CIMM Committee Meeting

37th PARLIAMENT, 3rd SESSION

Standing Committee on Citizenship and Immigration

EVIDENCE

CONTENTS

Monday, April 26, 2004

¹

1530

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

Dr. Hasan Zaidi (President, Canadian Association of Interns & Residents)

¹

1535

Dr. Jason Kur (Chair, CAIR's Advisory Committee on International Medical Graduates, Canadian Association of Interns & Residents)

¹

1540

¹

1545

Dr. Hasan Zaidi

The Chair

Dr. Anu Bose (Executive Director, National Organization of Immigrant and Visible Minority Women of Canada, Canadian Opportunities Partnership)

The Chair

Dr. Anu Bose

Mr. David Glastonbury (President, Greater Ottawa Chamber of Commerce, Canadian Opportunities Partnership)

¹

1550

¹

1555

The Chair

Mr. Mengistab Tsegaye (Executive Director, World Skills Ottawa, Canadian Opportunities Partnership)

º

1600

º

1605

The Chair

Mr. Art Hanger (Calgary Northeast, CPC)

Dr. Jason Kur

Mr. Art Hanger

º

1610

Dr. Hasan Zaidi

Dr. Anu Bose

Mr. Art Hanger

Mr. David Glastonbury

º

1615

The Chair

Ms. Colleen Beaumier (Brampton West—Mississauga, Lib.)

º

1620

Dr. Jason Kur

Ms. Colleen Beaumier

Dr. Jason Kur

The Chair

Dr. Anu Bose

º

1625

The Chair

Hon. Hedy Fry (Vancouver Centre, Lib.)

Dr. Jason Kur

º

1630

Hon. Hedy Fry

Dr. Hasan Zaidi

The Chair

Dr. Anu Bose

The Chair

º

1635

Ms. Colleen Beaumier

Mr. David Glastonbury

The Chair

Mr. David Glastonbury

The Chair

Dr. Anu Bose

Dr. Jason Kur

The Chair

Mr. David Glastonbury

The Chair

Mr. David Glastonbury

The Chair

º

1640

Mr. David Glastonbury

The Chair

Dr. Anu Bose

The Chair

Dr. Hasan Zaidi

The Chair

Mr. Mengistab Tsegaye

º

1645

The Chair

Mr. Art Hanger

Dr. Jason Kur

Dr. Anu Bose

Mr. Art Hanger

Dr. Anu Bose

Mr. Art Hanger

Dr. Anu Bose

Mr. Art Hanger

Mr. Mengistab Tsegaye

Mr. Art Hanger

Mr. Mengistab Tsegaye

Mr. Art Hanger

Mr. Mengistab Tsegaye

Mr. Art Hanger

º

1650

Mr. Mengistab Tsegaye

The Chair

Ms. Colleen Beaumier

Dr. Anu Bose

Ms. Colleen Beaumier

Dr. Anu Bose

Ms. Colleen Beaumier

Dr. Anu Bose

º

1655

Ms. Colleen Beaumier

Dr. Anu Bose

The Chair

Hon. Hedy Fry

»

1700

The Chair

Hon. Hedy Fry

The Chair

Mr. Art Hanger

Dr. Jason Kur

The Chair

Dr. Hasan Zaidi

»

1705

Mr. Art Hanger

The Chair

Mr. David Glastonbury

Mr. Art Hanger

Mr. David Glastonbury

The Chair

»

1710

Dr. Hasan Zaidi

The Chair

Dr. Anu Bose

The Chair

Dr. Anu Bose

»

1715

The Chair

Dr. Anu Bose

The Chair

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CANADA

Standing Committee on Citizenship and Immigration

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NUMBER 009

l

3rd SESSION

l

37th PARLIAMENT

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EVIDENCE

Monday, April 26, 2004

[Recorded by Electronic Apparatus]

¹  (1530)  

[English]

    The Chair (Mr. Sarkis Assadourian (Brampton Centre, Lib.)): This meeting is pursuant to Standing Order 108(2), a study on the recognition of foreign experience and credentials.

    We have witnesses from the Canadian Association of Interns & Residents, Mr. Hasan Zaidi. You have ten to fifteen minutes to make your presentation. Before you do so, I would appreciate it if you could introduce your delegation. Then we'll go to the Canadian Opportunities Partnership, and we'll do the same thing.

    Thank you very much.

    Dr. Hasan Zaidi (President, Canadian Association of Interns & Residents): Good afternoon, ladies and gentlemen.

    My name is Hasan Zaidi. I am president of the Canadian Association of Interns & Residents. I'm also a resident physician in internal medicine right here in Ottawa. With me today is Dr. Jason Kur, medicine resident from Vancouver, British Columbia, who is chair of our national committee on international medical graduate issues. We're absolutely pleased to be here today to share with you the perspectives of young doctors on the integration of foreign-trained physicians into our workforce.

    Just by way of background, the Canadian Association of Interns & Residents is a national voice for doctors in training. We represent over 5,500 medical residents or new doctors across Canada. We are a committed group of health care workers, proud to be providing around-the-clock coverage seven days a week on the front lines of Canada's health care system. As new doctors, we simultaneously fill the roles of clinical providers, learners, teachers, and researchers. Our membership reflects the diversity of Canadian society. We have been trained with a set of skills, attitudes, and values to sustain, enhance, and reform our nation's health care system. In essence, we are the new face of medicine.

    Medical residents are physicians who have completed their undergraduate degree, who have completed medical school, often eight years of post-secondary education already, and who are now undertaking specialized post-graduate training in a variety of disciplines ranging from family medicine, surgery, psychiatry, obstetrics and gynecology, just to name a few.

    The essence of residency training is providing medical services and patient care activities to the patients we see. Our learning comes primarily through service to our patients, in teaching hospitals and other institutions in urban, rural, remote, and northern settings. Residency essentially involves direct hands-on patient care. For 24 hours a day, seven days a week, residents are working on the front lines of all aspects of health care. In most major hospitals, a resident is in fact the first person you'll come in contact with.

    By providing clinical activities, resident physicians are working towards certification by either of the two colleges—the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada. For Canadian graduates, certification by either of these colleges is a requirement for licensure and ultimately for practising independently in our great nation.

    CAIR's passion for and commitment to accessibility and sustainability of our health care system is longstanding, dating back to the birth of the Canada Health Act over 20 years ago. In addition, CAIR has been actively involved in the debate surrounding the integration of international medical graduates since 1982.

    In 2002 CAIR established an advisory committee on international medical graduates, a working group of elected resident representatives from across the country. The members of this group were directed to further explore developments in the ever-changing field of licensure and assessment of international medical graduates, and to review and assess the recommendations made by the national task force on international medical graduates.

    The Canadian Association of Interns & Residents is definitely committed to help integrate international medical graduates into the physician workforce in Canada. By September 2002, the Canadian task force on the licensure of international medical graduates was struck. Dr. Jason Kur was appointed as the resident representative. It's my pleasure now to introduce Dr. Kur.

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    Dr. Jason Kur (Chair, CAIR's Advisory Committee on International Medical Graduates, Canadian Association of Interns & Residents): Thank you, Hasan.

    New doctors agree that the system to integrate internationally trained physicians in Canada right now is woefully inadequate. In many respects we applaud the efforts taken thus far to help reduce barriers for international medical graduates when they seek information on licensure in Canada.

    However, in the rush to fill the demands of the physician shortage here, we need to make sure we're not making the same mistakes of the past. We need to get it right this time. Ten years ago governments were telling us that there were too many doctors in Canada and they slashed opportunities for Canadian citizens to attend medical school in their own country. How wrong they were. This has led to a situation where opportunities for Canadians to study medicine in their own country have dried up. This year, in fact, there are more graduating medical students than there are residency positions.

    In the rush to create positions for more foreign-trained professionals, we need to ensure that the current system has enough capacity for Canadian-trained graduates. For years now members of the profession have been recommending that there be 120 residency positions for every 100 graduates of Canadian medical schools. This recommendation serves three purposes. Number one, it helps increase flexibility for Canadian graduates. Many of us who go through medical school find that our skills may not be suited for one speciality and we have to switch along the way. Someone in general surgery may find out they're not particularly suited for that speciality and switch into family medicine. Having some flexibility allows for that.

    Number two, having excess spots allows for re-entry of physicians already in practice. Family physicians in rural communities often find they want to do skill upgrades and do obstetrics or some GP surgery, and we need to have flexibility for that as well.

    Finally, having excess training positions allows for international medical graduates who need upgraded skills access to the system.

    We're certainly not there yet. Failing to achieve this goal is an attack on flexibility and training and re-entry for physicians at a time when those positions are at an all-time low. Provincial governments have recognized the need to train more doctors in order to meet the health care needs of the population. As a result, the number of positions in Canadian medical schools has increased cautiously in order to meet that projected need. Yet residency positions have remained static, and ever-increasing demands are being placed on current trainees in the system, teaching physicians, as well as the hospital infrastructures themselves.

