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Evidence of meeting #36 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 care.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Danielle Fréchette  Director, Health Policy and External Relations, Royal College of Physicians and Surgeons of Canada
Robert Sutherland  President, Canadian Dental Association
Euan Swan  Manager, Dental Programs, Canadian Dental Association
Pat Vanderkooy  Manager, Public Affairs, Dietitians of Canada
Noura Hassan  President, Canadian Federation of Medical Students
Chloé Ward  Vice-President, Advocacy, Canadian Federation of Medical Students
Christine Nielsen  Executive Director, Canadian Society for Medical Laboratory Science
Marlene Wyatt  Director, Professional Affairs, Dietitians of Canada

3:55 p.m.

Conservative

The Chair Conservative Ed Komarnicki

Thank you.

Mr. Lapointe, go ahead.

May 7th, 2012 / 3:55 p.m.

NDP

François Lapointe NDP Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

Thank you, Mr. Chair.

Ms. Fréchette, I would like to digress for a moment before I address what seems to be the main issue.

3:55 p.m.

Conservative

The Chair Conservative Ed Komarnicki

Are you okay with the translation?

3:55 p.m.

President, Canadian Dental Association

3:55 p.m.

NDP

François Lapointe NDP Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

Ms. Fréchette, your assessment of the situation regarding foreign-trained specialist physicians seems to be rather pessimistic. You said that the situation in francophone countries was rather disappointing.

Does that include people who were trained in Europe, such as French physicians who have to start their education process practically all over again?

3:55 p.m.

Director, Health Policy and External Relations, Royal College of Physicians and Surgeons of Canada

Danielle Fréchette

The quality of international medical graduates varies greatly. A physician may have been trained in India in an excellent institution and may be ready for immediate integration, while someone else may have been trained 40 km from that location and may not have the same skills at all, even in the same area of specialization.

3:55 p.m.

NDP

François Lapointe NDP Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

When people move from one European country to another, for instance, they don't have the same problem. I assume that the Germans and the French have a more stable system.

3:55 p.m.

Director, Health Policy and External Relations, Royal College of Physicians and Surgeons of Canada

Danielle Fréchette

That is not really the case. I spend quite a bit of time in France trying to build bridges. People are interested in the Canadian system. Our competency framework interests them. Some medical faculties do not require students to take an exit exam. People complete their studies, find someone who wants to hire them and get the job.

3:55 p.m.

NDP

François Lapointe NDP Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

Without taking a standardized exam?

3:55 p.m.

Director, Health Policy and External Relations, Royal College of Physicians and Surgeons of Canada

Danielle Fréchette

That's right. There is no standardized exam in the country. Training standards are very, very different. They are now developing a standardized curriculum. There is currently no such thing. In Paris, cardiology training may be different from that provided 30 km away, in the same city.

3:55 p.m.

NDP

François Lapointe NDP Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

Thank you. That information is useful.

Ms. Fréchette, I want to go back to what seems to be the key issue for you and for Mr. Sutherland. There is no acute shortage of resources, but their distribution is uneven. For instance, there may be too many cardiologists in Winnipeg, and not enough of them in Quebec City. How can we have enough flexibility at all stages of the process? When people are referred to specialized schools, does a certain degree of flexibility exist that helps quickly decide to train fewer people in one discipline and more people in another? In Canada, are there any statistical tools that enable your organization to adjust promptly?

Can you consult your members quickly and tell them that, for instance, there will soon be a shortage of cardiologists in Quebec City, but not in Winnipeg? Are improvements needed when it comes to that? Is there enough flexibility among the provinces so that people can move, if they wish, so that a better balance can be achieved between the regional needs on the ground and the available resources? We have understood that this is where the source of the problem is, but how can that flexibility be achieved?

4 p.m.

Director, Health Policy and External Relations, Royal College of Physicians and Surgeons of Canada

Danielle Fréchette

There is currently some flexibility when it comes to that. If a dentist or a physician has full licensure, they can go anywhere in the country, and that is a good thing. However, that does not necessarily solve the distribution problem. If someone wants to practise in the suburbs, they need to have the required resources and know about that way of life—so some of the things I have already described a bit. In addition, needs have to be better adapted to the production. That will continue to be a weakness across the country until we are able to better determine the needs and until each province starts to produce its own labour force, given that physicians move without having a Canada-wide idea of the needs. The provinces are going about it somewhat haphazardly.

4 p.m.

NDP

François Lapointe NDP Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

Is that one of the aspects of the problem?

4 p.m.

