THE STANDING SENATE COMMITTEE ON OFFICIAL LANGUAGES
EVIDENCE
OTTAWA, Monday, September 23, 2024
The Standing Senate Committee on Official Languages met with videoconference this day at 4:59 p.m. [ET] to study matters relating to minority-language health services.
Senator René Cormier (Chair) in the chair.
[English]
The Chair: Colleagues, I am René Cormier, senator from New Brunswick, and chair of the Senate Committee on Official Languages.
Before we begin, I would like to ask all senators and other in‑person participants to consult the cards on the table for guidelines to prevent audio feedback incidents.
Please make sure to keep your earpiece away from all microphones at all times.
When you are not using your earpiece, place it face down, on the sticker placed on the table for this purpose.
Thank you for your cooperation.
[Translation]
I now invite committee members participating in today’s meeting to introduce themselves, starting on my left.
Senator Moncion: Lucie Moncion from Ontario.
Senator Clement: Bernadette Clement from Ontario.
Senator Audette: Michèle Audette from Quebec.
Senator Aucoin: Réjean Aucoin from Nova Scotia.
Senator Mégie: Marie-Françoise Mégie from Quebec.
The Chair: Thank you and welcome, respected colleagues.
[English]
I would like to say welcome to viewers across the country who may be watching. I would like to point out that I am taking part in this meeting from within the unceded traditional territory of the Algonquin Anishinaabe Nation.
Tonight, we continue our study on minority-language health services by welcoming organizations able to address the themes of health care professionals and telemedicine and the use of new technologies, two of the seven themes of our study.
For our first panel, we welcome in person, Dr. Stewart Madon, Director, Professional Affairs, Canadian Psychological Association; and by video conference, Dr. Anita Gupta, President of the Canadian Psychological Association; and from the Canadian Physiotherapy Association, we welcome in person, Ms. Krissy Bell, Chief Executive Officer; and Dr. Jennifer O’Neil, Physiotherapist and Assistant Professor at the School of Rehabilitation Sciences at the University of Ottawa.
Welcome to all of you. Thank you for accepting the committee’s invitation. We will now hear each of your opening remarks. They will be followed by questions from the senators.
Dr. Gupta — I hope I pronounced your name well — the floor is yours.
Anita Gupta, President, Canadian Psychological Association: Thank you for inviting the Canadian Psychological Association, of which I am President, to contribute to this important topic. I am a clinical, health and rehabilitation psychologist, and work in a hospital in Nova Scotia seeing patients with cancer, and I also have a virtual private practice seeing patients who live in Ontario, many of whom are physicians and other health care professionals.
Any one of us, at any moment, could become a patient. Some of us may have received health care in a language other than our own. All of us can try to imagine ourselves in a situation in which we are unwell, injured or vulnerable, without anyone around us who can speak to us or understand us in the language in which we can best communicate. Language, as well as ethnicity, sexual orientation, race, gender, education, age, Indigeneity, trauma and medical history and much more informs how we seek and experience health care.
An estimated 60% of adults in Canada are unable to obtain, understand or appropriately act upon health information — a concept known as health literacy. Language barriers can complicate things even further. Globally, ethno-linguistic minorities living in their home countries often report higher rates of disease, disability and death and lower rates of health care utilization.
In Canada, speakers of minority official languages — French and English — First Nations and Inuit communities, newcomers to Canada — immigrants and refugees — and deaf persons may face barriers in health care due to first language.
Language-concordant care is typically defined as the provision of health care in a shared non-dominant, minority language. Language-concordant health care can have positive impacts on access to health information and care, trust between patients and health care professionals and improved health outcomes.
Misunderstandings due to language may lead to misdiagnosis, empathic failures and poor therapeutic relationships with poorer treatment outcomes.
Research continues to clarify how language impacts health care, such as individual differences in anxiety about communicating about one’s health in a second language and how that can impact willingness to seek care, or how needs for interpretation versus seeing language-concordant health care professionals may differ between those with no versus some ability in the care language.
We know that how we remember and describe our emotional experiences can differ when we speak in our first or second language. We are also learning about the potential benefits and cautions about when and how to use or not use AI, or artificial intelligence, in addressing language barriers.
Clearly, training, recruiting and retaining health care professionals who can communicate in the same languages as their patients is vital. This is gold standard. In some cases, we can connect patients with language-concordant health care options despite geographical barriers.
Language-concordant care is the gold standard, but we must also consider how all health care professionals, and those in training, can be better equipped in situations in which they do not share the same languages as their patients.
We must commit to using best practices even when alternatives may seem more convenient. For example, I think we can all appreciate the potential harm that could come from a teenager being asked to communicate a cancer diagnosis or ask very personal health- or trauma-related questions of their mother who may be deaf or speaks another minority language. Harms could include not only potentially inaccurate information but also psychological and emotional impact.
Psychologists rely heavily on communication — verbal and non-verbal — consider issues of cultural sensitivity and validity when choosing assessment measures, even when there is a language concordance, and work to build strong therapeutic relationships with patients. Learning how to do this well in partnership with professional cultural-linguistic interpreters benefit from specific training and organizational supports and resources.
Effective interpretation and language-concordant care require understanding of cultural expressions, cultural views about mental health, meaning of body language and other non-verbal communication.
In closing, we know that evidence-based, effective health care is not one-size-fits-all, and this applies to health care in the context of minority language needs. We must engage in and evaluate practical and effective ways to set patients and health care providers up for success, rather than leave them to figure things out on their own when language barriers arise.
We must also think beyond binary solutions; that is to say, what can we do to improve care for patients when 100% language concordance is not possible? In doing so, we can ensure that everyone in Canada can always access, navigate and benefit from health services and health information, taking into account the language that is most comfortable for them.
Thank you, again, for the opportunity to speak.
The Chair: Thank you so much, Dr. Gupta.
Ms. Bell, you have five minutes for your opening remarks. The floor is yours.
Krissy Bell, Chief Executive Officer, Canadian Physiotherapy Association: Thank you, chair, and members, for having me here today. The Canadian Physiotherapy Association, or CPA, proudly represents over 16,000 physiotherapy professionals and students across Canada. Our members embody our mission to enhance health, mobility, rehabilitative care and treatment, enabling Canadians to live well in their communities.
I am joined by Dr. Jennifer O’Neil, one of Canada’s pre‑eminent physiotherapists and researchers, and a professor at the University of Ottawa and the Bruyère Research Institute.
Physiotherapy professionals play a crucial role in our health care system and in expanding access to high-quality care, which includes care in a preferred language. However, Canada is a vast, diverse country, and this means that providing high-quality care to patients nationwide can be challenging.
But there are solutions. For example, in Budget 2024, the government announced the expansion of the Canada Student Financial Assistance Program to include physiotherapists, which will support physiotherapists working in underserved rural and remote communities, including those serving in minority‑language communities.
Every day, CPA members are finding innovative new ways to serve patients across Canada in their communities and their preferred language. For instance, physiotherapists in Quebec are delivering care to Cree First Nations and have learned key expressions and terms in Cree to serve Indigenous populations better. Physiotherapy professionals across Canada use AI translators to translate conversations in real time. And many also use Quebec-built AI technology CoeurWay to record, translate and automate note taking during appointments.
One of the biggest opportunities we see in supporting high-quality care across Canada is through hybrid physiotherapy, which combines in-person treatment with telerehabilitation.
During the COVID-19 pandemic, physiotherapy professionals were early and rapid adopters of telerehabilitation technology, which was key to ensuring that patients across Canada continued to receive care during lockdowns and closures. And since the pandemic, Canadian physiotherapists have collaborated globally to develop clinical practice guidelines on telerehabilitation. Telerehabilitation is comparable to in-person care, and ample research shows that it works.
However, there are challenges with the quality of translation in some telerehabilitation platforms, and words are often misunderstood or can be badly translated.
So there is an immediate opportunity for the government to fund digital health infrastructure, like telehealth platforms and live translation tools, to ensure that health care services reach those most in need. Translation services are costly. The larger hospitals can carry these costs but smaller clinics cannot. To support the widespread adoption of translation services, there is an opportunity for the government to offer reimbursement or subsidies for small independent clinics that want to improve their ability to deliver telerehabilitation or care in a preferred language using translation services.
This would improve care and health outcomes for patients in rural, remote, urban and minority-language settings. It would also allow providers with the necessary resources to scale physiotherapy services in their community.
Investing in accessible, reliable and affordable digital broadband infrastructure is also critical as it enables equitable access to physiotherapy care in rural and remote areas or those in marginalized situations. Also critical is an improved federal health human resource strategy that extends to all providers, including physiotherapy.
