Human Resources Committee on March 28th, 2022

[The Chair, Liberal, Bobby Morrissey]

Thank you, Mr. Janeiro.

Madam Smart, you have the floor for five minutes.

[Dr. Katharine Smart, President, Canadian Medical Association]

Thank you, Chair and committee members, for the opportunity to appear before you today.

I'm Dr. Katharine Smart, and I'm speaking to you today from Ottawa on the unceded territory of the Algonquin and Anishinabe nations. I'm a pediatrician based in Yukon.

As president of the Canadian Medical Association, I am honoured to represent physicians and medical learners from all jurisdictions. Every one of us has felt the impacts of a health care system stretched beyond its capacity. For health workers, the pandemic has been unrelenting. Two years in, organizations representing health workers across the country are sounding the alarm. Canada's health care system is collapsing.

As the national organization representing physicians, we too are calling for action. Doctors [Technical difficulty—Editor] are experiencing.... Over 50% of physicians and medical learners reported high levels of burnout—30% compared with pre-pandemic levels. Moreover, nearly a half of physicians reported that they would likely reduce clinical hours. The shortage of colleagues to cope with current and future demands is nationwide.

As many Canadians are feeling that the loosening of health measures are signalling an emergence from the pandemic, the same cannot be said for health workers. Our health workforce is in the biggest crisis we've ever seen, and because of it Canada's health system is on life support.

[Technical difficulty—Editor] grateful for the federal government's integral role in the pandemic response, but it's not over. Health care workers are relying on the leadership of the federal government to support a way forward. By aiding medical professionals, you are helping every Canadian—now and in the future.

Last fall, the CMA and the Canadian Nurses Association co-hosted an emergency summit to learn from nearly 40 health organizations representing nurses, physicians, respiratory therapists, personal support workers, psychologists and educational institutions. We knew then that we were collectively experiencing a human health resources—or HHR—crisis.

We recently met again, with close to 40 organizations representing health workers. What we heard is disheartening. Health workers are depleted and distressed. They're facing harassment, and leaving their careers and professions entirely.

The repercussions of this could be devastating in a country where already more than five million Canadians presently have no regular health care provider. Of those with a doctor, only 40% of patients could get an appointment within 48 hours, and 46% of physicians are considering reducing clinical hours over the next two years.

What we're learning is more than alarming; it's potentially catastrophic. Time is of the essence. More than a quarter of practising physicians claim low rates of overall mental health. Recent figures show that 20% of frontline health care workers have thought about suicide. A crushing 6% had planned an attempt.

To worsen matters, the barriers we've created over time for doctors and nurses practising in a new province or territory aren't helping to fill the 118,000 job vacancies in health care and social assistance across the country. It is why the current regulatory licensing frameworks need to move to a pan-Canadian licensure model. This would allow health professionals to work where they would like and where the needs are greatest. It's time to remove these unnecessary regulatory obstacles.

The result will affect every single Canadian and put their health or ability to access their health system at risk. This crisis has ballooned past what any jurisdiction can manage alone. We know that the premiers are focused on an increase in unconditional federal dollars. We believe that more strategic federal investments are required to support the rebuilding of health care delivery in Canada.

First, we need federal leadership for pan-Canadian integrated health and human resource planning. An intergovernmental approach led by the federal government is required.

Second, it's time to deliver on the promise to increase patient access to family doctors and primary care teams by delivering on the $3.2-billion commitment. As part of this commitment, the CMA recommends that $1.2 billion over four years be dedicated to a primary care access fund, and $2 million to undertake an assessment of interprofessional training capacity of family physicians [Technical difficulty—Editor]. Scaling up collaborative, interprofessional primary care is central to increasing access to care.

Third, we need a pan-Canadian licensure model that supports access to care, especially for rural and remote communities; continuity of care, including cross border virtual care; the mobility of patients and providers; and overall creates a more streamlined licensure process.

The past decades have witnessed remarkable advances in medicine, but we're still reliant on health workers.

