Evidence of meeting #35 for Human Resources, Skills and Social Development and the Status of Persons with Disabilities in the 41st Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was need.
A recording is available from Parliament.
Conservative
Devinder Shory Conservative Calgary Northeast, AB
Could anybody quickly give me an idea of any steps you would suggest that the federal government take to address the future shortage of these skills? We all know that we are and will be facing it. Are there any suggested steps to be taken by the federal government?
Professor, Department of Economics, McMaster University, As an Individual
Can I maybe return to your aboriginal question, which is a massive future need? I think of local examples. The First Nations Technical Institute is the type of partnership that traditional medical schools and nursing schools need to bring people through. These are first nations educational institutions that partner with more traditional mainstream educational institutions.
However, only three years ago, the federal government cut funding to almost all of those institutions. In Ontario, the provincial government stepped in and replaced some of the funding. But this is a real issue: If we want first nations doing those types of activities, we do need to fund first nations education. In fact we've been going the other way in recent years. So I think that's a real issue that we need to address.
I think it's an extremely important issue. I'll mention, for example, that there are four positions set aside in the medical school at Queen's for first nations students, and these are almost always not filled. They are almost always empty. So it's not a matter of there not being positions; it's a matter of having people who are prepared and who have the appropriate background to take up these positions.
Conservative
The Chair Conservative Ed Komarnicki
Thank you, Mr. Sweetman.
Your time is up, Mr. Shory.
Does anyone else have a comment they want to make?
Please go ahead, Ms. Bard.
Chief Executive Officer, Canadian Nurses Association
I think what is critical, as well, is that we need to invest in promotion and prevention programs. We need to reduce the demand. We need to help our first nation communities on the one hand to have better living conditions and try to help them on the other hand to maintain a healthier lifestyle. That is applicable to all Canadians, but certainly we do need to pay special attention because we still have cases in first nation communities where they don't have potable water. The social determinants of health are critical.
So we do need to have some programs that will help restore and also better support the youth to enter into education, and certainly a nursing program.
Conservative
Vice-President, Programs and Executive Director, Quebec Office, Canadian Institute for Health Information
When we look at physicians, there is a perceived shortage. But when you read a bit in the media, you will see there's a perceived surplus coming our way. You already have a surplus of cardiac surgeons and some other specialties, so I think you need to keep this in mind.
In terms of health expenditures, among the three largest expenditure categories, physician expenditures is the one that has been increasing the fastest in the last six years. That may raise some concerns with provincial government.
In terms of the long term, the aging of the population is not a tsunami, because a tsunami wipes out everything very quickly. It's a glacier. What is the issue with a glacier? You know that it will come your way, but you have time to move away from it. We need to think about reforming the way health care is being provided to Canadians for an aging population that needs a lot more primary care and a lot more home care services, which may require a different group of professionals. By focusing on the current professionals who provide the services, we may partially miss the boat regarding the needs of an aging population. We have a lot of time to react because the oldest baby boomers are 65 and will only start to be really demanding of the health-care system when they are 80 or 85. So there is a lot of time to adjust.
Conservative
NDP
François Lapointe NDP Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC
Thank you, Mr. Chair.
Mr. Sweetman, I don't know if your French is good, but I will do mine in French.
As an elected official in Quebec, we are always walking a bit on eggshells when we come to issues related to health care because, in Quebec, this is a fully provincial jurisdiction.
Still, I would like to take advantage of your experience because you are very interesting witnesses. I would like to take advantage of your knowledge to determine whether certain administrative solutions or ways of doing things could help us. We are talking about the lack of human resources. Sometimes the solution is to have more human resources, but it may also mean doing things more efficiently. So I would like to appeal to your pan-Canadian experience on the matter.
I am from a rural region where there is no major city and no city larger than 30,000 people. There are a lot of small towns of 500 or 600 people, and there is a crucial need for doctors who want to stay in the regions. I think the same problem exists in Saint-Pamphile and in Moose Jaw. I don't think it is specific to eastern Quebec.
One of the solutions we've recently heard about involves offering incentives so that trained doctors go and live in the regions. I know that, in Australia, they have addressed the problem from the opposite end, meaning that the Australians choose successful students in the regions and encourage them to become doctors. So when they become doctors, returning to live on the mountain, near the river or the ocean in a small community is something they want to do. It isn't necessary to offer them bonuses to go back to a way of life they enjoy. The Australians have been very successful with this approach.
Would this solution be plausible in Canada to help the regions finally have doctors? What do you think, Mr. Berthelot?
