Human Resources Committee on Nov. 1st, 2011

[Dr. Benoit Soucy]

The majority of the work in dentistry is done as a consequence of the Agreement on Internal Trade. We have a one-point facility for the assessment of credentials and testing afterwards, which is the National Dental Examining Board. They have been doing that for the last 10 years in a model that had a qualifying exam for foreign-trained dentists that led to the qualifying program, as I mentioned. Thanks to some federal funding they were able to come up with a model that can lead straight into practice, mostly through the addition of some simulation practices.

[Kellie Leitch, Conservative, Simcoe—Grey, ON]

I also wanted to ask what your thoughts are with respect to processes for pre-credentialling foreign sites so that students who are graduating from those sites—individuals who would come to Canada and train on Canadian soil and then be accepted into the process—could more freely and expediently enter into the Canadian workforce.

[Dr. Andrew Padmos]

Again, for the physicians, the Medical Council of Canada's evaluating examination is available online at several hundred sites around the country. I believe the language proficiency testing is also available. The Physician Credentials Registry of Canada could be accessed from outside the country. All of those stipulations could be met.

[Kellie Leitch, Conservative, Simcoe—Grey, ON]

What I mean by “site” is a physical site providing for the clinical capabilities of those individuals, not just a website. I apologize, I should have been more specific.

[Dr. Andrew Padmos]

That would be extraordinarily difficult, because we're requiring the evaluation, experience, and acumen of Canadian-trained or Canadian-placed individuals. Some might want to be exported to those faraway sites like Australia or New Zealand to conduct such work, but it would be out of context and probably inadmissible.

[The Chair, Conservative, Ed Komarnicki]

I think Ms. Bourgeault had a brief comment, if you could.

[Dr. Ivy Lynn Bourgeault]

There were a couple of comments in regard to where you establish such sites and whether or not they're examining sites, whether it's a written exam or a clinical exam. There are resource implications for those. There are also 50 countries that have been identified on the WHO list where you should not be recruiting from. There are additional countries where you should probably not recruit from as well, even though they're not on the list.

For this notion of mutuality of benefits, this creates an easier way for people to become integrated before they come to Canada, but it's a double-edged sword, because it does create a draw of people outside of countries that need their human resources as much if not more than we do.

[The Chair, Conservative, Ed Komarnicki]

Go ahead, Ms. Leitch. Do you have any further questions?

[Kellie Leitch, Conservative, Simcoe—Grey, ON]

I don't know if Mr. Soucy wanted to comment on that as well.

[Dr. Benoit Soucy]

As I mentioned, the approach we have chosen in dentistry is the mutual recognition agreement of accreditation systems in other counties. Setting up a specific process that would be operated from offshore is extremely difficult because of resource issues. What we have committed to is to make the equivalency assessment of the national board available to any international site where more than 50 candidates are willing to write the exam. For example, we have a site set up in London for next year where we have 70 candidates registered already.

[The Chair, Conservative, Ed Komarnicki]

Your time is up.

We will move to Ms. Hughes.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Thank you.

This is for Mr. Padmos.

International medical graduates need to complete an accredited residency program in family medicine or another medical or surgical specialty before obtaining certification. Are IMGs able to find residency placements rapidly after they arrive in Canada?

[Dr. Andrew Padmos]

That's a good question. In fact, the premise is not currently operative. We have a practice eligibility route to certification for people to whom medical regulator authorities have already given licences and who are practising in Canada. Those individuals are able to access the Royal College certification without doing a formal residency training program by going through a multi-step assessment, a multi-dimensional evaluation process leading to a portfolio evaluation of the type of work they are doing, rather than a full examination of the full spectrum of their specialty.

Also, the family physicians of Canada, as far as I know, do have alternate pathways that do not involve residency or examination, depending on the country and accreditation system that has been employed in those cases. For those individuals who are deemed by a medical regulatory authority—not by the colleges—to require a residency program, there are severe constraints on the availability.

Canada has approximately 2,800 residency positions for intake into the first year of training after medical school. That number is closely related to the output of medical schools so that they guarantee each Canadian graduate the chance at a residency program. There are few extras set aside specifically for international graduates. Most are in Ontario. Taken altogether, about 250 residency positions are available. This is, however, insufficient to deal with the several thousand permanent residents and citizens of Canada who are international medical graduates.

