CIMM Committee Meeting

37th PARLIAMENT, 3rd SESSION

Standing Committee on Citizenship and Immigration

EVIDENCE

CONTENTS

Monday, April 19, 2004

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1535

The Chair (Mr. Sarkis Assadourian (Brampton Centre, Lib.))

Dr. Louis Dubé (President, Canadian Dental Association)

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1540

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1545

The Chair

Mrs. Marie Lemay (Chief Executive Officer, Canadian Council of Professional Engineers)

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1550

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1555

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1600

The Chair

Dr. Sunil Patel (President, Canadian Medical Association)

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1605

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1610

The Chair

Ms. Madeleine Dalphond-Guiral (Laval Centre, BQ)

Mrs. Marie Lemay

Ms. Madeleine Dalphond-Guiral

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1615

The Chair

Mrs. Marie Lemay

Ms. Madeleine Dalphond-Guiral

Mrs. Marie Lemay

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1620

The Chair

Dr. Sunil Patel

The Chair

Dr. Louis Dubé

Ms. Madeleine Dalphond-Guiral

Dr. Louis Dubé

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1625

Ms. Madeleine Dalphond-Guiral

Dr. Louis Dubé

Ms. Madeleine Dalphond-Guiral

Dr. Louis Dubé

The Chair

Hon. Jerry Pickard (Chatham—Kent Essex, Lib.)

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1630

The Chair

Dr. Sunil Patel

Hon. Jerry Pickard

Dr. Sunil Patel

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1635

The Chair

Mrs. Marie Lemay

The Chair

Dr. Sunil Patel

The Chair

Dr. Sunil Patel

The Chair

Mr. Pat Martin (Winnipeg Centre, NDP)

The Chair

Dr. Benoit Soucy (Director, Membership and Professional Services, Canadian Dental Association)

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1640

The Chair

Mr. Pat Martin

The Chair

Mr. Pat Martin

Mrs. Marie Lemay

Mr. Pat Martin

Dr. Sunil Patel

Mr. Owen Adams (Asssitant Secretary General, Research Policy and Planning, Canadian Medical Association)

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1645

Dr. Sunil Patel

The Chair

Dr. Louis Dubé

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1650

Mr. Pat Martin

Dr. Louis Dubé

Mr. Pat Martin

Dr. Louis Dubé

The Chair

Mrs. Marie Lemay

Mr. Pat Martin

Mrs. Marie Lemay

Mr. Pat Martin

Mrs. Marie Lemay

Mr. Pat Martin

Mrs. Marie Lemay

Mr. Pat Martin

Mrs. Marie Lemay

Mr. Pat Martin

Mrs. Marie Lemay

The Chair

Mrs. Marie Lemay

Mr. Pat Martin

Mrs. Marie Lemay

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1655

Mr. Pat Martin

Mrs. Marie Lemay

Mr. Pat Martin

The Chair

Dr. Benoit Soucy

The Chair

Dr. Sunil Patel

Mr. Owen Adams

The Chair

Mr. Owen Adams

The Chair

Mr. Owen Adams

The Chair

Dr. Benoit Soucy

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1700

The Chair

Dr. Sunil Patel

Mrs. Marie Lemay

The Chair

Ms. Madeleine Dalphond-Guiral

»

1705

Mrs. Marie Lemay

The Chair

Dr. Louis Dubé

Ms. Madeleine Dalphond-Guiral

Dr. Louis Dubé

Ms. Madeleine Dalphond-Guiral

Dr. Louis Dubé

Ms. Madeleine Dalphond-Guiral

The Chair

Ms. Madeleine Dalphond-Guiral

Dr. Louis Dubé

Dr. Benoit Soucy

Ms. Madeleine Dalphond-Guiral

»

1710

Mrs. Marie Lemay

Dr. Sunil Patel

The Chair

Mrs. Marie Lemay

The Chair

Mrs. Marie Lemay

The Chair

Mrs. Marie Lemay

The Chair

Mrs. Marie Lemay

»

1715

The Chair

Mr. Owen Adams

Dr. Sunil Patel

The Chair

Dr. Sunil Patel

The Chair

Dr. Sunil Patel

The Chair

Dr. Sunil Patel

Dr. Louis Dubé

The Chair

Dr. Louis Dubé

The Chair

Ms. Madeleine Dalphond-Guiral

The Chair

Ms. Madeleine Dalphond-Guiral

The Chair

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CANADA

Standing Committee on Citizenship and Immigration

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NUMBER 007

l

3rd SESSION

l

37th PARLIAMENT

---

EVIDENCE

Monday, April 19, 2004

[Recorded by Electronic Apparatus]

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[English]

    The Chair (Mr. Sarkis Assadourian (Brampton Centre, Lib.)): The meeting is called to order. Now we can proceed.

    Pursuant to Standing Order 108(2), the study on the recognition of foreign experience and credentials, we have witnesses from three different organizations: the Canadian Dental Association, the Canadian Council of Professional Engineers, and the Canadian Medical Association.

    Welcome to you all.

    Each group has 10 minutes for a presentation. After the presentations, we will ask questions until about 5:30 p.m.

    We'll start with the Canadian Dental Association, Louis Dubé--s'il vous plaît.

    Dr. Louis Dubé (President, Canadian Dental Association): Thank you, Mr. Chair.

    Mr. Chair and members of the committee, bonjour. My name is Louis Dubé. Thank you for inviting us to speak to you today about the integration of foreign-trained professionals into the Canadian workforce.

    As president of the Canadian Dental Association, I hope to present to you the perspective of general dentists and dental specialists across the country, as well as the various components of organized dentistry that play a part in training, accrediting, certifying, and licensing dentists.

    The issue of how foreign credentials are recognized in Canada is an important one. I imagine that for government there are two main pressure points: one is the shortage of certain health care providers, which has led to access-to-care problems, and the second is from the population of foreign-trained professionals themselves.

    In dentistry, we are fortunate that we can have not yet experienced major manpower problems and that we have the opportunity to prevent them. Nonetheless, we are aware that potential solutions for medicine may impact on dentistry, so we appreciate the opportunity to present our point of view here today.

    As well, we recognize that it is important for foreign-trained professionals to have a good sense of the certification process before they decide to come to Canada. The Canadian Dental Association has made this information available through its website for several years, and we receive numerous requests from foreign-trained dentists each year.

    In considering possible changes to the recognition of foreign credentials, one thing is paramount: we cannot compromise safety or Canadian standards of care. In fact, it goes way beyond standards of care. It includes appropriateness of care, with cultural and language components. This by no means suggests that we are unwilling to look at ways to make the process more understandable, smoother, and if appropriate, less time-consuming. However, this must be achieved in a way that maintains the appropriate care that our patients deserve and expect.

    How do we know that practising professionals are meeting the high standards that Canadians expect? In dentistry, it has been through a solid four-part process of education, accreditation, certification, and licensure. This process ensures that licensed Canadian dentists have the training and the skills that are needed to deliver safe and effective dental care.

    Education is delivered at 10 dental schools in Canada. The schools offer either DDS or DMD programs, which are equivalent general practice degrees. Many also offer specialty programs in one or more of the nine recognized Canadian dental specialties. As well, a number of universities offer qualifying programs or degree-completion opportunities. These programs were created specifically to meet the needs of foreign-trained dentists, in order to assist them in integrating into Canadian dentistry. Candidates must compete for the limited available positions, based in large part on their scores on an eligibility exam. This is similar to the procedure for Canadian students, who complete a dental aptitude test as part of their admission requirements to dental schools and must compete against other students for the limited available seats.

    When we speak of accreditation in dentistry, we are talking about the institutional level, not the individual dentist. The Commission on Dental Accreditation of Canada, or the CDAC, is responsible for accrediting all dental and dental hygiene programs, as well as some of the dental assisting programs. Accreditation is a lengthy, involved, and expensive process that requires regular site visits and considerable expertise.

    CDAC has a reciprocal agreement with the American Dental Association. As a result, schools accredited by one are also recognized by the other. Graduation from a recognized program, whether it's a program leading to a DMD or a DDS in Canada or in the United States or one of the qualifying programs, is required prior to certification.

    Certification of general dentists is done through the National Dental Examining Board of Canada, and as the name suggests, its scope is national. The NDEB has undergone extensive changes in its processes over the last few years in order to achieve a system of examination that is fair and effective and that is recognized as one of the best worldwide. It is accepted as a basis for licensure by all provinces. This allows NDEB-certified dentists to apply for licensure in any province without having to undergo any further testing for their qualifications--which brings me to licensure.

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    As I mentioned, each province has a dental regulatory authority that licenses and regulates all general dentists and specialists in that province. In addition to licensure, these bodies are also responsible for the maintenance of quality assurance programs and for investigating complaints about dentists and taking proper action.

[Translation]

    This four-part system effectively ensures the on-going monitoring of the way Canadian dentists practise, from their entry into a dental program to their retirement.

    To consider methods that might expedite this process, we need an understanding of some of the limitations. For example, a natural place to look is at the qualifying or degree completion programs—why not just open up more spots so we could move more foreign-trained dentists through quickly? This is not as easy as it sounds. The universities are already near breaking point. Chronic underfunding makes it difficult for them to maintain the faculty and facilities needed to keep current programs operational—let alone expand.

    As well, we must keep in mind that many more Canadians would study dentistry if more domestic positions were available, so we must also consider their needs.