Currently, there is a nationwide physiotherapy shortage. There are job vacancies across the country, and the problem is expected to grow. This presents an opportunity for licensure mobility and innovative planning to fill job vacancies, including by expanding telerehabilitation services to address regional shortages. It is also an opportunity to support a standardized and enhanced scope of physiotherapy practice across Canada.
As a final takeaway, I will leave you with six core principles that are critical to ensuring that all Canadians get the care they deserve.
One, every Canadian, irrespective of their location, language or circumstance, deserves access to high-quality health care.
Two, it is important that we do not create a digital divide to physiotherapy care in Canada and instead build an approach that includes a hybrid of in-person care and telerehabilitation.
Three, high-quality translation of a wide array of languages is necessary in virtual and telehealth care.
Four, optimized physiotherapy should be a fundamental part of our remote and in-person health care services.
Five, we need innovative, forward-thinking solutions to support physiotherapy professionals in embracing new technology.
Six, we need to continue to explore how telerehabilitation can support marginalized and underserved communities.
Thank you for your time, and I look forward to the discussion.
The Chair: Thank you very much for these opening remarks, Ms. Bell.
[Translation]
Colleagues, being aware of the time available to us, I suggest that, as usual, each senator be allowed five minutes for the first round. If time permits, we will have a second round.
Senator Mégie: In your opening remarks, you talked about the resources that could be provided by giving grants to small areas, small clinics, to enable them to provide care. Did I understand correctly that you were talking about physiotherapy? Has this ever been tried? How successful has it been for people in minority language communities?
Jennifer O’Neil, Physiotherapist and Assistant Professor, University of Ottawa, Canadian Physiotherapy Association: Thank you very much for your question.
It raised two points. The first concerned financial support for small clinics, as we know that large organizations like hospitals have a different reality from that of small clinics when it comes to translation services. I think it was more of a request, if you will.
Your other point concerned access to physiotherapy services. Technological attempts have been made in the field of rehabilitation in different environments — hospitals, private clinics and community organizations. It’s been tested, it’s feasible and it’s comparable to in-person services.
On the other hand, I don’t think we should forget one important thing: Service delivery options are always the individual’s choice and depend on what they want in terms of service. These are types of service delivery that have been tested, yes.
Senator Mégie: That’s a good initiative.
My question is for you, Ms. Gupta. What is the process in the support programs to help foreign-trained psychologists adapt to Canadian requirements? What processes have been put in place? Are there any specific measures to help them? In terms of mental health, it’s clear that communication between the patient and the health professional is crucial. You can express how you feel about physical pain, but soul pain is more difficult to convey. Is there a process already in place to help them?
[English]
Ms. Gupta: Before I invite my colleague Dr. Madon to speak about nationally, I want to respond in terms of how important that question is. We have found that when we look at language it does seem to impact mental health care more. One important thing is that language and culture cannot be separated. When we say foreign trained or foreign psychologist, I think it is also really important to think of what country, what culture, what dialect. One of the things we are finding is you can have language-concordant care, but if it is not culturally relevant, regardless of the language, that’s still not fitting. I’m going to pass it to Dr. Madon to talk about the national response for foreign-trained psychologists, but I wanted to mention the point that language is not language is not language.
Stewart Madon, Director, Professional Affairs, Canadian Psychological Association: Thank you, Ms. Gupta.
Senator, I would have to get back to you about the process of bringing in foreign-trained mental health workers and foreign‑trained psychologists. It actually differs based on the province. I know everyone in this room is well aware that our mental health care, just like our physical health care, is regulated provincially, so the onboarding of new psychologists who are foreign trained, will depend on the province in terms of licensing processes and examinations and those kinds of things. Understandably, most provinces do have requirements in terms of people being able to speak one of the two official languages, and most examinations are done in one of the two official languages, usually in English, but in some cases we will see them in bilingual provinces or French-speaking provinces in French. If you are looking for a pan-Canadian approach to bringing in foreign-trained people, I don’t believe there is one but I would have to get back to you.
[Translation]
Senator Mégie: Thank you.
You raised something very interesting that we’ve also seen in other studies conducted by this committee. Even when professionals are sought to work in francophone communities, the exams they take are in English. We’ve always thought that was absurd, but that’s what’s been happening so far. Do you have any other processes that could change this, or is everything the same?
Mr. Madon: Not nationally, I don’t think. This is an area of provincial jurisdiction, after all, and all our certification processes are currently provincial.
[English]
Senator Moncion: My question is for Dr. Gupta. You mentioned something in your opening remarks about you doing online services for doctors and nurses. You were talking about your virtual practice. Could you just talk to us a little more about your virtual practice?
Ms. Gupta: Yes, thank you for the question. I recently moved to Nova Scotia for this job in the hospital. Before I was working in psycho-oncology here, I had a private practice. I lived in Toronto. Just because of the nature of some of my work experiences previously, my patient population is comprised quite largely of physicians, but I see other health care providers as well. Because I increased my private practice in 2021, everything was virtual at that point. In some ways, for health care professionals, the virtual format can work really well. One of the things it does is it allows for flexibility in terms of timing. It doesn’t require an extra commute after a long day to go see someone and then back. There is that flexibility, as long as they have a private space, right? We are following all the ethical reasons.
I found that people have been very happy to continue virtual. When I moved, I considered, do I want to keep doing this virtually? When people contact me to see me, I let them know right away I’m only doing virtual. I assess if maybe in-person would be better for them if they have a preference. If so, I find them someone else. I’m mindful of clinically if there are situations where it would make more sense to have someone locally to help with that transfer as well.
One of the things that is really important when we do virtual care across different provinces — I’m licensed in Ontario and Nova Scotia — licensure is one thing, but we need to have local knowledge. If I had not lived in Ontario, I certainly could get a licence in other provinces. I think that’s wonderful because it increases access to care, language-wise or otherwise. But I think it behooves us as health care professionals to learn about the communities where we are treating our patients.
I’m so pleased to share the room with our physiotherapy colleagues. As a rehab psychologist, I have worked a lot with physiotherapists. All of the things that Ms. Bell identified, if we can increase virtual access for physiotherapy, we could use the same platforms for psychology. We know that physical health and mental health are so connected. That applies whether your patients are physicians or nurses or anyone else.
As I was writing my opening remarks for this, I was thinking about my patients and my colleagues too, but the ones who I see are my patients. This adds to the stress that health care providers feel. This adds to the moral distress and tension and how hard their day is, namely having to figure out on their own, how to see patients with different languages when the infrastructure for interpretation and language-concordant is not as strong as it needs to be. Interpretation and translation services are piecemeal across the country. We don’t have consistency.
In this city, for example, the IWK in Halifax Children’s Hospital has interpretation services in-person or virtual. It is different in the adult hospital. We have a lot to do. It would help my patients who are health care providers as well as the patients they see. Thank you.
Senator Moncion: Thank you. You have given us more insight on how you do your work and it is important because during the pandemic there was a lot of online consultation, and since the pandemic it has been reduced considerably. It is unfortunate that we have now reverted to old ways of doing things that were not working for a lot of Canadians.
I was going to ask how you can be in Nova Scotia and have patients in Ontario, but because you are licensed in both provinces, you are able to provide services to both provinces. That’s also important to provide access and to be able to provide services to more Canadians. I guess you are a very good example to follow.
I would like to know how we can help you with getting this across Canada, because from what I understand and for you also in order to be able to provide a service in another province you have to be licensed in that province. I find it a little [Technical difficulties] because it limits the kind of health services that could be provided easily for a lot of people at any time because we are in different time zones. How can we work around a problem like this? Do you have any ideas on what the federal government’s role would be in creating a barrier-free country where you are free to operate across the country and help people across this country, in any language?
The Chair: Go ahead, Dr. Gupta.
Ms. Gupta: That’s a really wonderful question. I’m very appreciative of the high standards that each of the provinces has in terms of being able to be licensed in each one of them.
When we think about it, there is a great deal of cost associated with being licensed. It makes sense. If we are wanting to incentivize, for example, having individuals with specialized language skills to be available to patients across the country, then we have to think about what the burdens they might experience are, whether that is specialty knowledge about certain populations, language use or cultural knowledge. We want to be careful about overburdening specialists in terms of being the only one. How can we get them to train people and spread the knowledge? But also, how can we think of incentivizing being able to provide services in another province or whatnot? That’s something to think about.