    If these problems aren't addressed now, we're not going to be able to accommodate the increased assessment that's required for internationally trained physicians. We definitely need to expand assessment and training for internationally medically trained physicians. The federal government's recent $4 million announcement for an assessment of training is certainly a step in the right direction. However, faculty and resident support is a key feature of any expanded program, and I would like to explain why.

    Currently, many IMG programs that are assessing and evaluating internationally trained physicians in Canada rely on the daily support, teaching, and supervision of senior residents like ourselves. We are often the most involved in IMG teaching and supervision, and while extremely enriching for ourselves and the system, it can detract from the overall educational experience of other medical students and junior residents, and ultimately can affect patient care. IMGs frequently have unique cultural and educational needs that can be extremely time-consuming and demanding on individuals who aren't trained to provide the supports that they need.

    Our membership has expressed concern over the potentially negative impact that increasing IMG supervision has on the current cohort of people in the training system. Certainly this is not something we've been trained to do over the years. Currently the medical training system is strained, with underfunding, inadequate resources, and too few teachers. In fact, the expansion of current programs due to increased undergraduate enrollment requires more planning, evaluation, and support.

    As a resident physician in British Columbia, I can speak to these stresses on the system, as our expanded medical school, which is projected to double in the next five to ten years, is creating increased demands because of lack of space, lack of teachers, and lack of funding, which are rampant problems. Without careful planning, expanded IMG programs will only add to this stress. Furthermore, every IMG is unique and really has to be evaluated on an individual basis. As a result, they enter the system with varying degrees of knowledge and ability. Before adding any additional pressure point to the system, policy-makers must ensure that the system itself receives the needed supports and funding to guarantee quality patient care.

    That being said, expanding IMG assessments is a worthwhile endeavour, one we fully support, assuming the appropriate financial and human capital investments are made.

¹  (1540)  

    In terms of standards, CAIR supports the need for a standardized evaluation process for all foreign-trained physicians who didn't graduate from Canadian medical schools. However, we caution that changes to licensure requirements must be consistently applied for everyone. That is to say, the same criteria for certification must be required of anyone who wants to be a doctor in Canada.

    The medical education process in Canada is more than passing national exams. For Canadian graduates, it's the culmination of a long process of self, peer, and educator evaluation. The current tools we have right now for assessing an individual's knowledge are really designed for products of our Canadian educational system, and their track record has not really been proven in people who have trained at other schools. Really, they're to assess the last verifications of one's training before entering practice. There isn't evidence that these tools have been validated or applicable to individuals who have trained outside of our typically accredited schools.

    As a result, it would be inappropriate and potentially unsafe to use these tools as the sole mechanism for assessing undergraduate or post-graduate training. If we are really serious about getting more foreign doctors into the system, we need to develop new tools that will properly assess their skills in a time-appropriate manner.

    As new physicians, we strongly believe that all doctors in Canada should be held to the same standard of excellence. We want Canadians to have confidence in all doctors. When a patient enters a doctor's office, they shouldn't need to verify on the wall where they went to school, what exams they passed, and their certifications. We want all Canadians to know that every physician meets a certain standard of excellence and they can take solace in the fact that they will get the best care possible, whether they're in downtown Toronto or in Fort Smith, Northwest Territories. Diluting educational standards to fill positions will be a disservice to the health of Canadians in the long run.

    We also believe that an overall strategy is needed to address the physician shortage in Canada, and while seen as a short-term solution by many people, the integration of IMGs into practice is just one part of that solution, and definite longer-term planning is needed. Canada must not become reliant for its future physician resource needs on the production of physicians in other countries over which it has no control.

    We as new doctors who will be working in the health care system for the next several decades strongly believe that more emphasis needs to be placed on determining the need rather than opening the floodgates to an infinite number of IMGs abroad. The number of full and partial post-graduate training positions available for foreign-trained doctors in Canada should be determined on the basis of needs of the health care system and re-evaluated continually, just as we do for undergraduate entrance physicians.

    Recent trends also suggest that the number of Canadians studying medicine abroad is growing rapidly. Schools in the Republic of Ireland and Australia are becoming enclaves of Canadians who have had to leave Canada for their training because of the lack of spots in this country, and certainly Canada has the worst ratio of opportunities for medical students of any of the OECD countries.

    Unfortunately, due to the dissimilarities of the educational systems, these individuals, often without any post-graduate training or residency that we're doing, often seek entrance into the system in the mid-point of the training life cycle. This is an alarming trend, and reflects the lack of opportunities for Canadians to study medicine here. Canada must strive to provide enough undergraduate and post-graduate positions to meet the health care needs of its population. We can't rely on for-profit medical schools overseas to meet these needs.

    Clearly, internationally trained physicians are a valuable resource and always make up a significant component of our physician population. In the global academic environment, though, Canada has a moral obligation to help provide specialty training to doctors who will return to practise in their countries of origin. However, CAIR strongly believes that Canada should be self-sufficient in the production of doctors to meet its health needs. It's also ethically questionable to seek, recruit, or poach physicians from developing nations. Although Canada is a nation of immigrants, the active recruitment of highly skilled physicians from resource-poor countries, in our belief, is wrong.

    International medical graduates have made and will continue to make an important contribution to the quality of medical care in Canada. Certainly they are members of our organization and they become our colleagues. However, in the rush to increase the accessibility to IMGs to practise, it is vital that we not compromise the high standards of medical education that we have achieved in Canada.

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    Dr. Hasan Zaidi: In closing, I'd like to draw four conclusions. First of all, the lack of capacity of the educational system to accommodate Canadian graduates must be dealt with before foreign-trained physicians can be added. The second conclusion I'd like to draw is addressing the IMG system in Canada must occur in the context of a national physician resource strategy, which we currently don't have. The third conclusion is all that graduates of Canadian medical schools must have access to post-graduate training. The last conclusion is that Canada must move towards an official policy of self-sufficiency in the physician workforce.

    On behalf of the Canadian Association of Interns & Residents, we'd like to thank you for the opportunity to present before you today.

    The Chair: Thank you very much, Dr. Zaidi, Dr. Kur.

    In the Canadian Opportunities Partnership we have three groups. Maybe you could explain to me how this arrangement was done. We have Anu Bose, executive director, National Organization of Immigrant and Visible Minority Women of Canada; David Glastonbury, president, Greater Ottawa Chamber of Commerce; and Mengistab Tsegaye, executive director of World Skills Ottawa.

    Go ahead, please. Thank you.

    Dr. Anu Bose (Executive Director, National Organization of Immigrant and Visible Minority Women of Canada, Canadian Opportunities Partnership): Thank you, Mr. Chairman.

    Good afternoon, members of the Standing Committee on Citizenship and Immigration, clerk Mr. Farrell, Mr. Dolan, researcher.

    My name is Anu Bose, and I am the executive director of the National Organization of Immigrant and Visibility Minority Women of Canada, which is a women's equality-seeking group. NOIVMW is not a stranger to this committee; we have had a habit of turning up like dirty shirts whenever this committee meets. But it's the first time we're appearing before you, Mr. Assadourian, and we are grateful.

    The Chair: Thank you.

    Dr. Anu Bose: We are here today as part of the Canadian Opportunities Partnership, a coalition of organizations and individuals, NGOs and business, who wish to keep diversity issues at the heart of Canadian public life.

    There are three of us here today. With me is Mr. Glastonbury, a former president of the Greater Ottawa Chamber of Commerce and an ally of the NGOs on the phenomenon of brain waste; and Mr. Mengistab Tsegaye, executive director of World Skills, LASI, whose organization is at the cutting edge of the fight for the recognition of credentials earned overseas. We each have a particular message to take to this committee, and we are grateful that we are allowed to appear as the three stooges...or the three musketeers.

    David.

    Mr. David Glastonbury (President, Greater Ottawa Chamber of Commerce, Canadian Opportunities Partnership): Mr. Chairman, a picture is said to be worth a thousand words. I'd like to use several verbal pictures to introduce my comments.

    I take you back to the year 136, which saw the completion by Roman engineers of Hadrian's Wall. I had a chance to walk it quite some number of years ago, and it's quite a feat. Built for the purpose of restricting access by northern tribes to Roman Britain, this engineering feat, despite being evacuated in the year 383, is still in evidence today.

    In the year 1862, Anna Leonowens, a widowed mother, took up a position of governess at the court of the King of Siam. During her five years of employment she had a significant influence on the future ruler of Siam, today's Thailand.

    The Rideau Canal, which starts its journey southward just adjacent to Parliament Hill, was built in the early 1800s. Acknowledged as a feat of modern engineering, the stonework on the many locks is a tribute to the craftsmanship of Scottish stonemasons.

