Human Resources Committee on Sept. 21st, 2006

[Brian Storseth, Conservative, Westlock—St. Paul, AB]

Thank you very much, Mr. Chairman.

I want to thank you all for coming and giving such concise testimony. I also want to thank Dr. McMillan for coming and providing some insights that I haven't heard in regard to rural recruitment and retention.

Obviously, doctor recruitment and retention is a major issue in my rural community in northeastern Alberta, but I want to shift the focus a little bit to the pharmacy aspect of things, because it's also a very major issue. These people are a vital component of our rural communities. I believe they're having to put in time and hours above and beyond what you would have to do in an urban community to give the same level of service.

I was very interested, in looking at your Pharmacy Examining Board of Canada, which obviously looks after the licensing requirements and qualifications of your industry, to note that you have an MRA signed, I believe, with nine provincial jurisdictions. I wanted to get your input on how you feel this has been working within the pharmacy industry.

Has it increased mobility by taking down some of the barriers within the industry? Is the industry seeing it as a success?

[Janet Cooper]

We've actually, just in the last few months, started looking. We had funding from HRSDC to look at a lot of these issues. Prior to this, only medicine and nursing had funding to look at health human resource issues. Now some of the other professions are getting money, and pharmacy, fortunately, is one of them, but there certainly need to be more.

I don't think there's really been any study yet on how that MRA that was signed five years ago has worked. We do know it takes a lot less time. Alberta is a fairly attractive province for pharmacists, and I don't think they're a big exporter of pharmacists. Some other provinces, like Saskatchewan, export a lot of their pharmacy graduates. Still, the challenge in rural areas is huge. The pharmacists there, when they want to sell their stores, often can't find anybody to sell them to, or they can't get anybody to come in and do a locum so that they can actually take some time off. It is a big challenge, but we don't yet have the data, and that's one of the things that we need across the profession--better data. We're starting to collect that, and we'll be able to tell you more in a year from now about just what the really big challenges are.

It certainly is a concern in smaller towns and rural areas to actually have a pharmacist, because often that might be the only health care provider who's there. They may not have a family physician, but at least if they have a pharmacist, it is somewhat of a help.

[Brian Stowe]

Just anecdotally, I get the impression that where it was initially going to provide immediate benefit was in moving in these international pharmacy graduates. They were getting licensed in Saskatchewan and then moving straight into Ontario. I heard first-hand of these cases, that now it would be easier to get around the Ontario restrictions so that the chain pharmacies could bring them into Ontario. I think, again, it comes back to the international pharmacy graduates.

I want to reinforce that this isn't our solution, bringing pharmacists here. I was down at a conference in Brazil. We're bringing pharmacists in from South Africa, where pharmacists are trying to mount an educational program against HIV. It isn't responsible action by Canada to pull these pharmacists from these countries to solve our human resource problems here.

[Brian Storseth, Conservative, Westlock—St. Paul, AB]

Indeed, I'm asking here more about the availability for mobility across the different provinces. We've asked the physicians. Do you see any potential solutions for our rural pharmacy needs?

[Janet Cooper]

We were actually part of the work that CNA and CMA did on looking at rurality, and Lisa spoke to what a lot of the issues are. There is a shortage. Often in small communities they're independently owned pharmacies as well, and a lot of the larger chains and franchises have a lot more opportunities to recruit--incentives and those types of things.

One of the things that came up is that if you can bring pharmacists from those smaller communities in to train, there's a lot better chance that they will go back to those smaller communities. As Brian said, a lot of the faculties don't look at the geographic population within the province any more. That may be something they need to look at again.

[The Chair, Conservative, Dean Allison]

Brian, 30 seconds.

[Brian Storseth, Conservative, Westlock—St. Paul, AB]

I want to ask HEAL a question. Under section B you talk about strategic directions, recognizing regional centres of excellence. I just want to get you to expand a bit on both, where you see that fitting into your vision.

If anybody else wants to answer, it's being used in Alberta. I just want to see if they're overlapping.

[Pamela Fralick]

I'll make one comment. We do have the more detailed background document, which expands on each of those, and I was just trying to find the place. But I'll defer to CMA to comment on that for you.

[Dr. William Tholl]

To give one example, it took a commission of inquiry to determine that in Winnipeg, pediatric cardiac surgical cases weren't going as well as expected, and that kids were dying unnecessarily because there wasn't the critical mass of cases to support a good quality pediatric cardiac surgical program. So now all pediatric cardiac surgeries are being referred to the Capital Health Authority from all Manitoba, all Saskatchewan, all Alberta, and northwestern Ontario to try to create this centre of excellence in care. That would be one example of high-level tertiary and higher-level care services, where we need to see this kind of interprovincial cooperation.

[Brian Storseth, Conservative, Westlock—St. Paul, AB]

So it is the same kind of--

[Dr. William Tholl]

Right.

[The Chair, Conservative, Dean Allison]

Okay, that's all the time.

We're going to move to the third round, and we're getting tight on time, so we're going to move the questions to three minutes so we can get more people in.

Mr. St. Amand, you're away, for three minutes.

[Lloyd St. Amand, Liberal, Brant, ON]

Thank you. I'll try to ask a pointed question then, Mr. Chair.

Thank you, each of you, for your cogent presentations this morning and this afternoon.

Certainly the case has been made by all of you that--if I can phrase it this way--within each component of the health care system there is a relative lack of coordination or symmetry, and among the various components there is a relative lack of coordination. Something needs to be done.

I just wondered if--and I'll ask this specifically of Ms. Fralick--one of your recommendations is the establishment of a Canadian coordinating office for health human resources. I have two questions. First, has that ever been attempted, and if so, was it abandoned or suspended at some point? Second, what can we learn from Germany, Belgium, and France with respect to a national office?