The other thing is that as we are moving forward, you are right, I don’t think we have gone back to all old ways; at least in my profession, virtual is here to stay. It should always be a hybrid model. There should always be a clinical judgment if it is best to do something virtually or good to do something in person. Because I know the community where I see my patients so well, I know very easily how to connect someone to another provider if they need or how to connect them even with a physiotherapist.
Training is the answer. How can we think of this as a specialized ability in terms of being able to provide services across the country? I think rather than jumping in and doing things like we have to sometimes, we can have a thoughtful approach and think about what kind of training might be necessary. We are talking about training in terms of providing psychological services or physiotherapy services in a certain language, and that requires not only language but different skills also. I think that’s important.
The Chair: Thank you. Do you want to add to this briefly?
Ms. Bell: I think it is a very important question, the topic of licensure mobility, especially for health care professionals when we are looking at it from an official language or minority language perspective.
For physiotherapists currently, the scope of what they are allowed to do actually differs province to province. There are steps that need to happen before licensure mobility is an option. That’s recognition of the full scope of the physiotherapist across the provincial jurisdictions.
For example, Nova Scotia recently added the ability to order a diagnostic image to the scope of a physiotherapist which is a competency that physiotherapists are trained in. In other provinces, that is not the case, so that limits the mobility of the licence across provinces because the practice or the realities of that licence are quite different.
There are things we can do to recognize the full scope of the health care service practitioners across the country to ensure that mobility is available. An example is that we have seen the success of one clinic in particular of fly-in, fly-out physiotherapists. There will be a rural or remote community that does not have a physiotherapist in the community. So a clinic in an urban setting will pay to have a physiotherapist fly in for a week and they will see several patients. They will speak to them in the language that they like. If there were a French-speaking community, they would send a French-speaking physiotherapist and provide services.
Then for the rest of that month the patients do not see a physiotherapist. They see them virtually so they can continue to keep up with that patient.
These types of services or mentorships across the profession could happen if you had a physiotherapist in B.C. who was not French-speaking, with a French-speaking patient; they could partner up with a physiotherapist in Quebec and work to provide a meaningful solution for that patient who isn’t supported in their community but does have access to the wider resources across the country. Licensure mobility would be critical for those types of solutions to cross borders from province to province, or province to territory.
The Chair: Thank you. Do you have any specific recommendation to give to the federal government, because we will prepare a report and want to make strong recommendations? I’ll leave you with that.
[Translation]
Senator Aucoin: That was actually something I wanted to ask about, either if there was anything specific you could recommend or if you had any other ideas on what the government could do to facilitate that mobility. Thank you for adding that comment. I was wondering how physiotherapists can practise remotely. You’ve given me a few possible solutions that are very interesting.
For psychologists, I was wondering the same thing. Is there anything else you’d like to add? I’ll ask my other question later. Would Ms. Gupta or Ms. Bell have anything to add?
[English]
Ms. Gupta: Yes, thank you.
When we talk about licensure across the province, I’ll invite my colleague from the CPA, Dr. Madon, to speak to this.
Mr. Madon: Thank you, Dr. Gupta.
I am going to echo what Ms. Bell said. The concept of finding a place to start from in terms of a national credential will inevitably facilitate interjurisdictional practice.
To your point, notwithstanding infrastructure issues like high‑speed internet and those kinds of things, and all of the other things we already talked about, having a place and being able to recognize a common core or competency base for psychologists across the country would also be helpful because, like our colleagues in physiotherapy, we are a rather disparate group of regulations and entry-to-practice requirements for psychologists in Canada. Being able to harmonize those would be an important first step in order to facilitate interjurisdictional practice.
[Translation]
Senator Aucoin: Have your associations already made representations or taken the first steps to make this happen? Perhaps we could support that.
[English]
Mr. Madon: We are working on a position paper on national credentialing right now. I would be happy to share it with the committee once it’s reached its final form.
Ms. Bell: We have issued a statement on the scope of practice for physiotherapists that [Technical difficulties] adoption and recognition nationally of the full scope of physiotherapy.
We have a position paper. We also have several economic data points that show physiotherapy is a cost-effective solution to many issues facing the health care system. Already, we have put some legwork in with regard to identifying what the full scope of physiotherapy is. As mentioned, recently we’ve seen Nova Scotia add diagnostic imaging. We’re working with our provincial partners to ensure we can find a consistent or national approach to scope that would allow for that licensure mobility.
If we were to give feedback, or recommendations to the government regarding national licensure, a big piece would be that recognition. Also, the government is pulling together the health, human resource strategy at a national level.
Currently, when we come to Health Human Resource Strategy tables, and we speak with the federal government about a national Health Human Resource Strategy, doctors and nurses are always present in the room. The rest of the health care system needs to be considered in those discussions, including physiotherapists, because understanding the jurisdictional divides of scope for the physiotherapist and how to move those barriers is going to help Canadians receive the care they deserve and in the language they deserve. It will also take pressure off physicians and nurses who are operating within areas that physiotherapists can help with.
Ensuring that Health Human Resource Strategy and adoption focuses on all of the professionals within health care, including physiotherapy, is a critical step for the federal government, the recognition of additional professions.
[Translation]
Senator Aucoin: I see that you talked a lot about two professions. You talked about the service you could offer in different languages. However, with regard to official languages, which is a subject that concerns us as a committee, do you currently have a list of professionals who can provide services in English in Quebec and in French in the other predominantly English-speaking provinces? Are these services easily accessible to these two minorities? I imagine that my colleague will be able to talk about Indigenous peoples and Crees.
[English]
Ms. Bell: Our regulatory bodies are an important place to go for comprehensive lists of health care professionals, given the nature of their role within the health care system. They would also have the demographic data on which language a practitioner is able to speak.
As an association made up of members, we do work closely with our partners in our branches in Quebec, New Brunswick and Ontario understand where there are minority language practitioners. We do our best to provide all of our resources in both official languages.
In terms of a comprehensive list of health care practitioners, a regulator is likely the best place to start for that kind of information.
The Chair: Thank you. Would you like to add to this, Dr. Gupta?
Ms. Gupta: Yes, thank you. That’s a wonderful question.
Every province, their board or college, has a list of licensed psychologists that are in that province. Any member of the public can go on that directory and look at who they are and what language they can practise in.
We need more than a list. When we think about it, it’s not just about language. Say, for example, someone needs treatment for post-traumatic stress disorder, or PTSD. We want language concordance. We want someone who speaks the same language as they do, let’s say it is French. Take Prince Edward Island, for example. You want someone who speaks French and has experience and expertise on the condition that the patient is coming in with.
We know that our health care system is at capacity. Even if we find a person on a list who has that language competency — and has the expertise — from a health care perspective, how long is the wait to see that person?
We know we’re at capacity publicly. We also know privately there can be waits. Many times what happens is we’re doing this piecemeal.
For example, say someone reaches out to me. They’re looking for someone. I realize it makes more sense to have someone see someone with this particular expertise. I’m reaching out to my networks. Do you know anyone? Where could we do that? That’s the kind of thing we could figure out, how to do less of that. We’re happy to do it as health care providers, because we always want to connect people to the right people.
That’s more of a question than an answer. We have to look at more than who has language competency and where they live. We also have to look at wait lists and who is available right now. We know timely access to health care is a big part of getting good health care.
The Chair: Thank you for that answer.
[Translation]
Senator Audette: Thank you very much for your testimony and your presentations. Since I really like my neighbour here, I’ll continue on the topic of First Peoples. I’ve just come from [Innu‑aimun spoken] where a young girl of 11 committed suicide just 12 moons ago. When I was in the woods, a young man of 24 also committed suicide. We have a lot of suicides and mental and physical health problems, and it’s far away. The second language is English or French, but the first languages are Naskapi or Innu.
Do you have people in your organization who have provided professional services with a culturally sensitive approach? For me, the figures are important and help show that there are needs in remote regions and in the nations that I hold so dear. There have also been some good examples, such as certain Maritime provinces agreeing to share resources. Do you know if any other regions in the rest of Canada could be included in our report? Does this exist elsewhere? What would you recommend to Health Canada and the federal government to say that, among Indigenous peoples — as you yourself mentioned, Ms. Gupta — ethnicity and language are important issues and that a misunderstanding can lead to a misdiagnosis or a wrong approach? Sometimes it can kill, as in the case of Joyce Echaquan. Do you have any recommendations for Indigenous peoples? We try to speak French and English. For me, it will be important to listen to you.