Director, Health Policy and External Relations, Royal College of Physicians and Surgeons of Canada

Danielle Fréchette

That's the key aspect.

4 p.m.

NDP

François Lapointe NDP Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

You also talked about reconciling work and family. In my generation, that's less and less a matter of gender. I took care of my children from 30% to 60% of the time, depending on the year. My wife is also a professional. At times, I was the one taking care of the children 60% of the time. It all depended on who of the two of us had a better contract in a given year. That's relevant. Around me, I am seeing people in their forties who are professionals. They refuse to work 80 hours a week, as they want to have two or three children and live a quality life.

What kind of measures do you think the government could adopt to facilitate the reconciliation of work and family? How could our work in the House of Commons make the process easier? Should we make sure that the training production increases? That way, not all physicians would necessarily have to work 85 hours a week to meet the needs. What could be done about that?

4 p.m.

Director, Health Policy and External Relations, Royal College of Physicians and Surgeons of Canada

Danielle Fréchette

The notion of full-time equivalence does not match up with the number of people. According to CIHI data, there are over 67,000 physicians in Canada, but they don't all work at the same level of intensity. We should not compare ourselves to the OECD countries. We compare ourselves to nations where physicians work at various levels of intensity. In Italy, working 30 hours per week is fine, as there are many more doctors. The number of physicians per 100,000 citizens means nothing.

4 p.m.

NDP

François Lapointe NDP Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

So that's not an essential condition. It depends on whether physicians tend to work 30 hours or 60 hours a week. That makes a huge difference.

4 p.m.

Director, Health Policy and External Relations, Royal College of Physicians and Surgeons of Canada

Danielle Fréchette

Exactly. It is really a generation-based notion. Everyone wants to strike a better balance and be a better parent.

4 p.m.

NDP

François Lapointe NDP Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC

What can the governments in Canada do to resolve this issue?

4 p.m.

Conservative

The Chair Conservative Ed Komarnicki

Thank you, Monsieur Lapointe. Your time is up.

But we'll conclude with the answer, if you could go ahead, Ms. Fréchette.

4 p.m.

Director, Health Policy and External Relations, Royal College of Physicians and Surgeons of Canada

Danielle Fréchette

Thank you.

I keep coming back to the same solution. It's a matter of gaining a better understanding of what the Canada-wide needs are. We need to stop operating in our provincial and territorial bubbles.

4 p.m.

Conservative

The Chair Conservative Ed Komarnicki

Thank you.

Mr. Daniel.

4 p.m.

Conservative

Joe Daniel Conservative Don Valley East, ON

Thank you, Mr. Chair. Thank you, witnesses.

My question is skewed a little bit, but I'll ask it anyway.

Obviously, the doctors and nurses, etc., are the heroes of the medical profession. But clearly there are going to be a lot of other support skills and staff needed. Can you talk a little bit about medical technicians? Without them, the doctors cannot complete their work. Or are there any other skills? Really the question is, in your view, what are the foremost issues resulting in skill shortages for the medical sector?

4:05 p.m.

Director, Health Policy and External Relations, Royal College of Physicians and Surgeons of Canada

Danielle Fréchette

One of the studies we're running right now is quite interesting. We're looking at the employability of physicians. It came to light that a number of doctors were either unemployed or underemployed. Looking at the new skill mix and the upscaling of different health professions, it is having an impact on how our physicians should be trained in the future and the numbers we'll actually need.

In a very integrated model in orthopedics, for example, where you could have an occupational therapist, physiotherapists, and so on working together, we're seeing that we need fewer actual orthopedic surgeons. We're also looking at really interesting ways of triaging patients. The hip and knee registries are really paying off now; the patient sees the first available clinician. So those are really neat ideas.

But how are we factoring in all of these new innovations and success stories to align with the needs and the actual production of the future?

There are some disciplines that are in absolute shortage. With an aging population, geriatric medicine is problematic. Family practice has a stream for care of the elderly, but it is a problem as patients are becoming more and more complex. Internists are in high demand as well.

So the disciplines that don't require a lot of infrastructure are having greater ease finding work. At the Royal College we're actually considering what will probably be a vastly different training paradigm, where education will really be more integrated. We have our maintenance of certification program, which is a life-long learning process, but to create some basic entry points so that you can then stream more easily, more nimbly, depending on what the needs are of the country.

4:05 p.m.

Conservative

Joe Daniel Conservative Don Valley East, ON

So it's really probing to see how essential the medical technicians are who are actually doing all the work on samples and what have you in support of the medical profession.