[Pamela Fralick]

Thank you.

This coordinating office referred to by HEAL is the same entity we've all been talking about this morning, so I won't repeat those comments, but that is what we're talking about. In terms of international information, I don't have a response to that right now, but perhaps one of my colleagues knows more about that international scene.

Bill?

[Dr. William Tholl]

Thank you, Mr. Chair.

There are two points. One is what we're asking for is that we do no more and no less for people than we do for technologies. Since 1989 we've had a Canadian Coordinating Office for Health Technology Assessment. All we're asking is to start to look at what we can do. Is it possible? Is it feasible? Of course it is. We've done it for technologies and collaborations. Now we only evaluate technologies once and then leave it to the provinces to figure out whether to buy them or not.

As for the European experience, the European Economic Community has eased mobility throughout Europe in terms of licensing and mobility of physicians and others and has created offices, like the one we're suggesting, in The Hague and elsewhere to try to coordinate.

[Lloyd St. Amand, Liberal, Brant, ON]

Thank you.

If I have time left--and I hope I do--Mr. Russell has a brief question, I think.

[Todd Russell, Liberal, Labrador, NL]

Yes, I do, a very brief question.

I grew up on the south coast of Labrador, in a very small community of 50 people. Seeing a doctor was a major community event. Pharmacist? We didn't know how to spell it or what it was. This is true, and not much has changed to this day.

I know what you are talking about is very important: more professionals in the health care system, trying to take away barriers of all sorts. But living in a rural area, in a very remote area, largely aboriginal, how does your strategy hope to address this issue? In rural and remote Canada, northern Canada, the issue of access has different connotations than it does for people in urban Canada. The issue of wait times has a whole different meaning in rural and northern Canada than it does in urban areas. I notice it's not just about having more people; it's about how we have people stay in these areas. It's a question of resources, particularly when you talk about the employer attracting people. There have to be numerous incentives, it seems, to get people in northern and remote areas. I'd just like some comments on that particular facet.

[The Chair, Conservative, Dean Allison]

Ms. Sholzberg-Gray.

[Sharon Sholzberg-Gray]

I think an example of effort would be the members around our board table who run health systems in Nunavut, the Yukon, and the Northwest Territories. There are a number of solutions. They aren't all involving more health human resources on the scene because it's not necessarily available, but certainly recruitment in tension areas and appropriate workplace environments and incentives and so on....

The other issue is that tele-health and new technology are used a lot, so that we can share information without necessarily being there in person and we can actually take care of people without being there in person. Across this country there are magnificent moves forward in tele-health. I wouldn't want to lose the notion also of centres of excellence, of making sure that people who need to be taken are taken by airplane, by helicopter, and what not to the centre of excellence that can better meet their needs. You can't have a full set of services in every single remote community, but you can meet needs through a combination of tele-health, through a combination of nursing stations. Here we're talking about using people according to their skills and competencies and not worrying too much about scope or practice and competitive professional disciplines and so on.

There are a number of solutions and people are working on them, but I agree it's a specific and extreme challenge, particularly when we're talking about managing the chronic conditions of people on an ongoing basis. I really do think new technology is one of the solutions, together with health care, which means that health professionals--this is the other thing--need to be trained in those technologies in the future.

[The Chair, Conservative, Dean Allison]

That's all the time we have for this question.

Ms. Yelich, last question, and you have three minutes.

[Lynne Yelich, Conservative, Blackstrap, SK]

Thank you.

That was really very interesting. I have a quote by someone from the Fraser Institute and I just want you to comment on it. It says:

The only way for Canadians to ensure that they have enough doctors to meet demand in the long term is to deregulate the supply of physician services.

I would like a comment from each of you, if you agree or disagree with that.

[Dr. William Tholl]

Through you, Mr. Chair, there are at least two ways to respond to that. One is deregulate in the sense of taking regulations off that regulate the quality of training. I think that's a non-starter. So maintaining...and maintaining a universal quality standard across the country.

Deregulating supply is an interesting concept. I think the provincial governments whose business it is to fund undergraduate training programs unfortunately still see doctors, nurses, and others as cost centres rather than value centres. I think rather than looking at deregulating supply and forcing down price, I would be looking more at what we're trying to suggest, which is a better approach to planning--needs-based planning.

[Lynne Yelich, Conservative, Blackstrap, SK]

Although we don't have time today, I would like to hear more from you along the lines of the inefficiencies in the whole system, in the deliveries. We all know that we can go down to the health districts and we can see the way they spend money just because they have jurisdictional issues. I think that inefficiencies aren't covered, because it seems like when they address inefficiencies they cut the doctors and the nurses, or else they put the workload on the doctors and the nurses. They're all overworked, so who wants to have a long life in either of those careers when in fact they are making up for the inefficiencies that I think can be done through regulations sometimes? Sometimes the expectations of doctors and nurses, particularly, are almost prohibitive--the documenting they have to do. My experience with nurses is they want to be nurses; they don't want to be always documenting.

I am particularly interested in your comments on that, if you have any.

[The Chair, Conservative, Dean Allison]

Ms. Little.

[Lisa Little]

I think one of the inefficiencies in the system that can be solved by the federal government is the investment in technology, and particularly around the electronic health record. I was at a meeting last evening and speaking with a person in the community who indicated that his child had left CHEO, the children's hospital in Ottawa. He was now 18 and moved to the adult hospital. There was no transfer of information. He was going there and the health professionals at the adult institution had no record of this child's past history, of his medical condition, of his drug list, nothing. They had to start the process all over again. We hear that time and time again from Canadians. They go in and they have to tell the same story again. They get the same test done again because that physician or that health professional doesn't have access to those results.

I think investment through the Health Infoway in accelerating the electronic health record and getting broadband access out there is a clear will to help inefficiencies in the system.