    Another possibility is to expand our reciprocal agreements base. Again, money is a huge factor. It is very expensive to examine educational programs and conduct site visits overseas. As well, there are political and ethical concerns. We must be careful not to wantonly steal high-skilled labour from less privileged countries.

    We are also aware of the existence of “credential assessment” services that would seem to be a relatively easy and inexpensive way to determine whether a graduate of a foreign program could be considered for licensure in Canada. Unfortunately, again the reality is less than promising.

    The National Dental Examining Board conducted test cases through credential assessment organizations and the results were dangerously inadequate. Graduates of all test cases were deemed to be equivalent to Canadian grads despite an enormous variance in the quality of their education. In fact, even graduates from schools with no clinical training at all were given passing marks.

    There is no doubt that this is a complex problem. To examine these issues, the Canadian Dental Association recently brought together a wide range of stakeholders for a one-day forum. The forum included representatives of the Commission on Dental Accreditation of Canada, the Deans of Dental Schools, the provincial regulatory authorities, the specialty groups, the National Dental Examining Board of Canada and others. These are the groups that governments need to be familiar with, and consult as we look together for best practices on recognition of foreign-trained dentists. This group identified a number of key areas for further examination.

    First, we need more flexibility, especially in the qualifying and degree completion programs. Ideally, there should be some method to identify candidates who might require less than two years of additional training and customize a program for them. Again, this would require the investment of time and money in order to avoid overtaxing the already stretched resources of our dental schools.

    We must also train more Canadian residents. If manpower problems arise in future, it is ethical and responsible to look first at training more Canadian residents to meet this need. At the moment, many students cannot get into dentistry because of a shortage of spaces rather than inadequate marks. This is by no means an exclusionary approach. Canada is a country of immigrants and dentistry proudly reflects that diversity.

    Earlier I mentioned it would be good to assess the possibility of entering into more reciprocal agreements. Although this approach does present some problems, the potential remains. However, what is needed is a better knowledge base of the pros and cons for both Canada and other countries.

    As a follow-up to our forum, a task force has been struck to continue to examine the issue from dentistry's perspective. This group will look at the issues I have just identified, as well as opportunities to increase awareness of the Canadian process overseas, so that foreign-trained dentists will know what to expect, and make an informed choice about coming to Canada.

    To wrap up, Mr. Chairman, I would like to thank you for listening to my remarks. This is a huge policy area, and one that has clearly become a priority for this government.

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    I applaud you for consulting with the many groups that you will hear from during your hearings. And I encourage you to continue to consult with the many dental stakeholders on a move-forward basis.

    Joining me at the table are Dr. Benoit Soucy and Mr. Andrew Jones, both from the Canadian Dental Association. We are all available to answer any questions you may have. Thank you.

[English]

    The Chair: Thank you very much.

    Now from the Canadian Council of Professional Engineers we have Ms. Lemay.

    Mrs. Marie Lemay (Chief Executive Officer, Canadian Council of Professional Engineers): Thank you very much, Mr. Chair and members of the committee.

    My name is Marie Lemay and I am the chief executive officer of the Canadian Council of Professional Engineers.

[Translation]

    My name is Marie Lemay and I am pleased to be here today. I am the chief executive officer of the Canadian Council of Professional Engineers.

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[English]

    Established in 1936, the Canadian Council of Professional Engineers represents the 12 provincial and territorial associations that regulate the practice of engineering in Canada and license Canada's 160,000 professional engineers. Not a licensing body itself, CCPE has a role to facilitate consistency among the licensing and regulatory practices of the associations in such areas as accreditation of engineering programs at universities, guidelines on engineering qualifications, engineering practice, and ethical conduct.

    We're pleased to be invited to appear before the citizenship and immigration committee to talk to you about foreign credential recognition, a subject that is very important to the engineering profession and one we've decided to address head-on.

    Some of you may have heard me talk before on this subject. You may recall that I made a presentation in front of the citizenship and immigration committee regarding the changes to the Immigration Act. We then came to discuss some of the changes we believed were problematic, but we also listened to what the Government of Canada had to say to us. Today I want to share with you what we've achieved and what we are doing to facilitate the integration of internationally educated engineers into the engineering profession without lowering the standards of safety and practice that benefit all Canadians.

    Before I begin to shed some light on some of the specific work we have been spearheading, I wish to outline the reasons CCPE has committed so many of its resources to tackle this problem. First, CCPE has historically and until recently had an important role in the immigration selection process for international engineering graduates through an MOU signed between CCPE and the then Canada Employment and Immigration Commission in 1981.

    Second, the engineering profession wants to help immigrants to settle and be integrated into employment in the engineering field. There are risks to IEGs--and I'll refer to international engineering graduates as IEGs--not successfully integrating into professional practice. Those include circumstances where newly arrived IEGs may practise outside the legal boundaries of licensing and where unlicensed practitioners may be unaware of safety standards and codes of conduct that govern our profession and may unintentionally undermine or erode public safety.

    I want to provide you with some background and expand on the initial reason for our involvement. CCPE was recently involved in the immigration selection process for IEGs by providing advice to visa officers regarding the qualifications of skilled applicants who declared engineering as their field of employment. This advice took the form of an assessment of the likelihood of licensure. The assessment was not a licence to practise; rather, it was an indication of the likely outcome of a potential immigrant's application for licensure. The arrangement with CIC provided value to skilled immigrants and supported settlement because under these terms the IEGs could make a more informed decision about their eligibility to practise engineering in Canada prior to immigrating.

    This relationship, though, changed as a result of Bill C-31, when the new regulations effectively removed the role of the engineering profession in the selection process for IEGs. With the reorganization of the immigration process, immigration officers in issuing countries no longer have input from experts inside the profession on an applicant's qualifications.

    The most dramatic illustration of the impact of changes in the regulations due to Bill C-31 is in the number of assessments processed since the regulations went into effect in June 2002.

[Translation]

    During the three years leading to the changes in the regulations, the Canadian Council of Professional Engineers carried out on average 23,000 assessments of the training of potential skilled immigrants who said they could work as engineers. In 2002, the year in which the new regulations came into force, the figure fell to 6,700, and in 2003, to 1,500.

[English]

    IEGs are still coming to Canada, but the strong incentive they had before to contact the profession prior to doing so is now gone. We understand the government's reasoning for making some changes to the Immigration Act, but we strongly believe that in a skills model, the education of the IEGs needs to be assessed for Canadian equivalency by the engineering professions, since education is the first step toward licensure. Canada's remaining competitive globally will depend on strategies that ensure that skilled professionals immigrating to Canada are able to adapt to our regulatory climate; otherwise, settlement problems will occur. Furthermore, this failure to consult with the engineering profession is occurring at the same moment as the Government of Canada is emphasizing the need to recruit vast numbers of skilled professionals. Therefore, at perhaps no other time has it been more important to minimize the settlement problems for IEGs and to include the engineering profession in the immigration selection process.

    Through some dialogue at the bureaucratic level and with the former Minister of Citizenship and Immigration, the Honourable Denis Coderre, CCP discussed the impact of the new regulation and sought ways to again be included in the selection process. During these discussions the federal government requested that CCP and its constituent members develop a framework that would link the educational assessment to licensure. CCP and its members, the 12 provincial and territorial regulatory bodies, have agreed to provide a one-stop educational assessment link to the provincial and territorial licensing process. Therefore, we're asking the government to restore the role of the engineering profession in the immigration selection process. This would direct all prospective immigrants who declare engineering as their field of practice to complete an assessment of their education, which would be done by experts within Canada's engineering profession. Again, this assessment would be linked to the issuing of a licence.

    Recently Minister Sgro wrote to us reflecting positively on what we've accomplished thus far. The minister's note in the letter dated March 16 said, “I am pleased that CCP has been able to secure the support of the provincial and territorial licensing bodies and has agreed to a national approach for assessment of credentials of IEGs.” Mr. Chair, we are glad our work is acknowledged and is of value to the Government of Canada, but we really need a commitment on action.

    Our work with Citizenship and Immigration Canada also coincided with the release of the national innovation agenda strategy in 2001. We had been talking about this issue for quite a while, and we recognized that as a profession we had a responsibility to do more to promote and assist in a settlement process for skilled engineering immigrants. This involves improving communication, finding ways to effectively evaluate gaps in the education and experience of IEGs, and generally making the path toward licensure clearer.

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[Translation]

    It may be important to start by saying that despite the links between the two concepts—immigration and settlement—the two are very different things. Within the government, responsibility for immigration matters comes under the Department of Citizenship and Immigration. When people immigrate to Canada, their ability to get into the labour market, which is termed a settlement matter, is the responsibility of the Department of Human Resources Development, as well as of the provincial and territorial governments and a whole range of employers in Canada.  

[English]

    One thing that became clear to me very quickly was that this issue is a multi-jurisdictional nightmare. To assist the Government of Canada and to find new ways of improving the integration of IEGs into the profession, in December 2002 CCP and its members, with financial assistance from the former Department of Human Resources and Development Canada and support from Citizenship and Immigration Canada, officially launched a project we call “From Consideration to Integration”. The title says it: from the moment they start to consider it to the moment they actually get into the job market. The three-phase project was born from the recognition that IEGs face challenges along the road to obtaining licensure and employment in the engineering field in Canada and that improvements were required in immigration and settlement processes to ensure that their skills were better integrated into the national economy.