    What's the common thread among these three examples I've used? The common thread is that in the regulated environment of Canada of the 21st century, none of the talent in these examples could get a job here in Canada.

    Despite years of designing and building infrastructure in Roman-controlled areas, Roman engineers, not having Canadian experience, would be unable to work here in their profession. And yet we go to Europe and see viaducts, aqueducts, all sorts of buildings that still stand 2,000 years later, but they couldn't get a job here.

    Despite five years of experience teaching the King of Siam's extensive family, Anna would not qualify for a position as a Canadian teacher, despite the fact that I understand from my research she died in Montreal in 1914.

    Despite years of experience working in malarial conditions to build the Rideau Canal, in fact just down the street here, between Dow's Lake and the Chateau Laurier, Scottish stonemasons would not be permitted to work in today's Canada.

    In 2002 there were just over 229,000 immigrants who came to Canada. More than half—136,525—were professional and skilled workers. This economic class, as they are labelled, encompassed 77,000 persons with university degrees, which included in excess of 17,000 masters degrees and more than 3,000 doctoral degrees.

    Statistics Canada indicates that between 1991 and 2002 immigrants accounted for 70% of the total labour force growth, and that by the year 2011 they will account for virtually all growth in the labour force.

    The Conference Board of Canada has estimated that Canada is forgoing $5.9 billion a year in economic benefits because of this situation. The result of this inability to harness these willing and able resources is to augment the ranks of the working poor.

    One of the city of Ottawa's top workforce challenges is that 70% of families on this city's waiting list for subsidized housing in 2002 were immigrants with an average annual income of $18,011. One in five Ottawa residents is foreign-born and one in five is a visible minority.

    Which comes first, the chicken or the egg? The federal government has given an indication that the plight of Canadian cities will be addressed. Does this include more money for public housing? Is this the correct emphasis?

    Certainly the calls for more funding have credible arguments, but are we attacking the symptoms rather than the cause? Our regulatory system is strangling opportunities for new arrivals to be net contributors to the common good. Instead, these resources, despite being in great demand, are prohibited from realizing their full potential.

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    It appears that the log-jam facing our immigrants is most prevalent in those areas that are the most regulated. I draw your attention to the situation that occurred at the height of the high-technology boom. We couldn't find enough high-tech talent fast enough. It didn't matter whether their degrees originated in Hong Kong, India, or Bangladesh; as long as the people had suitable backgrounds, they were considered for employment.

    In occupations such as teachers, medical doctors, and skilled tradespeople, why are there so many barriers to skilled immigrants? It is precisely in those fields where there is an abundance of skilled talent eagerly awaiting an opportunity to contribute to their new country's economy. As an example, there are 250 known and 400-plus estimated foreign qualified medical doctors resident in Ottawa. Just try to find a family doctor in Ottawa to take on new patients. Yet we have hundreds of medically trained immigrants who only need the opportunity to serve.

    My local pharmacist just moved into a new building. He purposely built his new accommodations with space for a doctor upstairs. He's been in there several months and has interviewed a few people, but is still waiting for a doctor to take up residence. He's holding onto that space, so there is an opportunity. He's still looking for someone to come in there.

    Too often in Canadian society the easy route to meeting our challenges is to call for more money. Present funding enables many promising results, but they equate to taking on an iceberg with a hand-held ice pick.

    When it comes to skilled trades in this country, for instance bricklayers, many of our tradesmen are over 60 years of age. I don't think you can find a stonemason under the age of 60. I don't understand, from a business perspective, what is different. If we bring a bricklayer here from Italy, does he stand the bricks on end and have to be trained in Canadian experience to lay them flat? I'm being facetious, but that's the kind of thing that comes up. Do nurses who are foreign-trained put bandages on upside down, so we have to retrain them? I leave you with that question.

    My first recommendation is to appoint a czar of immigrant employment to crash through these barriers at all levels. Second, attack the root cause of immigrant poverty, not the symptoms. Third, refocus the spending to maximize results, not create more studies and more bureaucracy.

    Thank you.

¹  (1555)  

    The Chair: Thank you very much.

    Mr. Tsegaye, please.

    Mr. Mengistab Tsegaye (Executive Director, World Skills Ottawa, Canadian Opportunities Partnership): It's hard to add anything to those remarks.

    My name is Meng Tsegaye. I work with LASI World Skills. We are a local agency serving immigrants. It's a partnership of six organizations: the Catholic Immigration Centre, Immigrant Women Services Ottawa, Jewish Family Services, Lebanese and Arab Social Services, the Ottawa Chinese Community Service Centre, and the Ottawa Community Immigrant Services Organization. We work in partnership to provide employment services, but we also provide a wide range of services in Ottawa-Carleton.

    Today I just want to share with you one initiative we implemented here in Ottawa, and maybe it could also be looked as a model for other sectors. I'm sure you're all aware of the many barriers and challenges faced by internationally trained professionals, therefore I'm not going to dwell on the many issues that have already been documented.

    The project we have implemented is for foreign-trained teachers. We have about 600 foreign-trained teachers in our database. We developed a partnership initiative with the Ottawa public school board and Queen's University. The program is basically for foreign-trained teachers who already have the education and experience but lack the one-year teaching certificate in Canada in order to practise in Ontario.

    This program is funded by the Ministry of Training, Colleges and Universities. It's a pilot project for three years, and 90 people will be going through this program. So at the end of the program they will obtain their certificates and will be licensed to teach in Ontario.

    We had our first graduates last year, in October, when 26 people graduated from the first cohort, and 16 of them are now working in their profession. Some of these people were on social services or EI prior to this program. So when someone was on social services in September, and was earning $55,000 in January, you don't need to do any research or study on whether this kind of initiative is successful or not.

    Out of these 600 people we had to choose 90 people, based on a simple criterion. We took people who were on EI and we took people who were on Ontario Works, because at least they had access to training resources. But many of the foreign-trained immigrant teachers will not be able to enter this program and access this training.

    The other thing that was important for us in this initiative was the partnership that was developed between the training institutions, the regulatory body, and the community organizations. This is something that's very new for us, and we really value it. We had an excellent experience with the Ontario College of Teachers. In fact, out of this experience we are in the process of exploring other types of partnerships.

    Just to give you one example, most of the 26 graduates in the first cohort were on Ontario Works or EI, and they were sponsored by those programs. Another five people really wanted to go into the program, but they could not access any training money. So we had to arrange some private loans for those people to participate in that program.

    Out of this partnership we learned that there are structural barriers, but when partners come together there are also many ways things can be implemented. For example, part of the theory for this program was in Kingston, and part of it was in Ottawa. The practical placement was of course with the school board. But for the seven weeks when the people had to be in Kingston, Queen's University came up with an idea to help them with their finances. They decided to have the program in the summer, when the students were away and the residence was free.

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    I'm just giving you an example. Money is not always the solution. There are other creative ways, when partners come together, that we could construct a successful model.

    Based on our experience, I think there are probably four areas that need to be considered in designing or delivering bridging initiatives for foreign-trained professionals. One of them is coordination between all levels of government, the training stations, and the accrediting bodies.

    Universal access to training, upgrading opportunities for newcomers, is a big issue. If you're a newcomer to Canada, you haven't worked before in Canada, and you're not on social service, you don't have any access to training for upgrading your skills.

    On sustainable core funding for employment initiatives, we have this program, and I have shared with you how successful it is. It is a pilot project. It's going to end in 2005, and there is no commitment to continue the program.

    The strategy to involve employers in the integration of newcomers into the workforce is again a very important element. We've seen some other models. Ontario Works has an incentive for employers to help them offset the initial costs of training a new employee. Something like that could also be looked at to engage employers in this issue.

    We feel there should be a partnership between the different levels of government. There's always one initiative by the federal government, another initiative by the province. There has to be a way to coordinate those initiatives.

    The topic of internationally trained professionals has become everyone's issue, we feel, but it hasn't really become anyone's main agenda. If we have a plan to recruit the best and the brightest from the four corners of the world, we certainly need a plan also for how to integrate them into our workforce.

    Thank you.

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    The Chair: Thank you very much.

    Mr. Hanger, ten minutes.

    Mr. Art Hanger (Calgary Northeast, CPC): Thank you, Mr. Chairman.

    I would like to thank the guests for their presentations.

    I'm not quite clear. I hear a strong message from the two fellows on my right, and I'm not quite sure where everyone else is coming from, if we're all sharing the same viewpoints. I gather that's not the case here. I hear from Mr. Zaidi and Mr. Kur that there's a concern over the dilution of educational standards, and that's a possibility in evaluating IMGs, and that the educational needs of IMGs are something of a barrier. I would like some clarification on that. What are you referring to when it comes to educational needs?