Ms. O’Neil: Thank you for your question, which really shows the importance of taking a community-centred approach. That would be the first thing to think about. I can give you an example, not with First Nations as such, but with francophones living in minority communities across the country. We’ve set up a fall prevention project called Marche vers le futur. It’s a telehealth program aimed at improving access to care for francophones living in minority communities from coast to coast to coast. What we found was that it was really important to go and ask in each province and each community because we all agree that francophones in New Brunswick or Prince Edward Island speak a different kind of French than francophones in Alberta and have different needs; they are different communities.
If we take this approach, I think that having the time to evaluate and develop projects that meet the needs of each community and each First Nations community is of great importance, as long-term benefits will be better. There will be better implementation and better uptake of services. One of the recommendations would be to fund community-centred approaches, not to take a project and adapt it to the community. Creating projects really has to come from the community. That’s what francophones have told us. They have told us that it was important for them to see that they had access to a falls prevention program in their language, but above all, that this program was provided by someone in their community. This practice can be adopted. I think it’s something very important that’s often forgotten, which is to take the time to listen to communities and their needs and adapt programs, whether telehealth, hybrid care or face-to-face care, to the needs of each community. We need to build the capacity of communities so that they can deliver the services themselves.
[English]
The Chair: Dr. Gupta, would you like to answer this question, or do you have suggestions?
Ms. Gupta: This is such a fundamentally important question, and we have to think both the long term and short term. There are people who are considering suicide tonight. It is so important that we work to incentivize and recruit and have people trained to be psychologists from all communities in Canada and from all cultures.
In the meantime, there are people dying. I don’t think there is a divide between mental health and physical health, so I think if we have any kind of health in any community, I think that’s going to help overall.
What I would say is that we have to be careful that we are not doing harm, but not to the point that we do nothing because we’re scared of doing harm. What I mean is that we know there are assessment tools that we can use that come in languages. Let’s say we have a tool that comes in French, and we’re seeing someone — it might not be their first language, or it might not be their second language, but they can speak some French.
What if this test is looking at someone’s — it has items, because we have tests like this — that ask about how to turn on water to brush your teeth. If this is a community that has had a boil water advisory for decades and decades and decades, this is not an appropriate tool, or we have to think about how we are using this tool and change items or whatnot.
It isn’t just about language, and it isn’t even just about culture. It’s also about recognizing when we shouldn’t do something and when we shouldn’t use a tool and when we have to be creative and use things kind of in between.
You mentioned rural communities. Well, I’m thinking of the same test, and it has items on how to get on the bus and how to use ATMs or whatnot. Things don’t necessarily always apply.
I think the danger is that when we are serving minority communities — especially if numbers are small — we have to be careful not to underestimate abilities, because that can be the danger. Misdiagnosis for sure, but also underestimating someone’s abilities, because we’re not asking the right questions.
I really wish that we had better infrastructure that supported appropriate cultural and linguistic interpretation and that we had proper training for health care providers and interpreters to learn how to work together and that we had space in terms of appointment times. Best practice is doing a consultation before and a debrief after. But we also know that studies don’t say that interpretation is always better, either. The studies show that concordant language care — if you’re seeing a health professional who speaks the same language as you — that’s better. Interpretation is so important, and if we’re going to do it, we need to be trained properly.
Sorry. I think I went over time.
The Chair: Thank you, Dr. Gupta. I want to make sure that everyone has a chance to ask questions.
I will give the floor to Senator Clement, but my question would be that that is pretty clear in terms of means, but what would the federal government do specifically, because some of that work is provincial or community work? What kind of recommendation might you have? We might come back to this after.
I’ll give the floor to Senator Clement.
Senator Clement: Thank you all for being here, and thank you for your careers, as well. Thank you for your careers. They are so helpful.
I’ll ask the questions and then get out of the way.
The first one will be for Dr. Gupta. I like the way you say language concordant care and culturally relevant care are two different things that we have to look at, and I want to dig into this training thing you keep raising.
Is there training? Does your association support training? Should it be mandatory training around cultural competency? Can you provide more detail around that?
You’re sitting in Nova Scotia, and I know that the Atlantic colleges of surgeons and physicians have started a sort of shared licensing registry. If you had any comment about whether something like that is a good start, that would be interesting to hear about. The question could be for Dr. Gupta or Dr. Madon.
The questions for physiotherapy — and physiotherapy has saved me so many times — but I was able to afford it, and I’m also a legal aid lawyer, and when my clients can’t afford it, I see the real difference in outcomes. But that’s a separate conversation.
You outlined six points. It felt like a mission statement, and your sixth one was around supporting marginalized communities. I wondered specifically how you do that.
You also referenced the health and human resource strategy and not being at the table. Explain what you mean by that strategy if it’s the labour shortage strategy. I wasn’t quite understanding what you meant by that.
We can start with Dr. Gupta and Dr. Madon.
Ms. Gupta: I’ll answer half of it, and then Dr. Madon, who is CPA’s Director of Professional Affairs and the registrar of accreditation, can answer the second question.
The first, in terms of cultural competency training — because we have that — I want to talk a little bit about professionals once they’ve already done training, and they are already licensed. The training I’m referring to is the idea of — we know that language concordance is important; we know that. We know that if we can’t understand what a patient is saying, then we’re only going to be able to help them so much, and yet interpretation services are such a patchwork, and it’s hard to figure out how to use it. It should be standard. Why isn’t it in the orientation when I start a new job if it’s important enough?
I was also reading recently about how there are only three provinces that have language on people’s health cards. I think that shows how important we’re taking language, and we’re maybe not thinking of it as connected to health as much as we should. If we can’t access that data, it makes it harder to engage in processes like offer first, in terms of asking people, “Oh, would you prefer to be spoken to in French,” and all of that.
That’s the little piece I wanted to give. I’d like to invite Dr. Madon to talk about cultural competency, because we do take that very seriously in our training of psychologists.
Mr. Madon: Thank you. Absolutely, we have accreditation standards for training programs in professional psychology. Our association currently accredits about 46 doctoral programs in professional psychology, and in the competency matrix in the most recent revision of our standards, individual social and cultural diversity is a crosscutting foundational competence.
In addition to that — because we recognize that it’s not just about training people to do the work — we took steps to revise or change our standards to remove some of the systemic barriers to enable equity-deserving groups to access training to become professional psychologists, so they can then go back and provide services in their communities.
Senator Clement: Is this mandatory?
Mr. Madon: Yes, it is absolutely mandatory. A program cannot be accredited without being able to address that training in a local context.
We do have a separate training standard specifically for Indigenous interculturalism in response to the Truth and Reconciliation Commission of Canada report, so that is separate from individual social and cultural diversity, but both of them are crosscutting, foundational competencies. A program that is not addressing them would not be accredited.
Ms. Bell: We’ll start with the support for marginalized communities.
At the association, there are several things that we can do — specifically right now is about advocacy. Our recent win in Budget 2024 to see the expansion of the Canada Student Loan forgiveness program into rural communities is really going to enhance access.
You’ll hear me say the word “access” a lot. I’m sure you guys also say the word “access” a lot. When we talk about health care, fundamentally, that’s what it boils down to.
For us, the recognition of the full scope of the physiotherapist and enabling them to work to that full scope supports us in supporting those marginalized communities and building partnerships and strategies like the fly-in, fly-out community that I had previously mentioned. Advocating for new programs of that nature is a big way that the association has been supporting those communities.
We have a lot of work to do as an association and as a profession to ensure that access supports all equity-deserving groups. We don’t take that lightly, but it’s an important part of the access conversation, which is one we continue to butt up against.
When we talk about health and human resource strategy, the federal government frequently convenes tables of health care practitioners and health care leaders to inform them on policy, funding models, and things of that nature. Those are the tables where I think that diversity of thought — from a practitioner perspective — is really important to inform the discussion on what access to the health care system is. Physiotherapists, our colleagues in occupational therapy and speech language therapy bring a different perspective, so they too should be at the table.
You mentioned the unfortunate reality of physiotherapy service frequently being a service that somebody can or cannot afford whether their employer pays for a benefits plan for them or not. This is a reality that doesn’t often get represented at policy-making tables, and the need for expanded public access for communities, marginalized communities, or Canadian patients, writ large, will expand the ability for physiotherapy to support the health care system.
The two questions are quite intertwined, because some of the decisions being made around health and human resource strategy need to be thoughtful about the way that other practitioners are experiencing or contributing to the health care system.
The Chair: Thank you so much. We have four minutes to go, and I would like to hear you on the barriers that internationally trained health professionals are facing. We spoke a lot about Canadians and mobility in Canada, but what about the international professionals?
There is the federal government, the provinces and territories, the associations and the post-secondary institutions. In a nutshell, what would be your recommendations concerning that, because there are a lot of issues to bring those professionals here to Canada.
