:
All right. We'll attempt to bring this meeting to order.
I'll remind the committee that we'll devote the last 15 minutes to committee business. That will be at about 5:15.
We'll hear from the presenters and, of course, we'll be able to ask questions. At about 4:30, we will break for a few moments and then recommence.
We have with us Mr. Arthur Sweetman, who will be presenting. Also, on behalf of the Canadian Institute for Health Information, we have with us Jean-Marie Berthelot, vice-president of programs and executive director of the Quebec office. We have the Canadian Nurses Association with us as well.
With that, we'll start with Mr. Sweetman.
Go ahead.
Since much of what you've been looking at has to do with the private sector, I thought it would be good to start by addressing the need for health human resources, which in the health sector are quite different. Canada's single-payer medicare system is the primary source of divergence between the public and private sectors. While many health service occupations are outside of medicare, its influence remains substantial. As a result, the affected labour markets are not competitive, and what we normally think of as supply and demand do not operate.
Consider the extreme example of physicians. In each province there's only one employer, and fees are bargained collectively. On the supply side, the provinces, with some consultation, set the number of domestic applicants admitted to medical schools, as well as the number of international medical graduates admitted to practise. Provincial governments also legislate the regulatory colleges that provide quality control and oversight.
In determining the number of open slots for new physicians, provinces need to play a balancing game. They need to take into account the health care requirements of their populations. Also, they need to take into account the tax revenue or debt financing needed to fund those positions. This is extremely challenging. In this context, a lot of data and a lot of information and planning are required.
This process has generated a perceived shortage that is slowly being reduced. In fact, in the last decade, many provincial governments have moved very aggressively to increase the number of physicians per capita.
In Ontario, for example, beyond physicians, the Regulated Health Professions Act traditionally covered 24 professions and, at the moment, two or three occupations are in the process of being brought under the act. As well, many health services occupations that are not regulated are primarily employed by provincially funded hospitals or other institutions. None of these occupations operate in the way we traditionally think of labour markets operating.
So what's the federal role? I'd like to raise two issues for you to consider. First, my personal view is that while many of the appropriate institutions are in place, they are frequently not as active as they could or should be. I believe that communication and coordination among the provinces and the federal government are still not sufficient, and there's a need for increased information sharing. Health Canada and CIHI play very important roles, as does Statistics Canada. Also, since it has a lot of capacity in the area, HRSDC also plays a role, though it could play a larger one.
I should note that what I'm talking about is routine. It's what I consider well below the radar screen.
One of the examples that I might think of as a structure for facilitating this is the existing federal-provincial-territorial Advisory Committee on Health Delivery and Human Resources. This is a standing committee of the federal-provincial-territorial Conference of Deputy Ministers of Health. In my ideal world, an invigorated version of this group would, in coordination with CIHI, generate substantial sharing of health human resource data and practical experience between governments and other relevant stakeholders, such as the Canadian Nurses Association and the Canadian Medical Association.
The second issue is a focus on immigration, which plays a very important role in these areas. I believe that immigrant selection for individuals working in health professions, where the provincial governments are the principal payers, should be taken out of the federal skilled worker program and put into the provincial nominee program.
The current points system is very poorly suited to regulated health professions under our single-payer system. A coordination problem arises from having immigrant selection at the federal level while employment and planning occur almost exclusively at the provincial level. This is completely different from private sector markets. I suspect that the most useful approach would be to shift this responsibility to the provinces, since they have the levers to verify credentials in the health area and to implement their health human resource planning.
Thank you very much.
Good afternoon. On behalf of the Canadian Institute for Health Information, I would like to thank you for inviting us to participate in your study of labour shortages.
I am accompanied by Carole Brulé, who is one of our managers of the HHR databases we collect in CIHI.
[Translation]
CIHI is an independent, not-for-profit corporation that provides essential information on Canada's health system and the health of Canadians. Established in 1994, we are funded by federal, provincial and territorial governments. We report to an independent board of directors representing government health departments, regional health authorities, hospitals and health-sector leaders across the country.