    Dr. Jason Kur: Maybe I'll just give you a personal example. I'm a senior resident at St. Paul's Hospital in Vancouver. On my team I have with me usually two or three medical students, two junior residents, and often an internationally trained physician going through a dedicated program that has been developed at St. Paul's Hospital to get more internationally trained doctors. Each new internationally trained doctor comes from a different background, a different educational training system, and a different knowledge base. You really can't make any assumptions of a person's capability until you see them in action, and that takes time. It can detract from other responsibilities in our current job, because these responsibilities are added and expected of us, because that's our role.

    So it's really important that we have tools that make sure the individuals we're putting in patient care roles have had adequate training and are capable of filling those roles. I would argue that we don't have all the tools necessary to screen someone quickly and in a time-efficient manner that says this individual came from this country and this training system, so as to be able to find out at what point in the system they can be fitted in. Do they have the equivalent knowledge of a medical student? Are they a junior resident? Are they ready for practice? We have all those types of doctors out there from foreign countries. We need to have tools that will be able to slot people into these roles quickly. Right now internationally trained doctors are being put in residency positions, because that's the easiest point at which to do it, as it's a fairly supervised capacity. You can then branch out into whether a person can have more patient care responsibilities and go on to writing exams. I definitely think there's a lack of tools to do that. We need a bit more support for people who don't do this on a regular basis.

    I don't want this committee to get the impression that as new doctors, we're being protectionist. That's certainly not our attitude. So many IMGs make a huge contribution to our system, and they're members of our organizations, but our bottom line is patient safety and ensuring that all Canadians have the same experience when they go to the doctor.

    Mr. Art Hanger: To use Mr. Glastonbury's analogy, you have an Italian bricklayer, and there's some restriction on his coming into this country. Let's face it, half the bricks in this country were probably laid by Italians. Given that, though, there's a big difference between a bricklayer having the skill of laying a brick and a doctor in his endeavour to determine someone's medical condition. I can understand the need to have a mechanism in place to evaluate, but I'm wondering how much of a fast track you are advocating to move someone like a doctor, maybe already trained, maybe with experience in his own country, into our system, as far as the evaluation aspect of it is concerned.

º  (1610)  

    Dr. Hasan Zaidi: There is indeed a big difference between laying bricks and teaching someone to be a physician, take care of sick patients, and gain public confidence. If I were to move to any other country, I would fully expect to have someone assess my credentials. I would hope it's not going to be fast-tracked. I think that's dangerous for public safety and irresponsible. International medical graduates and international physicians continue to play a huge role in the delivery of health care services. One in every five practising physicians is an internationally trained physician. To reiterate what Jason is saying, proper ways of assessing credentials and proper ways of licensure must not be sacrificed, and they must adhere to the same standards to provide optimal patient safety.

    Dr. Anu Bose: I've got a new physician. The gentleman is a Sikh from Yorkshire, with a turban and a broad Yorkshire accent. He's an MRCP from Britain. I asked him how he managed to become integrated into the Canadian medical establishment. He said he got it as dowry from his Canadian wife, the money to take the exams and upgrade himself. Not everybody has a wife who can afford this kind of dowry, I'm afraid.

    Let's look at the example of Britain. The National Health Service would shut down if it were not for all these Commonwealth-trained doctors. They have assessment procedures. Surely, it behoves the Royal College of Physicians and Surgeons to look into this. Further, a doctor is a doctor is a doctor. Perhaps what they would need upgrading on is the medical culture of Canada, which is probably even more open than that of Great Britain. It also behoves us to look at the Australian experience. I have put in a reference for your researcher to look at about how Australia developed these joint protocols with the States to assure quality across Australia. So there are other examples we can learn from.

    As I say, if the Government of Canada is willing to bang heads together on health, they could do it on credentials as well. We've waited a very long time. I don't think we can wait much longer.

    Mr. Art Hanger: I see the need to have some sort of protocol set up, and I'm not hearing that message from anyone sitting at the end of the table here. But ultimately it comes down to this country setting the standard and it being adhered to. I've picked up over a bit of time here that there's resistance on one side and an initiative on the other to move things along at a much faster pace. I'm still trying in my own mind to determine where we are, even as a country, on this protocol to analyse the credentials, especially medical credentials, of outsiders. The big danger, in my mind, is that you can move it ahead, and it may not receive broad acceptance through the provincial authorities, and then you end up with undue pressures on them from, say, a federal scene. There doesn't seem to be this broad cooperation, so far as I have been able to detect yet in the presentations that were given here this afternoon.

    So where are we?

    Mr. David Glastonbury: I think the answer is, we're nowhere. I quoted a figure of $6.9 billion. There's a huge gap, with due respect to these gentlemen over here, when they talk about ensuring that there are places for all Canadian applicants in medical schools. I look at my local Loblaws store, where they want to make use of the produce they have there now, they don't throw it out. And the same thing happens, I would suggest, with the new talent that comes into our country. We want to make use of this talent before they lose their skills.

    That's not to suggest for a moment there shouldn't be criteria. It doesn't mean that just because an individual has a piece of paper from a particular higher level of education, we're going to accept that on face value. There have to be some hurdles, but I suggest to you that at the moment these aren't hurdles, these are barriers. I gave you the example of the high-tech area. When we needed people, they didn't care where they came from, as long as they had the experience and the training that was required.

    To go out on a limb here, what if we shut down all the medical schools for two years, took all the immigrants, and put the Canadians in afterwards?

º  (1615)  

    The Chair: Thank you. That's it.

    Ms. Beaumier.

    Ms. Colleen Beaumier (Brampton West—Mississauga, Lib.): Thank you.

    As a white Canadian, I feel a great deal of shame, and I'm reminded of it every time I get into a taxicab at the airport. We have medical doctors, veterinarians, and people with masters degrees and PhDs driving taxicabs in this country--if they're lucky.

    I know there are ways of measuring.... I'm going to deal with the physician situation. One day my paperboy knocked at the door and wanted to clear up the bill because he was going to the United States--he was a medical doctor and he would never be able to practise medicine in Canada. He did not have the resources to practise medicine in Canada and he was going to the United States, where in six months he was going to be able to practise medicine. What a disgrace that we feel we are so wealthy in this country, we've become so arrogant, that we can throw away educated minds. It costs a lot of money to educate a mind, yet we are still at the point where our arrogance allows us to toss these minds away.

    You talk about bricklayers laying bricks differently. Well, if someone graduates from an internationally recognized medical school in India, are you telling me that people in India have their kidneys up here and their hearts in their toes? I know it's not quite that simple. However, we do have internationally recognized medical schools. It still makes no difference.

    We have to have something in place, and the medical association, if the will were there, could come up with a similar kind of program. I don't know if any of you have looked at the programs in the United States that allow doctors to become qualified, but I think that's a responsibility. Not only does it make sense in economic terms, but also, I think, in terms of morality. That's number one.

    Number two, I was pleased, David, to hear you speak of that, especially representing the board of the chamber. When I go into the bank and I look around my bank.... My constituency is 62% first-generation Canadians, and probably 90% of those are visible minorities. I go into the bank--and the bankers are smart--and there may be 14 people in line, and I'm the only white person. I look around the bank and I see that the bank represents the demographics because that makes good business sense.

    However, if I go down to city hall in Brampton, I am hard-pressed to find anyone who is visibly different. The hiring practices in our government operations are not representative, demographically, of the people who pay the taxes, and I think that's another disgrace.

    Sorry. I got that off my chest. I feel much better--I think I'll go home now.

    I would like you to comment on how we can.... Should we just say to people, if you're a medical doctor, don't bother applying because you're going to have to sweep floors--if you're lucky you'll sweep floors in a hospital or drive a cab. What can we do? Do we just stop medical people from coming here?

º  (1620)  

    Dr. Jason Kur: There seems to be a question that I'm hearing around the table of what's going on right now to improve this. I think, with all due respect, there is a lot going on. I think the national task force on the licensure of internationally trained physicians has taken a lot of steps over the past two years. I've been at this table now for two years, and one of the things that is happening is the centralization of information. Right now every province has different rules for Canadian graduates, let alone for internationally trained doctors.

    So we're getting these bodies to the table and saying it's a fiasco for IMGs. We have to start providing one central point of information so that someone can legitimately go and say this is what it takes to become a doctor in Canada--do I have A, B, C, and D in order? Right now we don't have that, but people are looking at putting it together currently.

    There are increased programs across the country, but the problem is that programs in Ontario, in Manitoba, in B.C., and in the Maritimes have developed independently. They need to start sharing the tools they're using to evaluate individuals, and that's starting to happen now by having the cross-pollination of ideas in the assessment of IMGs. It's also forcing the regulatory bodies to sit down together and ask themselves how they deal with this, which ultimately is going to make things easier for everyone who practises medicine in Canada.

