THE STANDING SENATE COMMITTEE ON OFFICIAL LANGUAGES
EVIDENCE
OTTAWA, Monday, October 7, 2024
The Standing Senate Committee on Official Languages met Trade met with videoconference this day at 5:04 p.m. [ET] to study matters relating to minority-language health services.
Senator René Cormier (Chair) in the chair.
[Translation]
The Chair: Colleagues, I am René Cormier, senator from New Brunswick, and Chair of the Standing Senate Committee on Official Languages.
[English]
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 all for your cooperation.
[Translation]
I would now invite committee members participating in today’s meeting to introduce themselves, starting on my left.
Senator Moncion: Good evening. Lucie Moncion from Ontario.
Senator Audette: [words spoken in Innu-aimun] Michèle Audette from Quebec.
Senator Aucoin: Réjean Aucoin from Nova Scotia.
Senator Mégie: Marie-Françoise Mégie from Quebec.
The Chair: I wish to welcome all of you and 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 theme of health care professionals, one of the seven themes of our study.
For our first panel, we welcome in person: Dr. Jean A. Roy, President of the Médecins francophones du Canada.
Welcome to our meeting. We also welcome the witnesses joining us by video conference. From the Association of Faculties of Medicine in Canada, we welcome Danielle Barbeau Rodrigue, Chair of the Francophone Minorities Network and Director of Francophone Affairs at Northern Ontario School of Medicine University, Dr. Julien Poitras, member of the Board and Dean of the Faculty of Medicine at Université Laval, and Anne Leis, member of the Francophone Minorities Network and professor of community health and epidemiology at the University of Saskatchewan’s College of Medicine.
Welcome and thank you for having accepted the committee’s invitation. We are now prepared to hear your opening remarks, which will be followed by questions from senators. Dr. Roy, you have the floor.
Dr. Jean A. Roy, President, Médecins francophones du Canada: Thank you for allowing me to testify before this Senate committee. I salute the distinguished senators on this committee, in particular Dr. Marie-Françoise Mégie, whom I know well, as we are members of the same association.
I was invited as President of Médecins francophones du Canada, formerly the Association des médecins de langue française du Canada, founded in 1902. This is not a new association.
Médecins francophones du Canada offers continuing medical education and professional development to physicians and health care professionals across the country. We work to enhance the skills of health care professionals so they can provide the highest quality services to the French-speaking population across the country. This is always done with the goal of serving francophones. We also have a mandate to promote well-being, social responsibility and environmental protection.
The association also wants to foster networking — this is one of the points I’ll emphasize at the end of my presentation — and encourage members of francophone communities to work together within their communities, but also in partnership with all francophones across the country and, of course, with the association’s Quebec members.
I’ll begin by introducing myself: I’m a family physician and associate professor of family medicine at the University of Ottawa, and I work on the Montfort Academic Family Health Team. This is the University of Ottawa’s francophone family medicine training unit at Montfort. I’ve also been a physician at Montfort Hospital since 1988.
To give you a sense of my trajectory, I helped create the French family medicine residency program in 1992 in Ottawa. They sought us out, and that’s when I unwittingly landed in medical education and teaching. Over the years, I’ve taken on various responsibilities within the program. I now direct the Ethics, Humanities and Behavioural Medicine program.
I was also involved in the creation of the Office of Francophone Affairs in the Faculty of Medicine at the University of Ottawa and served as Associate Dean for over 16 years. The francophone component of the University of Ottawa’s medical program was born of a recommendation made in 1995 — it’s worth mentioning — as part of a project called Educating Future Physicians for Ontario (EFPO). I constantly remind the students that they are there to serve Ontario’s francophones, who have requested just that — doctors and professionals who speak their language.
I’ve also had the good fortune of working in the field and of implementing the Consortium national de formation en santé (CNFS) plan. Every year since 2000, eight students from outside Quebec and Ontario — and some from francophone minority communities — come to Ottawa to study medicine. I should point out that we make a point of sending them back to their communities whenever possible. That works well, because most of them return to their francophone minority communities for their internships and to meet the people in the community. In that context, I’ve met several of the witnesses I see up on the screen.