Ms. Bell: Internationally educated professionals represent over 2,000 physiotherapists inbound in our last intake for our credentialling examination, so tonnes of physiotherapists are entering Canada with the intention of practising health care in Canada.
There are several barriers that they experience that the federal government could support them in. One is subsidizing the cost of licensing. Internationally educated physiotherapists need to prove their language requirement, either in English or in French. They also need to take a set of credentialling exams, like every other health care licence in the country, and the cost of those can be a barrier. I think subsidization of the cost to enter the profession for internationally educated physiotherapists would be one.
Currently, it’s easier to access an English as a Second Language course than a French as a Second Language course, unless you live in this city. English as a Second Language education courses and programs that practitioners might take to ensure they’re ready to challenge their exams are far more readily available than French language speaking courses.
That’s another infrastructure piece, making sure that French as a Second Language courses are available to those practitioners coming into the country, and information for those practitioners about where and how they could get employment in that language.
I think assumptions are made that English is what is going to get you a job when you come in as a new Canadian, and so I think informing them of the ability to speak French — many internationally educated physiotherapists come in multilingual, and so there is a point for some of them where they make a choice on if they’re going to credential in English or credential in French. Often those decisions can be informed by which exam is the most available to them.
The Chair: I don’t want to interrupt you but because of the time, in your opinion is it necessary to develop an accelerated pathway for skilled foreign workers from health professions who are francophone or bilingual? Do you think it could be part of the solution?
Ms. Bell: I think it is important for us to build an accelerated pathway to get all internationally educated physiotherapists into the system to increase access, which would potentially open the ability to access the practitioner that you need in the language that you speak because there is less burden writ large on practitioners across the country.
The Chair: Dr. Gupta or Dr. Madon, do you want to add something to that in a few seconds?
Ms. Gupta: Hear, hear, is what I would say to that. I think accelerated does not mean lesser quality. Accelerated does not mean that we are not paying attention to the standards. It just means we are lowering some barriers.
Something that Ms. Bell said really struck a chord with me. I had a psychologist contact me the other day who works in an academic institution and said, “I really want to improve my French; I really want to work on my French.” This isn’t a student. This is a professional. And she said, “But the only courses that are available in my institution are at too high a level.” So that is an act that can be done at the federal level. I know that health is a provincial matter, but if we could have better access to language training this could incentivize health care providers to improve their language skills by having lower costs or having it available at different levels. This would help those who would like to improve their skills in languages other than their primary language.
The Chair: Thank you so much to the four of you for your comments, presentations and answers. It will help us with our report.
[Translation]
Colleagues, we are resuming the meeting to continue our study on minority-language health services under the theme of health care professionals and the recognition of foreign credentials.
[English]
We now welcome in person, Dr. Deborah Cohen, Chief Operating Officer. Health Workforce Canada; and by video conference we welcome Dr. Harold Wallbridge, Registrar of the Psychological Association of Manitoba.
Welcome to both of you. Thank you for joining us this evening. Let’s start with your opening remarks, followed by questions from senators. Dr. Cohen, the floor is yours.
Deborah Cohen, Chief Operating Officer, Health Workforce Canada: Thank you for the opportunity to speak with you today.
Health Workforce Canada is a small, new, not-for-profit organization launched in November 2023. The establishment of our organization arose from the federal-provincial-territorial, or FPT, desire to strengthen health workforce data and planning. We are in the process of getting up and running and are happy to share what we can today.
Our role is to identify the sector’s information needs, and then to work with data engines in this country like the Canadian Institute for Health Information, or CIHI; Statistics Canada; and Employment and Social Development Canada, or ECDC; and others to facilitate access to existing data and to work toward enhancing this data foundation over time.
I want to tell you about Health Workforce Canada’s new publicly available pan-Canadian data dashboards. They are designed to bring information into one place so users can understand what we know, and still don’t know, about the health workforce in Canada. It is clear that Canada’s pan-Canadian health workforce data needs to be better connected, standardized and enhanced. However, we do have some statistics that may be of interest to this committee.
We know that our country is short of health providers across all jurisdictions. According to Statistics Canada, in 2022/23, there was an average of 96,000 workforce vacancies in the country. This vacancy rate was four times higher than it was in 2016.
According to CIHI, in 2022, the overtime worked by nurses and others on inpatient units in Canadian hospitals was 14.2 million hours. This represents a 53% increase over the previous year and is equivalent to over 7,000 full-time positions.
These data paint a picture of the strain on the health care system, but they do not tell us everything. We have a limited understanding of the languages spoken, for example, by our health workforce at a pan-Canadian level. This lack of comprehensive data on language and others significantly hampers effective needs-based planning.
Other than for physicians, CIHI does not currently collect annual administrative data for languages spoken by the health workforce. However, CIHI is now working toward collecting language data for nursing, pharmacy and occupational therapy, and annual data collection is expected to start later this year.
We do have older statistics from Statistics Canada, which indicate the proportion of health care workers who can speak French actually decreased from 12.3% of the population in 2001, to 11.5% in 2016, to 10.9% in 2021.
Of the internationally educated health professionals, of IEHPs, residing in Quebec in 2021, for example, 70% spoke French, while 2.9% of IEHPs residing in other provinces and territories could do so.
As a data and planning organization, Health Workforce Canada does not have a direct role in foreign credentialing or licensure. However, we do have some other statistics that may be interesting. According to CIHI, in 2022, 35% of pharmacists and 31% of family physicians were internationally trained, whereas only 10% of registered nurses were internationally educated. The proportion of internationally educated nurses, or IENs, has consistently been lower than other professions. However, even this proportion is growing. In 2017, IENs made up 8% of the newly licensed nurses. In 2022, that number rose to 12%. That’s an inflow of 5,000 new IENs over five years.
These data serve as a signal of the recent efforts to increase and streamline recruitment, foreign credentialing and licensing in the country.
While Canada leverages IEHPs to create sufficient supply for the country, not all of them are employed in health care. According to Statistics Canada, in 2021, only 67% of IEHPs trained in medicine internationally worked in health care compared with 95% of physicians educated in Canada. Furthermore, of the new immigrants to Canada who trained in nursing, 42% were employed in the nursing profession and 21% were working as personal support workers.
For each profession, there are multiple pathways to licensure for newcomers. The National Newcomer Navigation Network, also known as N4, is an organization that assists newcomers in navigating the complex Canadian health care system. N4 produces standardized information about the pathways to licensure for nurses and physicians and they track variability across the provinces and territories. These pathways are publicly available on their website, and we would be happy to provide you with a link if you are interested.
Thank you for the opportunity.
The Chair: Thank you, Dr. Cohen.
Dr. Wallbridge, it is now your turn to deliver your opening remarks. The floor is yours.
Harold Wallbridge, Registrar, Psychological Association of Manitoba: Thank you. I’m a registered psychologist, and the registrar of the Psychological Association of Manitoba, or PAM, which is the regulatory college. In addition, I am the director of the Psychological Service Centre, which is a training clinic for the clinical psychology training program at the University of Manitoba.
Access to minority language services in Manitoba — in this case French — is extremely limited. The number of registered psychologists who are fluent in French is very low. The actual number if not known to me, but I expect that it is less than 5, out of 266 registered members. Of this small number, not all would actually practise in French, either because they lack confidence in their level of fluency due to how little they use it professionally or they have an institutional position that only involves English. In fact, if I were to be asked to name a single psychologist in a private-practice setting who could serve a French-speaking client, I cannot name one, although one did retire a few years ago.
It is possible that there are some French-speaking MA-level school psychologists in the French school system, but school psychologists are not required to be registered with the regulatory college, so I have no direct information of their numbers.
Factors associated with limited French-language service in Manitoba are — I have four suggestions. Generally, the low number of psychology providers overall is a factor. The absence of a French-language psychology training program in the province. The primary and only training program for clinical psychologists in Manitoba is at the University of Manitoba, where I happen to work and is in English. The Université de Saint-Boniface has contemplated such a program, but this is at the very preliminary stage and the creation of such a program would be years away. As a result, the only French-speaking psychology providers who could practise in Manitoba would need to be trained out of the province.
Third, the Psychological Association and the regulatory college have too few staff and too small of a budget to actually offer regulation in French. We have an office but no full‑time employees, only part-time contractors. Moreover, no PAM committee could conduct business in French. Any French‑speaking provider would need to be regulated in English with the resources that we have currently available.
