further resources to integrate these graduates into our community.

The reality is, however, that we train fewer physicians than we need, and not only is our capacity inadequate in the undergraduate level, but also at the graduate level. And we are failing to provide enough resources to meet the demands of training Canadian medical graduates, let alone addressing the needs of the foreign graduates.

We feel the solution to this quandary is to develop short, medium, and long-term strategies for integrating international medical graduates into the medical workforce.

In the short term, the federal government could provide funding to clear the backlog of qualified international medical graduates--maybe as many as 1,100.

In the medium term, all governments at all levels need to work with key stakeholders in the development of sufficient health, education, and training opportunities.

And in the long term, we feel Canada must adopt a policy of self-sufficiency in the education and training of all health professionals in Canada.

A recent pilot project in Ontario was funded to allow international medical graduates to qualify and work as physician assistants in supervised medical practices. We think the federal government should support such initiatives.

The last area is that of foreign medical credentials. At present, the CMA supports the creation of a Canadian agency for the assessment and recognition of foreign credentials. With the appropriate mandate, we believe such an agency could play an important and needed role. We propose that it should promote and facilitate the adoption and awareness of our national standards for certification and licensure.

It should also develop procedures for the assessment of credentials of internationally trained professionals. These might include: one, the facilitation of international exchanges with regulatory bodies; two, the development of an evaluation framework to assess the fairness, accessibility, coherence, transparency, and vigorousness of the process to assess foreign credentials; and finally, the development of template materials to promote international sharing of information about career prospects in Canada for various occupations, even before immigration.

In summary, our message to the committee is threefold: one, the importance of national standards; two, we need a more comprehensive strategy for international medical graduates, one that increases and enhances opportunities for all Canadians to have access to medical education at both the graduate and post-graduate level; and finally, that the federal government can play an important role in the area of foreign medical credentials by promoting awareness of standards and facilitating the sharing of best practices.

Mr. Chair, I appreciate the opportunity to present to you today with my fellow professionals. I look forward to your questions.

[The Chair, Conservative, Dean Allison]

Thank you, Doctor. We appreciate that.

We're going to move on to the Canadian Nurses Association. We have Mrs. Little.

[Lisa Little, Senior Nurse Consultant, Health Human Resources Planning, Canadian Nurses Association]

Thank you.

Good morning, Chair and members of the committee. My name is Lisa Little and I am here today on behalf of the Canadian Nurses Association.

We appreciate the committee scheduling this panel of national groups representing health professionals and employers. Our collective purpose this morning is to highlight issues of the health workforce pertaining to employability. CNA will speak to the issue of mobility of workers. Our perspective has three dimensions: mobility between urban and rural, from one province or territory to another, and across international borders.

First let me offer some demographic information about the registered nursing workforce related to the three types of mobility. There are over 250,000 registered nurses in Canada. Of those nurses, 40% are eligible to retire within the next five years and 18% of nurses work in non-urban areas, compared to 22% of the Canadian population.

Saskatchewan, Prince Edward Island, and Newfoundland and Labrador lose 30% of their nursing graduates to work in other provinces and territories across the country. As many as two in ten nurses leave the country within three years of graduation, and most go to the U.S. for full-time employment. According to Industry Canada, during the 1990s Canada witnessed a gross outflow of over 27,000 registered nurses through permanent emigration to the United States.

With those numbers as a backdrop, let me now turn to the issues related to mobility in terms of urban and rural. One of the characteristics of working in rural and remote areas is professional isolation--limited opportunities to network with peers and experts for advice and guidance on evidence and research to inform practice. Further, professionals working in non-urban areas face challenges accessing continuing education. These challenges include distance, cost, as well as lack of replacements.

Research conducted by the Canadian Medical Association and the Canadian Nurses Association identified effective strategies in promoting recruitment of workers to rural and remote areas of Canada. These strategies include investments in electronic information and communications to support work in rural Canada. This is particularly important in light of the recent report by CIHI highlighting the health disparities and mortality rates between rural and urban Canadians.

I will now speak to the issue of interprovincial mobility. Nursing is a mobile workforce. As I previously mentioned, three of the provinces in this country lose 30% of their graduates to other provinces. You should note that this movement of workers is a feature of other health professions as well. Newfoundland, Quebec, and Saskatchewan are net losers of physicians, while Ontario, Alberta, Manitoba, and British Columbia benefit from interprovincial inflow of physicians. You can see this from the graphs I have provided in the speaking notes.