CIHI works in partnership with stakeholders to create and maintain a broad range of databases, measurement tools and standards on health information. We produce reports on health care services, population health, health spending and health human resources.
[English]
CIHI has been collecting detailed information on physicians and nurses since its inception. More recently, we created new databases that provide demographic and workforce information on pharmacists, occupational therapists, physiotherapists, medical laboratory technologists, and medical radiation technologists. CIHI also collects aggregate data for an additional 17 health professional groups, such as dentists, midwives, and psychologists.
Altogether, more than one million people in Canada, over 6% of the total Canadian workforce, are employed directly in the heath care system. In 2010, approximately 70,000 of these health care professionals were active physicians.
Over the past five years, the growth in the number of these professionals has consistently outpaced population growth. In fact, there were 203 active physicians per 100,000 Canadians in 2010, the greatest proportion there has ever been in this country. Most of the growth in the physician workforce is due to an increase in the number of medical graduates from Canadian faculties of medicine. Since 2003, it has increased by nearly 60% to more than 2,400 graduates in 2010.
The overall number of training seats continues to grow, so the upward trend in the supply of physicians is expected to continue.
[Translation]
Regulated nurses, the largest group of regulated health professionals in Canada, are also increasing in number: in 2010, there were close to 35,000 registered nurses, licensed practical nurses and registered psychiatric nurses working in nursing in Canada—an increase of nearly 9% since 2006, about twice the rate of the increase in the Canadian population for the same period.
The nursing representative will no doubt cover nursing care in depth, but still, it is interesting to note that the supply of new nursing graduates was over 14,000 in 2006 and over 16,000 in 2010—a growth rate of 17%—so the increase in workforce numbers is likely to continue.
[English]
There are also increases in the supply of other health professionals. For example, the per-population supply of all pharmacists in Canada has increased consistently from 82 per 100,000 in 2006, to 91 per 100,000 in 2010. Supply as a whole grew by 16% in that period, reaching a total of approximately 32,000 physicians in 2010.
CIHI data shows that the number of all regulated health professionals, other than physicians, nurses, and pharmacists, also increased by 16% from 2006 to 2010. In total there were approximately 160,000 in the 18 other professions for which CIHI collects data.
Supply-based trend information for all of these professionals is available through a series of reports called “Canada's Health Care Providers”. They contain a broad variety of other supply and graduate data to support health services management and research.
We also have separate and detailed analyses on doctors, nurses, pharmacists, occupational therapists, physiotherapists, medical radiation technologists, and medical laboratory technologists. All of our reports are available on our website.
[Translation]
The brief we are presenting to the committee contains further information, including interesting provincial variations, details about the nursing workforce and a list of groups on which we are collecting data.
We know that Canada has more doctors and pharmacists than ever, and that nurses have yet to return to their pre-1990 numbers—but we also know that numbers alone do not tell the whole story.
[English]
The demand for services from all health professionals depends on a number of factors. These include population health care needs, the hours professionals spend on patient care, the individual professional's scope of practice, demographic changes to medical and health workforces, and the way care is organized.
The issue of labour supply among health and medical professionals is especially complex. We hope that our data on health human resources help inform discussion on the subject.
We would be pleased to answer any questions you may have in the official language of your choice.
Merci beaucoup.
On behalf of Canada's quarter of a million registered nurses, I really appreciate the opportunity to speak to you today concerning health labour force issues.
Evidence of a nursing shortage in Canada has long been clear, from frustrating wait times in clinics and hospitals to poorer results for patients. The negative impact of the shortage of registered nurses and other health professionals is something that Canadians face every day.
Current research puts Canada's shortage of registered nurses at approximately 11,000 full-time equivalents. Left unaddressed, that shortage is projected to reach 60,000 full-time equivalent RNs by 2022, a reality that stands to risk future health outcomes. That my colleague said that the numbers are increasing is a good sign. However, there are still some other matters that need to be addressed.