    So there is a lot going on, and I think we are going in the right direction, but it takes time. It's tough to assess someone in just a few short months or weeks, to get them into practice. I'll give you an example. If I quit medicine now and decide not to work for the next ten years, I can't just go out and get a licence and start working in ten years. I am subject to reassessment of my competency. Those rules apply to everyone, not just internationally trained doctors.

    So there are things going on to streamline the system; information is getting centralized and the licensing bodies are getting together. And we, as the new face of medicine, want to see this simplified a lot more, because we agree, it's a bit of a fiasco.

    Ms. Colleen Beaumier: Well, why can my paperboy go into the United States and practise medicine in six months? What do they have that we haven't, other than maybe a little economic smarts?

    Dr. Jason Kur: Unfortunately, medicine and training is different in the U.S. There are certain schools that are jointly accredited with Canadian medical schools, and as a result Canada and the U.S. have had a very good relationship in terms of the exchange of those professionals. But there are medical graduates from the U.S. who don't go to those medical schools who would have the same restrictions as any other foreign-trained physician.

    Again, I go back to the standard. In the U.S., many people will go to their physician's office and have to look at the credentials on the wall to see if their physician is board-certified. Where did that doctor go to medical school? What has this person done? Can this person be trusted? We don't have that in Canada because the product of our schools is so uniform. I think it's something many Canadians take for granted, and I don't think we should sacrifice that to do things faster.

    The Chair: Dr. Bose.

    Dr. Anu Bose: I was going to say that I agree very much with what Ms. Beaumier just said, and I'm very grateful that she said it.

    Why is it that Britain was able to evaluate the credentials of doctors from Bangladesh, Pakistan, India, Ghana, and Nigeria and we are not able to? Surely we could ask the British--even if we don't buy their expertise--how they do it. And now they're being forced to evaluate the credentials of EU-trained doctors. They've withdrawn the Commonwealth preference now. The expertise is out there, the tools are out there.

    What Dr. Kur was saying rings a bell with me. There are a lot of piecemeal initiatives going on. We need this brought together under one roof, as it were.

    I see Dr. Fry is here. She has special responsibility, I know, to coordinate this effort. So we would suggest that this committee recommend that Dr. Fry be given a secretariat to run, which is adequately resourced, so she can really bang heads together and get on with it. Let the women get on with it if the men can't.

º  (1625)  

    The Chair: We definitely need you, Dr. Fry. Go ahead, Dr. Fry.

    Hon. Hedy Fry (Vancouver Centre, Lib.): Thank you very much.

    I'm glad, actually, that Dr. Kur talked about some of the initiatives that have been taken as a result of the task force on international medical graduates. It's been a long time coming, but it has begun to happen. There has been this meeting of everyone to come to talk about the tools for an assessment that is pan-Canadian. However, what I wanted to focus on was something that is very, very important.

    I've been in politics now for ten years. If I wanted to go back and practise medicine tomorrow, I would have to go back and do continuing medical education for a certain number of hours or months to be able to allow me to catch up. When I was practising medicine, I had to read six medical journals a week. If I missed reading them, six months later there were new ways of treating the stuff that I thought I knew how to treat six months ago. Medicine is moving at a very fast rate. The impact of drugs, the effectiveness of drugs on the patient, how to do certain things, it's all changing. So I would have to go back into training. I couldn't just go back and practise medicine now, myself.

    There are two problems that I think need to be addressed. I would like to hear Dr. Kur's response to them. One problem is with assisting physicians who are international medical graduates, who have been driving the proverbial taxi for six years. How do we assist them to gain access to the resources they need, not only to do the exams, to prepare for the exams, but to find residency or other training so they can get up to scratch to go back into practice? For those who are in family medicine it's a shorter period of time, but for those who want to go back into a speciality, it requires a longer period of training. And I know the lack of these kinds of resources is a huge problem, especially if you've been working at a very low-paying job for all of the time that you weren't able to practise your profession.

    We put in about $3 million to $4 million about a month ago to assist in this. I announced it in Calgary. But that's just going to hit the tip of the iceberg; it's not going to deal with the number of physicians out there who need to have this assistance and this resource. I'd like to ask Dr. Kur what he thinks we should be putting into that kind of pot to enable this to happen.

    I agree with Dr. Kur fully that residency training is a key part of any physician's training. No matter how good the qualifications are, physicians have to go out into residency to be able to show how they practise. What are your suggestions with regard to matching these physicians, the number of them who are out there, with residency positions, given that there are so few residency positions in the teaching and the tertiary care units? How do you see us getting people into training positions in other parts of Canada, not just in the big cities? Is that a possibility, and what do you think the resources needed to do that are? And how will they be trained and supervised?

    Dr. Jason Kur: Those are a lot of questions; I'll try to manage them.

    Maybe I'll start with the last question, on how to assist physicians to get out to other parts of Canada, particularly internationally trained physicians. I think it's important to know there's an assumption that internationally trained physicians are going to fill the need in all the rural communities of Canada. Studies have shown us that immigrants to Canada tend to congregate in the major cities, so we do need to have a strategy that's going to address how we get people to these other communities.

    That strategy has to be for Canadian grads as well. We have to look at why doctors aren't practising in these smaller communities, not just foreign-trained doctors but Canadian doctors as well. By providing the support and infrastructure in those communities, we'll be able to attract not only Canadian graduates but international medical graduates. I think that's one way to start looking at it. We've done a lot of work in various provinces on physician resource issues in rural communities and have initiatives to try to attract people to those communities. Those initiatives need to be applied for IMGs as well; there's not one cookie-cutter answer for that.

    In terms of matching, that's a bit of a problem because again, every province applies the rules separately. Some provinces have dedicated spots for foreign-trained doctors to retrain, and other provinces lump them together with Canadian-trained graduates for residency spots. Our organization has been advocating that there be separate, dedicated positions for internationally trained physicians in every province. That way it gives an internationally trained doctor at least an idea of what their chances are for getting into the system. By throwing everyone into one pot, it doesn't really give a fair idea to a foreign-trained physician of what their chances are for getting in.

    The program in Ontario, which is expanding, is going to take--I'm not sure what the numbers are--over a hundred IMGs this year. That gives hope to someone in Ontario that there are going to be more training spots.

    So I'd suggest a dedicated pool of retraining positions, whether they be full residencies, partial residencies, observerships, or whatever is needed.

    Lastly, the first question you asked was how to assist IMGs to get the resources in this entire process. That's a tough one because there need to be human capital and, unfortunately, financial capital to do this. I mentioned in my talk that in B.C. we're having a lot of issues because they want to double the size of the medical school, but along with that come a lot of new problems. They're trying to get people out into the community earlier, and I think IMGs can be part of that. We have to look at the picture all at the same time. When we're saying we want to get more people into training, where are the spots to do that?

    A lot of people in downtown cities are now looking outside the ivory tower of the medical school. They're saying we have brilliant doctors in Kelowna and the interior of B.C. who are foreign-trained physicians themselves, many of them, who want to take on training roles. We need to tap into that market of physicians who traditionally have been outside academia and who want to help with assessing and training individuals.

    That's where more support is needed, because they're going to take on new roles of teaching in terms of assessing the education of IMGs. They're going to need infrastructure support in terms of technology if we want to make sure they have the most up-to-date Internet access for online journals and things we take for granted in the big centres. Those tools will benefit Canadian graduates who go out into those communities as well as those in the increased spots for foreign-trained professionals.

    We really need to capitalize on the quarter of our population of physicians who are foreign-trained doctors. It's a huge resource we could be using to help other doctors who are from foreign countries.

º  (1630)  

    Hon. Hedy Fry: I just have one quick piece. The big question is that a lot of people who've been out of practice for a while, for instance, need to go off and be assessed. They need to repeat the exams; we know they have to do three exams and each one of them costs over $1,000.

    What do you think we should do? Is there a role for the federal government? Although we don't want to continue to be a cash cow for anything, we want to know how we can help with partnering with resources to allow them to be able to take their exams and to get that assessment done if they don't have the money. Do you see a role for us in underwriting loans or for giving grants? How do you see that happening, or is it a mixture of both?

    Dr. Hasan Zaidi: I think it's a combination of exactly what you said: grants, scholarships, and loans to assist them--absolutely.

    I'm going through my exams. I've gone through some of them, and they're incredibly expensive; the final royal college exams are in the order of a couple of thousand dollars, so that's for certain.

    But just going back to your question about infrastructure, I think the seven recommendations outlined by your task force--providing a centralized clearing house, providing information on websites, offering the exam more frequently--are all steps in the right direction to help with infrastructure and to help with assessing training by providing the resources to go forward.

    The Chair: Dr. Bose.

    Dr. Anu Bose: Thank you, Mr. Assadourian.