    Phase one of the project was completed in August 2003. During that initial phase we conducted research to learn more about what was happening--I call it the picture--from the moment they considered it to the moment they entered the job, in the licensing bodies, all the different processes, the settlement agencies, what they were saying to these people, what information they were getting from the government.

    From that picture, phase two started and it is nearing completion. We are presenting the recommendations of our steering committee to our board of directors in May. It will identify the gaps in the integration process, while developing recommended models for the engineering profession to establish an equitable, efficient, and transparent system for credential recognition and employment. The project will also identify recommendations for groups outside the engineering profession, including government and immigrant-serving agencies. I call it the road map, the canvas. The goal is to identify the gaps. They're not necessarily to be subject to action by the engineering profession, but at least it's putting all the pieces together. Much work has been done on this issue over the years, but in isolation, because people have only their jurisdictions to look at. We saw it as a challenge and said the engineering profession can take a horizontal look at this.

    Phase three will be implementation of the different projects to fill gaps or enhance models. FC2I is finding solutions to settlement challenges by identifying new ways to integrate the IEGs into the licensing practice, streamlining the settlement process while protecting the public's interest and maintaining existing standards of practice.

    You may ask, what's different about this project? I'd just like to point out four things. First, the project is horizontal. Instead of working in silos, we decided that if we could get the engineering profession to look at it, we could maybe cut across all these barriers, get the different people at the table, and be able to take a broader look at it.

    The second thing that was crucial to this project was the support of the licensing bodies. We're a national organization, we can come up with all these great ideas, but where the rubber hits the road, as they say, is in the licensing bodies. They will issue the licence. I can get a group of people in a room, create a forum, and come up with great ideas, but if they don't buy into it, the report will sit on a shelf. So we decided to get the leaders of our provincial associations all in a room and explain the situation. We basically said to them, if you're not in this, then let's not do it, because I've got better things to do and our staff have better things to do. But if we're serious about it and believe it's a real issue, you've got to be ready to put the resources into it and we have to make it happen. They unanimously said yes right from the beginning. It wasn't that easy, there were good discussions, but we had been talking about this for a number of years already. So we got the support from the licensing body right from the start, and when we entered phase two, the phase I call rolling up the sleeves, we went back to the licensing body to ensure that we had their support again, and we did.

    The third element was the multi-stakeholder approach. Our steering committee has 24 members. We have people from licensing bodies, obviously, federal government, provincial government, settlement agencies, IEGs, employers, universities. We told this to our people from the licensing bodies too: there are a lot of perceptions out there, and perceptions are reality; if you don't hear the perceptions, you'll never be able to address them. We absolutely need this not to be a project for engineers done by engineers, so we have to get the outside view. That has been very beneficial.

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    As for the fourth thing, I call it a ground up approach. We really did work from the ground up. We did work with the people in the licensing bodies, the people on the ground in the settlement groups.

    To give you an idea, we met with at least 40 major employers and 20 settlement agencies. We had focus groups; I think it was with IEGs licensed and IEGs non-licensed. We had at least 30 or 40 meetings, and all of this was within the last 12 to 15 months. It has been a major use of our resources.

    Mr. Chair, as you can probably see, CCPE is committed to facilitating the integration of IEGs in the engineering profession and engineering employment without lowering the standards. We also need help from the federal government to meet the challenge.

    As a profession that has been instrumental in the development of the growth of Canada, from the Pacific railway to the Canadarm, engineers have met the challenge issued by the Government of Canada. We are establishing new, more efficient ways to evaluate IEGs through licensure. Through projects like FC2I, or From Consideration to Integration, and agreements to link the educational assessment of prospective immigrants to licensure, we are clearly overcoming obstacles and working toward simplifying the licensure process without diminishing the standards of practice.

    We ask that in its final report the committee recommend the inclusion of the engineering profession in the immigration selection process. By doing that, you will provide the conduit, the link, to the engineering profession for IEGs. We will provide them with accurate information and an evaluation of their education that is linked to the licensure process. This will allow IEGs to gain knowledge of the licensing process that governs the engineering profession in Canada and to be better prepared for immigrating. This will enable IEGs to make informed decisions and not feel disappointed upon arrival in Canada.

    CCPE and the engineering regulatory bodies want to ensure that qualified new Canadians are licensed to practice and are given every chance to integrate successfully into the engineering field in Canada.

[Translation]

    Like the Government of Canada, we are convinced that innovative, well-coordinated approaches to settlement and recognition of credentials will enhance the value of skilled immigrants and will ultimately be reflected in an improved standard of living nationally.

    Thank you very much.

[English]

    The Chair: Thank you very much. That was very nice.

    Next is the Canadian Medical Association, Mr. Adams and Mr. Patel.

    Dr. Sunil Patel (President, Canadian Medical Association): Thank you, Mr. Chair. Good afternoon, ladies and gentlemen.

    Mr. Adams, who is the associate secretary general, and I are pleased to be here with you today on behalf of the 57,000 members of the Canadian Medical Association. As a foreign-trained doctor, I believe that I can provide also a personal perspective to your study of credentialing of international graduates in the medical profession.

    The CMA, founded in 1867, is the national voice of Canadian physicians. Our mission is to serve and unite the physicians of Canada and be the national advocate, in partnership with the people of Canada, for the highest standards of health and health care.

    The CMA is a voluntary professional organization representing the majority of Canada's physicians. It comprises 12 provincial and territorial divisions and 45 affiliated medical organizations.

    The CMA advocates for improved access to quality health care, facilitates change within the medical profession, and provides leadership and guidance to physicians to help them influence, manage, and adapt to the changes in health care delivery.

    The CMA sees its role as carrying out a program of research and advocacy to promote a health system that meets the needs of Canadians over the short, medium, and long terms. The Canadian Medical Association was pleased to be a member of the Canadian Task Force on Licensure of International Medical Graduates, and we congratulate Doctors Dale Dauphinee and Rodney Crutcher, from Calgary, for their tireless work in co-chairing that task force.

    In the case of the medical profession, the recognition of these credentials of internationally trained physicians is only one part of a larger issue, namely, our inability to be self-sufficient in graduating enough doctors to meet the health needs of Canadians. Even 40 years after the addition of four new medical schools, almost one out of four practising physicians in Canada is an international medical graduate.

    Although precise data are not available, our best estimates indicate that some 300 to 400 IMGs new to Canada are licensed to practise each year. While we have and continue to recognize the importance of IMGs in our health system, we believe that Canada needs a national workforce policy, one not based on the premise of “beggar thy neighbour”.

    Health workforce planning in Canada can aptly be described as being trapped in a boom-to-bust cycle. In the early seventies, we took over 1,000 IMGs every year in Canada. Growing concern over health care costs in the 1980s and the fiscal crunch of the 1990s led to a decline in that number, but with the emerging shortages the numbers may yet be increasing.

    In recent years, Canada has been criticized internationally for poaching physicians from countries that can ill afford to lose them. This is no longer the result of systematic recruitment, although in the past some provinces have engaged in active recruitment in countries such as South Africa. In fact, the CMA helped to develop a World Medical Association policy statement on ethical guidelines for the international recruitment of physicians adopted in Helsinki last fall.

    In my case, I came to Canada in 1972 because it represented an opportunity to practise medicine the way I felt it should be practised. Canada remains an attractive destination for people from all countries and occupations.

    The CMA has long recognized the need for a needs-based national physician resource planning process, something that has eluded us thus far. To factor IMGs into such a plan, the CMA recommends short-, medium-, and long-term approaches. A critical first step would be to create a body similar to the recent IMG task force, but to tackle the full breadth of the workforce issues.

    First, in the short term, the CMA recommends the federal government fund additional training positions so that a number of more than 700 IMGs eligible to begin their post-MD residency training could do so immediately. Such funding could also provide for comprehensive assessments of IMGs based on models developed in several jurisdictions. The CMA also strongly supports the initiative of the Medical Council of Canada in developing a pilot for the offshore electronic administration of its evaluating exam.

    These efforts, coupled with initiatives such as the recent announcement by Dr. Hedy Fry of $4 million in support of task force recommendations, are important beginnings; however, this is just a first instalment of what is required.

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    In the medium term, the CMA and other national organizations see the size of the post-graduate medical training system as a bottleneck, both for Canadian medical graduates and IMGs alike. The number of post-MD training positions funded by provincial governments has remained flat since the early 1990s and barely meets the needs of the graduating cohort. This leaves virtually no room for either IMGs or for practising Canadian graduates wishing to retrain. The number of IMGs applying in a second iteration of the Canadian Resident Matching Service has more than doubled over the past few years. In 2000 alone there were 294. This year 758 will be seeking placement in a Canadian post-graduate training program through the second round of the CaRMS match that would take place by the end of this month. Last year, however, only 67 IMGs among the pool of 625 matched in the second round.

    The CMA and other national medical organizations have been advocating for a minimum of 120 post-graduate year-one training positions for every 100 medical students graduating from school. Some provinces have already stepped up to the plate. Increased efforts and resources will also be required to recruit additional community-based teachers to participate in both the undergraduate medical education and post-MD training and to support and retain those already doing so.

    In the long term, I am aware that a critical issue facing the committee is a complex web of licensing and credentialing standards that exist at the provincial and territorial level. I think medicine can be proud of the fact that there has been a national standard for portable eligibility for licensure since 1992.