Just as we have stood on the front lines, it's critical that the federal government create pathways that will stand for the protection of medical professionals. We need the federal government to finish this long shift with us.

Thank you, Chair.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Dr. Smart.

Now we go to Mr. Villeneuve for five minutes.

[Michael Villeneuve, Chief Executive Officer, Canadian Nurses Association]

Good afternoon and thank you, Mr. Chair and members of the committee, for inviting the Canadian Nurses Association, the national and global professional voice of Canadian nursing, to appear today.

My name is Mike Villeneuve and I am speaking to you today from the traditional lands of the Algonquin and Anishinabe people. I'm the chief executive officer of CNA.

Mr. Chair, I have been working in health care for the past 44 years [Technical difficulty—Editor]. I have never seen the gravity of the kinds of [Technical difficulty—Editor]. CNA predicted Canada would be short about 60,000 nurses by 2022. We're a quarter of the way into that now and [Technical difficulty—Editor] shortages are worse than we imagined.

Canada's nearly 450,000 nurses, 91% of whom are women, are the backbone of our health systems. Today, they are completely exhausted and demoralized. We are seeing alarming numbers of them not just leaving their jobs, but even the profession.

Many nurses face working 16-hour shifts, have not been able to take a day off or take a break, or have had their vacations suspended and they face chronic and dangerous understaffing. Rates of severe burnout among health care workers have almost doubled. You heard what Dr. Smart said about the number of people who have planned and attempted suicide. It's 6%. It's alarming.

Vacancies for registered nurses and registered psychiatric nurses have increased by over 85%, which is the largest increase of all occupations. Nurses have been sounding the alarm for decades about these problems—long before COVID-19. The issues are not new, but they have been exacerbated by the pandemic.

The factors influencing nurse retention have been studied intensively for 40 years through myriad studies, reports and millions of dollars in research. Nurses have a clear understanding of the problems and we know the solutions needed to stabilize Canada's health workforce crisis.

The challenge is creating and sustaining political will at all levels to implement these tough changes. Canada needs targeted federal funding to help health care systems train, retain, recruit and improve education and working conditions for health care workers. The federal government has an important convenor and coordinator role to play. It needs to work together with provinces and territories on both short- and long-term strategies. Maintaining the status quo cannot be an option.

In the short term, we need retention incentives for nurses and health care workers to stay in their jobs, such as retention bonuses, student debt forgiveness and tax incentives. Additional funding is also needed to help optimize workloads for health care workers. This could include increasing administrative, cleaning and other support staff in nursing settings to unlock more time for care.

In the longer term, CNA echoes the calls for a national health workforce body to collect high-quality data to support a strong, modern pan-Canadian health human resources strategy that includes planning at the provincial, territorial and national levels. CNA also recommends increasing the number of seats in schools of nursing and greater capacity for clinical placements. We recommend expediting the process for recognizing internationally educated nurses and funding for mental health supports for health care workers.

We need emergency and definitive interventions with immediate action and a multi-faceted strategy to address the complex problems in Canada's health workforce. We have to be bold and creative. Strategies that serve to retain a nurse at 25 are not going to be the same as what will retain a nurse at 65. What attracts people to stay in home care may be very different from critical care or palliative care. We need to be nimble, marshal the evidence and develop a tool box of strategies that can be adapted across care settings and across career stages.

Finally, as the proportion of older adults in Canada rises, we will need a strong care economy and workforce to support our aging population into the future.

In conclusion, we applaud the committee's decision to conduct this important and timely study. I'd be happy to try to answer any questions.

Thank you, Chair.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Mr. Villeneuve.

We will now open the floor to questions, beginning with Madam Gladu for six minutes.

You have the floor.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Thank you, Chair.

Thank you to all of the witnesses for being here today and for all the work you've done.

I'm going to start with Mr. Villeneuve.