The issue, of course, lies in the fact that each province does its own planning related to education and employment. Each independently projects future health needs. The value of uncoordinated efforts in the area of employability is diminishing. Canada needs to pull together to recognize the growing mobility of health professionals and others. We were pleased to read the recent announcement by governments identifying interprovincial mobility as a policy priority. This has implications for professional bodies, and we encourage this committee to recommend that governments engage appropriate stakeholders to ensure this happens in a timely manner.

Finally, I will speak to the issue of mobility across international borders. The Organization for Economic Cooperation and Development predicts that Canada and the United States will face the worst nurse shortage of all OECD nations within a decade from the perspective of employability. Canadian-educated nurses are an attractive commodity for the U.S. and other recruiters. The projected shortage in the U.S. is one million registered nurses by 2012. This poses a tremendous threat to the Canadian nursing workforce and the health system.

Of the current registered nursing workforce, 6% are internationally educated nurses. CNA projects that proportion will not increase over time due to the global nursing shortage and the U.S. appetite for internationally educated nurses. Federal, provincial, and territorial governments and individual employers are competing with one another in this arena as well. Canada needs a coordinated retention strategy to keep as many nurses as possible in light of the global nursing and U.S. shortage. We must also look to repatriate Canadian nurses from countries they emigrated to in the 1990s.

In summary, CNA supports the call for a pan-Canadian approach to health human resource planning that considers the mobility of nurses and the technologies needed to recruit and retain nurses in all areas of the country.

Thank you. I'm quite willing to take questions when appropriate.

[The Chair, Conservative, Dean Allison]

Thank you, Ms. Little. We appreciate that.

We're going to move to our last presenter, Ms. Sholzberg-Gray from the Canadian Healthcare Association.

[Sharon Sholzberg-Gray, President and Chief Executive Officer, Canadian Healthcare Association]

On behalf of the Canadian Healthcare Association, I would like to say that I am very happy to be with you today.

I'd just like to explain that the Canadian Healthcare Association is the federation of provincial and territorial hospital and health organizations across Canada. Through our members, we represent a broad continuum of services. Here we include acute care, home and community care, long-term care, public health, mental health, palliative care, and so on. Our members are the regional health authorities, hospitals, and facilities and agencies that serve Canadians and are governed by trustees who act in the public interest. Together our network comprises over 900 hospitals and more than 4,500 health facilities.

Having heard from my colleagues representing various professions--and of course from the Health Action Lobby, to which we belong--I'd now like to offer the employer perspective on health human resources, as my members are the employers of many of those who work in the health system.

Broadly defined, our board has defined that our goal is to achieve a stable health workforce with the right number, mix, and distribution of health providers in order to provide access to high-quality care for all Canadians.

We all know why it's so important to address employability issues in the health system. We all know that health is the number one issue for Canadians. But maybe we don't know that the health system in Canada is a major employer. It employs 1.1 million people. One in ten Canadians is employed in the health system. They constitute a highly educated and skilled workforce, greatly contributing to not only the health of Canadians but to our country's tax base as well.

What might not always be known also is that the cost of labour, the contribution of labour, is a major component of our health system. Now, we ought to look at this as a cost, and of course we have to look at it as an investment, but employers naturally always look at the bottom line--as do governments, I'm afraid. What we'd really like to say is that without health human resources, and without making the investments in these costs, we won't have the health system that we value so much.

We all know about the global health shortage; you've heard my colleagues talk about it. We all know, of course, that if we don't deal with health human resource shortages, we won't be able to meet health needs and sustain our publicly funded system, without which we'll lose an important area of competitive advantage for Canadians. Therefore, the federal government must play a leadership role in dealing with HHR issues, and I'd like to address a few of those issues.

First, you heard my colleague mention the need for a pan-Canadian planning mechanism, one that would bring together key stakeholders, key players, including government, so that we can anticipate and plan for future needs and changes in the health system. This is absolutely essential. This body has to link health, labour, immigration, and education policies. Without that we won't be able to meet needs in the health system of the future. It doesn't matter whether we call it a mechanism, a body, or a strategy, we have to have this approach.

