National Defence Committee on Nov. 27th, 2006

[BGen Hilary Jaeger]

May I offer you some specifics, sir?

[Joe McGuire, Liberal, Egmont, PE]

I would like to point out that as far as mental health staff is concerned, in Edmonton there are 27, in Valcartier there are 35, in Petawawa there are nine, and that's where the soldiers are coming back. How many are in Ottawa now to offset the nine?

[BGen Hilary Jaeger]

The number is about 30, sir.

I was the brigade surgeon in Petawawa in the late 1990s, the senior physician on that base, and we had three mental health care providers then. We've tripled that number to nine, and the mental health care project seeks to triple it again, to roughly 31.

The reason there is such a large number in Edmonton, and some other bases you've mentioned, is that those bases host operational traumas at stress support centres. We have five of these centres, a network of five across the country. When those centres were set up in the late 1990s, the decision was made that the regional centre for Ontario would be in Ottawa, because it serves not only Ottawa, but Kingston, Trenton, Toronto, Borden, and Petawawa.

[Joe McGuire, Liberal, Egmont, PE]

So those soldiers come here, rather than to their families in Petawawa, because doctors won't go there?

[BGen Hilary Jaeger]

Well, we are doing the best we can to entice doctors to come and work for us. We're not going to give up, but it's very, very hard work.

[The Chair, Conservative, Rick Casson]

Thank you very much.

Mr. Hawn.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you, Mr. Chair.

Thank you, Commodore and General, for joining us.

I met a lot of soldiers who were coming to Edmonton, of course, in the most recent rotation, and I met a lot of those folks coming back in the Airbus. Given the challenge, the care they are given, in their own words, was spectacular. I simply want to commend the CFHS for that. I spent a fair bit of time with people like Paul Franklin, the double amputee above the knee, and talking about getting back to activity duty, he is probably a double amputee who will be back to active duty. Obviously it will not be combat-related. He was a medical technician, of course.

On the medical technician side, how are you doing with numbers of medical technicians relative to your manning levels? How are you doing with recruitment? How are you doing with retention? Are the ones that have been trained as physician assistants being tempted away to civvy street in any significant numbers?

[Cmdre M. F. Kavanagh]

We're doing reasonably well on the recruitment front with bringing people in to become medical technicians. I'm not as happy as I'd like to be with the retention piece. Some of that is demographics. We have physician assistants in the same demographic bulge as I am, who are looking for other opportunities.

The civilian sector has finally discovered physician assistants, so we now have a competitor. We are working very actively and aggressively with the civilian sector to make this a win-win for us and them. We think it can help the civilian health care system, as well as ourselves, if we approach it the right way.

The medical technicians are better trained. Again this is a direct result of the Rx2000 project that was put in place five years ago. We enhanced the training. They are very skilled PCP-trained medical technicians, which then again makes this competitive. Some of them have chosen to pursue employment opportunities outside of the uniform after their basic engagement.

I'm not as happy with the retention numbers as I would like; that is a challenge. Recently I was informed of what they actually are from the junior ranks, and I think we have some work to do to encourage them to stay and to challenge them with clinical activities, because that's what they joined to do. They joined our organization to be around patients, because that's their interest.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

What kind of a reception are you getting from the civilian health care organizations that would like to hire them, with respect to making it a win-win, with respect to having them release them back for reserve duty for six months at a time, for example? Are you getting a decent reception, or is it pretty tough?

[Cmdre M. F. Kavanagh]

The surgeon general has worked more with the University of Manitoba and the province of Manitoba, which were the first ones off the mark, and she can comment specifically. Those who have taken the time to understand this and realize what it is we have to offer are very willing to become engaged. They want to participate with us, and see this as an opportunity we can both benefit from.

This is such a novel concept in this country. Physician assistants are common in the U.S., but they're relatively new here, and there's still this fear of the unknown in many places as well. So some of it's really good, and some of it is just not understanding the issue yet.

[BGen Hilary Jaeger]

I'll speak to the physician assistant piece, which I know well. There are opportunities and threats out there. We have seized the opportunity because we believe we have a valuable tool or resource that can have applicability across the Canadian health care landscape. We're very enthusiastic about teaching our colleagues on the civilian side about what the potential might be.

On the other hand, if they understand it too well, we are the only provider of physician assistants in Canada at the moment, and on our small training capacity, if you spread it across ten hungry provinces and three territories, isn't going to go very far.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

How many physician assistants do you train a year?

[BGen Hilary Jaeger]

We train a graduating class of 24 a year, and that takes every ounce of instructional capability we can muster.

I call the difficulties we run into sort of turf sensitivities. There are nurse practitioners also seeking more recognition and broader opportunities across Canada. We certainly have no heartache with that, as we employ both of them, but some people can't see that there's room for both. Some people see it as if one side gains, the other must lose. We don't see it that way.

[The Chair, Conservative, Rick Casson]

Thank you.

I'll go to Mr. Bouchard, and then back to the government.

[Robert Bouchard, Bloc, Chicoutimi—Le Fjord, QC]

Thank you, Mr. Chairman.