I’ve learned a great deal about the needs of these communities and forged lasting bonds. During this whole period, I also worked to transform Montfort Hospital into a first-rate academic institution.
Here’s the best way to describe what I’ve accomplished: I was there at the time, we took a French-speaking community hospital and turned it into a university centre that is gaining quite a reputation and conducting proper research. I now work mainly in clinical research development and medical education.
What I thought I’d highlight in this presentation — we’ll see where that leads us — is my belief that we need to encourage all initiatives that bring francophones together and allow them to network, especially in minority communities.
From what I’ve often heard — and Anne Leis may reiterate the same thing — even francophones in minority communities don’t necessarily know each other if there aren’t many networks. That’s an important first step — that these people get to know each other and work together. That could be among the roles we take on, while trying to facilitate these encounters at Médecins francophones du Canada.
One very important thing I firmly believe — and I might not have said so in the past, because I may have been more naive back then — is that if we don’t manage our own institutions, care and training, whether it’s a clinic, a hospital or a university, it won’t work in the long term, in my opinion.
Professionals must have the opportunity to practise their skills in French in a francophone environment to properly serve the francophone population and maintain a high level of expertise. To go a little further, if there’s a French-speaking occupational therapist or physiotherapist, people need to be able to work together in French in order to create an environment. This has to be done first to get to know the medical terminology and the patient’s language, which are not the same, though everything stems from that too. There are skills and a language to develop to properly care for francophone patients; if we don’t do it, it’s not just about translation, it’s something much more profound and precious than that.
I’d also like to say — and I’m certainly venturing onto a slippery slope — that although we’re happy with francophone-run institutions, and they have ensured our continued existence to some extent, I remain worried about the future. At my clinic, 60% of us were francophone at one time; it was a designated francophone clinic. We recently realized that currently, 40% of us are francophone. This is in Ottawa, an area with many francophones. We have the freedom to choose, since we practise family medicine, but we quickly become saturated. We’re looking for doctors, so we’re going to give preferential access to francophones; otherwise we’ll become anglophones.
I’ve also worked at Hôpital Monfort for 36 years and the ratios are reversed. We’ve gone to 50% English-speaking patients. We can’t turn them away when they come to emergency, but at the same time, I feel it’s a long-term threat. I haven’t spoken to anyone else about this; these are really my impressions and my personal concerns for the future of French and French-speaking health care professionals.
Thank you for your attention. I am pleased to answer your questions.
The Chair: Dr. Poitras and Ms. Barbeau-Rodrigue, we now turn to you. You have five minutes for your opening remarks, and then we’ll open the floor to questions. The floor is yours.
Dr. Julien Poitras, Member of the Board, Association of Faculties of Medicine of Canada: Thank you, Mr. Chair.
Honourable senators, Senator Michelle Audette — a colleague from Laval University — kuei, thank you for inviting us to contribute to the study on the critical issue of offering equitable health care in minority language communities.
I am a doctor and the Dean of Laval University’s Faculty of Medicine, member of the Board for the Association of Faculties of Medicine of Canada (AFMC) and Chair of the Association’s Standing Committee on Social Accountability.
With me are my colleagues, Danielle Barbeau-Rodrigue, Chair of the AFMC’s Francophone Minorities Network and director of the Office of Francophone Affairs at the Northern Ontario School of Medicine (NOSM), as well as Anne Leis, Professor at the Department of Community Health and Epidemiology at the University of Saskatchewan’s College of Medicine.
Together, we represent the AFMC, the voice of academic medicine. It brings together the country’s 17 faculties of medicine and represents nearly 2,700 graduates each year, as well as 11,500 students in pre-doctoral training and 15,000 residents.
The AFMC plays a key role in a number of areas, notably by developing training, such as that on opioids or on cultural safety. It can have a real impact on the teaching done in our faculties of medicine.
We are here to testify on the importance of medical training within the framework of French-language health services, especially in a minority context. It is a critical issue to guarantee equitable access to care for all Canadians. However, equity of access must include linguistic considerations when a patient’s safety could be compromised if they can only speak in their preferred official language.
Over the last few years, Canadian faculties of medicine have invested significant effort into cultural safety and access to medical studies for members of First Peoples communities and black populations. They have done so while recognizing significant needs in this regard, as well as the racism experienced by these communities. We welcome the attention the Senate committee is bringing to equitable access for Canadians in minority communities, and we thank you for it.