I'd like to touch on a few other issues that are particularly important from the employer perspective. First, there's the whole issue of entry to practice. Here we're talking about improving the supply of health providers. There are a number of facets to it, including entry-to-practice credentials. We're pleased that there is now a process for an FPT table, where people are discussing the minimum entry-to-practice requirements for a number of provider groups and professional groups.

We're also pleased that health employers are going to be consulted--or at least we hope they are--about any changes to credentialing for entry to practice. We realize that with a shortage of health workers, if we do anything...and that's not to say we shouldn't. But if we do anything to increase the minimum entry-to-practice credentials, there are issues of shortages of workers and so on; we need periods to integrate and restructure, that type of thing. In any event, we need to stress that employers have to be at the table when these decisions are made, because they hire the people who provide the care.

The other issue is education system capacity. Frankly, we think the federal government has to contribute to this, as do the provinces. We need to increase enrolments for health professions and health disciplines. We also need to supply extra funds for the infrastructure developments needed to accommodate these increased enrolments. We can't forget about that.

We also have to pay for the price, I think, of having appropriate clinical and placement opportunities for health human resources. Nobody can provide health care to Canadians without the opportunity to have a clinical setting, and this includes medical residency positions. There's a role for the federal government to play in helping to fund these training opportunities in the health system across this country.

You've already heard my colleagues talking about foreign-trained providers. The Canadian Healthcare Association believes that Canada must ultimately be self-sufficient, but that doesn't mean we shouldn't work to integrate as much as possible those people who have the credentials to work in the Canadian health system.

We've heard about the data, and we'd like to hear mentioned in particular the work of the Canadian Institute for Health Information in helping to provide data. But the job isn't entirely done. Frankly, if we have this pan-Canadian mechanism that we're talking about, we're going to need more and more data to be able to meet the health needs of the future. So a pan-Canadian approach is absolutely essential.

We think if we make progress in these various areas dealing with entry-to-practise credentials, clinical and placement training opportunities, and the educational sector, making sure we work together to achieve our common goals, we can make progress in meeting the health needs of Canadians.

We've often said that money is needed to support a health system, but we've all heard today that it isn't money alone; it's health human resources. On the other hand, whenever we say it isn't about the money, we also have to have the appropriate resources devoted to achieving the objectives we all agree to.

[The Chair, Conservative, Dean Allison]

Thank you very much.

If I can encourage all my colleagues to be as succinct with their times as the presentations, we'll be able to move through this fairly quickly.

We're going to start our first round of seven minutes with Mr. D'Amours.

[Jean-Claude D'Amours, Liberal, Madawaska—Restigouche, NB]

Thank you, Mr. Chair.

First of all, I would like to thank each and every one of you for taking the trouble to come and discuss with us today a very important issue, which you clearly identified, that is, health professionals and their employability.

My riding is located in rural New Brunswick. I have been told that there is an ongoing high turnover problem and that it is very difficult to keep our professionals in Canada. It is a vicious circle. If we lose our professionals because they are going to the United States, we have to find other professionals from abroad to fill the positions that ours have left.

I would like to ask several questions, but I am going to ask them one at a time and I will see how much time I have left. Obviously, I do not expect you to come up with miracle solutions for us today, but do you think there are more effective ways of doing things so that the health professionals that you represent might be more interested in settling in Canada’s rural regions and providing their services in these areas? As we know, it is often very difficult to find pharmacists and family doctors. It is even more difficult to find specialists. The same thing goes for nurses.

My question is addressed to you all. Do you have any suggestions or solutions to propose in order to improve the situation?

[Lisa Little]

Thank you, yes.

I referred to previous work done by the Canadian Medical Association and the Canadian Nurses Association around a framework for rurality. A number of strategies were identified there on what works to attract and retain people in rural Canada. Basically it needs to look at both professional and personal factors.

Professional factors include having access to other health professionals and being able to network with your peers, which implies access to such things as broadband, the Internet, and new research through technology, as opposed to the physical access you often get in a large academic centre.

Personal factors include focusing on housing for them and looking after family supports and spouses who may be coming, in terms of employment for them and their families. It's a big package. There's no one thing. It's not money alone that attracts them to rural areas; it's a combination of a number of things.

