Human Resources Committee on May 7th, 2012

[Danielle Fréchette]

Absolutely. You can't have an open-heart surgery without a properly staffed intensive care unit and cardiac nurses at the ready. So it's an interwoven piece.

When we're doing our workforce studies, we try to get an understanding of those various bits. But we're all trying to do this within our own resources.

We're not investing enough in HRH research. This is the highest-cost centre in the country for health care. It's the people who run it. And yet we're not investing in really understanding it, optimizing it, and implementing our wonderful pilots.

[Joe Daniel, Conservative, Don Valley East, ON]

On the dental side—I know you have lots of dentists—what's the situation with regard to hygienists, all your support staff, etc.? Are there enough of them being produced?

[Dr. Robert Sutherland]

There are actually more hygienists in Canada than there are dentists. So it's really not a skill shortage per se. It's more of a location shortage, where those skills meet the patient.

Dentistry works in a team concept. There's a tremendous respect for each others' skills and the skills of the other team members. You mentioned that dental hygienists are absolutely essential to providing the care that's required. The challenge is less on the numbers and the shortage of skills than in trying to get those skills to where they're needed and have them stay there.

[Joe Daniel, Conservative, Don Valley East, ON]

Do you have any ideas of how to incentivize that so that you have the skills in the right place?

[Dr. Robert Sutherland]

We need to be looking at, as I said earlier, alternate delivery models, looking much more at public health clinics, satellite clinics in these more remote areas. There may not be enough of a population there to have a full-time dentist, so we have to create a situation where a dentist may be there one or two days a week, or two or three days in a month, and still have a viable practice. That's part of it.

You mentioned the incentives. I think they also tie into this. When you can be there only a few days a week.... You have overhead and you have space and employees who are there the rest of the time as well. So there's an overhead aspect to it.

Probably the major thing we need to get at is the prevention end of it. The vast majority of all dental disease—decay and gum problems—is preventable. So we need to get out there in the schools much more. We need to talk prevention. We need to raise awareness. That's more the direction.

[Joe Daniel, Conservative, Don Valley East, ON]

Mr. Swan, do you have any further comments on that?

[Dr. Euan Swan]

No, I have no further comment on that. Thank you.

[Joe Daniel, Conservative, Don Valley East, ON]

Should we be doing things like providing the same sorts of tax incentives for medical technicians? This is kind of where I was leading to, in terms of being able to support the medical profession in remote areas. That's where I was kind of going with that. I don't know if you can make any comments on that.

[Danielle Fréchette]

Financial incentives are only part of the solution, because we have to have a broader infrastructure within which you could work. The electronic health record is one of those pillars that we often look at, so just throwing more money at it isn't necessarily the solution. I know it's almost heresy to say that, but I don't think—

[Joe Daniel, Conservative, Don Valley East, ON]

I don't think I was suggesting throwing more money at it, but more like providing tax incentives for doctors and other medical folks in that....

They really can't do their job unless they have the supporting lab facilities and lab technicians, etc., for whom we're not providing any tax incentives.

[The Chair, Conservative, Ed Komarnicki]

Thank you, Mr. Daniel. Your time is up, but go ahead to provide some concluding remarks.

[Danielle Fréchette]

Investing in infrastructure is definitely a very important solution, and you'll often find that if the physical resources are there, the people will follow.

[The Chair, Conservative, Ed Komarnicki]

All right.

Mr. Cuzner.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

Thank you, Chair, and to our witnesses today.

I think what you're getting at, then, Ms. Fréchette, is that there's an absence of a paying Canadian HR strategy in the health sector, so that the college advocates that one be undertaken and put in place.

I apologize about not knowing more about the observatory you referred to. Could you just take 30 seconds and enlighten the committee?

[Danielle Fréchette]

Absolutely.

Respecting provincial and territorial responsibility for its own workforce planning, the observatory could be a hub of research, where we could go to deposit our research, for example. It could also be the place where the various provinces, such as the advisory committee on health delivery and human resources, could go to and get comprehensive data. There would be full-time scientists that would actually be trying to connect the pieces.

I spend a lot of time looking at HR research in the country. We have really neat stuff going on, but nothing to pull it together, so this would become a national resource for the jurisdictions that are trying to make sense of this mess and would potentially better identify needs, better rationalize the production pipeline, including not just, in my case, of physicians, but the cross-impacts of new health professions coming upstream.

One of the next things I'll be looking at are scopes of practice. Within our own specialties...you have an orthopod working on a spine, you have a neurosurgeon working on a spine, but what is the need for spinal surgery in the country, and should my organization be changing its training requirements?

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

Good. I appreciate that.

Mr. Sutherland and Mr. Swan, the studies about skill shortages—I'll inform you that in the next short while you'll discover many skill shortages in your most recent hire.

He's a great young guy.

You're saying now that you're at the sweet spot now with the number of seats and the number of dentists that are being produced in this country. Has that come about over a period of time? Was there a shortage? Was there a strategy to address that? Were additional seats opened, or did it just come about naturally? Could you enlighten us on that?

[Dr. Robert Sutherland]

Certainly, if you go back after the Second World War, there was—

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

Oh, it's that far back, though?

[Dr. Robert Sutherland]

It would start.

The demands around the times that we live in would dictate the number of seats that are there. When I graduated, there were nearly 130 people in my class. There are about 90 people in graduating classes now.

The dentist to population ratio is, again, right on par with the OECD, so I think for that reason we're graduating the right numbers of people. Again, it's the distribution of those numbers.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

You had identified that there were seven institutions out of the ten that are training dentists that have special programs that are allocating seats to first nations people. Is that an institution by institution decision, or is it driven by the provinces for those institutions? Where is the impetus for that coming?

[Dr. Robert Sutherland]

The seats that are there are available for these groups of people; I wouldn't say they're all dedicated to any particular group. They're available and they would apply for those.

I would suspect that it would be—and I'll ask Dr. Swan—institution by institution.

[Dr. Euan Swan]

Yes, that's correct. Each faculty of dentistry and their associated university would develop policies regarding places for aboriginal and first nations people.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

What would be an average application rate for dental training? How many applications get turned down, institution by institution? There's no problem with the application rate, I'm sure.

[Dr. Robert Sutherland]

It's probably in the order of eight to ten applications per available seat.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

What about the first nations seats, those you try to identify for first nations?