    The CMA strongly supports this clear national standard for medical practice and this application to both Canadian medical graduates and IMGs. It also provides tremendous peace of mind for patients that their physician has been held to the same high standard, whether they were trained in Canada or elsewhere. Canadians are well served by a uniform standard of medical practice that applies to both Canadian medical graduates and IMGs alike. The CMA strongly supports this national standard, and it must continue to be a cornerstone of a long-term vision and plan for Canada's physician workforce.

    In moving toward such a plan, the CMA believes that Canada should adopt a policy of increased self-sufficiency in the production of physicians in Canada. There are simply too few opportunities for Canadians to pursue medicine as a career at home.

    In 2002 there were roughly 6.5 first-year medical students per 100,000 people in Canada. Contrast this with just over one-half of England's level of 12.2 per 100,000. This shortfall exacerbates current shortages by forcing growing numbers of Canadians to pursue an international medical education as a result of the shortage of medical school places at home. The CMA has long recommended a target for 2007 of 2,500 first-year medical positions. At best we are tracking toward achieving the figure of 2,200.

    In conclusion, the medical profession believes federal, provincial, and territorial governments must make the high-level policy commitment to a nationally coordinated plan for the physician workforce. Such a commitment is long overdue. Implementing the recommendations of the Canadian Task Force on Licensure of IMGs will contribute significantly to this plan.

    For our part, the CMA is addressing the task force recommendation 5(b), calling for a recruitment database allowing IMGs to post their resumés and employers to access this information. We have implemented a module on our national online career forum, medconnections.ca, which provides IMGs with electronic tools to create an online resumé and to search and apply to medical- and health-related employment opportunities.

    I know the excitement generated by the promise of coming to a new country and being able to bring one's skills to bear and contribute to my new society. Without a national plan to support and capitalize on those skills, we risk losing them and all the benefits they can bring.

º  (1610)  

    I look forward to your questions and I thank you for your attention.

    The Chair: Thank you very much.

[Translation]

    Ms. Dalphond-Guiral, you have 10 minutes, please.

    Ms. Madeleine Dalphond-Guiral (Laval Centre, BQ): Thank you, Mr. Chairman.

    Good afternoon, everyone. I'm sorry that I was a bit late, but we've caught up. Some people got here after me.

    The whole issue of recognizing credentials is not a new problem. The problem existed 40 years ago. I worked for a long time in pediatrics and I remember a resident at Sainte-Justine who turned out not to have a degree in medicine. So the requirements were tightened up, and I find that acceptable.

    However, when you tighten up the requirements too much, you wind up in a situation where qualified people loose their qualification because it's too difficult.

    This morning, in the car on the way here, I was thinking about you. When you're all alone, you get to thinking. I have a question that I'd like to ask everyone. I imagine that in countries as developed as our own—and there are a lot of them—the training must be more or less equivalent, whether in medicine, dentistry, engineering, architecture or pharmacy. Do you currently have a bias in favour of certain faculties? For example, do you decide that for people who have done their studies in England, Germany or Finland, automatically, that's okay?

    If you are already doing that, would it be conceivable to have placements, and not six months, one year or two years after arriving in Canada or Quebec? Basically, what you want to verify is know-how in all professions. That goes for nurses too. It's one thing to have the knowledge, but to ensure quality care, you also have to verify that the person has the know-how. The person has to have the soft skills too, of course, but the know-how as well. In health, that is verified in a clinical setting, and for the other professions, it is done in the field. Is that conceivable?

    I was listening to the statistics about the number of doctors coming from abroad that we would need to meet basic needs, to deal with the health situation. It seems to me that it should be possible to do that. I heard you say, for example, that the universities have no more money. That's true. However, I do know that in a lot of hospitals, it's getting very hard for residents to live up to their responsibilities. Surely there must be some way to reconcile the needs of the hospital with those of the doctor on the way to being accreditated and those of the profession.

    Ms. Lemay, you weren't talking about health, but you were saying that a few years ago, 23,000 assessments were being done, and that the number is now 1,500. I guess there's a problem. That really surprises me.

    I'd like to hear what you have to say about that. My mind was wandering this morning on the drive and I thought that this might be feasible.

    Mrs. Marie Lemay: You've asked a number of questions in one.

    Ms. Madeleine Dalphond-Guiral: I'm an expert at that, because I always get cut off.

º  (1615)  

[English]

    The Chair: Go ahead.

[Translation]

    Mrs. Marie Lemay: First, with respect to education credentials for engineers, we have various agreements. We have agreements with certain countries, like the Washington accord with eight other countries, for engineering graduates from universities in those countries who come to Canada. Virtually all they have to do is put a check mark in the education box.

    There's another level called substantial equivalency. At the request of a foreign university, a team from our accreditation office does an accreditation visit.

    There are also other criteria for setting a value on education in another country.

    I believe that you touched on the very important point of placements. I don't want to reveal our recommendations because that will happen in two weeks.

    Ms. Madeleine Dalphond-Guiral: No?

    Mrs. Marie Lemay: However, I can tell you about the results of the discussions we had and about the groups we met. It became obvious that the skills of the person really come to light during the year that person is working, and you are perfectly right about that. For employers, the first concern was communication; that's what we found out from our meetings. These people need to be able to communicate and they need to have a certain degree of familiarity with the language and the culture. For immigrants, it was jobs. That was their main concern.

    How do you match the two? Of course, employers and professional associations are not the only ones involved. There's an entire system, too. Our project recommendations will not target a single group. It's often just a matter of opening up the lines of communication between the various groups and to make sure that the right information gets across. You can establish relationships. There are all kind of ways of establishing these relationships, but you were bang on when you spoke of placements. That's really where everything plays itself out.

º  (1620)  

[English]

    The Chair: If anybody wants to hop in here, go ahead.

    Dr. Patel.

    Dr. Sunil Patel: Oui, merci.

    Madame Dalphond-Guiral, it is a good question and it seems like there should be an easy answer to provide a fast-track mechanism for foreign medical graduates to enter into Canada. But let's put it into perspective. The rest of the world has a more serious problem than we do in Canada in terms of the number of physicians available per population. As I've said, and as has the World Medical Association, poaching from other countries is not an ideal thing to engage in.

    Having said that, we want to go from the short-term solution to a long-term sustainable solution for Canada. Start preparing now for the onslaught of problems we're going to get in ten years, when most of the physicians my age will be retiring, and there will be nobody, or fewer physicians, to replace them. So we have to plan for the future. We could quite easily buy our way out of this crisis by going overseas and importing physicians from South Africa, for example. There are more South African physicians in Canada than in any other country in the world except their home country of South Africa. Really, we must recognize that problem.

    The third thing is that there used to be a preferred university accreditation program in Canada when I came to this country from the U.K. Well, we run afoul of human rights legislation in the fact that we may discriminate for a physician licensed or practising in the United Kingdom versus somebody who may come from, let's say, Botswana. Really, this is the whole problem. There have been legal challenges in British Columbia and elsewhere where physicians and others who are international medical graduates have taken the licensing bodies to task as to how they could dare discriminate against one race, creed, or colour.

    Really, it's a whole complex issue, which brings us back to the main problem we have in Canada. We do need more hands on deck, but we need to establish a national plan that maintains the standards of Canadian physicians, so that Canadians can have the best health care in the world. Those standards are very hard to maintain. It requires a tremendous amount of effort on the part of the licensing bodies to accredit other universities and their programs before physicians can come to Canada. The problem is complex.

    It would appear that we could buy our way out of it, but I think we need to have a national program such as the health institute of human resources research, which we have recommended, so we can provide the right number of physicians for Canada in the future.

    The Chair: Monsieur Dubé.

[Translation]

    Dr. Louis Dubé: I'll address two aspects of your question. First, foreign programs or universities probably have programs which are on par with ours. We have a reciprocal agreement with the United States which works well. It took some time to reach that point, and it would be difficult to reach the same kind of agreement with other countries. One of our problems is a lack of money. These things have to be evaluated.

    Over time, we also realized that when we tried to establish whether foreign courses or programs were at the same level as ours, we found false positives, in the sense that—

    Ms. Madeleine Dalphond-Guiral: [Inaudible—Editor]

    Dr. Louis Dubé: There's a bit of that. You have to watch out for that kind of thing. It came as a surprise to us. We thought we could count on the studies, but the conclusions were a lot less interesting than what we had expected. This means we really need to rethink the way we evaluate those programs or find another mechanism.

    The other part of your question was whether it would be possible to have programs in Quebec or Canada to assess these people. There is a structural problem in dentistry if you compare that field with medicine. The medical infrastructure is institutional; there are hospitals, clinics, local community health care centres, community clinics, and so on. In dentistry, the majority of services are provided by private companies which are often fairly small. In some cases, it's not even an SME, but rather a micro-business operated by a single dentist.

º  (1625)  

    Ms. Madeleine Dalphond-Guiral: It depends on the practice.

    Dr. Louis Dubé: It depends on the practice, but the vast majority of the infrastructure is private. Pilot projects have been established to see whether the students or candidates can work for a private company or for a dental office. However, you have to make sure that they have the skills beforehand.

    It's not easy to develop and implement these kinds of programs. Again, it's a matter of money. For one thing, if a person hasn't gotten a licence yet, how can they practice or have the right to practice in a private office? So there's a structural problem and a problem with regard to civil and professional liability. This isn't an easy issue. Yes, we are trying to find solutions, but it's just not that easy; it's a different situation, where the field of dentistry is concerned.

