Human Resources Committee on April 25th, 2012

[Ryan Cleary, NDP, St. John's South—Mount Pearl, NL]

Thank you, Mr. Chair.

Thank you to the witnesses.

First, to Mr. Sweetman, going back to your opening statement, did I hear you correctly that the immigration of health professionals should be taken out of federal responsibility and made a provincial responsibility? Are you saying that health-related immigration should be handed over to individual provinces, who know the shortages they have and the weaknesses in their health care systems, and who are better able to plug those holes and address those weaknesses?

Is that what you're saying?

[Dr. Arthur Sweetman]

Yes, that's exactly what I'm saying. I think especially with IRPA, the current points system under it is particularly poorly suited to health professions, where the provinces are the principal payers. For things in the private sector, IRPA works very well. On many dimensions, IRPA is better than what came before it, but for regulated health professions, IRPA, I would argue, is worse than the legislation that came before.

Under the points system before, there were occupational points. It was virtually impossible for physicians to immigrate in the economic class. They could come as family class, as refugees, as spouses, but it was very, very hard. This was in the days when we thought we had a surplus. There was a so-called perceived surplus of physicians.

Under IRPA, at least before the most recent ministerial instructions, there were no occupational categories. So physicians became prime candidates for the points system and a massive number of them entered Canada and the provinces did not want to hire them. There was a massive surplus of international medical graduates and a large number of people complaining that they couldn't find jobs. They'd been admitted under the point systems, but the points system didn't coordinate at all with provincial needs.

My argument is to take regulated health professionals, who are primarily paid by provincial governments, out of the federal points system—because the coordination problem between the provinces and the federal government is really, really difficult—and put them in the provincial nominee program.

I'm not saying to take this out of the system altogether. We have a stream that works very efficiently. Although there are some problems with the provincial nominee program, it works pretty well. But put the regulated health professionals, who are primarily paid by the provinces, into that stream.

The provinces regulate the regulatory colleges that do credential recognition. They do health human resource planning. They know what's needed. They know the credentials. Let them manage it. They're close to the ground; they can do it better.

[Ryan Cleary, NDP, St. John's South—Mount Pearl, NL]

Has there been any appetite by the provinces, or individual provinces, to do just that?

[Dr. Arthur Sweetman]

Do you mean outside of Quebec?

[Ryan Cleary, NDP, St. John's South—Mount Pearl, NL]

Outside of Quebec.

[Dr. Arthur Sweetman]

Quebec is on board to do that, definitely.

[Ryan Cleary, NDP, St. John's South—Mount Pearl, NL]

Of course.

[Dr. Arthur Sweetman]

I don't know if that question has been posed to any elected politicians, but my informal understanding, from the rumblings I'm aware of from two or three provinces, is that they would be very happy to take that on.

[Ryan Cleary, NDP, St. John's South—Mount Pearl, NL]

Can you name those provinces?

[Dr. Arthur Sweetman]

Well, I hold the Ontario Research Chair in Health Human Resources, so I know a little bit about Ontario. I think Ontario would be very happy to take that on.

I think some of the smaller provinces might face greater challenges. Again, that's where they would need support from an information system like CIHI to help in planning.

I could be wrong, but I suspect that the larger provinces would be more than happy to take that challenge on, because they have the policy levers to do it well.

[Ryan Cleary, NDP, St. John's South—Mount Pearl, NL]

My next question is for Ms. Bard, and it's related to the topic of health professional shortages.

You mentioned in your opening statement, Ms. Bard, unique identifiers to be tagged to nursing graduates, so that you can track where they work around Canada and North America, or that sort of thing. Has that been done as a pilot project anywhere?

[Rachel Bard]

It's certainly something that we've been highly recommending. Certainly, there has been some work done to start looking at it. We've recommended it. Actually, I know that at the post-secondary level they have also looked at it. It really helps to plan in terms of the supply and dispersal of them, so that you can start to build a pan-Canadian approach to human resource coordination and address some of the shortfall. That's why we believe a pan-Canadian approach is what we need to strive for to retain our people here in Canada.

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

I'll just add that CIHI, in collaboration with the provinces and territories, conducted a feasibility study for a national unique identifier for nine professions. They identified a start-up cost and a continuing operation cost. I think it was stalled because of the costs. I don't know if CIHI wishes to speak to that more, but certainly there has been a feasibility study done.

[Ryan Cleary, NDP, St. John's South—Mount Pearl, NL]

Before you respond to that, what was the cost, and were there any concerns expressed in regard to privacy?

[Lisa Little]

The start-up cost was $17.27 million over three years, and the subsequent annual operating cost was about $5 million.

This has already been done. In some cases, the physician community already has, in essence, a national unique identifier for it. They also did a pilot with the licensed practical nurses at one point. So I think they found ways to get around the privacy issues and use existing provincial numbers already assigned, etc., to create the national number, without large intrusions on people's privacy. But my understanding is that in the end it was the cost, ultimately, that was the barrier.

[Jean-Marie Berthelot]

If you have a national unique identifier and associate it with a person when he or she starts going to graduate school, I guess to post-secondary school, it will also allow you to know more about what's happening in the university or the college. You could look at dropout rates, and that's a value-added.

The cost was an issue. But there are also issues regarding the role of the regulatory bodies at the provincial level. There was some discussion about governance, about the institute that would manage a national unique identifier. So what CIHI did was mainly a feasibility study, and it came up with the cost. It wasn't clear that CIHI would be the organization that would run that national unique identifier.

In terms of privacy, we're talking about professionals. They have some obligations. I don't think privacy is a barrier. Things need to be done in a privacy-sensitive manner, but that's not a barrier to creating such a national unique identifier.