Vice-President, Programs and Executive Director, Quebec Office, Canadian Institute for Health Information
I seem to think there is a university in northern Ontario where the goal is basically to train doctors who will go to the regions.
The allocation of health human resources is a very complex thing. It varies greatly from province to province and depends on how the health care system is organized.
Compared to several other provinces, I think Quebec's doctors are relatively well distributed in the regions.
NDP
François Lapointe NDP Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC
In my region, we've been closing emergency rooms for two years now.
Vice-President, Programs and Executive Director, Quebec Office, Canadian Institute for Health Information
They are also being closed from time to time in urban centres on the other side of the river.
Clearly, there is an issue when it comes to allocating resources. If we take Quebec as an example, it's the province that has the most doctors per capita in Canada. Given the way the health care system is organized, people make more use of the local community service centres and walk-in clinics. As a result, that population has the lowest percentage of people who say they have a family doctor.
The issue is still ensuring that there are health care professionals in the regions. There are the experiences of places like Australia and Ontario that, in my opinion, do not resolve the problem entirely, but that may be part of the solution.
NDP
François Lapointe NDP Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC
Do you think we could use this as inspiration in several Canadian territories?
Vice-President, Programs and Executive Director, Quebec Office, Canadian Institute for Health Information
Yes, I think so.
Professor, Department of Economics, McMaster University, As an Individual
Thank you. It's a very good question.
I agree, actually. Quebec is probably doing the best of the provinces in Canada on this front. So as poor as things look to you, they look worse in other provinces, and we're certainly in the area of provincial jurisdiction right now, not federal jurisdiction.
I think that a large number of policy proposals, or more than a few, could be put forward, but would need intestinal fortitude if they were to be pursued. You could do what Quebec does but even more strongly. That is to say, let primary care physicians or primary care practitioners, not just in medicine but more broadly, be hired by regional health authorities rather by provinces. So if there's a need in a certain area, they hire, and if there's no need on the island of Montreal, they don't hire. That would distribute people.
You could also change the way you recruit into medical school. It's exactly what you're saying. But you could put even a bit more bite into it. You could have people, as part of the admissions process to medical school, make a commitment to where they want to practice, and the admissions committee could take that into account in adjudicating admissions. If the admissions committee had two people who looked the same, and one wanted to practice in northern Quebec and the other one wanted to practice in Montreal, whom would they admit if they looked otherwise comparable?
I think there are a number of policies we could pursue.
NDP
François Lapointe NDP Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC
Those are interesting solutions.
Professor, Department of Economics, McMaster University, As an Individual
There are solutions. They would take intestinal fortitude.
NDP
François Lapointe NDP Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC
Do I have a few more minutes?
Since I still have a bit of time left, I would like to mention some other very interesting initiatives. In Holland, for example, the proportion between the long-term care provided at home and in health care institutions is completely the opposite of what we have here. There, the proportion is 80% and 20%, whereas here, it is 20% and 80%. When long-term care can be provided at home, the Dutch hire personnel instead of spending billions of dollars on infrastructures.
Do you think we could consider this as a real long-term solution?
Chief Executive Officer, Canadian Nurses Association
Certainly, the association puts forward models such as primary health care and at-home services so that people can stay in their homes. It's very good. I think that we should also consider offering incentives to encourage professionals to go and work in the rural areas or to stay there. Currently, about 10% of nurses work in rural areas, while 30% of the population live in rural areas
The World Health Organization made recommendations that dealt with four major sectors. In education, we are talking about study incentive programs to encourage people who live in rural areas and who are more likely to return there. We can also improve the working conditions and remove obstacles, among other things, to ensure that nurses can work in the full scope of their practice.
We could also use nurse practitioners to respond to some shortages within the professional team. We could also consider incentives to better support people who want to study health sciences as a nurse and better support them once they are on the labour market. Incentives could be offered to help them pay back the cost of studying, and so on. We could also look at providing support and a framework for professionals who work in rural regions.
NDP
François Lapointe NDP Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC
Is the big initiative, which might mean going so far as to reverse this proportion, changing the definition of the duties carried out by nurses, discussing with all the unions and reviewing the way all the provinces do things, feasible or even desirable?
If it is feasible, how long would it take? Are we talking five years, 10 years? Are the majority of the provinces interested in doing this? Do you understand basically what I'm asking?
Conservative
Chief Executive Officer, Canadian Nurses Association
If we really want to put in place primary health care, we should initially act on prevention and promotion. We should also consider the entire continuum of care within an interprofessional practice to maximize the capacity of all the professionals to avoid enormous shortages in one sector. It's really important to look at that.
Conservative