    This is, I think, partially in answer to your question, Dr. Fry.

    Your predecessor, Mr. Fontana, in his last standing committee report said that immigrants were bringing in more in landing fees and sponsorship fees than they were getting back. He suggested very boldly--and he was not talking about being a cash cow either--that each non-family-class immigrant to Canada be given--and here we add the word--a “voucher” for $3,000 to be used solely for the purpose of getting them integrated into the workforce. They could use it to get their credentials evaluated or to upgrade language or other skills. This was bankable, but it was not to be used for consumption purposes.

    Mr. Assadourian, we would like you to take up this particular challenge.

    The Chair: I'll pass that on to Dr. Fry.

    The Prime Minister is going to meet with the premiers. Maybe it should be one of the topics Dr. Fry pushes the Prime Minister or the premiers to discuss come August.

    I'd like to ask a question if I may. We have two groups here, one professional and one labour-oriented. We talked about the bricklayers and what have you earlier; that's the connection I want to make.

º  (1635)  

    Ms. Colleen Beaumier: I don't remember anything about bricklayers.

    Mr. David Glastonbury: I made reference to bricklayers.

    The Chair: I think the needs of the two groups, professionals and labour groups such as bricklayers, are two different things. Am I right?

    Mr. David Glastonbury: No, Mr. Chair; I'd take exception to that. What we're talking about are fences that are built up by various, can I call them, guilds that prevent our immigrants from reaching their full potential. There are barriers for doctors, there are barriers for skilled tradesmen, there are barriers for--

    The Chair: The point I wanted to make is about when, say, a doctor from the U.K. comes here, a physician just graduated from the University of London, and he or she must have a residency in a hospital for a period of time in order to qualify to be a practising doctor here in this country, right? The same thing applies when a Canadian doctor goes to England....

    Pardon me?

    Dr. Anu Bose: It is a different set-up.

    Dr. Jason Kur: Actually, I don't know what it would take, what steps you would have to go through in England as a Canadian physician, to become licensed. I'm not actually up on that.

    The Chair: I think it would be beneficial to know that because then we could maybe learn from them or they could learn from us how to do it. The point was made earlier that they could practise in London, but now they're opening up for the EU and they cannot do that. That's my first point.

    Second, Mr. Glastonbury's point was that bricklayers in Rome or wherever they may be and bricklayers here are the same. I agree with you there too. You made the point that to be a bricklayer you don't have to be a rocket scientist, that there is only one way to lay a brick or something. But why is it we cannot get qualified people to come here, knowing full well it's not like a doctor coming here where they have to go through an internship or a residency? What's lacking such that we cannot get them in?

    Mr. David Glastonbury: Well, again, I come back to the point of the barriers, Mr. Chair. One accepts the fact that for the skilled trades there are undoubtedly safety concerns, and someone who wants to enter a trade here would have to become familiar with the safety regulations that apply on these work sites and so on. That's understandable, and we agree with that. But we suggest to you that some of these barriers that are put up are artificial. Although I stop short of suggesting it's protectionism, I would perhaps whisper with a small p that I think it is.

    With the resources many of these professional and trades organizations have, I would like to see them spending more of those resources in figuring out how to take hold of this talent and add it to their membership as opposed to putting up another barrier to make it difficult for these newcomers to come into the area.

    The Chair: Before I go to Dr. Bose and Dr. Zaidi, we were told in the past we have difficulty bringing in labour from European countries, but what's the problem with bringing labour from India, for example?

    Mr. David Glastonbury: As I mentioned earlier, it's with respect to those areas that have some sort of regulation to them. I'm going to call it a guild, for want of a better word, whether it's a professional organization or a union. There are certain barriers that they put up.

    The Chair: Who puts up the barriers?

º  (1640)  

    Mr. David Glastonbury: The professional organizations, unions, and so on. I don't have to tell you that there's a real lack of connection. Canada goes out and recruits promising new Canadians, and the criteria are such that if you're well educated or have a skill, Canada wants you. As soon as you get off the boat, you become a taxi driver or you flip hamburgers.

    The Chair: Okay.

    Dr. Bose, Dr. Zaidi, then Mr. Tsegaye.

    Dr. Anu Bose: Mr. Assadourian, as you know, when Mr. Coderre was Minister of Immigration, the bar for entry was raised ever higher. There aren't going to be any carpenters and bricklayers coming to this country very soon. There will be a powerful number of PhDs, engineers, and doctors. There seems to be a lack of fit between immigration entry requirements and immigration settlement requirements. There's no labour force planning here--I know planning is a very dirty word since the collapse of the former Soviet Union.

    Having said that, I myself am a victim of having a degree from the U.K. I have a PhD in economics from a top British university, but I'm told that it's not as good as what's served up at Carleton. So I too am a victim of protectionism. I'm beginning to wonder now whether this is not a case of racial discrimination, as opposed to just plain guild-style discrimination.

    The Chair: Dr. Zaidi.

    Dr. Hasan Zaidi: With regard to the whole issue of protectionism and what not, I'm obviously from a visible minority. I'm a child of an immigrant family that came here from India many years ago. I was fortunate to be able to pursue the career that I chose, because my father was able to work and what not. I don't really feel this is an issue of the medical establishment being protectionist or putting up artificial barriers. I think it's a matter of maintaining standards, recognizing that things change very rapidly in medicine today. The drugs, for example, that we use in cardiovascular disease and the way we treat cardiovascular disease are completely different from the case seven or eight years ago. A lot of the medications we use today weren't even around seven or eight years ago. So it's a matter of continuing medical education, assessing credentials, and what not.

    I think we're taking great steps in that direction through the national IMG task force, through the committee Dr. Fry has set up and Dr. Kur sits on. Things move slowly, unfortunately, but they need to move in the right direction, and I believe we are moving in the right direction.

    The Chair: Thank you.

    Mr. Tsegaye.

    Mr. Mengistab Tsegaye: I want to be very brief.

    We probably spend more time talking about the doctors, but let's just talk in general about internationally trained professionals, period. Nobody's asking that we lower our standard of education, ower this, lower that. I think every internationally trained doctor would like to challenge the Canadian exam and go through that system. What we're talking about is facilitating and creating opportunities or resources for them to go through the process, whether it's in medicine, teaching, trades, anything. I think sometimes we talk about other issues that are not even topics among the internationally trained professionals.

    The big issue was mentioned earlier. The federal government is responsible for recruiting internationally trained professionals. The province and the regulatory body are in charge of the whole business of licensing and accreditation. The employer may be sitting in the local municipality. There is absolutely no connection between those three. I think that's where it needs some coordination.

    The last point I would like make is that bringing in internationally trained professionals has to be looked at as an investment. It's not an expense, it is an investment. Instead of talking about how much it's going to cost us to integrate them, we have to look at it as an investment.

    Those are the areas we should be looking at, along with common programming. Consider Dr. Fry's question earlier. What do we need to do to assist or facilitate integration into the community? There are a lot of best practice bridging initiatives. The province introduced bridging initiatives for internationally trained professionals in nine different projects. There's a project for nursing, a project for the teachers, which I talked about earlier, a project for trades, a number of them. I think we can learn a lot from those initiatives.

º  (1645)  

    The Chair: Thank you.

    Mr. Hanger, five minutes, second round.

    Mr. Art Hanger: A term Ms. Beaumier brought forward to the committee was internationally recognized medical schools. Is there a list of internationally recognized medical schools?

    Dr. Jason Kur: There's a directory, basically a phone book of where medical schools are. Steps are being taken now by accrediting bodies in Canada and the U.S. to look at training systems elsewhere, to look at countries and what their medical education means, but my understanding is that it's basically a phone book of where medical schools are in the world. There is starting to be more dialogue about what those schools actually do, but that information is not centralized.

    Dr. Anu Bose: You could certainly get one of the researchers to call up the British Council and see what they carry on their books. I'm sure the Australian High Commission would also be able to help you on this, because they are probably leaders in this right now.

    Mr. Art Hanger: Are you suggesting that Canada does not have a list comparable to what Britain or Australia has for an assessment of those schools?

    Dr. Anu Bose: No, I'm not suggesting that, but to the best of my knowledge, as Dr. Kur has said, there is nothing but a laundry list right now.

    Mr. Art Hanger: A phone list.

    Dr. Anu Bose: On the other hand, Britain has had long experience with Commonwealth doctors, and it does have a list that it keeps. Otherwise, the NHS would shut down, Mr. Hanger. You would be hard-pressed to see a white face in the National Health Service.

    Mr. Art Hanger: Mr. Tsegaye, you talked of a pilot project that involved foreign-trained teachers funded for three years. The first round of graduates was 26. How many entered?