The system has limited capacity to expand further. We now have residents-in-training outside major hospitals and urban centres all over. If funding were made available--deans of medicine are known to respond to the provision of hard cold cash--perhaps further residency slots could be made available.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

I appreciate that. That's what we heard last week--that there is a big shortage of placements for international professionals.

The Government of Canada allocated $75 million over five years for the international educated health professionals initiative to support projects aimed at facilitating the assessment and recognition of foreign credentials, as well as the integration of medical graduates into the health care system.

Have you participated in any of the funded programs under this initiative?

[Dr. Andrew Padmos]

Yes, we have. We're members of working groups, particularly the national assessment collaboration, which is headed up by the Medical Council of Canada. It has developed what's called an objective structured clinical examination for international medical graduates to ascertain their suitability for residency positions. That examination has now been rolled out in several provinces and soon will be available in all provinces. We participate in programs of that nature on invitation. We're not funded to conduct any of them.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Mr. Soucy, do you want to comment on this--or anybody else?

Are there any improvements that need to be done to that?

[Dr. Benoit Soucy]

The biggest problem we have in dentistry is that, unlike medicine, we don't have a public system of care delivery. All the care is provided privately. The only place we could send a resident is to a dental school.

As we were told, the deans seem to respond to cold hard cash. We haven't been able to get ongoing funding in order to set up this type of program. We are definitely lacking in opportunities to train certain categories of dentists when they come here. We even have the same problems for dentists who are practising in Canada and require remedial education because they ran afoul of the regulator in their province.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Where are the shortages of dentists in Canada, or is there a shortage?

[Dr. Benoit Soucy]

There is no shortage of dentists in Canada in numbers. There is a problem with distribution. When you get into a sparsely populated area, there simply isn't the population required to maintain a viable business. That's a huge problem in the areas that do not have dense populations.

[The Chair, Conservative, Ed Komarnicki]

Thank you, Ms. Hughes.

We'll now turn to Mr. Butt. Go ahead.

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

Thank you very much, Mr. Chair.

Thank you all for being here today. I think I'll start with Dr. Padmos.

Is there a physician shortage in Canada right now?

[Dr. Andrew Padmos]

That depends on whether you're a patient or a member of the public. But I think there is a physician shortage. Part of it is maldistribution. A lot of it is because physicians are doing things they probably shouldn't do that others could do just as well or perhaps even better.

In some respects there are specific shortages. Primary care is an area where, if we accept the proposed model of a medical home, a large number of Canadians do not have access to a comprehensive, continuous family practice environment, which is the ideal model for delivering primary care.

There are some specialties in medicine. There are 65 specialties and subspecialties within our purview that are considered to be short. There are others where the supply is probably at least temporarily more than we need. Some physician specialists and surgical specialists are currently looking for positions or continuing their training in more and more arcane and erudite areas of medical practice in order to wait or to train themselves for a specific practice opportunity.

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

I think you mentioned that 2,800 per year are going through residency and eventually becoming physicians or surgeons in some way, shape, or form. Is that number sustainable each year? Are we going to fall further and further behind because there aren't enough graduating to replace those who are retiring or ceasing to practise in some way?

On the second part of that question, is that number sustainable only with Canadian graduates, or will we require, as we move along, more and more doctors in Canada who have been trained internationally?

[Dr. Andrew Padmos]

If the stock market improves I think there will be a sudden shortage of physicians, because many of them are still practising beyond normal retirement age. That is a significant current issue.

The number of 2,800 is not enough to have national self-sufficiency in our supply of physicians. Of Canada's medical workforce, 25% trained outside of Canada, and that has been the case for a long time. So if we want national self-sufficiency, we probably need to have an intake or at least a medical school output of well over 3,000 per year, and a suitable number of residency positions to fully train and certify those individuals.

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

I was going to ask Dr. Bourgeault a question. You said you studied four countries, their systems and what they're doing. Who is doing it better than we are? Who is getting their international medical graduates recognized quicker, practising quicker, whether it's Australia or whatever other country? Who is doing a better job, and why is it better?