Talking about nurses, my daughter is a nurse. I'm certainly well aware of many of the issues facing nurses. She's been attacked. She has been forced to work overtime. She has had her vacation suspended. Even though she's only in her twenties, she's one of those considering leaving the profession.

If we look at all of these issues, why have they not been addressed? They've been known for a long time, but nothing seems to have been done.

Is it a lack of money or a lack of political will? What do you think?

[Michael Villeneuve]

Thank you, Mr. Chair, for the question.

That's the million-dollar question, isn't it? We've been looking at these issues; I can tell you that I've been involved in this since the year 2000. At that time, the conference of deputy ministers directed the country to develop a nursing strategy for Canada to address the shortages in these ongoing issues.

I can share with the member, Chair, that I looked at it again this morning. It was published in 2000, if you want to look it up. The nursing strategy for Canada had a number of recommendations. Its first recommendation was to create a Canadian nursing advisory committee to talk about all these issues. I happen to have the honour of being the executive lead of that.

Again, I looked at those 51 recommendations. Hand to God, you could just change the date on both of those reports, and literally every single thing we're talking about today is exactly the same. There just has not been the will to make the kind of changes we need across the system. Frustratingly, some places do it very, very well, so one might ask why all the rest don't. Many hospitals in this country don't have any trouble recruiting people and retaining them. I would say don't even invent anything new: Just copy that and do it in other places. We know the solutions.

It's been a tremendous frustration, Chair, that we haven't seemed to be able to move the dial. I won't go into the rabbit hole of gender, but I am very, very concerned that this is not the case in workforces heavily dominated by men. I've watched it play out for almost 45 years.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Thank you very much. I fully agree. I'm increasingly concerned when I see that we have an aging demographic and an increase in dementia, which will only exacerbate, I think, the already difficult situation.

Mr. Janerio, do you have any information about the percentage of PSWs who are not full time? We see that people chronically are made to take two and three part-time jobs with no benefits. Is there a quantity that you can put to that?

[James Janeiro]

That's an excellent question. I don't have that data off the top of my head, but I can certainly get back to you with it.

I can say that there has been an interesting development over the course of the COVID-19 pandemic. This is speaking specifically about the Ontario experience with COVID, but it was replicated in other provinces. As the realities of COVID became clear, and it became obvious that staff working for more than one employer was a vector for transmission of the disease, a number of agencies in the PSW sector, developmental services and other caregiving sectors started to move people purposely from part-time to full-time employment. They offered them the opportunity to go from being a part-time employee to a full-time employee, certainly with predictable hours but often with benefits and access to pensions and stuff like that.

Speaking in Ontario, at least, there was a lot of interest among those part-time staff to go to full-time employment, given the option. Even as the orders enabling all of that stuff have started to recede in Ontario, the interest in staying on as full-time employees rather than going back to part-time is huge. I would say it's probably the vast majority.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Absolutely. That's the direction we need, for sure.

Dr. Smart, we heard testimony the other day from Linda Silas about nurses. About 8% of them lost their jobs because they weren't vaccinated. That just made the situation even worse when there was already a shortage of nurses.

With respect to doctors in this country, did we see something similar? I've heard anecdotally at my office about different things—doctors who decided they were going to shut their offices, doctors who shut their offices because they felt their conscience rights were being threatened, and people who had their licences threatened.

I mean, I hear these things anecdotally, but in terms of a labour shortage, was there an impact from the pandemic on the medical staff?

[Dr. Katharine Smart]

I don't think we've seen a really significant impact that way amongst physicians. Over 99% of physicians are fully vaccinated against COVID-19 across the country. Certainly, we've heard a case here or there, but I don't think we've seen a substantial impact on the workplace.

I think we have seen other impacts, of course, from the pandemic. Many people in the community who were trying to provide primary care had to pivot to totally virtual health on a very short timeline. They have tried to maintain access for their patients over the past two years with changing public health requirements. That's been very stressful. It was one of the things noted in our national physician health survey as contributing to burnout—just the constant need to adjust to new expectations and ongoing and crushing workloads.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

What are the biggest barriers to getting more doctors in Canada, which is clearly what we need? Is it credential recognition? Is it financial donations from the federal government? What is the barrier?

