Thank you very much for the opportunity to appear before this committee to discuss ways to ensure an adequate supply of physicians in the Canadian health care system.
The reality today is that nearly five million Canadians do not have family physicians, including more than 900,000 here in Ontario. Over one third of all Canadian physicians are over the age of 55. Many will either retire soon or reduce their practice workload.
Many physician practices are at capacity and unable to take on new patients. Canada's supply of new physicians relative to our population is well below the Organisation for Economic Co-operation and Development average. We're the seventh-lowest supplier of physicians per capita amongst OECD nations. Canada ranks below the European Union nations and the United States.
Ensuring Canada has the appropriate number of physicians with the appropriate mix of specialities to meet patients' needs requires planning and leadership at the federal level. Canada must address specific shortages and ensure self-sufficiency in health human resources for this country. Better planning would also help address the issue of wait times and their negative impact on patient care.
The Canadian Medical Association recommends, first, ensuring a needs-based speciality mix; second, targeting health infrastructure investments to optimize the supply of health human resources; and third, addressing the issue of foreign credential recognition.
On our first area of focus, ensuring a needs-based specialty mix, a CMA survey this year of provincial and territorial medical associations on physician resources underscores the pressing need for a pan-Canadian approach to health human resource planning. All jurisdictions in Canada are experiencing challenges, although shortages by type of practice vary from province to province.
Ensuring an appropriate specialty mix requires planning. At present there is no pan-Canadian system to monitor or manage the specialty mix. Our survey found only three jurisdictions that have a long-term physician resource plan in place, while, until today, only one jurisdiction had employed a supply- and needs-based projection model—Nova Scotia just released a second one of these today.
The consequences of this lack of planning are evident. From 1988 to 2010, the number of post-graduate trainee positions in geriatric medicine—care of the elderly—was essentially constant at only 18 physicians, while the number of trainees in pediatric medicine—childhood illnesses—increased by 58%, in clear contradiction to the demographic trends.
The last time the federal government prepared a needs-based projection of physician requirements in Canada was 1975.
The second issue I wish to address is health infrastructure. Recruitment of specialists and subspecialists is affected by the limitations of existing hospital infrastructure, such as operating rooms. Ensuring that infrastructure is in place to allow the doctors that we do have to carry out their work would no doubt help address Canada's persistent problems with wait times.
The CMA recognizes the federal government's commitment to address the issue of foreign credential recognition and recognizes that physicians are in the target group for 2012. The medical profession is well positioned to support the federal government's objective.
Under the auspices of the National Assessment Collaboration—a group of federal, provincial, and other stakeholders—the medical profession is working to streamline the evaluation process for international medical graduates for their licensure in Canada.
The pan-Canadian portable eligibility for licensure is another important issue for physicians. In 2009, the Federation of Medical Regulatory Authorities adopted an agreement on national standards for medical registration in Canada that reflects the revised labour mobility chapter of the Agreement on Internal Trade. The federation and the Medical Council of Canada are working on a one-stop process for IMGs to apply for licensure in Canada.
Close to one-quarter of all physicians in Canada are IMGs. I'm one of them. While the CMA fully supports bringing into practise qualified IMGs already in Canada, actively recruiting doctors from abroad cannot be the only solution to our physician shortage. Canada must strive for greater self-sufficiency in the education and training of physicians.
To conclude, for several years now, the CMA has advocated health care transformation. With the Canadian Nurses Association, it has developed six principles to guide transformation. These principles have been endorsed by over 100 medical, health, and patient organizations.
One of these principles is sustainability. Addressing health human resource shortages is critical to ensuring a sustainable system that's also accessible and patient-centred.
Despite progress, our country continues to experience a persistent shortage of physicians. This is hardly surprising given that few jurisdictions engage in any health human resource planning and that the federal government has not examined physician supply in almost 40 years.
Canada requires a pan-Canadian approach to ensure adequate health human resources in support of a sustainable health care system.
Thank you very much for your attention. I'll be pleased, if the opportunity presents itself, to answer any questions.