Human Resources Committee on Oct. 6th, 2011

[Margo Craig Garrison]

Thank you very much for your question.

First, I'd like to say that Health Canada recognizes that the provincial and territorial governments have jurisdiction over health human resource planning. That includes the recruitment and retention of health professionals, as well as the number of residency seats that are available on an annual basis.

At the same time, I can tell you that some improvements are being made. For example, we now have online self-assessment tools to assess someone's readiness to write qualifying exams. We have exams being written more frequently and online in other countries. This is a step forward as well.

We have multimedia faculty development programs for teachers of international medical graduates. This is being implemented to more fully integrate internationally educated medical professionals into the health workforce. We also have a website that is a central source of information.

The more complex issues are also being tackled. One of them is related to the assessment of IMGs when they come to Canada and seek a residency placement. We have consistent standards developed around entry to residency through the Medical Council of Canada and with a number of other stakeholders, including regulatory authorities and provincial and territorial governments, as well as a whole host of stakeholders.

That work has been done. It's been completed. It is in the implementation stages. This should help accelerate...or certainly it will help people's expectations around what is required of them for entry into residency. It speaks to some of the issues related to the FQR framework around fairness, transparency, and timeliness.

The basis of this work that we're doing now will support work that is starting to happen around entry to practice and developing the same types of consistent standards around assessment for entry to practice. So when someone comes to Canada and has been a practising physician in another country, these processes will help accelerate their assessment; and then if the assessment is not what they had hoped, there'll also be an opportunity to help direct a person into a possible alternative career.

[Jean-François LaRue]

I might also add that through the economic action plan, the government has provided us with significant means of addressing some of those issues.

As you know, over the course of two years we invested $50 million to address a list of priority occupations. The federal government has included physicians as part of the next set of priority occupations. That's certainly a very concrete step.

The $50 million also served to fund a project with the Medical Council of Canada—certainly with HRSDC, and in collaboration with Health Canada—to develop a national process to provide support for international and Canadian medical graduates as they apply for medical registration.

What this project will literally do is to streamline the process for obtaining a medical licence. When we talk about concrete examples of what the framework does in terms of dealing with the occupations, these projects are fundamental. We have, as you know, 14 priority occupations, and we've had projects with all the occupations to date. We're continuing, through the process of national consultation, to establish and identify the priorities for those occupations and then to determine how we can help them improve their process.

Obviously not all of the occupations start from the same starting points, so we adapt our projects to their needs.

[The Chair, Conservative, Ed Komarnicki]

Thank you. Your time is up—in fact more than up.

We'll move to Mr. Cuzner for seven minutes.

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

Thanks very much.

Thank you to the witnesses for being here today.

Madam Craig Garrison, I'll ask a question that's probably posed around a table at Tim Hortons on a fairly regularly basis. In a country as affluent as Canada, why is it we're not able to fill the demand for medical professionals, for doctors and what have you? Why are we not able to provide enough Canadian doctors for current and future needs? Could you give me an overview of the number of seats in medical schools across the country? Are they growing? Have they grown?

I know for a fact that young people from my riding who are skilled students, great students, have continually applied to medical schools and there's just no room for them. Two of them, a brother and sister from my riding, friends of my oldest guy, are in medical school in the Caribbean now. It's not a bad gig, I guess, but they hope to come back here and practice.

Why are they not being allowed the opportunity here? Or are we providing enough opportunity, I guess, for those who want to study medicine in this country?

Perhaps I could have your comments on that before we get into the credentials.

[Margo Craig Garrison]

Thank you for your question.

Medical school enrollment has increased substantially in the last few years. In fact, first-year undergraduate medical school enrollment has increased by 60% over the last decade.

The provinces and the territories, which have responsibility for health human resources and deciding how many seats will be made available, have increased the seats by over 1,000 in the decade between 2000 and 2010. First-year residency positions have increased by 84%.

I think part of what you may be describing is the very competitive nature of people who wish to go to medical school. It's commendable that young people want to go into medicine, but there are a finite number of resources the provinces and territories can dedicate to their health system functioning. I think their cooperation with their medical faculties results in a set number of residencies becoming available.

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

With the increase of 1,000 seats, have we seen the number of foreign medical professionals go down over that period of time, or does it continue grow?

[Margo Craig Garrison]

No, the numbers of IMGs applying to post-graduate residency training are up significantly, and more Canadians are going abroad to study. We estimate that there are 3,500 Canadians studying medicine abroad, with approximately 700 graduates each year, and many of them seek to come back to Canada.

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

I think anybody around the table who's travelled to African nations, or wherever, and has come back and has a Nigerian doctor, that's all well and fine, but we know that the country is less.... I'm just thinking that with our country's wealth and our understanding, you can see that we should continue to invest and grow those opportunities for Canadian students, as well.

[Margo Craig Garrison]

I think I'll come back to my original point about provincial and territorial governments wishing to control that aspect of their health systems. It's a very important and very large part of their system. Health human resources comprises a big part of the system. They make their own policies. They make their own plans, and we--

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

What about these 3,500 Canadian students who study abroad? What's the difference between their coming back to qualify and a foreign-trained national from another country coming in to qualify? Is there any grace given to the Canadian student?

[Margo Craig Garrison]

In terms of students who are applying to go into residency training, there is no real difference between Canadians who grew up in Canada and went abroad to do their undergraduate training and people who have come to Canada and wish to go into a residency position. All of the applicants must be permanent residents of Canada to apply.

So it depends. In fact, that is not the case: they are the same in terms of their positioning in the residency competition. A large number of Canadians are studying abroad.

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

So these two young people, whom I used as a concrete example, will have to wait in the queue just as somebody else who wants to immigrate to Canada to get their credentials?