Communication between doctor and patient is crucial. Case histories often reveal essential details to establish a diagnosis. The opportunity to tell one’s story in their language of choice is therefore fundamental.
Today, more specifically, we are proposing initiatives to broaden access to care and health services in French.
We have observed a lack of French-language health training outside Quebec, at the University of Ottawa, at the Northern Ontario School of Medicine (NOSM) and at the branch campus in Moncton.
Indeed, many students who study medicine only in English did French-language immersion until the end of high school. Current medical training in Canada is rigorous and subject to strict standards.
Unfortunately, this limits innovation. The resources needed for those innovations are often insufficient. To achieve an equitable offer of care, French-language training options must be developed and integrated into anglophone universities’ curricula.
One model that proved its worth is that of contingents, such as the First Nations and Inuit contingent. This model stemmed from a documented shortfall in services for these populations. Resources were devoted to encouraging vocations early on in the school system by, for example, raising awareness among students in secondary schools. This process made it possible to identify potential candidates for medical studies in the community, who were then prepared and encouraged to apply. Once admitted, a community spirit was created between students from these populations. They were together, they identified with each other, and mentors supported them to help them integrate and maintain their identity. A similar approach could be implemented to identify francophone candidates who want to enter anglophone medical schools.
We could also consider bursary or financial support programs for these students, as well as support to counter linguistic insecurity.
Other examples include the simulated language clinics (SLCs) in Saskatchewan, where workshops give future practitioners the opportunity to consolidate their medical vocabulary in French with a simulated francophone clientele. To make this skill official, we also suggest developing a medical terminology certificate recognized by universities, which will require resources to support its implementation.
In small group training courses, it would be a good idea to offer a French option for francophone students, as well as the opportunity to intern with francophone preceptors. The launch of the new Pathways to Medicine initiative at the NOSM University is a step in this direction.
Lastly, if doctors in training do not speak the language of the minority and an emergency makes it impossible possible to choose a care provider, they must at least have the necessary skills to use an interpreting service effectively.
In closing, the need for resources is great, but above all, it is essential for the Canadian government to send a clear and unequivocal message about the importance of guaranteeing every Canadian access to health services in the official language of their choice, even if it is a minority language. This is the AFMC’s first wish, and everything else flows from it.
We also recommend mandating the AFMC and providing the necessary resources to conduct an environmental scan on this issue and develop a series of recommendations in order to increase available training in minority languages in all faculties of medicine. This could include collecting linguistic data on francophone and francophile students outside Quebec, facilitating access, special cohorts, continuing education, and so on.
Once these recommendations are clearly established, they should be incorporated into accreditation standards for Canadian medical schools. However, to make those changes and meet those standards, we will need significant investments to set up programs and improve the availability of French-language training in all faculties of medicine, not just those that already offer programs in French.
The more we support the graduation of French-speaking students, the more we will help guarantee future capacity to teach, provide preceptorships and offer clinical rotations in French, as well as ensure access to care in Canadians’ chosen minority official language.
Thank you for your attention. Mr. Chair, I’d like to point out that we’re saving a few minutes, since I grouped together the presentation of my colleagues, Ms. Barbeau-Rodrigue and Ms. Leis, so there will not be any more presentations before question period.
The Chair: We are now ready to move on to questions. Dear colleagues, as usual, you will have five minutes for questions, including answers from witnesses. We have rather a lot of time.
Senator Moncion: My first question is for Dr. Roy. You talked about managing institutions and you identified three points, specifically initiatives that support francophones, knowledge and working collaboratively. You talked about managing our institutions and those in the area. Are you talking about the 17 institutions in Canada?
Dr. Roy: I was speaking generally. When we can manage our institutions, it’s easier to function. If we represent a small part of a larger anglophone body or large university, it is not always easy to continue functioning in French. That’s what I meant.
Senator Moncion: When it comes to management, it is therefore by, for and with francophones?
Dr. Roy: Yes.
Senator Moncion: Or does it tend to involve anglophones?