    Mr. Mengistab Tsegaye: This is a three-year pilot program with three cohorts. In each cohort there will be between 25 and 30, each intake. The first cohort graduated, and we had 26 in it.

    Mr. Art Hanger: How long did they attend this program?

    Mr. Mengistab Tsegaye: This is a one-year program, with 14 weeks of classroom time and about five or six months in the practicum at the school. The program is actually flexible, so they can work part-time while they are going through it. The reason we had to do this with Queen's is that at that time Ottawa was not ready. It was not ideal to have a program in Kingston for people who live in Ottawa, but this is a new program, and Queen's was ready to take it.

    Mr. Art Hanger: For the teachers, what level of standard will they reach after attending this one-year program?

    Mr. Mengistab Tsegaye: They will be subjected to any of the Queen's exams, as for a bachelor of education, for example. In fact, they have to do the new teacher qualifying exam. They were the first victims. So they will be going through exactly the same program. There is no difference. The only reason they have to go through this is because the one-year teaching certificate is not a requirement in some countries; once you finish university you can go into teaching. So they have 10 to 15 years of experience and university degrees, but they lack one-year teaching certificates.

    Mr. Art Hanger: So they obtain those here.

    If we were to apply this pilot project to the medical profession, what kind of shape would it take?

º  (1650)  

    Mr. Mengistab Tsegaye: Each profession is different in its requirements. But what's important is creating a resource for upgrading to support the participants, to bring all the different players together, and to plan the upgrading or retraining program. Each profession has its own characteristics, so it will be different, but it's a model that can be looked at.

    The Chair: Ms. Beaumier.

    Ms. Colleen Beaumier: Okay, we're talking about when people come to Canada. In order to advertise that they have PhDs that are equivalent to what we give here, they send their papers off to the University of Toronto. It assesses them and looks at the universities and the standards and measurements they have for those universities, and then recommendations come back: “If you have a master's degree, we'll give you a bachelor's degree and three courses. You have to get these other courses.” I'm not sure why the medical association or medical schools wouldn't have the same thing.

    However, I think there's another big problem. You ask, “Is it protectionism? Is it racism?” I'd like to know what you or your associations can recommend, because I do think that racism is fear. Racism is born out of fear, and it does play a role.

    We hired a chemist. He came to us and needed Canadian experience. He had a PhD in chemistry and could not get a job. He's now the most productive and biggest money-maker my husband has in his company. What can we do about taking away this fear, this attitude of businesses that “I'm going to become a minority in my own country?”

    I think Tim Hortons should get an award, because in Brampton, two-thirds of the people employed by Tim Hortons are black women. I just.... It upsets me. And they're educated black women.

    Dr. Anu Bose: Xenophobia is certainly part of the equation, but I think Canada has two examples it might look at. What happened to doctors who came here after the Hungarian revolution, and what happened to doctors after the Prague Spring? Surely there are precedents there for Canada to learn from.

    Ms. Colleen Beaumier: Absolutely. I agree with you. But let's leave the doctors alone. Everybody picks on doctors all of the time--not that they don't deserve it--but there are other areas. Everyone who comes here who's a professional is not a doctor. There are teachers, people with PhDs, and scientists. How do you get Canadian experience if no one is going to hire you in Canada without it?

    Dr. Anu Bose: It's is a bit of a catch-22 situation, I admit, but when producer interests are also the regulators, there is definitely a problem.

    I would very much suggest that Mr. Assadourian is our new champion in this field. I look to what Mr. Tony Clement suggested, when we were polling all the Conservative leadership candidates on what they would like to see done with this problem. He said an institute of foreign professional qualifications should be created at the centre to take charge of this. It should be time-bound, and should discharge its functions to develop these joint protocols, just as Australia has done.

    But as for xenophobia, we will always have it, and it's not going to get any better post-9/11.

    Ms. Colleen Beaumier: I certainly hope that's not an endorsement of Tony Clement.

    Dr. Anu Bose: I am non-partisan. I wouldn't endorse you, Ms. Beaumier, should you run.

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    Ms. Colleen Beaumier: He's running against me in the next election.

    Dr. Anu Bose: I didn't know that. In that case, he should be suppressed like the dormouse.

    The Chair: Ms. Fry.

    Hon. Hedy Fry: There are some things that have come up that I would like to put into perspective.

    The institute that Mr. Clement suggests is doing what I'm supposed to be doing, giving the Prime Minister a plan of action to deal with all persons who come to Canada, whether they're from regulated professions or non-regulated professions, whether they are skilled--and we need their skills, again, the proverbial bricklayer and tile layer.

    So all of that has to come in under one rubric, and I think there were some very important points made. You talked about getting all the stakeholders together, and I think that's important.

    The biggest problem to date has been, of course, that the provinces have jurisdiction over non-regulated and regulated professions. There is legislation that gives them jurisdiction, and the legislation, of course, allows for professions, councils, sector unions, or whatever that can decide who should lay bricks or who should practise medicine.

    In terms of medicine, we've brought people around the table. A lot of the things you've suggested here since February are now moving forward. Obviously, money has been put in. Whether it's enough.... And that's what I was asking Dr. Kur: how much more do we need to put in?

    But the problem around the pilot projects is that Ontario has moved forward very much as a province. Our concern is a pan-Canadian thing, because we need people, not just foreign-trained, but also Canadians, to be able to move across provincial boundaries and work in any other province. So many people have suggested, including sector councils, etc., in initial discussion that they believe we need to come together, all of us, with the learning institutions, with the credentialing people, the sector councils, the unions, and create some sort of portal where people can go to a website and have their training, etc., assessed and understand whether they're up to scratch or what they need to get up to scratch.

    The second piece is for private employers. Public employers are easy for the provinces to do, because they are doctors, teachers, nurses, etc., but private sector employers need to be given some sort of incentive to want to give people Canadian experience, and that is one of the things we're looking at. How do we develop incentives, assistance, whatever we need to do to help private employers want to hire that person, train them on the job, or give them the extra training; give them the language, if they need language on the job; give them the Canadian experience? So that's a big piece we're trying to look at.

    I think one of the things I wanted to comment on a little bit--it's not a question, it's a comment--is something we want to guard against. Xenophobia, as you've said, is alive and well everywhere we go, but I think seeing this as a racist issue is not productive. We have people who come from the Ukraine, from Russia, and from eastern Europe who are having the same problems getting their credentials recognized. So it's not a case of visible minorities versus non-visible minorities. This is a case of foreign-trained persons not getting the respect and having the ability to use their skills. I think that is what we need to focus on. How do we do that?

    There is one other piece I wanted to comment on. There has been a lot of reference to what England has done with regard to the national health care system, and what the EU has done in a hurry. Many people have analyzed what the EU has done. They have jumped on this issue, trying to get this movement of people across the whole EU and accepting their credentials. It hasn't proved to be as successful as it should be, and I think we need to not jump into something until it's been proven to be successful.

    I think Australia has a good system. We're looking at the Australian system. We also need to work with source countries so we can develop that kind of relationship with them, so we can get that kind of pan-Canadian assessment moving around the world. And this is something that Canada, by the way, took to the Durban conference as a recommendation for a pan-world, global assessment for all trained persons.

    So I just wanted you to know there are things moving forward. It's not going to happen immediately. There are immediate needs, but I think the most important thing is.... I'm a foreign-trained person. I studied in Ireland. I came here to practise in the seventies, and I didn't have any trouble getting in. I had to do my LMCC. I did it, and bang, I was practising.

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    The reason was the critical shortage at that time. The point is that after that critical shortage in the eighties, not even Canadian kids could get to medical school, because the enrolment had been cut so drastically. I think we need to understand that this is not only about immigrants, but that there are also a lot of Canadians who—

    The Chair: [Inaudible—Editor].

    Hon. Hedy Fry: No, it wasn't. People felt that they were doing the usual “economist” thing, in which they did a straight formula and said “We have x number of people, and we need x number of doctors for x number of people.” They said “We're turning out too many, and if we don't look out, we're going to be having a glut of doctors in Canada.”

    So using just this paper thing, it happened in the eighties, despite a lot of people in the medical professions protesting the cutting of medical school enrolment. We're seeing that now. It's not only our kids who are going to study somewhere else and can't come back home to work; it's not only an immigrant issue, but it's also a credentials issue.

    Now the issue is trying to prepare a long-term plan for matching immigrants with labour force needs, and also ensuring that we have the ability to have our own Canadian-born access what they will.

    I don't think these two things are incompatible, because if we look at what StatsCanada is telling us, by 2011—seven years from now—Canada will be dependent on immigration for 100% of our net labour market needs, regardless of whether we take every young person and put them into university and churn them out as something, or we put everybody into bricklaying and did everything else that we need to do.