[Margo Craig Garrison]

They're not immigrating to do that. They have to be here to apply.

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

Oh, yes. Okay. I'm sorry.

Thank you very much for that.

There are two other questions I want to ask.

One is on the benchmarks identified in the framework in 2009. Obviously, progress is being made, and you're very excited about the eight occupations and other six occupations in the priority areas. I apologize for not knowing this, but were there benchmarks set out in the original framework for the number of professions? Were there benchmarks set that you wanted to accomplish x number of professions by such and such a date?

[Jean-François LaRue]

That's exactly right.

The group of 14, as I indicated, was divided into two groups. The timelines were fairly tight for the first group. When the framework was launched—if I recall, it was in November 2009—we essentially had until December 2010 to streamline the first group of occupations. Now, we were pretty lucky, in the sense that we had been working for quite a while with many of those occupations, which allowed us to proceed and achieve the objectives we wanted.

The second group is scheduled for December 2012. We had two years for the group of six, which obviously reflects the more complex nature of some of the occupations, namely teachers and, certainly, dentists and physicians.

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

Teachers?

[Jean-François LaRue]

Teachers are part of the second group.

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

The reciprocity agreement you commented on makes tremendous sense.

Is the federal government involved in initiating such reciprocity agreements, or do they take place within professional organizations and we don't try to nurture those relationships?

[Jean-François LaRue]

You have to understand that the federal government is a facilitator. We're not necessarily accountable for this specifically. Provinces are responsible enough, and they delegate these responsibilities to the regulatory occupations. We work with the regulatory bodies and, as I said at the beginning of my presentation, every occupation is unique and at a certain place in its development.

These issues are fairly recent. Barely a decade ago, we wouldn't have talked as intensively as we're talking about these issues now. We're facing this problem of the aging of society and shortages and problems with productivity.

When we work through the projects, the first step is a diagnostic one with the occupations. Through the diagnostic, we identify all sorts of needs that they have.

For part of those needs and as part of those plans, we have a project coming for approval, which I can't talk about it because it's not public yet. But we have certainly encouraged the occupations to examine the potential for a mutual recognition agreements with various countries. Many occupations already have those in place with various countries. We try to encourage them to explore what partnership they could have with other countries that they think are fairly similar. That could fast-track the process of integration, because if there is a way to do it, that's certainly one.

[The Chair, Conservative, Ed Komarnicki]

Thank you.

I'll ask for a very short remark. we're well over his time.

[Jonathan Wells]

We've also recently announced a conference that will pull together all of the professions from the framework. It will look at the issue of mutual recognition agreements and reciprocity; under what circumstances they work; which countries should be targeted; what are the costs related to the upkeep of these; and whether they are viable vehicles, because they certainly are the express route.

So we do take that as one of our very serious strategies in terms of implementation. We have funded a number of professions to investigate and negotiate and sign these types of agreements.

[The Chair, Conservative, Ed Komarnicki]

Thank you.

We'll now move to Mr. Butt.

[Brad Butt, Conservative, Mississauga—Streetsville, ON]

Thank you very much, Mr. Chairman.

Can you give me some more details on the Budget 2011 commitment that we've made around the pilot project. What exactly does that entail, what kind of budget numbers are we talking about, and how many individuals do we think that initiative will serve?

[Jean-François LaRue]

You're going to have to allow me to step back a little bit to explain the context for the initiative.

We have heard musings over the last few months that many immigrants were faced with significant credentials costs when passing their exams. That's particularly true in the medical professions. Here, I'm not talking about physicians but about the medical professions in general. We've been asked to examine whether or not this was a real barrier. We know that language is a barrier. We know that credentialing is a barrier. We know that lack of experience is a barrier. But the question we were asked was, are financial barriers real barriers for individuals coming from outside?

What we had essentially heard is that when immigrants come here from outside the country, they don't have a credit history and literally cannot access our credit system as a result. It's the same for Canadians who have studied abroad. They are coming back and have this big gap, and the chartered banks in Canada are reluctant to lend money to people who don't have a credit history. So we've observed that.

We've looked at the literature out there on whether or not this is a real problem, because we want to do it based on evidence. There is not a lot of information, aside from survey data, telling us that 50%, say, face financial concerns and 30% cannot get credit when they try to get it. That information was pretty thin.

So instead of establishing, what I would call, costly new programs that sometimes don't work, the department over the years has learned to proceed carefully, step by step. What we have is an initiative whereby we're going to spend approximately $6 million per year over the next three years, working in partnership with the communities and the agents on various projects. We're going to have up to 10 project sites and are going to try to encourage the communities to assemble the key partnerships that are needed to provide access to credit.

We did a survey, or a scan, if you will, of what's going on in the country, and there are a few initiatives currently on the ground. They're great initiatives and we're going to try to solicit proposals on what we can do to support them. Essentially we're going to do an institutional test of sorts to find out the best model, the lessons learned, and figure out if there is a problem and what can be fixed, and how best we can provide support and whether there is a role for government in the long-term in doing this work.

[Brad Butt, Conservative, Mississauga—Streetsville, ON]

My next question is probably for Ms. Pateman.

One of the stories we hear from time to time from the recent immigrant is, “Well, if I'd only known it was going to be this tough to get my credentials recognized, and if I'd only known it was going to be....”

So can you tell me again a little more about what kind of assistance and pre-screening we're doing in the country of origin when people are considering coming to Canada, in warning them and not selling them a story that they're going to arrive here, get off the plane, and be doing an operation at 3 o'clock in the afternoon that day; that we're warning them that there are going to be credentialing issues and that it is going to take time and that certain professions are going to recognize their credentials more quickly than others? Can you give me a little bit more detail on what we're doing for these people before they get on Canadian soil?