[The Chair, Conservative, Dean Allison]

Doctor.

[Dr. Colin McMillan]

Through you, Mr. Chair, thank you for your question.

We've been looking at this actively. There are a number of things currently under way in our profession and others that are trying to address the issues you raise.

The two issues I would raise briefly are that, first, it's a dual problem of recruitment and then retention. There seems to be some evidence that if you train health care professionals—particularly doctors—who come from rural and remote areas, and have some training there, you can improve recruitment and retention.

There is a new medical school in northern Ontario, which just started, that is designed to do this. There are some outreach training programs now under way that actually train people in those communities with technological hookups to the medical school.

As we speak, there is a project from the University of Sherbrooke to train rural physicians in New Brunswick. There is a second project in the planning stage at Dalhousie University being designed to do the same in your native province.

The second point you touched on in your question at the beginning was the issue of the outflow of physicians to other countries, particularly to the United States. We have some data now that seems to show that for the first time last year, the net inflow of doctors from the United States into Canada was positive, rather than the other way around.

We think we know some reasons for this, so we've set up communications with the American Medical Association to get data on how many Canadians are practising in the United States, where they're practising, and how many of them might be interested in coming back to Canada.

One of the proposals we're looking at is a one time only financial incentive for this to happen.

[Brian Stowe]

In terms of this, you mentioned pharmacists. As I mentioned, one of the challenges is that 30% of our workforce are international pharmacy graduates. Of course, there's a cultural background that these pharmacists come from, and many end up in the urban areas because that's where they find their community. I think that's part of what's driving some of our challenges in bringing pharmacists out to the rural areas.

Back when I went to pharmacy school, there was a geographical distribution model. If you came from a small town, as I did, you received a more favourable step into the pharmacy program. But I think they discontinued that a number of years ago.

[Jean-Claude D'Amours, Liberal, Madawaska—Restigouche, NB]

Thank you, your answers were very interesting.

Ms. Little, a little while ago, you talked about the integration of families in rural settings.

Have any recommendations already been made by your professionals as a whole to tell the rural regions what they expect to find there with regard to quality and family life? Has this process been initiated? If so, would it be possible to receive some written documentation showing what the current needs of professionals are and what they are expecting?

[Lisa Little]

I would refer you to the document. We would be pleased to send a copy of the “Framework for Morality”, which we did with the Canadian Medical Association. It's a study we conducted a number of years ago about the recruitment and retention of professionals in rural and remote areas. We would be pleased to provide a copy, and it's published on our website.

[The Chair, Conservative, Dean Allison]

That's time.

Thank you very much.

Moving along to Mr. Lessard, you have seven minutes, please.

[Yves Lessard, Bloc, Chambly—Borduas, QC]

Thank you, Mr. Chair.

It is my turn to welcome you. Having the opportunity to meet all of you together is quite special. The entire, or almost entire, range of the whole health network is represented here today.

As much as I could, I have read your documents. I think that the Health Action Lobby was the only one to send us any. I was able to skim through the others. First, as far as the handling and analysis of needs is concerned, I notice that there is little mention of prevention. I may be mistaken, but that is what caught my attention.

Then, you quite rightly rank in first place the problem of numbers of workers. However, there does not seem to me to be any analysis of what caused this problem. Knowing some of the causes might help to guide us better in the future.

Furthermore, the financial participation of the Canadian government, in terms of support to the provinces for health, has fallen by almost 10% over the past 15 years. You will agree that health and social services are the responsibility of the provinces. Which leads me to my second question.

Have you considered this aspect with the provinces, either with your associations or with the provincial corporations? I assume that you have done so. I would like to know what their thoughts are.

Finally, you seem very concerned about the idea that there should be supervision, a Canadian overview with regard to management of health and social services. I remind you that this is a provincial responsibility. Nevertheless, if the basic assumption is made that some elements should be handled by the federal government, is that a guarantee of success? We may think, for example, of the monumental failure of the management of the aboriginal reserves by the Canadian government. And this is a federal jurisdiction.

I come back to my first point, namely prevention. Out of 720 aboriginal communities, over 280 do not have drinking water.

You say that a Canadian agency should be created, but do you take into account the fact that, in terms of distribution of resources, analysis and perspectives, what the Canadian government had to manage proved to be a failure as far as health is concerned?