A labour shortage implies an imbalance in both supply and demand. Comprehensive thinking about the supply of registered nurses will help us better meet the health needs of Canadians. We need to go beyond the narrow thinking of strict numbers of nurses and think about their participation in the workforce based on the level of activities—that is, whether they are full time or part time—the rates of absenteeism, and how productive the workforce actually is. The number of services that registered nurses can actually supply in a day is affected by the model of care delivery in place, the composition of health teams, and how efficiently health teams work together. It also includes whether or not barriers exist that prevent health professionals from offering the complete range of care for which they are qualified—that is, working to their full scope of practice.
Productivity gains can be made through facility design, use of technology, and health delivery innovations. We see productivity gains with nurse practitioners in Newfoundland and Labrador, who are supported by teams and telehealth technology while providing care in rural and remote communities. By doing things differently we can enhance the use of the existing supply of nurses already working within the system, all the while providing more patient-centred care. As you can see in our brief, implementing measures to increase RN productivity by 1% per year would have a dramatic and immediate effect on the shortage.
We can also improve our access to and use of labour market information through the Canadian Institute for Health Information. To ensure that we have accurate information on where registered nurses are working, a national unique identifier should be employed. This in essence would be a number assigned to a registered nursing student that would enable us to track when and where they are entering the workforce, and their practice patterns. Implementing this identifier would significantly improve our ability to track the mobility of our nursing workforce both internally between provinces and territories, and externally, for example, when nurses leave Canada to work in the U.S. or other countries.
To better understand the capacity of the nursing workforce, a national study on the health and work of nurses should be repeated. When CIHI conducted a study of this in 2006 it revealed that registered nurses had an absenteeism and sick rate that was double the Canadian average of seven days. These 2006 survey results have led to some innovations in creating healthy workplaces. Repeating the survey now would provide us with current, accurate data, and allow us to evaluate the effectiveness of these innovations.
A third recommendation deals with pan-Canadian health human resources planning and mirrors one of the main recommendations made recently by the Senate Committee on Social Affairs, Science and Technology in its review of the 2004 health accord. The federal government should conduct a feasibility study to determine the benefit of establishing a pan-Canadian health human resource observatory.
Health human resource observatories have been implemented in some European and South American countries to analyze trends and health human resources needs and to identify opportunities to implement best practices, which ultimately lead to more value and better care within our health care system.
The opportunity exists to build this innovation into existing federal agencies to ensure that health human resource planners have coordinated resources and best information at their disposal to better meet the planning challenges of Canada's multi-jurisdictional health care system.
While it is important to explore ways to increase the supply of nurses, it is also critical that we take opportunities to reduce demand for health services, through illness prevention, health promotion, and especially the prevention of chronic diseases like heart disease, diabetes, and cancer.
Canadians benefit from federal programs that encourage smoking cessation or healthier living. CNA is concerned about cuts to these programs, the results of which are as threatening to the supply curve as the shortage of surgical nurses or emergency room doctors.
The stable and sufficient supply and deployment of Canada's health professionals continues to be one of our greatest health care challenges. By looking at these recommendations in concert with a comprehensive view to reducing demand through health promotion and disease prevention, we can take steps to address the nursing shortage and enhance the health of Canadians.
Merci beaucoup.
:
Thank you very much, Chair.
Thanks to all three of you for your excellent presentations.
We'll each be asking questions, so I'm going to focus my questions for the moment to Ms. Bard and deal with the nursing shortage in particular.
I know that the two challenges are both retention and the attraction of new nurses to the field, and I want to explore that a little further. Yesterday we had a witness who said that we needed to change the narrative in attracting people, and I think there is much merit to that with respect to the health field as well.