Fourth, the lack of a French-language, postdoctoral residency in Manitoba, and a residency is normally required to be registered as a psychologist. It might be possible to create a French-language rotation in the existing clinical psychology residency at the Department of Clinical Health Psychology, which is the hospital system. I believe one was offered in the past, but it would depend on an available French-speaking staff member.
The long-term solution, in my opinion, would be to support the development of a French-language clinical psychology training program at the Université de Saint-Boniface. Ideally, there would be two programs, one clinical and the other school psychology. It would probably be best for this to be a Doctor of Psychology, or PsyD program in order to simplify the research requirements and to orient graduates more to clinical practice. For reference, the University of Manitoba is a PhD program with a heavier research component. A PsyD would be quicker and easier to establish.
Second, to support the development of a French-language residency position in shared health. The caveat to this is that the capacity of the regulator college to regulate services solely within French would remain quite limited until such time as there is a critical mass of French-speaking psychologists who could serve as volunteers at a regulatory college to basically regulate the practice in Manitoba. A possible shorter-term solution would be to increase access to French-language psychological services in Manitoba by permitting easier interprovincial telehealth by French-speaking psychologists from other provinces.
Since the pandemic, for obvious reasons, the practice of psychology has changed drastically by seeing a much higher volume of telepractice. Not all psychological services can be provided this way. For example, assessments are often better done in person, as is the treatment of children. But ordinary psychotherapy can frequently be conducted online.
In order to comply with provincial legislation, a psychologist providing services to a resident of Manitoba currently needs to be registered in Manitoba. Currently, we have four pathways for this to happen: Full registration via reciprocity legislation which permits full practice; temporary registration for 60 days; extended telepractice registration which offers someone outside of Manitoba to see a single client for up to a year which costs $250; and a courtesy telepractice registration for 30 days which is free, which is basically a transitional registration.
I believe that some provinces, for example, Quebec and Nova Scotia, are open jurisdictions, wherein anyone registered in Canada can practise into their province. I am unclear how this is permitted under their legislation, because Manitoba’s legislation is clear that the provider needs to be registered in Manitoba. However, it is possible that all provincial regulators could negotiate an easier mechanism for interprovincial telepractice. Perhaps something similar to the Psychology Interjurisdictional Compact, or PSYPACT, system in the U.S. could be possible. Note that PSYPACT does still require changes to state legislation. PSYPACT is a potential system that when you have it you can practise to another state via telepractice. I don’t know the details of it but I know that it exists.
Alternatively, an interprovincial agreement, such as what was done for labour mobility, might be negotiated between the different provinces that could facilitate telepractice across provincial partners. I would caution that this would not allow for the full range of psychological services, as I mentioned earlier, but certainly would facilitate ease of psychotherapy services in French to residents of Manitoba. Those are my comments.
The Chair: Thank you so much, Dr. Wallbridge. We are ready for questions from the senators.
Senator Moncion: Thank you both for your comments. The first question I have is for Dr. Cohen. It is about the percentages you were presenting. You were saying that there are 96,000 vacancies, which is four times higher than 2016, and you were talking about the vacancies for nurses. The same applies to education, because there are vacancies in education. These are things that have been known for years. Because I was in the university environment. I was on a board at that time. We knew that in 2010 to 2020 we were going to start to have problems with doctors and with teachers. We are there now and we have the numbers that you are providing. Why?
Ms. Cohen: It is a really good question. Thank you for that. I think it is important to help you by positioning my organization and what we are here to do. I think this organization is new and just getting started but we really are about helping to establish the data foundation that allows for future planning. I don’t think there is any question that people would acknowledge that inherently people had a sense for the fact that these were going to be challenges coming.
Perhaps one point to make, though, is we don’t have a strong enough data foundation today to be able to forecast what we are going to need for tomorrow. Without numbers, it becomes difficult to make a compelling case.
Our organization is interested in both working with those data engines to improve the data, not just for doctors and nurses but, as our panellists talked about before, all of the different health workers so that we can, first of all, understand what we are working with today. But that’s not enough. We have to understand the needs of the population as they will occur in 10 and 20 years from now and provide estimates of how many will be required. That will allow us to work with our own internal education systems to start to articulate the growth in seats. We will also be able to talk about how many internationally educated health providers we can or should ethically bring in, in what languages, and where, so we are working with numbers we can manage.
Senator Moncion: I think it is important information that needs to be provided, and there needs to be a plan worked on moving forward. I’m always disappointed with the lack of foresight that our system has in many aspects. Thank you.
My other question is to Mr. Wallbridge. You were saying some provinces have the willingness to let other physicians — or in this case I think it’s psychologists — practise in multiple provinces. In your province you were saying that in Manitoba it is not there yet. What kind of effort has been put in place to get that to happen in your province?
Mr. Wallbridge: I’m not sure how the other provinces manage to get permission to allow open practice into their jurisdiction. In the case here, if the Government of Manitoba said that’s what we want you to do, then that’s what I would do. So it would be dependent on basically provincial legislation or provincial approval. The regulators have worked recently. They meet and they have facilitated easier ways to provide telepractice across provincial borders, and the most recent memorandum of understanding about this was of a more limited scope either for special cases or shorter-term work. That was a preliminary step that was recently done. It had not evolved to a level higher than those that the provinces operated in, where anyone registered in Manitoba outside of Quebec could, say, practise into Quebec. That’s not the case for us yet and for a few other jurisdictions. But if that’s what the provincial government told us they wanted us to do, that’s what would happen. Basically, the barrier to that is by complying with the legislation we require registration in Manitoba to provide a psychological service.
Senator Moncion: How much of a push has your association made to get more services for the francophone community? From what I understand, you only have about five psychologists who speak French, and I think you are unsure how many practice in French, what the actual need is, or what clientele they serve. I would say that’s a little bit disturbing when you think that you have a pretty good francophone population in your province. They don’t have the ability to get the training in your province. You don’t provide access for psychologists outside of your province, so I would say it is limiting for francophones to even get the service.
Mr. Wallbridge: It is. Because we are a smaller jurisdiction, as the registrar I do have some flexibility to make decisions to, in a sense, register someone. I have done that in the past. If a person said to me that they were seeking a service that couldn’t be obtained in Manitoba and they found a psychologist in another province who provided it, I could and I have permitted that psychologist to be registered in Manitoba for telepractice, basically using the extended telepractice registration mechanism.
I do that on a case-by-case basis when the question comes up. I would say we aren’t flooded with requests for doing this, despite the fact that there is a modestly significant French‑speaking population in Manitoba. Perhaps by the environment in which they existed for many years in terms of health care, they adapt to it rather than us, and so they normally get services that they wish in English because they are largely bilingual. That wouldn’t be an available option for French‑speaking immigrants, however. So, if it were the case where somebody only spoke French, or another language — not necessarily French — I have given permission for providers to provide services in other languages if they found somebody in another jurisdiction. I just decided to offer that when it was requested.
Senator Moncion: Thank you.
The Chair: I want to make sure that I understood well. It means you are not proactive in terms of French services unless somebody is asking for it. Is that what I hear? You are saying that francophones do not really ask for that service because they can manage in both official languages?
Mr. Wallbridge: That has been my experience, yes. I mean, partly the issue has not come up because there simply aren’t that many providers in French where we are being asked to identify them or to regulate them because the numbers are so small. When someone wishes for services in French, it is either they find the service in English because they are bilingual, or if that wasn’t the case, if they approached me and asked me if I found a way — and I have had a couple of cases where this happened — the person found a provider in another jurisdiction, I basically permitted this to happen for telepractice, but the numbers are small.
The Chair: Thank you for that answer.
Senator Aucoin: I’ll continue with Dr. Wallbridge.
[Translation]
What can the federal government do to encourage the creation of a French-language program to increase the number of clinical psychologists who can practice in French in Manitoba and to remedy the problem of the lack of services provided by francophone psychologists in Manitoba? There is no active offer to francophones because you have few psychologists who are able to work in French.
[English]
Mr. Wallbridge: I think the proposal or the idea proposed by the Université de Saint-Boniface to develop a French-language clinical psychology program is something worth pursuing. On a smaller scale, I think facilitating a rotation within the internship in the hospital system would be another potential route. I think the other major pathway would be to look at mechanisms such as PSYPACT, or something like that, a similar agreement as labour mobility legislation, to facilitate interjurisdictional practice, particularly if you have providers in minority languages, not just French and English but in other languages as well. If you could have someone in New Brunswick who could provide services in Tagalog, that might be useful for a person living in B.C. if there was a way to facilitate interjurisdictional practices, particularly to facilitate this kind of question of access to language. There is the homegrown developing the system within Manitoba to provide French-speaking psychologists who are trained in and wish to live in Manitoba, and ultimately I think that would be a great move. Short of that, but also to provide maximum flexibility, I think looking at mechanisms to increase interjurisdictional telepractice with the caveat that there are some psychological services that simply cannot be delivered that way because you need to be in the same room with the person. But nevertheless many could be provided via telepractice.
