Human Resources Committee on Nov. 1st, 2011

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

Thank you, Mr. Chair.

Welcome to the witnesses who are here today.

I will direct this question to Ms. Nielsen.

One of the things I have found in life is that the easiest way to succeed is to copy smart and successful people and ideas. Have you looked at any other models from other countries that are taking professionals in? What is their success, and how do they approach this? Really, our government is trying to address a problem: we need a framework, we have put huge amounts of money forward, but we want something that works and is going to be timely.

Have you had any experience of models elsewhere that we could copy?

[Christine Nielsen]

The model I'm most aware of relating to the health professions would be the Australian model. I had an opportunity to go in March with a Canadian delegation of health professionals to look at how they handle their immigration and to share best practices and common challenges. Obviously their immigration policies are a little different from Canada's, so we'll have to acknowledge that, but one of the interesting things they do is pre-assessments before someone is approved for immigration, which possibly helps them select people who have the best chance of being integrated quicker.

They also have had standing bridging programs, I believe since the 1960s, and they are in the federal model. So if you're a physiotherapist who has a really great chance of practising in the field, you know where to land and what program will be accepted. I believe it's subsidized as well by the federal government.

So they do a little more selection pre-immigration. They don't really allow a person to self-declare their occupational code; they verify. They even do offshore competency assessments whereby somebody might do a clinical assessment offshore. They have authorized people in those jurisdictions to do these.

Now, this is from a handful of countries, not from all nations. But they know, just like Canada, what their source countries are, so they've been able to work towards this, and it seems to work for them in the health professions.

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

Dean Murphy, let me ask you a question. Through technology there's an opportunity to train people online. Is that something that also could be looked at, wherein if somebody applies to come to Canada wanting to be a nurse, we could link them up so that they're aware and could take the training online? Or do you feel that it has to be done in Canada in a work setting?

[Dr. Sandra Murphy]

I have a couple of comments. First of all, I believe it has to be done in Canada. We have tried to put part of the practical nursing program overseas. In order to be approved by the College of Nurses of Ontario as an educational institution, we have to have Canadian training, so we can only offer one of two years of training overseas.

Online training for an internationally educated professional can only be done, I feel, in adjunct to traditional classroom teaching as well. I think online training is fine, but we are pulling from countries where individuals do not have the technological resources. We have to be very careful with technology. In fact, in the case of internationally educated nurses, as an example, one of their biggest difficulties is the technology.

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

Okay.

Let me direct a question to Mr. Brennan.

You mentioned that Canada's standards are significantly higher. That was comforting, but is it arbitrary? You look at other professionals working in many other countries and you are saying they're not acceptable. But obviously they're operating and doing the job in those other countries.

Who sets the standards, and are they arbitrary? I want to make sure that people who are helping me with my health are professional and well-trained, but are we setting the bar too high?

[Michael Brennan]

That's a fantastic question, and any health profession has to have the courage and honesty to ask itself that on a regular basis.

Our competency standards are equivalent to those of the U.K., Australia, and New Zealand, and that's it. Everywhere else in the world, physiotherapists are not able to do a differential diagnosis, for example, and convey that information to patients, and so on. There are certain distinct advantages; one talks about efficiency in the health human resource labour force.

There are reasons why the situation has evolved this way in Canada that take away the arbitrariness, if you will, because it involves working in collaboration with health professionals. But there are other models. Certainly the Canadian model is not the best—we all recognize that—but it would be very difficult to reverse-engineer where we have wound up. I'm not sure necessarily that we can go backwards to go forward, but maybe that's the solution. It's not practical, though, when we talk about the theme of today's conversation.

But as I said a little bit earlier, part of the solution may be some kind of limited licensure to integrate and get working. It's very much one of the recommendations out of the Deloitte study today: let's use the capacity that's there. If we need to build on top of it, then let's take the time to do it, but let's get them into the workforce right away.

[The Chair, Conservative, Ed Komarnicki]

Thank you, Mr. Mayes. Your time is well up.

We'll move now to Mr. Cuzner.

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

Thank you very much, Mr. Chair. I want to congratulate you and Mr. Shields on a great day one of Movember. Both of you are off to a great start. I'm sure Phil and I are going to catch you in the long haul—eh, Phil?—but it will be a big finish.

Ms. Murphy, I had a group of lab techs in from Atlantic Canada this week. They felt that in most of the health service areas, with the number of seats that have been added in institutions in Atlantic Canada, they were going to be able to fill job openings in Atlantic Canada. The areas in which they were having problems were placements and work experience. What they're saying is that in some of the rural hospitals where, let's say, historically they have had three lab techs, they now have one. The additional focus of mentoring somebody and training somebody is putting additional strain on capacity.

First, talk about the number of seats that have been developed to accommodate the demand. Are we turning away people who are applying? Are there enough seats there?

Then also talk about those training opportunities. Is there no financial incentive there, or is there a void in the number of people who are able to provide the training?