We've seen a bit of credential creep, if you will, whereby nurses who want to enter the field need to have increasingly higher levels of education. Yet, because of the way salaries are negotiated in the field, these aren't really keeping pace with the cost of that education. It's difficult to attract young people to a field where the tuition fees are unbelievably high.
I wonder if you would comment on whether it might make sense to explore ways to reduce the barriers to that kind of education, whether it's through incentive programs and loan forgiveness perhaps—if nurses were to practise in areas where there are acute shortages.
If you're comfortable with this, I'm going to pose a whole whack of questions and then turn the floor over to you for answers to all of them.
If we're changing the narrative in the nursing profession, I do know that it's one of the professions that has the highest rates of occupational injury and that retaining nurses is incredibly difficult in an environment where sick days are often higher than the national average. You've largely addressed that.
We are now also faced with a policy on the government's part, where we're potentially going to increase the age at which people can collect the OAS from 65 to 67. Nursing is an unbelievably physically demanding occupation. I wonder if you could comment on whether it would be possible for nurses to continue to work until they're 67 and do the jobs they're doing. Again, that speaks to retention, but perhaps from a bit of a different angle.
And lastly, I'm from Ontario, and I remember the Mike Harris years. The premier, I think, infamously compared nurses to hula hoops, that their time had come and gone. At that time we had a huge out-migration of nurses from Ontario to the States in particular—to Florida and Arizona—which then created a shortage at home from which I don't think we've recovered.
If we're looking at retention of nurses, there are work environment morale issues as well. I wonder if you could speak to that and give us some guidance as to what we can do, as federal legislators, to improve the work environment in all three of those respects.
Thank you.
:
Thank you very much for your question.
I will refer you to our report, Tested Solutions for Eliminating Canada's Registered Nurses Shortage, because it addresses some of your questions.
Starting with student retention, we know that a high percentage of students leave in their first year of learning, and it's clear that we do need to have some programs that will help retain students. We know that if we can reduce by even 10% the number of students who leave, that will actually have an impact on the numbers of nurses graduating and who are able to enter the workforce.
So we do need to provide some support. We have students who are starting a second or third career. They have families and therefore they need to have some social programs that will help them, certainly from a financial perspective, or even in terms of better support to help with adjustment and so on.
So I think that has been identified. We've seen this is a policy direction that needs to be addressed.
In relation to absenteeism in the workforce, and certainly the quality of work life of nurses, again I think our report identifies the high percentage involved. If we can address some policy to retaining our nurses and improving the work life and work conditions of nurses, removing barriers for them so that they can practise to their full scope, and providing them with the necessary support, that will have an impact on retention of our nurses and on keeping our nurses in a healthy workplace environment. So definitely, there's a need to address some of that.
CNA has also produced, in collaboration with RNAO, which is within one of our jurisdictions, a report on nurse fatigue. That report identifies some evidence that we need to pay attention to. It requires a collaborative and collective approach between the employers, the nurses, the professional body, such as our association, the Canadian Nurses Association, and the government to create an environment and address some of the barriers and the hindrances in the workplace. It takes a collective effort. It's not just one side: it requires federal intervention as well as provincial intervention.
Retaining nurses over the age of 60 was another policy direction in our Tested Solutions report, where we see there are models for doing so. We can retain nurses so that they work beyond the age of 60 and over 65, provided we create a climate that will address their work balance. There are models right now that have been tested, where there's an 80-20 situation. So nurses who are more senior in their practice and more experienced and are older can become mentors for the younger generation and provide other types of services so they're not fully into direct care. Again, you try to retain them as long as you can, but you need to adjust their work conditions.
Thank you, everyone, for being here today. I greatly appreciate your time and your effort to get here. I have two sets of questions, and I hope we can stay short and succinct.
The first set is about data. I wanted to ask you if you have recommendations for improving the Canadian occupational projection system. Just looking at our notes, I find it interesting that physicians and veterinarians and dentists are all in the same category. It's great to know there's a shortage there, but is there a shortage in all three, or in one or two?