[Translation]
Senator Aucoin: I’m not sure if I got an answer to my question, which was what the federal government can do and if you have any suggestions as to how the government could help in this area.
My next question will be for Ms. Cohen.
[English]
Mr. Wallbridge: I didn’t identify the response of the federal government because the government that is the greatest in my mind is the provincial government, because that’s the one that writes the legislation that I need to use. There has been talk of a national standard for psychology licensure in Canada. One of the features of psychology is that there’s a lot of divergence in terms of what the educational credentials are for psychologists, whether it’s a master’s degree or a doctorate. To some extent, the issue has been solved with labour mobility legislation, where we basically accept masters and doctoral level psychology providers in Manitoba. That was done by interprovincial government negotiation.
What could the federal government do directly? I’m not that sure. There’s certainly funding for post-secondary institutions that could be very powerful. One of the reasons why the number of graduates in Clinical Psychology in English at the University of Manitoba is on the lower side has to do with the amount of funding the university receives to provide training. Of course, that’s provincially directed as well.
I’d have to really think a little bit about what the federal government could do to facilitate this. So many times the fingers that are pulling the strings with respect to the regulation of psychology and provincial services are provincial, so I am not immediately sure what the federal government would do.
[Translation]
Senator Aucoin: Thank you, Mr. Wallbridge.
Ms. Cohen, I am flabbergasted by the statistics, as it has often been said that there is a shortage of nurses and that people are working overtime. However, we see that only 10% of this workforce is foreign-trained, compared with 35% of pharmacists. This means that there is a disconnect somewhere, which means that more nurses are not being accepted.
You say that we don’t yet have all the statistics and that, once we do, it will be possible to make representations to the government. Aren’t you doing the same thing that Senator Moncion alluded to, namely that 10 or 20 years ago we already knew that there would be a nursing shortage today?
If it takes you 5 to 10 years to gather the statistics you’ll need to convince the government, we’ll be at another stage and we still won’t be meeting workforce needs 30 years from now.
Is there anything you can do with the federal government, with the data you have right now, to move these issues forward that are so important to the health of Canadians?
[English]
Ms. Cohen: Thank you for that. You’re right: Data is expensive, and it takes a long time. So our position is that we need some short-term approaches that complement the long term. This is a long game for us. This is not a sprint; this is a marathon. Our health workforce challenges will be with us for some time. Part of our objective is to work with our data partners to really expand the data foundation over the long haul.
In the short term is where I mentioned the data dashboards that I put in the talk. The data that we have in this country is fragmented; it’s all over the place and difficult to find. The Canadian Institute for Health Information has some, Statistics Canada has others. There are data pieces, but you really need to know where to look. So our dashboard, as a starting point — and we put this dashboard together in about three months, just as a start — we will build it over time — is to put it all in one place. Because once you see it all together, you see the numbers are staggering. That’s what compels not just the federal government but the provincial and territorial governments, and the many other actors, to do something.
What can the federal government do? I wanted to point out that the federal government, in February 2023, announced in their budget a significant investment of $500 million in data initiatives. Of that, our organization was born. We’re very small. We are a total of, I think, $20 million of the $500 million, so it’s a very modest investment. We’re a tiny organization, but other organizations were given dollars and compelled to advance their data foundation.
So the second thing we’re going to do is that we’re going to immediately start to work with these groups to create a data strategy, because you can’t create a plan without having all your players at the table. Just today, we met with the CIHI, ESDC and Statistics Canada to initiate the foundation for the creation of a data strategy. Those data strategies will actually be informed by the priority information needs of tomorrow as well as today, and we’ll create a plan to get there.
[Translation]
Senator Mégie: I’ll also ask you my questions in French, Ms. Cohen.
Is your data collected at the national level or by province?
[English]
Ms. Cohen: Most data sources are broken down by province. It depends upon where the data come from. So CIHI will generally have the pan-Canadian numbers as well as the provincial number. We produce those in our dashboard today. For us, our goal is to not just be at the provincial and territorial level, but to go to a smaller area than that. We’d like to be able to produce a regional level analysis to get us toward things around rural and remote communities that are part of a province but very different from the urban centres. That’s part of the next iteration of our dashboard, and we’ll be releasing region level statistics on those dashboard by the end of this fiscal year.
[Translation]
Senator Mégie: Do you get your data from Statistics Canada or do you take it from different sources and then work with Statistics Canada? How is your data collected?
[English]
Ms. Cohen: The Canadian Institute for Health Information and Statistics Canada actually collect the data. We’re so small that we will not become a new data engine for the country; we have investments there. They will improve their data, and we consolidate all of that data into meaningful dashboards that are easy to use so you don’t need a PhD in Epidemiology to understand what you’re looking at.
Right now, we have our wonderful organizations like these, but they list our data in data tables and many things, and you’re just looking at a sea of numbers. What we’re doing is to pull this information together so you can interact with this dashboard in a visual way to see how many overtime hours are being worked and so on.
[Translation]
Senator Mégie: Here is my last question.
Do you expect the organizations that need your data to consult you or, on seeing a catastrophic figure, will you act as a whistleblower and tell them that things are not going well with their organization?
[English]
Ms. Cohen: In terms of our goal, we’re very new — only 10 months old, so we’re just getting started — but when we built the dashboards and put them up, within a very short of time, we could check by the number of web hits that people were just looking at the data and information. We’ve been out on a bit of a provincial and territorial roadshow to each of the provinces — the ministries of health and those who work in health and human resources — to show them the data consolidated. So far, the provinces and territories we’ve spoken to have been delighted. They themselves don’t see this overview; they have their provincial information and don’t necessarily see the whole piece.
It might be in the future that we can say, “Here is a red flag, and we’re anticipating we’re going to have a problem for tomorrow,” but right now, we’re creating the foundation so that everyone can see the information and work together collaboratively to start to create those solutions.
The Chair: I have a complementary question, Dr. Cohen. You’re a small organization, but do you plan to be proactive in the dissemination of the data? There are governments, but there are also organizations that would appreciate being able to receive that information. So how — what is your planning with that?
Ms. Cohen: Thank you for that question. It’s a big part of our work. It’s not enough to just have data. You need people to know it’s there and to use it. We have a pillar in our strategic plan about convening the network of networks. There are many actors in this system. We have the federal, provincial and territorial governments; employers; professional associations; regulators; unions; researchers; patients; caregivers and so on. We’ve been talking to all of them, and all of them are asking for information. They’re asking for data. It’s the thing they’re all crying for, and that’s why we decided to start where we did.
So, in a month from now, we’re actually holding our first conference, an action symposium, in Montréal, and we will be hosting it so that it’s accessible both virtually and in person. The goal of the action symposium is not to talk about all the problems and count numbers and just put them out there, but to put all of those people that I just mentioned in a virtual room or in a physical room together to start talking about action. What are we going to do differently for tomorrow?
The Chair: Will it happen in both official languages?
Ms. Cohen: It will.
The Chair: Great. Thank you for that.
[Translation]
Senator Audette: The federal government has been creating organizations like yours for several decades. We’ve noticed over time — whether it’s for Indigenous peoples or on important issues that affect Canada as a whole — that services are often provided in English. I really appreciate the fact that you are making the effort to provide them in both French and English.
In your official mandate and since your organization was created, I see that you are making an effort for First Peoples. You have two First Nations doctors on your board of directors, as well as a Quebecer from the Université de Montréal. Is there a paragraph or anything that confirms that you absolutely must have French-speaking voices within your organization, not only from Quebec, but from other territories or regions?
Do you have a mandate to ensure that in your data you always see what the place of the francophone minority community is across Canada, so that we can see those numbers? If not, it could be a recommendation. I’m not trying to influence you. However, when we create national organizations, don’t you think that the federal government should make sure that there are spaces in the bill, in the organization, in the governance of the organization, for francophone minority communities?
[English]
Ms. Cohen: Thank you. For our organization, we are actually just about to release our strategic plan, so it’s being reviewed by our board at the moment.
In terms of what our strategic plan and mandate compel us to do, we have four strategic pillars. The first is to convene this network of networks that I just mentioned. The second is to work toward enhancing that data foundation. The third is actually to work across the system to catalyze the modelling and forecasting capacity, so we’ll know what we need 4 or 20 years from now. The fourth thing is knowledge translation to action, and that is really about celebrating all of the innovations that are happening across the country and identifying what is working and what is not on a variety of topics.