[The Chair, Conservative, Ed Komarnicki]

Your time is up, Mr. Cleary. Thank you.

We appreciate the comments with respect to the provincial nominee program. But the uptake by the provinces has been different from province to province. Some have embraced it, and some haven't. From personal knowledge, I know that Manitoba has, and Alberta, Saskatchewan. Ontario has not, to the same degree. It is an area should perhaps be investigated by this committee in our report as well. So thank you for that.

We'll now move to Mr. Mayes.

Go ahead.

[Colin Mayes, Conservative, Okanagan—Shuswap, BC]

Thank you, Mr. Chair. And thank you to the witnesses for being here today.

One of the long-term concerns I have, which has also happened in the education sector, is this. We hired a bunch of teachers, built a bunch of new schools, and all of a sudden there were fewer children. People were having fewer children. So now we're closing down schools and all these educated teachers are finding other employment. This is a wave we're dealing with now with the baby boomers. When that wave of baby boomers goes through, we could have a lot of empty hospital rooms and nurses standing around because there are too many of them.

Mr. Sweetman, or either one of you gentlemen, have you looked at any projections in your studies in regard to what we are going to do 20 to 25 years from now? Do you think we're going to see that wave go through and some of the current needs are going to become redundant? Or do you see that need continually growing?

[Dr. Arthur Sweetman]

The baby boomers are still pretty healthy. In fact, right now is the golden age. If you look at baby boomers, they're still old enough to be paying taxes. The oldest baby boomers are 65. Serious medical costs don't start for another five or ten years.

So the aging population hitting medicare hasn't actually happened yet. When it does happen, most estimates argue that you're talking about an increase in the number of physicians or physician services of something in the order of 0.6% per year. It's not enormous.

Yes, there is going to be a need to change down the road to reduce the number of physicians. You're talking about a time beyond the career of the typical graduate today.

There is a bigger issue. In some sense, you're worried about shortages, but inside most provincial ministries, which are closer to the ground, the concern is about surpluses, not shortages.

Depending on whether they're family practitioners or specialists, there is a six to ten-year training period for physicians. If you go back ten years exactly, there has been a 73% increase in the number of people in medical school, which is dramatically larger than population growth, which has been around 11% in the same period. We're going to need to be pulling back our enrolment in medical school in the near future, or else we're going to have a giant surplus.

The issue of aging is not actually about the number of physicians; it's about the composition of specialities. We really haven't started dealing with that as a society yet. We have the wrong specialities graduating from medical school. If you think someone is going to practice for 30 years, you need to be thinking about what specialities we will need over the next 30 years. We are graduating a lot of pediatricians and not so many geriatricians. We need to think about those things.

[Colin Mayes, Conservative, Okanagan—Shuswap, BC]

I'm going to cut you off so I can hear some comments from Madame Bard.

[Rachel Bard]

Thank you.

I would like to add that right now, in nursing, we have three applications for every one entry into the seats available. Our report, Tested Solutions, suggested that we should be increasing the number of seats by 1,000 for three years, from the year 2009 when it was launched until 2011. The impact would such that it would take 15 years to actually reduce our projected shortfall of 60,000 FTEs to 45,000 FTEs.

As you can see, we need to keep producing students, because we also have retirements coming. We have demographic realities. Reducing the seats will not be a solution; it will compound the problem.

[Colin Mayes, Conservative, Okanagan—Shuswap, BC]

I appreciate your holistic approach, as far as healthy living and helping ourselves to address the situation are concerned. We've said that it's not necessarily about the number of nurses. You talked about more productivity and resource management.

We just had a new hospital built in my constituency, in Vernon. It has state-of-the-art equipment. No longer is a nurse trying to heave a huge fellow across a bed or something. All of that is automated now.

I noticed in some of the notes here that 40% of the nurses are over 50. Not that 50 is old, but there are some challenges, in that there is physical stress. In one smaller hospital in my area, it costs $500,000 a year for stress leave for nurses. Those costs are hindering service delivery.

Do you see more technology, as far as help for care and better resource management are concerned, as going to help the situation, that it's not just about a labour shortage but about better organization and better use of the facilities?

[Rachel Bard]

Absolutely. When we talk about improving productivity, we don't mean doing more with less. We actually say that we should look at our models of care. Let's look at how we can best utilize the technology. How can we remove the barriers to allow nurses to practice to their full scope?

There are some good programs. For instance, the lean methodology, which has been used in Saskatchewan to release time to care, has really removed barriers and has increased the number of hours nurses have around patients. Of course, it also improves the quality of work life.

We also know that we need to make sure that we stabilize our workforce by having full-time positions. Right now, about 58% of positions are full-time positions. We're saying that our standard should be about 70% so that we maximize and ensure that the patient has the right level of care.

[Colin Mayes, Conservative, Okanagan—Shuswap, BC]

But is that the association saying that? I ask because at one of the hospitals I am familiar with, what the nurses say is that because of seniority, they have found that when they phone for a nurse, the person will say no. They have to go through a list, and all of a sudden somebody is working a double shift because they can't get anybody in. To me, that is a management or organizational problem that needs to be addressed, more so than a lack of resources.

There are a lot of people in the profession who do not want to work full time; they want to work part time. It's a career choice. I think some of the challenges we're having in health care have a lot to do with management of resources and technology within the plant.

How am I doing, Mr. Chair?

[The Chair, Conservative, Ed Komarnicki]

You are right at seven minutes, so that's a good place to stop.

We will adjourn for five or ten minutes and recommence with Mr. Cuzner.

Thank you. We will suspend.