[Dr. Katharine Smart]

I think one of our biggest challenges is that without a human health resource plan, we've never defined clearly how many positions are needed to serve Canadians on different levels of medicine. For example, we know that we need people in primary care. Well, what's that exact number? We know we need specialist care. What's that exact number? Where should the physicians be located?

Without that pan-Canadian human health resource plan, it's then challenging to start back at the beginning. At the medical school level, how many people should we be training? How many should there be at the postgraduate level? How many people should we then be training in these different specialties of medicine, which types and where? Right now I think the issue is that none of this is integrated. That's very challenging, and it means we have these shortages.

The other piece is that we do have internationally trained medical graduates in Canada who have been unable to access the system. They remain uncredentialed and unlicensed, and they haven't been able to participate in the systems that exist to get into actual practice and caring for Canadians. There's also work that could be done there to bring more of those folks on board and into our system.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Very good. Thanks so much.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Ms. Gladu.

We'll go now to Mr. Long for six minutes.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

Thank you, Mr. Chair.

Good afternoon to my colleagues.

Thank you to the witnesses for your testimony.

I'm a member of Parliament for the great riding of Saint John—Rothesay. Last week I had an opportunity to sit down with Dr. John Dornan, who's the CEO of Horizon Health Network. We talked about very innovative ideas, but also, obviously, a lot of concern came out of that meeting.

Again, I thank MP Zarrillo for this wonderful study, and we're here today because we certainly are faced with a crisis in the community care economy—doctors, nurses, caregivers—in every sector. From a federal perspective, as an individual and an MP, as a federal politician, as the federal government, I look for answers as to what we can do. We certainly recognize that jurisdiction is a major issue when it comes to our involvement in health care matters.

My first question is for you, Dr. Smart.

You alluded to the $28-billion ask from the provinces for health care, but you also mentioned that it may be better—and I don't want to put words in your mouth—targeted. Can you just elaborate on what you mean by targeted investments?

[Dr. Katharine Smart]

I think what we see is that there are certain areas right now within the health system that are particularly in crisis. We believe that targeted investments to ensure that funds go to supporting those areas have more opportunity to create accountability in the system and outcomes for Canadians versus large sums of money being absorbed into a general budget. For example, with regard to surgical backlogs in diagnostic imaging, we know there are hundreds of thousands of Canadians waiting for those procedures, so targeted funding for that, earmarked for hospitals to make sure those services are provided, would benefit those Canadians directly.

We know that there are significant issues with mental health, which has worsened for Canadians throughout the pandemic. Again, funds that can be targeted towards that will ensure that Canadians have better access to more holistic and more extensive mental health supports.

We're talking about primary care. Again, this is a huge crisis. Over five million Canadians are without access to a primary care provider. This is the front door to our health care system, so when you have Canadians without access to that type of care, it's very problematic. It increases costs over the long term, as many chronic diseases remain unmanaged and patients bounce between intermittent types of care.

Targeted investments, in terms of increasing integrated, team-based care, we think, again, can go to creating those better outcomes for Canadians. That's why we're recommending that the federal government, in alignment with stakeholders, identify those priorities and ensure that the funds go to meeting those goals.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

Thanks for that answer.

Also, I had a meeting with Dr. Michael Barry, a past president of the CMA.

How severe do you think the shortages are in infrastructure or issues with infrastructure? Certainly he talked about diagnostic imaging equipment. What level of concern do you have with the age of the infrastructure?

[Dr. Katharine Smart]

The things that need to be replaced vary across the country and across communities, for sure. We see that with diagnostic imaging equipment, with surgical equipment and, really, hospital equipment. I think you're going to see that different jurisdictions have different challenges.