So those are our major pillars, and it’s underpinned by a desire and need to support equity-deserving populations and very much to support First Nations, Inuit and Métis people and truth and reconciliation. That is the frame. Do we have something that compels us to reflect francophones in particular? No, we do not. However, it is very much part of our fundamental philosophy that population needs-based planning means understanding the needs of minority individuals, francophone or other minorities, and working toward achieving health for all, and that means having different solutions for minority populations than for the majority. We’re interested in looking across that broad landscape and making sure that we have the health workforce solutions which address not just urban centres, for example, but rural and remote; not just settler-based populations, but for Indigenous populations as well; as well as the francophone and anglophone communities.
[Translation]
Senator Audette: Thank you very much. I understand that, but unconscious biases exist. If we sit around a table and we all speak the same language, if the francophone representative isn’t there, we think we’re doing the right thing and forget about it. Don’t you think it’s important, as soon as an organization is set up, to make sure it gets off to a good start, that the foundation is solid and that it ensures representation, and therefore responsibility? I can forget about anglophones if I’m surrounded by francophones. When I have an obligation or a responsibility, I have to check everything, including the women and members of the francophone community. When creating future organizations, shouldn’t we make sure to include a strong and present francophone community?
[English]
Ms. Cohen: I don’t really feel that that’s within my purview to make a recommendation along those lines. It does make sense. From a philosophical perspective, you never want to have a lone voice at the table in any context. I mean, that’s very true of an Indigenous individual at a table as well, where you do not have cultural safety, and you want to create a safe space for all. But I don’t know that I could necessarily comment on that as a recommendation to the federal government.
Senator Audette: Thank you very much.
Senator Clement: Thank you both for being here. I’ll ask my question and then engage with Dr. Wallbridge, but I’ll ask you the question and come back to you.
The question I have for you is about your network of networks that you were describing to Senator Audette. I’m interested in smaller organizations that work with intersectionality. Those are often served by smaller organizations, like the interdisciplinary group at the University of Ottawa which works on Black-health issues. Collecting data is expensive. It’s hard to analyze. So I wonder how your organization is reaching out to smaller organizations who would really provide interesting data for smaller communities.
How do you plan to work with small groups, and how do you see your organization ten years from now? I know you’re going to release the strategic plan, but I’m trying to figure out what your goals are for a longer term.
I’ll engage first, though, with Dr. Wallbridge.
[Translation]
I really like Manitoba.
[English]
I am a senator from Ontario, but —
Mr. Wallbridge: I think this is more of a question for Dr. Cohen, because I am the regulator. She is involved with the organization that is collecting data.
Senator Clement: Sorry. That question is for Dr. Cohen, and I’m going to get back to her. I’m going to engage with you about Manitoba.
Mr. Wallbridge: Okay.
Senator Clement: I’m just saying that my mother was a Franco-Manitoban, a graduate of the University of Manitoba. It sounds like your province has a lack of services in French for psychological services, and I wonder if you know if there are poorer health outcomes because of that for francophones in your province. Oftentimes, my experience, comme francophone, is if we can’t get the service, we’ll find ways to get it. Just because we’re not asking for it doesn’t mean that we don’t need it. So I’m just wondering if you’re aware of that, poorer outcomes.
Then the other thing is, coming back to the need for francophone services, are you working to recognize foreign trained social workers? Are you using the Express Entry program? Are you trying to recruit international social workers to be able to provide services in French in your province?
Mr. Wallbridge: I’m not sure about social workers because, of course, I’d only be focusing on the regulation of psychologists. We don’t reach out to them. What will happen is that someone will inquire of us how to become registered in Manitoba, and I would provide them with information about how to do that. We use a national credentialing portal that is supported by the Association of Canadian Psychology Regulatory Organizations, or ACPRO, which is an organization of regulators in the country. Not all regulators use it, but because we’re smaller, we do. The person would have their credentials vetted or validated through that process, and then they apply to us. Then it ends up becoming very much an individual collaboration with that person.
As an example, I recently had a couple of psychologists apply who were Iranian, and they had difficulty obtaining validated copies of their transcripts from Iran because of the sanctions, so we found another way for them to get us copies of their credentials. We individualized their pathway to becoming candidates in Manitoba. Because we’re a smaller organization, that kind of flexibility is what we do.
Your question was more about us reaching out to organizations to facilitate communication with them. I’d say that, frankly, we don’t. I’m a part-time registrar in Manitoba, and so I respond to emails and inquiries from individuals who are seeking to be registered and work with them on an individual basis to try to facilitate that. That’s how I do it.
Senator Clement: You need funding to be able to do that, right?
Mr. Wallbridge: I can see it is reactive. I have that flexibility, but I don’t have the resources to build relationships. I do have the flexibility to be a little creative, but not in a way that would be more outreach in its orientation, I think, which is what your question was about.
Senator Clement: Yes. Okay. Thank you very much.
Ms. Cohen: Thank you for the time to think through my answers.
You asked me a couple of things. The first one was about working with smaller organizations where we can explore intersectionality. It’s very much a part of what we’re interested in doing, namely to reach out not only to the big data machines, but to all the different actors in the system. It’s critical that we do that.
For example, we’ve started conversations with La Société Santé en français, with the First Nations Health Managers Association and with the Alberta caregivers’ association. These are groups that are critical and that are part of the ecosystem. We will continue to expand into some of the other research groups that look truly at intersectionality as well. I think they’re a critical part of the machinery; we can’t do this without them.
On that other note, though, I will say that there’s a bit of an opportunity for us to lean into the big data centres to say intersectionality is critical. Can you please go off and enhance your data standards to add language spoken? We need to know about Indigenous identity, and that needs to not just be an Indigenous identifier but something that identifies a distinctions‑based approach and other things that identify all of the different aspects of equity-deserving populations so we can measure them and get them into the big machine.
The last thing you asked me was about what success would look like in 10 years. We are very new, so it’s lovely to blue sky, but we really are just getting up and running and putting our first strategic plan together. If I had to put it out there, I would say that in my blue-sky vision, we would have a stronger data foundation for the country that would be inclusive of all the different health care providers, regulated and unregulated. In my dream, it would also include caregivers, because caregivers are an incredibly important part of our health system; they offset the shortages in health human resources every day.
The other pieces, though, I would say, the data just can’t hide behind a wall; it needs to be accessible. People need to be able to understand it, and it needs to be timely.
Furthermore, I would say we need to work toward scenario‑based planning models so that we can look and see if we have more family practitioners. What do we need in relation to nurse practitioners? What about if we put physiotherapy in the mix? What about occupational therapists and pharmacists? How do we move toward team-based care that truly optimizes all of those professions by modelling them appropriately for the future?
Senator Clement: Thank you very much.
The Chair: If I may ask, what would be your recommendations to the federal government to make sure that you can achieve that?
Ms. Cohen: I think we need to continue to invest in data. Data is not something that everybody finds terribly exciting. I’m an epidemiologist; I find it exciting. But a lot of people think that numbers are not that interesting. We need to invest in the appropriate amount of dollars in the data foundation. Data is expensive to capture and collect across the country, and to do all of those things that are required will cost money.
But, as I said, the health workforce challenges that we have are a marathon, and sustained effort that will only be allowed to be monitored and managed over time are required. We need the data so that we can continue to track our progress. My advice to the federal government would be the investments that were made are a very good start and are very important. As we grow, we need to continue to invest in the data foundation for health care for the country.
The Chair: Thank you. Dr. Wallbridge, is there anything else you would like to add to this conversation concerning the role of the federal government in your province but more broadly? Do you have anything else you would like to say?
Mr. Wallbridge: I suppose I would say there are two broad strategies. One would be the shorter-term strategy to work with the provinces to facilitate interprovincial movement, either in person by moving or telepractice. Although that legislation isn’t written by the federal government, the federal government could host, sponsor or cajole provincial governments to try to make progress in that area.
The other one would be — again, it’s not the responsibility of the federal government directly — to advocate to the provinces for funding for training professionals, which is one of the things we’ve talked a lot about in this last hour, not only access to French-language services but access to any services that are, in many ways, limited. The federal government can work to ensure that provincially regulated universities are sufficiently supported to provide that training.
The Chair: Dr. Cohen and Dr. Wallbridge, thank you for your comments and recommendations. This concludes our panel and our meeting today.
[Translation]
Respected colleagues, thank you very much for being here. Thank you for your questions and thank you for this very positive exchange.
(The committee adjourned.)