    Ms. Madeleine Dalphond-Guiral: The public doesn't seem to think that is such a huge problem; the perception is that it's worse in the area of health care.

    Dr. Louis Dubé: For now, there is no shortage in dentistry.

     However, statistics show that many dentists graduated in the 1960s and the 1970s, and that they will soon retire. Sooner or later, they will have to be replaced. Studies and figures show that this may or may not happen. One of our projects is to try to find valid and reliable statistics to help us forecast future dentistry needs and to find out whether there will be enough dentists in 10 or 15 years.

[English]

    The Chair: Thank you.

    Mr. Pickard.

    Hon. Jerry Pickard (Chatham—Kent Essex, Lib.): Thank you, Mr. Chairman.

    I would like to thank all of you ladies and gentlemen for coming and putting your views forward. I agree with much of what you've said, and I think most of us agree with what needs to be done in Canada on the professional side, and not just in engineering, dentistry, and health care. It applies to a cross-section of professionals wherever things are. We're not doing the job we need to do in Canada.

    How do we maintain the appropriate level--that's what you're talking about--and at the same time build the system to be self-sufficient? That's something we have not done. We haven't come anywhere near doing it, and that needs to be done. It's not just money investment and it's not just medical schools, because you have to fill those medical schools with competent people to teach. You have to fill those medical schools with people who have the credentials that we want to see developed and brought forward in this society.

    As two of the three witnesses have said--and probably all three agree--we can't keep poaching from other nations, but we are. Who is responsible? Is it federal, provincial, municipal, or professional people involved in this process?

    I really like what Marie Lemay suggested, that we get a combination of all the players together and move the agenda, but move it with practical suggestions as to what's needed in each profession. I think we have to do the same thing with each profession, because I look at the numbers Dr. Patel put out: 12 per 100,000 in England, and six in Canada. It doesn't make sense. We're already short big time, and we're not keeping pace with what we need.

    As you pointed out, in 10 years retirement is going to be another blistering issue. It's not just you and people your age who are going to retire; the baby boom society is going to need more health care. It's the people in our society who are going to need more engineering, dentistry, or whatever.

    So I'll throw a lot of things out and ask, what are the practical, on-the-ground things that need to be done now to deal with our internal problem, our need today? I believe the other types of professional licensing will take care of themselves on a different scale, and the different scale should be opportunity for people to come to Canada, not Canada's need to fulfill a profession. I think we're looking at the problem totally backwards when we talk of what we've done today.

º  (1630)  

    The Chair: Mr. Patel.

    Dr. Sunil Patel: The Prime Minister has suggested that we need to have reform in the health care system and look at the problem in a different way. You asked who's responsible. I would say both provincial and federal governments are responsible. They need to come to the table and work together to provide a solution.

    Remember, in the 1990s and prior to that physicians were believed to be cost drivers, and as a result medical school enrolment was intentionally reduced in Canada. That's why we have a serious problem today. A 17% annual reduction resulted in a shortage of physicians available to Canadians. There are 4.5 million Canadians who do not have family doctors.

    Indeed, I was on call on Saturday at my hospital in Gimli before I came to this committee hearing. I was shocked when a nurse phoned to tell me that an eight-month pregnant patient, first time pregnant, had not been able to see a physician yet. She came in with some complication that could have been severe, but fortunately I was able to get the appropriate tests for her in the Winnipeg Health Sciences Centre, and she was transferred.

    That should not happen. That's prenatal care. We all know that proper prenatal care results in prevention and a healthier outcome. How can we have a young, 23-year-old Caucasian, not even disadvantaged, an educated person, who is not able to get care in Canada? That's just one example out of three I saw that day in 24 hours.

    So we have said--and you have this presentation in front of you--on page 7 that we need to have a national plan and a health institute of human resources. It outlines the methodology of how we can achieve self-sufficiency in Canada. It's a 10-year plan. We have to plan today for that 10-year horizon, because we already have a problem that will get into crisis mode later on.

    Hon. Jerry Pickard: I don't mean to interject, but I just have a question.

    Do we need to re-examine what doctors and other health care people can do? I believe there are different levels of medical application and skills. In dentistry and engineering, I believe there are support elements we can build for the professions as well.

    Maybe we need to re-examine the whole issue of how things are delivered. Under certain directions we can maybe start to deal with some of the issues, but we're certainly not doing it the way things are. I don't know if we can build schools fast enough and fill schools fast enough to deal with the present problem, let alone the future problem.

    Dr. Sunil Patel: If I could just respond briefly to that, we have a shortage of 100,000 nurses in Canada, so shifting the workload from a physician to another health care professional is not going to be possible. We have a shortage everywhere in the health care environment. The scopes of practice document that the CMA has produced outlines the need to re-examine how we provide care.

    But let me also ask you why the Government of Saudi Arabia can buy, for $75,000, post-graduate training positions for their medical graduates, when we're not prepared to do that in Canada? The capacity is there in universities, but we're refusing to fund them because we have the mistaken belief that more physicians will cost more money to the system. I say it's the opposite: a healthy society will return to work quickly if it gets access to care.

    The problem today is not only not having a physician, a nurse, or a health care worker, but not getting timely care. This eight-month pregnant lady is just one such example. There was an 82-year-old patient with a stroke, and we could have prevented that stroke from worsening by providing the right care in a timely manner. The window of opportunity for that patient was 90 minutes. We didn't have the capability to provide that treatment, therefore that patient was left permanently disabled with a hemiparesis. Is that the level of care we want to guarantee to Canadians? Is that the care we want for ourselves when we get into that situation?

    We have to look at it from a patient-centric model, address the problem of access to care, and have the right number of health care resources to make sure that service is provided in a timely manner.

º  (1635)  

    The Chair: Ms. Lemay.

    Mrs. Marie Lemay: On your question, what I say here might surprise you, actually, because it did me. Maybe it's my engineering background, but I like to have facts before I draw conclusions.

    I told you about 160,000 engineers and about 25,000 potential new immigrants coming in. We realized through our study that we don't have the labour market information. We don't know exactly where they're needed, in what discipline. Engineering is such a vast field that all that information is not available. Without telling you what some of the conclusions are going to be, it is the first information needed. Where are the jobs needed? What is the market like?

    It has to be a dynamic tool, something you can upgrade that isn't static. It must be dynamic on a daily basis, not a picture, and then five years later another picture. We have to develop mechanisms to have access to that.

    The Chair: Thank you very much.

    Mr. Patel, to follow up on your question, you said there is a shortage of 100,000 nurses.

    Dr. Sunil Patel: Yes.

    The Chair: Three weeks ago we had the nurses' association here. I asked them and they said there is no shortage. But there is a shortage. There is no shortage in urban areas, but there is a shortage in rural areas. I'm confused. How do you define shortage in this case?

    Dr. Sunil Patel: Well, as you know, with the cutbacks in the health care system in the late 1990s, a lot of our nurses went overseas. Most of them went to the U.S. In terms of the availability of the nursing profession in hospitals to man the wards, it has diminished. The CNA has indicated that Canada could do with 100,000 more new nurses to address the needs, not immediately but over the next ten years as some of those nurses will retire or take on part-time occupations.

    The aging workforce.... Right now, the average physician is about 48 years old, and the nurses are not far behind. As they work less, or are able to work fewer hours, we need more people to man the boat, so to speak.

    So really, that is a complex problem, and that's how we estimate the shortage.

    The Chair: Thank you.

    Mr. Martin.

    Mr. Pat Martin (Winnipeg Centre, NDP): Thank you, Mr. Chair--

    The Chair: Oh, sorry, go ahead.

    Dr. Benoit Soucy (Director, Membership and Professional Services, Canadian Dental Association): Essentially, I think the point you're making is extremely valid. The big problem is that this is a human resource shortage that is all across the board. Whether it's engineers, physicians, or dentists, or whether it's skilled manpower or human resources in mining, this is the problem we're going to face because of the aging population. It's a huge problem.

    It's also a problem because it's in most of the industrialized countries. It would be very nice to be able to turn to Europe and import people from Europe. Their problem is even worse now. We know that most European dentists are pretty good. It doesn't help. We don't have the immigration from those countries. Dentists who want to come to Canada are dentists who come from less favoured countries, and then that raises the issue of poaching and worsening their own situations.

    I think the solution is exactly what you were talking about, which is to have a good look at the way care is provided, making sure the appropriate professional gets involved at the right time and making sure the training that is provided to those professionals is appropriate. That ties into the issue of resourcing for universities and for community colleges, but that also ties into the issue of the credential creep that we see in many occupations, which is trying to raise the bar for access to the occupation, asking not for just a certificate but going for a bachelor's degree. We have a lot of areas—and it's a fear we have in dentistry—where more and more our support staff are asking for additional qualifications that may not be needed. It just lengthens the time of training.

    The issue you are raising about the shortage of nursing is interesting, because they don't see a shortage; physicians see a shortage. We have exactly the same issue with hygienists. Dentists try to hire dental hygienists to work in their offices. They can't find them; they're not available. If you talk to hygienists themselves, they will say, we don't have a shortage. We may have a problem with distribution; there might be an issue in that rural areas can't find the hygienists they need; but no, there's no shortage. Yet we can't hire the hygienists we need. Part of the reason is that they're looking for other things than providing the care that is needed. They're looking at being involved in a public health setting and at being involved in areas that are not necessarily care to individuals, and that's where the distortion comes from.