Also, can you identify any additional challenges for the medical sector that are not adequately represented in the data sets that either you currently use—either yourself, Dr. Sweetman, as a professor, or at CIHI—or in the other data sets that you may access for providing information?
:
Let me answer your question in some sense and also come back to the first one a little.
The first question in particular seemed to assume that the labour market for nurses is similar to a private sector labour market, and I would argue that is not a useful way to think about it. I think it's the same in relation to the question you're posing now.
A COPS model does not work very well for physicians and nurses, because there is only one employer for 99% of physicians and nurses, namely the provincial governments; and demand for physicians and nurses can turn on a dime with a provincial budget or a series of provincial budgets. If a province is in deficit, the number of nurses being hired goes down dramatically, and it's the same with physicians. Since the provincial governments have substantial control over the number of places in medical schools, for example, they can reduce the supply very substantially.
Even though right now there's this popular perception of a shortage of nurses, there are actually a substantial number of unemployed nurses.
The problem is that this is not a private sector where you have supply and demand that equilibrate, but a situation where you have in each province a union that negotiates with the province and comes up with a wage or a set of fees for physicians. It's not a market the way you might think about a market, the way the first question posited a private sector market. It's not like that.
I think this is a situation where provincial governments plan and the provincial governments hire, though there are some rare exceptions. They are pretty much the only people who hire. There is a popular perception of shortages because physician and nursing care is for the most part free in Canada, but there is also a perception that taxes are too high, so we don't want to pay for that physician and nursing care that we think we have a shortage of.
Fundamentally, our medicare system makes this a political problem, whereby everybody wants free medicare but doesn't want to pay the taxes to pay for the free medicare.
I don't think there's an easy solution to this. I don't think that the private sector models fit. I think what we need more than anything else is really good provincial planning. This is a provincial responsibility at the end of the day, but that can be facilitated by really good assistance from the federal government in providing planning assistance, information, data, and the like.
As much as CIHI does have great data on some things, it doesn't yet have great data on everything, and not at the detailed level that provinces need for planning.
I think that type of information would be extremely useful to provinces and aid the kind of capacity that HRSDC has for planning. A lot of the provinces could use assistance with that type of detailed planning.
:
In terms of the occupational projections, if you don't mind I'll quote Yogi Berra, who said “It is difficult to make predictions, especially about the future”.
The challenge here is exactly what you mentioned. The number of seats in the faculty of medicine is controlled. The number of jobs available is controlled. Immigration, in some ways, is controlled.
You can make projections at the national level in the short term about how many physicians there will be five years from now, but to make long-term projections is very difficult.
It's the same thing with nurses. It depends how many seats are available. I don't think there's a shortage of people applying for nursing and medicine. There are the issues about how many seats are open.
In terms of data, CIHI has data about the supply. Provinces are working...and each province has its model for doing its health human resources planning. They're trying to focus on needs, but it's very difficult to do. Health human resources need planning because the scope of practice varies, depending on the needs of your population.
Interprovincial migration also plays a role. In Canada, we have observed in the last 30 years that places that have rapid economic growth effectively see an increase in their population and an increase in their health professionals, even though they may not have trained more of them than they have in the past.
In terms of the information, I think CIHI could probably do something regarding health human resources projections, but you have to take into account that those projections can only be short term if you want them to be relatively reliable because they are determined by policy more than natural phenomena or the market.
:
Yes, that's exactly what I'm saying. I think especially with IRPA, the current points system under it is particularly poorly suited to health professions, where the provinces are the principal payers. For things in the private sector, IRPA works very well. On many dimensions, IRPA is better than what came before it, but for regulated health professions, IRPA, I would argue, is worse than the legislation that came before.
Under the points system before, there were occupational points. It was virtually impossible for physicians to immigrate in the economic class. They could come as family class, as refugees, as spouses, but it was very, very hard. This was in the days when we thought we had a surplus. There was a so-called perceived surplus of physicians.