Dr. Roy: It’s not always possible; I’m a realist. I can use an example far removed from me. I am not very familiar with it, so if I make mistakes with my references, no one can be upset with me. When we worked for the Consortium national de formation en santé (CNFS), one of the things we did was recruit students from schools in Alberta. At that time, we were in contact with Campus Saint-Jean, formerly known as Collège Saint-Jean. We organized training sessions with doctors there. We brought them together when I was at the University of Ottawa. We had people we knew, so we could call them and find preceptors and supervisors for our students. Eventually, that campus merged with the University of Alberta. I don’t know the details, but since then, we’ve somewhat lost the plot when it comes to francophones. We kept going with the other contacts we had, but without the Collège Saint-Jean, we lost an institution that was reliable and useful to us. That is one example. Management was lost within a larger body.
We are not going through that at Montfort, but at the Faculty of Medicine here, it’s not always easy. We are the Office of Francophone Affairs, founded in 1995, and we still have to fight for our staff and our rights. We think it’s been acquired, but it’s never acquired. We spend a lot of energy fighting to exist instead of being able to carry out our projects, which are quite interesting and are in line with what people have said. That’s two examples.
Senator Moncion: Are you funded fairly, or is it still a fight?
Dr. Roy: I think the consortium is well funded. It’s a federal initiative that came at a time when Montfort was about to be shut down. We get good funding, which allows us to make great strides in terms of contacts and training. For example, we had great success in Manitoba because there’s a good community and we have a regional coordinator there who finds placements for us. Every year, for 20 years, I’ve given supervisors training in education and it’s working well. The CNFS funds us well too.
Senator Moncion: My other questions are for the Association of Faculties of Medicine of Canada. You talked about language proficiency clinics, which was interesting because you referred to First Nations and Inuit communities. In provinces other than Quebec, how does it work to attract people to those clinics so they can work together and help each other?
Anne Leis, Member, Francophone Minorities Network, Association of Faculties of Medicine of Canada: I will answer because we started those language proficiency clinics with simulated francophone patients in person and with trainers. We had patients who came in, were trained and had to speak in French with medical students in various rooms. During the pandemic, we used Zoom and were able to create a community of medical students interested in improving their medical terminology in French. We now hold regular language proficiency clinics with simulated patients, four to six times per year, that are offered to francophone and francophile students who typically study medicine in English.
We have had participants from the University of Saskatchewan, the University of British Columbia, various institutions in Ontario, Dalhousie University and so on. We have to deal with time zones, but it works very well and the students are very happy when they find the time to participate in this kind of exercise. The goal is to give them confidence and tell them: “You have already learned French, maybe you were in immersion, or you are francophones and studied in English, but you have basic medical knowledge in French.” We just have to give them a boost in confidence. Since they already have a foundation in French, they can start by taking the patient’s history, so we give them clinical cases and set them up in a room with a patient. We then have them repeat the same scenario with another patient. Suddenly they say it is easier the second time, and a little easier the third time. We just have to give them some vocabulary because they do not know all the vocabulary, and give them confidence that it is not an insurmountable problem. I’m not sure if I answered your question.
Senator Moncion: Yes. I have a follow-up question and other questions for other witnesses — I’m sure we will have enough time. The type of follow-up you do for those people from your little groups to see, once they are working, in hospitals in particular…. Are you going to create that type of system to see whether they are able to continue to practice medicine in French? Sometimes people say they learned French but have forgotten it because they don’t use it enough, do not feel comfortable, and then lose it. That is the kind of follow-up needed to ensure that this initiative can continue and expand.
Ms. Leis: Yes, I agree. You talked about evaluating the simulated language proficiency clinics and other initiatives. That is extremely important. One of the challenges we face is that medical students at the pre-doctoral level go on to do residencies. They apply to different places and are not necessarily in francophone communities. If they are not working in a minority community, they might not have francophone patients. It is a gamble, unless we are talking about more established institutions such as in Ottawa, the Montfort, or maybe in Manitoba, as Dr. Roy said, where there is family medicine training in French. It is a challenge, to be sure, but we do what we can.
Senator Moncion: Thank you. Do I still have time?
The Chair: We’ll come back to that. I’m sure there’ll be a second round.