    There are a lot of issues. And I agree with you, the only solution is a systemic approach where we're looking at the appropriate professional to get involved at the right level. We avoid overlapping qualifications, which is just wasteful, and we make sure we have a plan for training the number of dentists or physicians or pharmacists that we need in Canada, with room for people who want to immigrate to have the proper opportunities.

º  (1640)  

    The Chair: Thank you.

    Mr. Martin, a second start.

    Mr. Pat Martin: Thank you, Mr. Chair, and thank you to all of you for your presentations.

    We've interviewed other regulatory bodies from other professions--the nurses have been mentioned, and others--but certainly the CMA is one that the whole country is watching carefully. Engineers come to mind. It's fitting maybe that you're all here together. You three represent three of the most top-of-mind organizations regarding--

    The Chair: The most wanted.

    Mr. Pat Martin: The most wanted. There should be a poster.

    What people say about all of your occupations or all of your regulatory agencies is that it's part of the problem when you have self-regulation. How do you separate self-regulation from self-interest when your organization is first and foremost there to advocate for the best interests of your members, not necessarily for the...

    Mrs. Marie Lemay: No.

    Mr. Pat Martin: I don't know how you see it. I'm not being critical here. You'll get a chance at it.

    I used to run a union. Ours was a closed shop, and we'd get that accusation all the time, that we weren't interested in the general public or the industry, that we were protecting the best interests of our members. That's the way the public views you and you and you. Whether it's true or not, you'll get a chance to say. I guess I'd like your thoughts on that.

    Secondly, I'd be really concerned if I were looking at your CMA document, the backgrounder, as a labour market survey, Dr. Patel.

    I'm a carpenter by trade. I represented the carpenters' union. If I did a labour market survey for my interest, my industry, and if the average age of my carpenters was 49 years, and 30% were over 55, in an industry where you couldn't really go on forever, I'd have been really concerned.

    The burnout age for people in your occupation...surely at age 55, people are at least looking to not be working 24-hour shifts any more and slowing down, if not getting out altogether. That's more than a problem. Those are almost bordering on an emergency. It's certainly an urgent situation.

    I know I'm all over the map here. Another thing that strikes me from this sheet is that I didn't realize that 23.4% of all physicians practising in Canada are international medical graduates. That's amazing to me.

    To capsulize this, or to make it into a proper question, what do you say to those who accuse your organizations of being self-interested, first, and community interested or industry interested, second?

    Secondly, how did people like Dr. Odim and Dr. Afifi get by in Manitoba? How did these butchers get accredited to operate in our province? Dr. Patel, you'll be the first to admit that Dr. Odim, by all accounts, should never have had a scalpel in his hands. On Dr. Afifi, my own mother was one of the people who still shows terrible deformations from these quacks who got in somehow and got past the regulatory bodies.

    Dr. Sunil Patel: Mr. Chair, I will answer the last question after Mr. Adams gives you the background. Owen has served on many task forces and he's a wealth of information. Perhaps a non-physician will give you a more credible answer to the issue of regulation and self-interest. I would be happy to answer the last question after that.

    Owen.

    Mr. Owen Adams (Asssitant Secretary General, Research Policy and Planning, Canadian Medical Association): Mr. Chair, there is essentially a separation between the function of the licensing authority and the planning bodies that are responsible, the paymaster, if you will. In most provinces the whole planning function has been done by governments essentially in conjunction with associations. The licensing authority is really to represent the public interest, and they do not really involve themselves in planning at all. So there is the separation there.

    On your second point about the labour market study, absolutely, it took a lot of sustained advocacy. Dr. Patel mentioned the 10% enrolment cut that was implemented in 1993.

    In early 1999 we built a projection system that showed that come 2021 the ratio of population per physician would increase from approximately one physician for 530 of the population to one in 718. We use that as the basis for a lot of advocacy. Since 1999 there's been approximately 300 or 400 new places restored in medical school. But it hasn't been easy, for the concerns that Dr. Patel has outlined about the perception of cost centres and so on.

º  (1645)  

    Dr. Sunil Patel: If I could just take one minute, on the issue of the surgeons that you mentioned, I cannot comment on the specific cases because we don't have the exact information. But let me start by saying that the self-regulating licensing bodies in each province regulate physicians. That's why we have, since 1992, maintained a national standard of licensing, so that all physicians who practise in Canada must reach that standard. That did not happen in Canada before that date. When I came in 1972 it was much easier for an international medical graduate to put up his or her shingle in Canada.

    Those regulations have changed because we want to protect Canadian society. The royal colleges and the Canadian family physicians college now mandate 200 hours of continuing education per five-year period for all physicians. Yet no government has funded continuing education on a massive scale for physicians. We know that in any profession, whether it's engineering, medicine, or dentistry, we must have ongoing education programs that are appropriately funded, that are provided, so that a physician wanting to do an upgrade can get relief. At the moment there are no such mechanisms available.

    In remote locations you often have to abandon the population to go to get an upgrading course. When we say that one in four physicians in Canada is of international origin, in rural Canada it's one in two--or worse.

    Then you have the politics of the rural hospitals. You have so many hospitals in which physicians are asked to be on call every day or every second day, and it clearly leads to burnout. I think you're familiar with the recent problem in the Assiniboine region in Manitoba.

    Again, we need to have solutions. We need to have providers at the table to help governments come up with the right answers. We are prepared to be there. Both the physicians and the nurses of Canada--and I'm sure the dentists and the engineers--want to take part in an active manner in reshaping our professional service delivery models. We must be at the table.

    The Chair: Dr. Dubé.

    Dr. Louis Dubé: To address the self-interest part of your question, first of all, the CDA, the Canadian Dental Association, is not a licensing body. We are the national voice of dentistry. It's actually a tripartite thing. There's the CDA; there are the provincial associations, which do take care of the interests of the dentists provincially; and there are the licensing bodies that take on the interests of the population and the public.

    I can assure you the mandate that is given to the profession to take care of the regulatory aspect of the profession is given by the government. If the licensing bodies don't do their job, the government has the privilege to take away this privilege at any time. So they cannot afford to be self-interested, because their mandate will be taken away right away.

    I think the system, in that respect, is working well. I don't think that in either the medical or the engineering profession the people who are participating in the licensing aspect of the profession are there for self-interest. I can speak only for the dentists, but I can assure the people who are involved with the Order of Dentists in Quebec or whatever are really taking the population's point of view, the public interest.

    As for the second part of the question, on the crooks, in any profession, in any workforce, there are some crooks. In our system you are innocent until proven guilty, and unfortunately it's very difficult to catch those crooks. Once they do have a licence, either in engineering or in medicine, it's very difficult to prove that they are crooks. The burden of proof is on the professional side, and it's not easy.

    Fortunately, I think all the licensing bodies do work very efficiently and end up catching those crooks, but unfortunately, it's not an easy task. Once somebody has a licence to practise, it's very difficult to remove that licence from that person because of all the laws that are there to protect the people.

    So I think we do need to have the right mechanisms to catch those people. I think most of the time most of the professions are on the right track, yes.

º  (1650)  

    Mr. Pat Martin: In the one example that I cited, he was the director of the pediatric cardiac department, and 12 babies....

    Dr. Louis Dubé: Yes, unfortunately.

    Mr. Pat Martin: If there had been whistle-blowing legislation.... Nurses were saying this guy clearly didn't know what he was doing. They opened these babies up, and it was just tragic. Something failed in the licensing system in that case, because a lot of kids died at the hands of somebody who clearly wasn't qualified to do pediatric heart surgery.

    Dr. Louis Dubé: In the end we did catch him, but too late. I agree with you.

    The Chair: Ms. Lemay.

    Mrs. Marie Lemay: I'd just like to have an opportunity to explain why I jumped in. Our association is different from those of my counterparts because our members are the 12 licensing bodies. We don't have individual members. We advocate for the profession and not for the members' interests.

    Mr. Pat Martin: Who do you represent?

    Mrs. Marie Lemay: The Canadian Council of Professional Engineers.

    We've seen the story on the front page of the newspaper about the taxi driver who couldn't work as an engineer. There was a time when saying you're not qualified to meet the standard seemed to be good enough,. But that day is long gone, and that's what we've realized. Whether it's perception or reality, we have to address it. That's why the 12 licensing bodies are saying we have to do something about this. We want to license the qualified individuals. We want them to practise engineering under some regulations. We don't want them to practise without a licence if they can't join us. We don't want the ones who are not qualified out there practising.

    Mr. Pat Martin: If there were a surplus of engineers in the country, you wouldn't be able to set the fee schedules as high as they are. That's going to put a downward pressure on the industry fee schedules. It has to. Doesn't that come up in your organization?

    Mrs. Marie Lemay: The organization I represent doesn't set fee schedules.

    Mr. Pat Martin: Who represents the actual engineers?

    Mrs. Marie Lemay: It's the Association of Consulting Engineers, which may have appeared here. It represents the industry.

    Mr. Pat Martin: You didn't present a brief today, so I didn't understand clearly whom you represent.

    Mrs. Marie Lemay: We do have to address it, whether it's perception or reality, and that's what this whole project is all about.

    Mr. Pat Martin: But there are engineers practising today who would rather not have any more engineers move into their community. They would rather have that guy continue to drive a taxi than share that finite pie of engineering work that needs to be done. That's only human nature.