Under IRPA, at least before the most recent ministerial instructions, there were no occupational categories. So physicians became prime candidates for the points system and a massive number of them entered Canada and the provinces did not want to hire them. There was a massive surplus of international medical graduates and a large number of people complaining that they couldn't find jobs. They'd been admitted under the point systems, but the points system didn't coordinate at all with provincial needs.
My argument is to take regulated health professionals, who are primarily paid by provincial governments, out of the federal points system—because the coordination problem between the provinces and the federal government is really, really difficult—and put them in the provincial nominee program.
I'm not saying to take this out of the system altogether. We have a stream that works very efficiently. Although there are some problems with the provincial nominee program, it works pretty well. But put the regulated health professionals, who are primarily paid by the provinces, into that stream.
The provinces regulate the regulatory colleges that do credential recognition. They do health human resource planning. They know what's needed. They know the credentials. Let them manage it. They're close to the ground; they can do it better.
:
The baby boomers are still pretty healthy. In fact, right now is the golden age. If you look at baby boomers, they're still old enough to be paying taxes. The oldest baby boomers are 65. Serious medical costs don't start for another five or ten years.
So the aging population hitting medicare hasn't actually happened yet. When it does happen, most estimates argue that you're talking about an increase in the number of physicians or physician services of something in the order of 0.6% per year. It's not enormous.
Yes, there is going to be a need to change down the road to reduce the number of physicians. You're talking about a time beyond the career of the typical graduate today.
There is a bigger issue. In some sense, you're worried about shortages, but inside most provincial ministries, which are closer to the ground, the concern is about surpluses, not shortages.
Depending on whether they're family practitioners or specialists, there is a six to ten-year training period for physicians. If you go back ten years exactly, there has been a 73% increase in the number of people in medical school, which is dramatically larger than population growth, which has been around 11% in the same period. We're going to need to be pulling back our enrolment in medical school in the near future, or else we're going to have a giant surplus.
The issue of aging is not actually about the number of physicians; it's about the composition of specialities. We really haven't started dealing with that as a society yet. We have the wrong specialities graduating from medical school. If you think someone is going to practice for 30 years, you need to be thinking about what specialities we will need over the next 30 years. We are graduating a lot of pediatricians and not so many geriatricians. We need to think about those things.
:
I appreciate your holistic approach, as far as healthy living and helping ourselves to address the situation are concerned. We've said that it's not necessarily about the number of nurses. You talked about more productivity and resource management.
We just had a new hospital built in my constituency, in Vernon. It has state-of-the-art equipment. No longer is a nurse trying to heave a huge fellow across a bed or something. All of that is automated now.
I noticed in some of the notes here that 40% of the nurses are over 50. Not that 50 is old, but there are some challenges, in that there is physical stress. In one smaller hospital in my area, it costs $500,000 a year for stress leave for nurses. Those costs are hindering service delivery.
Do you see more technology, as far as help for care and better resource management are concerned, as going to help the situation, that it's not just about a labour shortage but about better organization and better use of the facilities?
:
There is a variety of issues. For the most part there is an excess of immigrants with credentials in most health professions relative to the number of spots available in provincially funded professions. In professions like dentistry, where it's more in the private sector, it's a slightly different issue.
Credential recognition is an issue. It's a manageable issue in the long run, but it's much more complicated. Don't forget that in almost every single health profession—nursing being a notable exception—the percentage of immigrants working is higher than the percentage of immigrants in the adult population.
In Canada, the percentage of immigrants in the population between the prime working ages of 25 and 64 is roughly 23% or 24%, and 33% of physicians are immigrants, and 29% of pharmacists are immigrants. I may be off by 1%, but it's more or less that. If you look at optometrists it's a similar thing. That applies to every group except nurses, which are close to the national average. So in almost every single regulated health profession, the percentage of immigrants is well above the national average.