[Dr. Sandra Murphy]

Whether we're talking about pharmacy technicians, pharmacists, or nurses, the preceptors who are in the field are hard to come by. I think there is a lot of burnout, there are a lot of students out there, and we are definitely overtaxing the system. I also think that the people working within some professions are not convinced that this is part of their professional requirement, that it is their obligation to have teaching for the people coming into their profession. I think that's happening.

Part of the answer is that we need to increase the amount of simulation we're using to replace actual clinical hours, but for our accrediting bodies to agree to that, we need to do research showing that it will inform and impact practice.

So I think we need to do simulation, and we need funding for it, and we need to do research on the effectiveness and how it informs practice.

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

If others have a comment, please, by all means, go ahead.

[Charles Shields]

I'd concur that simulation is something that is being seen and is used to assist with the clinical preparation in the profession my association has--medical radiation technologists. There are a number of institutions moving in that direction now. Additional funding would be helpful, but I think it's something that is happening. We have been taking steps to see what can be done appropriately through simulation. This is for entry-to-practice education, but it could be applied and transferred over to the internationally educated folks.

We have looked at this to see what sort of simulation makes it sensible to say that clinical competence can be demonstrated through simulation in these instances. So that kind of work is happening, and I think there is something to be said about looking further at it.

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

Thank you.

Mr. Brennan, the two pilot projects you referred to, in Nova Scotia and Alberta, didn't meet with a great deal of success. You indicated that this was because of the amount of incentive that was being offered. Could you explain a little bit more?

And in assessment, did they mention a number that would have been...? Maybe we could have access to some of that information.

[Michael Brennan]

Sure. I can certainly provide it.

The answer to question number two is that it wasn't really a numbers question, or at least that wasn't the initial finding. The findings were that in order to make the practicum of value, a drop in patient load was pretty much necessary so that they could have time for teaching and so on, which of course impacts revenue. But I think it was more a cultural issue, not based on any prejudice but more on the challenges of being able to communicate effectively to relay the context of a Canadian health care system and so on, so that both the student and the mentor were having some value in the practicum.

Essentially we tried a Canadian model, with a slight financial incentive to participate, and we got both context and funding wrong in the pilot.

[The Chair, Conservative, Ed Komarnicki]

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

Mr. McColeman, did you wish to use your five minutes?

[Phil McColeman, Conservative, Brant, ON]

Mr. Chair, I do. Thank you very kindly for allowing me to.

Thank you for being here. The expectation in looking at this might have seemed fairly simple at first blush, that we could boil this down to perhaps people writing an exam and, boom, they're in the occupation. But the more we delve into it, the more complex it is, so I appreciate your input today.

Two of the immigration issues in the forefront of my mind right now are the language issue and having a pre-qualified standard, as Australia does, testing immigrants to meet a certain standard before they come into the country so they can fit into the education system and the protocols of various occupations.

I'd like your comments on how feasible you think that whole pre-entry, pre-certification standard is in a country that's had an immigration policy, as we have in the past.

I'm not asking you to get political, and we're not here to discuss our immigration policies, but that's an issue, as a legislator, that we have to look at. How realistic is it to go to other countries to set up these types of structures that would be required?

Does anyone care to comment on that?

[Christine Nielsen]

I think if it were to move that way on a policy basis, it couldn't be all countries, all professions, and all fields, and it probably shouldn't.

[Phil McColeman, Conservative, Brant, ON]

Right.

[Christine Nielsen]

In my own profession, medical lab science, we know that probably 70% of people come from Canada's top three of the four source countries, with the exception of China. So for us, that would be an obvious place for us to create something.

You've touched on the complexity of it, in that sometimes individual regulators are doing credential evaluation. You've seen the limitation of whether simulation would be accepted by a regulator as being on par with the clinical practicum. It's fraught with political problems, and I don't know how one would go about encouraging the change in immigration policy.

For a profession to do it on a profession-by-profession basis, it's probably feasible, but for it to become embedded in policy might be difficult.

[Phil McColeman, Conservative, Brant, ON]

Would you agree, though, that one step that might be useful is the integration of Citizenship and Immigration Canada with HRSDC in terms of a one-stop coordinated approach?

[Christine Nielsen]

Absolutely.

[Phil McColeman, Conservative, Brant, ON]

That would be a step forward, in your mind.

[Christine Nielsen]

For sure.

[Phil McColeman, Conservative, Brant, ON]

Secondly, take it to another level; take it to the provincial level and the national level. We've been talking about some national standards, and perhaps the proposal would be to create a national standard across the country. But as we all know, there are huge interprovincial barriers.

What do you think the capacity is within the multitude of organizations that would have to be involved province to province to complete that process? Is it realistic to think we could ever do that?

[Charles Shields]

I was going to say we are doing that now, in medical radiation technology. It is possible. There is the will. We have the regulators together with the other groups to create that national assessment standard. That's in the process now. It's going to be finished in the next few months.

[Phil McColeman, Conservative, Brant, ON]

That is very encouraging. Thank you.

Dr. Murphy, how about in the nursing profession?