    Mrs. Marie Lemay: I'm sure that out of the 160,000 there are some who think that, but the general feeling of the profession is that we've now passed beyond that. We're at the point where if they're qualified people, they need to be licensed, and we need to find a way to get to them. We figure that of the 25,000 immigrants who said they were engineers, about 3,000 actually got a licence. For us, that is a huge issue because that means there might be about 20,000 out there who are doing something else, which is not good for the country because we're getting people with some skills and we're not using them, or they could be practising illegally, which is not a good story, either.

    The Chair: Or they were lying.

    Mrs. Marie Lemay: Or they were lying, which is not a good story, either. So all of this is not good.

    If there were a link to the profession, we could make sure they understand what they have to do and what they need. Maybe they say they are engineers but in reality they are technologists. Then we will direct them to the technologists.

    Mr. Pat Martin: It would be very interesting to know whether they scored on the point rating system and were allowed in on the basis of being engineers and now either haven't proved or are unable to prove that they really are engineers.

    Mrs. Marie Lemay: That is an interesting point, because with the change in the selection process, you give points for education, but it's not verified against Canadian equivalency.

º  (1655)  

    Mr. Pat Martin: That's my point exactly.

    Mrs. Marie Lemay: So somebody out there is saying it's on a list. What we're saying is that if you can link us to the process again, then we will tell you whether or not it's equivalent.

    Mr. Pat Martin: That's a good point.

    The Chair: Dr. Soucy.

    Dr. Benoit Soucy: On the self-interest question, we've reached a point where we're way past trying to protect our labour market. We're at a point where dentists who want to retire can't find a dentist to buy their practice. Dentists who are practising can't find somebody who will come to a remote area to practise with them and relieve them of some of the workload. We are crying for more dentists. So at this point, believe me, there is no attempt to protect the labour market and maintain prices or anything like that. The push is to make sure that we train and get enough dentists to help dentists practise in the way they want. Being a dentist in a small community who has to work 60 hours a week to keep the population free from pain is not fun. That dentist would much rather have a partner in his office and reduce his hours to 30 a week. That's where we are right now. When we say that there isn't a shortage right now in dentistry, it's because a lot of our members are doing more than their share. They are giving us the time to plan for the future and to try to find a way to get more dentists into practice.

    The Chair: How do you define international medical graduates? What's the definition of IMGs?

    Dr. Sunil Patel: Go ahead.

    Mr. Owen Adams: Yes, it's basically a physician who is not a graduate of the 16 medical schools.

    The Chair: In Canada?

    Mr. Owen Adams: Yes, in Canada.

    The Chair: If someone comes from England, or Pakistan, or India, or China, or Africa, is he or she an IMG?

    Mr. Owen Adams: That's correct.

    The Chair: Automatically.

    Let me ask you this question. It was 15 or 20 years ago when I first I heard of this foreign credential issue, because a friend of mine who was a doctor, born in Iraq, graduated in England, came here, and he could not practise his medicine. How could that be? We need doctors here. There's a shortage. I said, did you pass a test? He said, they won't allow me to pass a test. This was 15 to 20 years ago.

    I've been a member of Parliament for the last 11 years and I still ask the same question. If someone comes to me and says, I want to pass a test, I wonder why this person is not allowed to pass a test to be an engineer, dentist, or medical doctor. Why can't we have a simple system? Maybe I'm very simple person, I don't know.

    We could have two or three exams every year. Every three months you pass an exam; the first-year exam, then the second-year exam, and three months later the next one. And within a one-year period he or she will pass three or four exams, come to the graduation point, and past the graduation point he or she will be qualified, licensed, to practise. What's the difficulty with that, I can't understand.

    Dr. Benoit Soucy: I'll be able to take that. I've done a lot of work with the National Board of Medical Examiners.

    The system you just described is the system we had until 2000, which we got out of because of the risk to patients. If you try to have clinical examinations, you need to have patients who are submitting themselves to the work of those unproven candidates, and you run into a lot of trouble if you open to the door to anyone who has not had a very strong verification of what their credentials are. So the system was built around the requirements that if you want to be able to sit those examinations you have to go through a cycle of three written examinations and then you go to the clinical examination.

    Even there they had problems in that they had some candidates who were very good in theory and were actually dangerous for the patient when they were getting to the clinical examination part. They had to get out of that business in order to protect those patients.

    The other aspect of it is that you can't really judge the ability of someone in a high-stress examination, a high-stakes examination. You could be a very good candidate, and just because the stress of the examination is preventing you from performing well, you may not get the result you deserve.

    So the best way to ensure that the most qualified candidates get approved is to have a more prolonged evaluation period. Testing on a one-shot deal is really not a good way of getting that kind of information. Getting some placements when you have an opportunity and the right setting to evaluate people in an ongoing fashion is what we're looking for and really the best way of achieving what you are talking about.

    This is especially true since, as you've said, getting the people through all the tests that are required to get their certificate from the national board took about a year and a half to two years. We'd much rather have them, in that year and a half to two years, in a good evaluation system where they can get gap education and complete the knowledge that they need to practise in Canada than have them go from examination to examination in a system that is simply not reliable.

»  (1700)  

    The Chair: Dr. Patel.

    Dr. Sunil Patel: Thank you, Mr. Chair.

    If I could just point out, all levels of government have intentionally rationed the number of physicians in Canada. We have denied medical students, bright students, Canadian residents born in Canada, from applying to medical school. The competition is fierce. In some universities, for every one spot, there may be 10 applicants or more. The average is about one in four getting into medical school.

    We know we have a greater need, yet we do not provide the resources to the universities to have the infrastructure and the funding, as well as the teachers. So really we have intentionally tried to keep the number of doctors down, primarily because it was felt that the more doctors you have, the more it would cost the system. We've finally begun to move away from that dictum.

    When you talk about examination and a foreign medical graduate trying to apply to get the right credentials in Canada, they all must be treated on the same level as a Canadian medical student. They must all pass the same exams, and those exams are quite intensive. What we've done, however, is taken direction, taken an example, from the engineering society. They were the first to institute an overseas evaluating system. We have recommended that for several years, where we'd have a fast-tracking mechanism to electronically assess that physician from Iraq so that he or she could assess himself or herself to see whether he or she had the right credentials, and if not, what other courses he or she would need to take to meet Canadian standards. So they can plan before they even arrive in Canada to have those done in an expeditious manner.

    The problem, however, is that we do not have the spots for any more post-graduate training in Canada, because we are even denying our own Canadian medical students. This year, 67 of them were denied spots. So where do they go? They go to the U.S. to get their residency training programs. You know what happens once you leave the country--you very rarely return. In my case, the same thing happened. I left the U.K., came here, and didn't go back to the U.K.

    So you have to look at those kinds of issues, and we need to have a long-term plan. We need to start at the beginning. This ratio is an immediate need. We're not talking about huge sums of money. Probably each post-graduate training position to be funded costs $75,000 per year. Some of those IMGs may not require four years. A Canadian medical student going through the process would require four years of funding.

    So really there are lots of solutions available. We have not put in the right resources and we have not bought into the premise that we do need more physicians in Canada. That's really the problem.

    Mrs. Marie Lemay: I would just add that I concur with what my colleague from the Dental Association said. We do have a process. We don't have a standard exam, but we had a number of examinations, and through the project that we did, one of the things we realized is that if we can offer flexibility, the exam might not be the only option. You can have interviews; you can have portfolios. There are different ways of evaluating.

    The one thing you need to have is to test that savoir faire. You have to have that experience, clinical or in the field, tested. Some of the things we're looking at through the processes are, what parts of that can you standardize, what could you do to make it easier offshore to self-assess? There are definitely different components, and the system has to offer different flexibilities so that you can test all aspects, if you want to make sure that you don't drop somebody through the cracks.

    The Chair: Thank you.

    Madeleine.

[Translation]

    Ms. Madeleine Dalphond-Guiral: In an earlier intervention, one of you talked of scientific know-how, but also of the ability to communicate. Of course, when dealing with people, you need to be able to talk to them. However, we all know that at least a year, if not several, in some cases, goes by between the time the person thinks about seeking permanent residency and the time it is actually granted.

    Is it made clear to foreign professionals working in the areas we are discussing just how important it is for them to have language skills? By this I am referring to French or English, or both. Really, if it takes two years for a person to receive immigrant status in Canada, it becomes feasible for them to invest in learning a language.

    I'm wondering whether professional associations insist on this and whether the department is also doing enough. People could be told that if they master one or both languages, they will be fast-tracked. It would be a kind of incentive. I'd like to know what you think of that.

»  (1705)  

    Mrs. Marie Lemay: I'm the one who raised that issue, Ms. Dalphond. It was an important factor in our research. The law requires a basic knowledge of the language. We realized that as far as we were concerned, there were varying degrees of competence. When a person has a work permit, they are on the job market. This means that basic language skills are required from the outset to enter into the system, as well as to obtain a licence to practice.

    It's often been said that a person has two years to obtain their licence to practice, which implies that they have that period of time to acquire the requisite skills. However, the fact remains that a minimum threshold should be required if people are to understand the system, and the message should be conveyed that language skills are an extremely important factor.

    This issue was raised in the discussion groups we sat in on. In some of these groups, full-fledged engineers from abroad had their licence to practice, whereas others did not. Those who did not see this as a problem, but those who did said it was a very good idea, and that it should be made a requirement. It was interesting to see the difference between the two.

[English]

    The Chair: Dr. Dubé.

    Dr. Louis Dubé: First of all, the language....