There is a credential recognition issue for some people, but it hasn't stopped a very substantial number of immigrants from entering regulated health professions.
:
Thank you for your comment.
When I was talking about foreign credential recognition, I was not only talking about immigrants but also about all of those who are foreign qualified, whether Canadians or new immigrants.
Ms. Bard, I have a question for you. You mentioned the shortage of 11,000 full-time equivalent nurses, which will potentially be 60,000 in 2022.
I was looking at the report, which looked at the impact of six policies in areas designed to reduce the current and projected shortages. I wonder if you can describe which measures will be the most effective, in your estimation, at addressing the issue of shortages today or in the future.
[English]
Mr. Sweetman, I don't know if your French is good, but I will do mine in French.
[Translation]
As an elected official in Quebec, we are always walking a bit on eggshells when we come to issues related to health care because, in Quebec, this is a fully provincial jurisdiction.
Still, I would like to take advantage of your experience because you are very interesting witnesses. I would like to take advantage of your knowledge to determine whether certain administrative solutions or ways of doing things could help us. We are talking about the lack of human resources. Sometimes the solution is to have more human resources, but it may also mean doing things more efficiently. So I would like to appeal to your pan-Canadian experience on the matter.
I am from a rural region where there is no major city and no city larger than 30,000 people. There are a lot of small towns of 500 or 600 people, and there is a crucial need for doctors who want to stay in the regions. I think the same problem exists in Saint-Pamphile and in Moose Jaw. I don't think it is specific to eastern Quebec.
One of the solutions we've recently heard about involves offering incentives so that trained doctors go and live in the regions. I know that, in Australia, they have addressed the problem from the opposite end, meaning that the Australians choose successful students in the regions and encourage them to become doctors. So when they become doctors, returning to live on the mountain, near the river or the ocean in a small community is something they want to do. It isn't necessary to offer them bonuses to go back to a way of life they enjoy. The Australians have been very successful with this approach.
Would this solution be plausible in Canada to help the regions finally have doctors? What do you think, Mr. Berthelot?
:
Thank you. It's a very good question.
I agree, actually. Quebec is probably doing the best of the provinces in Canada on this front. So as poor as things look to you, they look worse in other provinces, and we're certainly in the area of provincial jurisdiction right now, not federal jurisdiction.
I think that a large number of policy proposals, or more than a few, could be put forward, but would need intestinal fortitude if they were to be pursued. You could do what Quebec does but even more strongly. That is to say, let primary care physicians or primary care practitioners, not just in medicine but more broadly, be hired by regional health authorities rather by provinces. So if there's a need in a certain area, they hire, and if there's no need on the island of Montreal, they don't hire. That would distribute people.
You could also change the way you recruit into medical school. It's exactly what you're saying. But you could put even a bit more bite into it. You could have people, as part of the admissions process to medical school, make a commitment to where they want to practice, and the admissions committee could take that into account in adjudicating admissions. If the admissions committee had two people who looked the same, and one wanted to practice in northern Quebec and the other one wanted to practice in Montreal, whom would they admit if they looked otherwise comparable?
I think there are a number of policies we could pursue.
I want to go back a little bit to our skills gap question. I know we talked a bit about how the average age of retiring nurses is 57, but I think the average age of most nurses in the workforce is older. The average age of a physician, at least in the province of Ontario, is 53.
There are some substantial challenges. With this aging of the health care professionals across the country, I am wondering what your thoughts are on how we can increase the participation rate of those groups who don't traditionally enter into health care professional roles. I'm thinking of aboriginal Canadians—and there Dr. Sweetman talked about spots for them going vacant at Queen's—or individuals with disabilities, for whom maybe there are things we should be doing to allow them to take on these roles, albeit some of them are quite physical, or older workers who want to transition into health care professional roles.
Do you have some thoughts on what we can do to help deal with our looming skills gap by focusing on those three groups of individuals: aboriginal Canadians, persons with disabilities, or older workers transitioning into filling that gap?