Thank you for being here this afternoon. I would like to ask you some questions about your personnel, and more specifically, about recruitment.

We know that the Canadian Forces have recruited 20,000 members over the past four years, bringing numbers up by 700. You yourself recognized that recruitment had been a challenge.

I had the opportunity to visit the Petawawa military base, where doctors told me that they were under a lot of pressure and had to work a lot of overtime. They even said that there was a shortage of staff.

Can you tell me whether all of your medical units have a full complement of staff? If not, why?

[BGen Hilary Jaeger]

Regarding doctors, allow me to give you the example of general practitioners. Thirty per cent of our GP positions at the captain and major levels are unfilled. As these are the people who provide medical care on our bases, we have a problem.

The situation is even worse for francophones. There is an even greater shortage of French-speaking doctors.

We are trying to address this problem by employing civilian doctors, but it requires a sustained effort.

The shortage of pharmacists stands at around 50% across the country. Again, we are trying to recruit civilian pharmacists.

It remains, however, that members of the armed forces can do certain tasks that civilians cannot. There's a difference between a civilian and a member of the armed forces. Having too many civilian medical personnel undermines our flexibility, particularly when a large number of troops are deployed. The work becomes increasingly difficult for those left behind.

They are, I think, committed. They can take pride in doing a job well. They know that what they're doing is important, and they are all very, very keen to make sure that, particularly when wounded people come back to Canada.... I have never had anybody say “I'm going away for the weekend; I can't possibly be there to meet the plane coming back.” I've never heard any feedback like that.

[Robert Bouchard, Bloc, Chicoutimi—Le Fjord, QC]

The Canadian Forces have recognized the mission in Afghanistan as being a priority.

What have been the repercussions of this mission on your staffing levels?

[BGen Hilary Jaeger]

The repercussions—

I think I'll answer in English, because I can explain it better.

There's the direct arithmetic. We have a certain number of physicians deployed in Afghanistan. We have a certain number of nurses. We have a certain number of medical technicians. Of course, those people are not available to us to provide care back here in Canada.

Not only are they not available, but their replacements, who are already on pre-deployment training to go, are not available. In some cases, those people they replaced, because they're on post-deployment leave, take some time to come back to work. So for every one person who's deployed, there are really two to two and a half people who are not available to do the work back in Canada that needs to be done.

On the other hand, it's a kind of work that is very motivating for people. Actually, in some respects, and for many respects, it's what they joined to do. It's the most real expression of what it means to be a health care provider in the military, so it can be a big motivating factor—for the families, perhaps, not so much of a motivating factor.

[The Chair, Conservative, Rick Casson]

Thank you.

Mr. Blaney.

[Steven Blaney, Conservative, Lévis—Bellechasse, QC]

Good afternoon, and thank you for having come to meet with us today.

I very much enjoyed your presentation. You spoke about the post-deployment screening that all deployed members undergo four to six months after returning home in order to ensure an early detection of any problems.

Could you give us some details on this? Each conflict leaves some soldiers with scars. How would you evaluate the general mental and psychological state of the soldiers who have returned from Afghanistan thus far?

[BGen Hilary Jaeger]

We began using this specific screening instrument in 2003 for the first time. We now have almost three years of experience and data using this particular instrument. Before that it was much less structured. There was always an evaluation, but not using the same questionnaire.

For the current mission, since we've moved to Kandahar and undertaken more active patrolling and more contact with the enemy that's been characteristic of this current mission, we do not have any data yet from anybody who has returned from that mission. The vast majority of the battle group that returned in August, who are centred in Edmonton and Shilo, will undergo these assessments after Christmas, so the data collection will run through January and February. After we have a chance to process that information, we'll have a better sense as to what the different stressors and the different nature of this deployment mean compared to the previous deployments in Kabul, or even to some other experiences we've had.

We don't know. You've probably heard lots of people say that because the mission is so active and there've been so many incidents that it must produce more mental health problems. There are some schools of thought on the psychiatric side that that's not necessarily the case, that because they have a mission, because they're pursuing their goals, and because they're out there allowed to engage the enemy, for some people and in some circumstances that might be less stressful than the enforced passivity of the classic UN peacekeeping mission. We just don't know. We're going to collect the data and see.

[Steven Blaney, Conservative, Lévis—Bellechasse, QC]

The fact that this is an active mission could have a positive effect on the mental health of our troops. At any rate, this is something that you are going to be assessing.

You mentioned earlier that the shortage of general practitioners stood at around 30%.

What are the issues and challenges you are facing in Afghanistan? Are you expecting to face problems over the upcoming months, in terms of equipment, for example? Are you expecting to face problems over the course of the upcoming months?

[BGen Hilary Jaeger]

We wall off the mission in Afghanistan. That's priority one, job one. So if we only had five physicians left in the Canadian Forces they'd be deployed to Afghanistan. So the shortages we face back here don't translate and have an effect over there.

[Steven Blaney, Conservative, Lévis—Bellechasse, QC]

You are saying that the situation does not carry any consequences for the mission in Afghanistan.

[BGen Hilary Jaeger]

The pain is felt back here and the backfill is done back here.

As to the equipment question—