[Translation]

    I apologize, but I will speak in French.

    Ms. Madeleine Dalphond-Guiral: That's your right.

    Dr. Louis Dubé: Language is a factor. Among other things, in terms of the provincial associations, there's a requirement that for entry to Quebec, you have to be able to speak French. The Canadian Dental Association has always felt that it was important to give people the information before they even contemplate coming here.

    Ms. Madeleine Dalphond-Guiral: That's precisely the point that I wanted to make : they should be getting ready while they're still in school.

    Dr. Louis Dubé: For a number of years, the Canadian Dental Association published a document and received about 100 requests per year from people who wanted to get it. It was a list of requirements for skills that a dentist needed in order to come to Canada. That document was available.

    It is now on our website. People all over the world can access that if they have Internet access. The demand is quite strong, but more needs to be done; there should be some kind of link to the embassies or high commissions. They, too, have Internet sites and information to disseminate.

    If we could establish a link, including a link to our website, the information might be more readily accessible. That way, fewer people would arrive in Canada not knowing what the requirements were. That would avoid surprises.

    Ms. Madeleine Dalphond-Guiral: Mr. Chairman, surely you are aware of the fact that we no longer have quorum, but nevermind, I'd like to ask one last question.

    The Chair: Okay, no problem.

    Ms. Madeleine Dalphond-Guiral: My question is for you, Dr. Dubé.

    On page 3 of your brief, you say that the National Dental Examining Board conducted test cases through credential assessment organizations and the results were dangerously inadequate.

    I assume that you looked into possible reasons for this kind of mixup.

    Dr. Louis Dubé: With your permission, I'm going to let Benoit answer that, because he delved into this issue more than I did. You will get a better answer that way.

    Dr. Benoit Soucy: Actually, the problem is that foreign universities don't give priority to information requests from credential assessment organizations.

    Our national board conducted its study using four universities that we know very well and that are at different levels. The board asked an accreditation agency to pass judgment on the university degrees in question. All that the accreditation agency was able to do, and this was predictable, was to get the program on paper. On paper, all of the programs look alike.

    Questions about the number of full-time professors, their qualifications or the existence of clinical facilities remain unanswered. The only way to get an answer to these questions might be to send someone there to inspect the university, but that would of course be too expensive. The lack of cooperation from the universities that they wanted to assess was the problem that these people encountered.

    Ms. Madeleine Dalphond-Guiral: Overseas, here and there, we have embassies, high commissions and consulates. In those offices, there are various advisors—who are quite well paid, for heaven's sake—performing duties in various fields, including science, culture and economics.

    I wonder whether the responsibility for going to do an on-site assessment of what's happening, even if it meant retaining the services of a doctor, dentist or engineer, could be included in their duties. If there are real needs, then perhaps the choices that are being made are open to question.

»  (1710)  

    Mrs. Marie Lemay: That looks like a good solution, but at the Canadian Engineering Accreditation Board alone, there are around 100 volunteers working on program accreditation. It's a huge task.

    We have recommended to the government in the past, and we still recommend, that it use existing groups in Canada, like ours, which has expertise in accrediting engineering programs. That doesn't necessarily mean that we're going to go over there. However, we do an awful lot of work with other countries. We have agreements with other countries.

    If there's any group that has this expertise, it's the group that represents the profession in Canada. We're terrified of external agencies doing educational assessments, because they don't do them for the same purpose that we do. For us, it's an initial step toward the issuance of a licence to practice. And that's quite different from calculating the number of hours of courses to take to get a job.

    In our opinion, that's extremely important if you want to be able to avoid the problems of foreign-trained engineers. Maybe their training is equivalent to Canadian training, maybe not. They may have to do something more when they get here, but they should know that before they leave their country. The best way to do that is to use the resources that you have here in Canada. We'll take care of it.

[English]

    Dr. Sunil Patel: If I could, Mr. Chair, I'll just add something to the issue of language skills. I think it's a very important one, especially in the field of medicine, where you're communicating with your patients; that expertise in communication is very important. The first step in the evaluating exam for candidates does address language skills.

    Could we do more? Absolutely. Could the federal government provide English language training courses or French language training courses for IMGs? Absolutely. We don't have such avenues available, but I think that's an excellent suggestion, one that could be part of this committee's recommendations.

    The Chair: May I ask a question that wasn't raised, I think, on provincial jurisdiction and provincial bodies? Ms. Lemay, you mentioned you represent 12 organizations. Can you tell me, on a scale of one to ten with one being lowest and ten being perfect, what kind of uniformity you have in provincial jurisdictions in medical aspects, dental practice, or engineering? It's because I note—correct me if I am wrong—that if you're a graduate from Nova Scotia, you can't practise in Ontario, that an Ontario graduate can't practise in B.C., or whatever the case may be. If that's the case, how much of a problem do you find, because of provincial jurisdiction, in making one uniform national policy for doctors, dentists, or engineers?

    Mrs. Marie Lemay: From the engineers' point of view, the education is totally mobile because of the accreditation of the engineering program. If you graduate from Nova Scotia and you want to register in B.C., that education box in the licensing process is ticked off. But to practise engineering in a province, you need a licence to practise in that province. So that addition of--

    The Chair: How do you get your licence?

    Mrs. Marie Lemay: You have to have four years' experience, you have to pass a professional exam--

    The Chair: It's the same story if you come from India, China, or England as if you come from Quebec or Nova Scotia.

    Mrs. Marie Lemay: It's the same for filling in the education box, yes.

    The Chair: So it will still take four years of engineering in Nova Scotia to practise in Ontario or B.C.

    Mrs. Marie Lemay: Yes. Actually, once you have a licence, there is now an inter-association mobility agreement in the engineering profession and, I believe, in a lot of professions, where you can go to a province, apply for a licence, and get your licence virtually very quickly if you have your licence in another province.

    Where it does differ is in the operations or the mechanics between when you graduate to actually getting.... There could be some little differences, but when you have the education and the licence, normally you should be able to move. That's our job at the national level, to try to bring about that uniformity and consistency between the provinces.

    Mobility is a huge issue for engineers. Companies send engineers all over the country all the time, so that is one we need to and are forced to address.

»  (1715)  

    The Chair: Mr. Adams.

    Mr. Owen Adams: In the case of medicine, as Dr. Patel mentioned, there has been a national standard since the 1992 completion of the two-part Medical Council of Canada qualifying exam, with certification in either the College of Family Physicians, the Royal College of Physicians and Surgeons, or the Collège des Médecins du Québec. So for Canadian graduates there is that national standard.

    It's still a matter of getting a provincial licence, but there is that standard for portable eligibility for licensure. Where there's an issue is in the case of international graduates, and there's flexibility between jurisdictions in terms of how licensure status is granted. It's certainly not perfect, but there is a workable national standard.

    Dr. Sunil Patel: If I could, I'll add to that to clarify. Each province has a medical act, legislation that dictates how that licensing body will provide a licence to a qualified physician. Of course, that is in place. The provinces want to maintain control over mobility. A particular province may not want an influx of physicians into, for example, downtown Toronto. The province has traditionally maintained that control. Each and every provincial jurisdiction and territory has a licensing body that has to obey the medical act in that particular province. That's the real reason: the legislation in each province across Canada needs to be changed if we want to have true national portability.

    There is another issue we must address quickly, and that is to allow a fast-track mechanism for applicant physicians who want to move between provinces. In the case of SARS, physicians actually responded to a plea by the CMA; 84 physicians were available and wanted to move to Toronto. When we actually tried to look into it, we found the licence had to be applied for and the insurance had to be applied for because their insurance was no longer valid. So really, we need a fast-track mechanism. We need to break down those legislated barriers; in certain instances we need to have that mobility.

    The Chair: To give a more simplified example, let's take the border of Manitoba and Ontario. If someone lives on the Manitoba side of the border and likes Dr. Smith on the other side, he or she cannot go see Dr. Smith because Dr. Smith happens to be a graduate from Ontario. Is that what you're telling me?

    Dr. Sunil Patel: No, no, no. A patient can go to a physician in either Ontario or Manitoba, and the system covers--

    The Chair: The doctor cannot come--

    Dr. Sunil Patel: The doctor cannot go and practise in the other province without applying for a licence.

    Not only that, there are provinces where you may get a licence to practise but may not bill the medicare system, for example. You won't get paid because you've established a practice, let's say, in Montreal, and you need to go to Jonquière or Baie-Comeau to get your fees approved by the insuring agency. There are really a multitude of problems.

    The Chair: I think there's lots of work to be done in the country before we talk about foreign doctors, foreign engineers, or whatever .

    Dr. Sunil Patel: Absolutely.

    Dr. Louis Dubé: Our situation is a lot easier. Once you've passed the national board exam, you instantly have total mobility, period.

    The Chair: It's an example to follow.

    Dr. Louis Dubé: Absolutely.

    The Chair: Thank you very much for your cooperation and your presentations. It was very educational.

    I'm sorry we don't have too many members these days; obviously, there are some rumours of elections in the air.

    Ms. Madeleine Dalphond-Guiral: I'd come anyway, my dear.

    The Chair: Well, except you. You are not running, so there's no good reason not to.

    Ms. Madeleine Dalphond-Guiral: You know pretty well that even if I was running, I would be here; you know that.

    The Chair: Yes, I can testify to it. Thank you very much.

    Thank you and good night. The meeting is adjourned.