    So we need to start planning now, and not do what we have been doing over the last 30 to 40 years, which is reacting and suddenly bringing in a bunch of people, then closing the doors down, and then opening them again, which is a very silly way to do it. That's why we're also looking at setting up a long-term plan that will be proactive and look at what our needs are going to be and start researching the trends and looking at what we need to do over the long term.

    What we need to do now is to deal with the people who are currently here, who are Canadians. We talk about immigrants, but I'm not an immigrant but a Canadian. I'm sorry. I came here in 1970. When you become a citizen of Canada, you become a Canadian. So let's not talk about immigrants, but let's talk about Canadians—first-generation Canadians, and potential immigrants who want to come to this country—and how we can utilize their skills to benefit Canada, not only in terms of our productivity, economic development, and competitiveness, but also in terms of social cohesion and nation building.

    This is an important thing for us to do, and I think we need to be very careful to look at what we need to do in the immediate, medium, and long term, and that we are careful not to start blaming, but start building bridges and forming the kinds of groups we need to come together and make it happen.

    The Chair: Thank you.

    Mr. Hanger, a final question.

    Mr. Art Hanger: There's a lot of talk of Canadians leaving this country to find undergraduate opportunities in other countries. What is your estimate of that deficiency?

    Dr. Jason Kur: I think it's a symptom of a problem, and that problem has been the lack of opportunities for Canadians here. A few years down the road, we are just starting to see this large group of Canadians who have been forced to go overseas for training.

    It creates unique issues, because, again, the training systems are different, and many in those countries don't have an opportunity to complete their training. They have to come back for residency, at least in terms of medicine. So it does create unique problems, but the reality is that we need to increase the capacity, so that we can accommodate more people in upgraded training positions, whether they are originally Canadian citizens who had to go abroad, or whether they're internationally trained people who have moved to Canada for legitimate immigration reasons.

    We can't treat anybody differently based on their country of origin. It's a reflection of where they've done their training. There should be more opportunities for everyone in that group.

    The Chair: Thank you.

    We're going to ask for part of the answer from Dr. Zaidi.

    Dr. Hasan Zaidi: Earlier in our talk, Dr. Kur alluded to the fact that Canada is probably the most difficult country for you to pursue a career in medicine. For example, the year that I applied to medical school, there were about 980 applicants for 66 spots at the University of Calgary. That was about four years ago.

    So in this country, it is extremely difficult for somebody wanting to pursue a career in medicine. That's why we're seeing people going to Ireland and other countries to get their undergraduate medical education and then incorporate it....

    So it's not just a matter of lack of opportunities for foreign-trained positions, but it's also a lack of opportunities for undergraduate students in Canadian universities.

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    Mr. Art Hanger: One of my relatives had two degrees in engineering and built the laser equipment for the doctors at the Foothills Hospital in Calgary. They suggested that he take his medical degree, and he did so. As a result, he looked around for a job. He was now highly qualified in a lot of different areas, but he never had an opportunity to practise those skills in this country. He's now in Houston.

    You may even have opportunities for skills training and upgrading for those within our country—and he was born and raised here—but gravity seems to be pulling everybody to the south, as opposed to the other way around. They don't seem to have those great opportunities in this country either.

    What are we doing? Are we only feeding the process as we pull in people from other countries in the world and maybe retrain them?

    Gravity still seems to move to the south. I think that in fact is happening too.

    The Chair: That's true.

    Mr. David Glastonbury: Mr. Chair, I wouldn't like the discussion to lose track of the situation with the foreign-trained professionals and skilled tradesmen. When these people come here, they generally bring up-to-date skills with them. I agree that they have up-to-date skills in their home countries, but there's a shelf life for these people.

    The doctor indicated earlier that things are changing in the medical area. I would suggest they are changing in a good many other places. The longer we wait to allow opportunities for these people, the less value their skills have. I wouldn't like to lose track of that. We bring them here relatively up to date with their skills, whatever they might be, but the longer we wait to put them to work, the more they lose their skills. It's like a battery losing power. There's a time element here.

    Mr. Art Hanger: I still think we're talking about the same problem if the opportunities aren't even here, or maybe they're not even in this country, for those we're already training. We have a limited number of positions, obviously.

    Now the hue and cry goes out for shortages, for example, in the health care area. We're seeking doctors outside our nation when we're losing them at almost the same rate. Should that problem not be addressed?

    Mr. David Glastonbury: Yes, but what I am saying is we have this talent. I don't want to suggest for a moment that we wouldn't provide opportunities for people who are born in this country to take advantage of opportunities, as well. But in terms of scarce resources and so on, when we have these trained people who already have some training—and I leave it to you to decide what level of training they have—why would we ignore it and start with somebody who has no training?

    The Chair: May I offer two final points?

    First, Dr. Zaidi, you said when you went to school in Calgary you had applications for 66 spots. Who decides on 66 spots and not 166 spots? We all know there is a waiting list at the Calgary hospitals. Why not take 166 instead of only 66? That's my first question.

    On the second question, you mentioned earlier, I think, that in the States you can go to a doctor's office and check the diplomas. If you like it, then you sit; if you don't like it, you go to another doctor. I think you mentioned that. In Canada, it's all uniform. Is that because in the States one of the major problems is that the insurance premiums are very high, while it is very low here because of the uniformity and there is less risk for Canadian-trained doctors? Is that what it is?

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    Dr. Hasan Zaidi: Sure. I'll address your two comments.

    Your first question pertained to the number of spots. In terms of waiting lists and why there are so many people, this factor is influenced by a number of things, not only the number of physicians, but also hospital infrastructure, operating room time. There might be a surgeon who's willing or available to do your operation or to see you, but he just doesn't have clinic time or operating time because that comes from the hospital or the infrastructure of where he practises. So waiting lists and those kinds of things result from a number of causes, not just physician numbers.

    Second, who determines the number of undergraduate spots? Usually it's what the medical school is funded for by that provincial ministry. As we all know, health care is very much a provincial concern. The funding for those spots is in large part determined by how much money the provinces have.

    Based on task force one and task force two, studies that have come out through the Canadian Medical Association and other organizations have shown that we should be producing more physicians, and undergraduate enrollment has gone up. When I graduated from the University of Calgary, there were 68 other people who graduated with me; today, I think that class size is now close to 100. Studies have shown that there is a need for increased undergraduate enrollment, so medical schools, almost across the country, have increased their enrollment to some extent, but it's limited by funding because it costs a tremendous amount to produce a physician.

    So that's in answer to your first question. On the second issue you raised--what happens in the United States in terms of needing to check on the wall if a doctor is board-certified or not board-certified--in Canada, we have the luxury of not having to worry about that. If you go to your family physician or if you're referred to a specialist, there's no question about it. There's no issue as to whether or not your doctor is going to be board-certified or not board-certified. We don't have that issue here in Canada, and I think we're very fortunate. Everyone who practises is certified by either the College of Family Physicians or Royal College of Physicians and Surgeons, certifications that are among the highest standards in the world and should never be sacrificed. Every physician who practises should have those same standards.

    I think we're very fortunate in that sense. Patients don't have to worry about whether this physician is board-certified or not board-certified. I think it's driven by economics in the States. There's a lot more privatization. There are more HMOs, PPOs, competing for the cheapest bidder. There are a lot of other influences like these in the States that we're fortunate not to have because we have largely a single-payer system.

    For those reasons, I think our system is very good, and we should not move towards a system like the one in the States, where patients aren't as protected.

    The Chair: I was going to close on that positive note.

    Yes, you raised your hand, Dr. Bose. Before we conclude, go ahead.

    Dr. Anu Bose: I would still ask that you end on a very positive note, Mr. Assadourian, because after all, you are our champion.

    The Chair: Thank you very much.

    Dr. Anu Bose: I was going to say that this has now been reduced to a supply management problem--I can't put it any other way--and I don't mean just the medical profession, but with every other profession. There is a pie, and the pie isn't going to grow any larger, but there are going to be more people wanting the same pie.

    I am all for universal coverage. I believe in the Canadian universal coverage system, the British national health system--though that has been eroded considerably, and there is a two-tier medical system there.

    But I still say that warehousing immigrants is to the detriment of all of us. There's a $6 billion hole that immigrants could have contributed to filling if they were allowed to practise the profession for which they were trained, plus there is the brain drain from poorer countries. That we haven't factored in.

    We would like to end on an upbeat note by thanking you for this opportunity to be here and expressing our hope that you will carry the torch.

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    The Chair: Thank you very much. It's been a very exciting exchange of ideas, and with every meeting we have had I think we have learned a little bit more. By the time we complete this study, I think it's going to be very, very good. Thank you very much.

    Tomorrow afternoon we have a briefing from Mrs. Fry, I believe. You may come and listen to the briefing. Thank you very much.

    Dr. Anu Bose: We would love to come.

    The Chair: You're most welcome. Thank you.

    The meeting is now adjourned.