I think the other big infrastructure issue we have is the infrastructure for providing primary care. In our traditional model of fee for service medicine, that infrastructure is provided and funded largely by physicians. That's becoming more challenging with rising labour and rental costs, and a lot of physicians are challenged to open and maintain primary care clinics because of the cost associated, as well as the ability to staff those particular forms of infrastructure.

I think there are many challenges in that domain, absolutely.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

Okay. Thank you for that.

Mr. Villeneuve, thanks for your testimony.

Again, recognizing jurisdiction between federal and provincial governments, how do you think that we as a federal government can help provinces and territories when it comes to staffing shortages?

Obviously, sadly, there's not a nurse—MP Gladu's daughter, any nurse that I talk to—that is not severely overworked. The mental health crisis in our nursing sector is of major concern.

What can we do as a federal government, Mr. Villeneuve?

[Michael Villeneuve]

Thank you for the question, Chair.

One of the realities across the country.... If we just look at nursing, there are roughly 450,000 nurses. We have a terrible shortage of nursing care. I'm never sure if we have a shortage of nurses. In many places, half of those people are part-time. What are the kinds of things you can do, even if you took a chunk of them and moved them to full-time hours?

Many people who are internationally educated graduates in the country are not getting into the system as quickly as they could.

What do you do to move people in and retain them?

People who are in the system are telling us that the reason they're going is not the money or retention bonuses. It's staffing. If the federal government could make some effort.... We had suggested a $300-million package to support better staffing.

The government could use some incentives, such as tax forgiveness, for example. If I'm 25 and you said to me that if I stayed for five years, you would wipe my student debt clean, that would get my attention, or if I'm 65 and you say to stay for two more years and you'll forgive the first 25% of my income. There are some creative levers that the federal government could do that would be attention getting for people.

The nurses are telling us, for example, late in career that they're making pretty good money. Five thousand dollars doesn't attract someone who is in the $80,000 to $100,000 category to stay in terrible working conditions.

What do you do to keep as many people in the system as possible?

We think the strong funding support of the federal government plus convening some planning—the federal government is good at doing that—would go a long way to shoring up the resources in the nursing sector.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

Thank you very much.

[The Chair, Liberal, Bobby Morrissey]

Ms. Chabot, you have the floor.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Thank you, Mr. Chair.

Thank you to all of the witnesses.

I would like to speak to the situation described by representatives of the Canadian Medical Association and the Canadian Nurses Association.

We are seeing labour shortages across the country. The problems vary from province to province and they have different causes, but there is an overall problem with burnout, as well as with recruitment and retention. As you said, it's not about using the same strategy from one industry to another.

My problem is not with what you said, because I think you are painting a general picture of the situation. However, you know very well that the real solutions fall each province's jurisdiction. I will give Quebec as an example. I am a nurse by profession and I was a union representative for nurses for quite some time. As in every province, the major nurses' unions, the Fédération de médecins omnipraticiens du Québec and the Fédération des médecins spécialistes du Québec negotiate the organization of care and the conditions of practice in areas that affect them. The same approach cannot therefore be used to fill full-time vacancies. The federal government cannot use a unilateral approach, as this is not its area of expertise, but that of the provinces.

However, I agree with you that it is absolutely necessary for the federal government to invest significantly in our public health care and social services. Under Canadian law, we must provide universal, free public care and we must have the tools to correct the unfortunate situation you describe. These investments cannot have strings attached.

Quebec and the provinces are making demands to this effect. The federal share of provincial health care spending is currently 22%. If nothing is done, it will be 18% in five years. Restoring the balance between the federal and provincial share of health care spending is imperative, because we see that the federal share is decreasing. The federal share of funding used to be 50%, but now it is 22%. Furthermore, the federal government is not making any commitments. Currently, the federal government commits to giving one-time payments to meet specific needs, but these are not recurring or predictable amounts of money.

Do you agree that the best solution is bring up health care funding to at least 35%, with no strings attached? That would support workers.

[Michael Villeneuve]

Excuse me, Chair, is that question for me or Dr. Smart?