Senator Mégie: My first question is for the Association of Faculties of Medicine of Canada, because the language clinic got my attention. Does it work only when you’re in Saskatchewan or on Zoom, or can you transfer them to other provinces?
Ms. Leis: Yes, that’s exactly what I was saying earlier. Now that we have Zoom, it’s even easier, depending on the number of students enrolled. Advertising is always a challenge. We use Facebook and other platforms, as well as lists we have at various universities, but we don’t always reach students who would be interested. Organizing this is a lot of work. Some students from anglophone universities have participated, not regularly, but one, two or three times. The beauty of it is that we’re focused on medicine, but Franco-santé [Technical difficulties] means we can include students in pharmacy and other professional programs.
However, we have to be able to adapt the scenarios we offer to the participants. That’s an added degree of complexity. It happens on a volunteer basis now. We don’t have a lot of resources. As Dr. Poitras said earlier, this needs to be better integrated into medical schools’ curriculum.
Dr. Poitras: I would add that, in the current context, these initiatives aren’t structured. Students opt in if they want to. Some kind of structure could certainly be introduced. Some medicine programs offer their students different profiles. A francophone profile might be worth trying. That would be one way to provide more structure for this kind of initiative.
Senator Mégie: I actually have a question about the networking that would enable us to expand all that. What ever happened to Franco Doc? It may seem like old news, but I haven’t heard anything about it for quite a while. It might be from before your time. It was all about networking for health professionals in different provinces. Is it still around?
Danielle Barbeau-Rodrigue, Chair, Francophone Minorities Network, Association of Faculties of Medicine of Canada: I chair the Francophone Minorities Network, the network that created Franco Doc through the efforts of New Brunswick’s Dr. Aurel Schofield. We had six good years, from 2015 to 2021. Unfortunately, we weren’t able to renew funding for this wonderful project. As Ms. Leis said earlier, it kind of got absorbed by Franco-santé, but the focus isn’t so much on medicine. The other professions are more involved, more so than our medical students and residents.
As Dr. Poitras said earlier, the good thing about Franco Doc was that it identified a lot of francophone students and residents who were studying medicine in anglophone institutions. That gives us a reason to renew funding for the project. We need to be able to identify our francophone and francophile students and residents so we can build capacity for francophones to deliver care to francophone populations across the country.
Unfortunately, Franco Doc isn’t operational right now, but we do hope to bring it back someday.
Senator Mégie: Thank you.
This question is for Dr. Roy. You said earlier that, initially, 60% of the doctors or professionals were francophone and 40% were not, but that the proportions have changed. Is this just because of demographics? Are there more anglophone patients, which led to attrition? Are there francophone patients who feel they have to speak English because they’re in an anglophone community?
Dr. Roy: I wasn’t talking about professionals. Within the Montfort Academic Family Health Team and at the Montfort Hospital, the vast majority of our professionals speak French. We do get some anglophones, but they eventually learn French because the work environment is very francophone. Ottawa’s population is growing.
I sometimes cite Orleans as an example. It used to be a francophone city, but it’s more anglophone now. That’s not because of ill will on anyone’s part. I like to say that the Montfort Hospital and our clinic are victims of our own success. People are very happy with what we offer, because we do good work. People are interested and want to come to us. That’s what happens. What are we supposed to do if, at some point, we’re no longer serving francophones? That’s not ideal.
Senator Mégie: Thank you.
Senator Aucoin: Dr. Roy, you said a lot of things, including that the Consortium national de formation en santé is funded by the federal government. Are there other initiatives the federal government could take to improve health services for the francophone population?
Dr. Roy: At one point or another, I was part of all those initiatives to teach in French. I worked on that with Ms. Leis for a long time. We were a kind of pilot for the French classes they offer.
I think all those initiatives are good. They’re working. They should be evaluated more. Those initiatives are working. Franco Doc worked, but it was always chasing its next subsidy. I haven’t been involved in that for some time. We were just getting the project up and running, and the funding ended. Médecins francophones du Canada used to be part of Franco Doc, and all of its initiatives should be supported and financed. We have to look at all the opportunities out there and choose what we want to do. All the things we’ve heard about so far are things that have been tried. They would all benefit from funding. The consortium is relatively well funded, which has enabled us to do a number of things. We’ve taken on several of those roles over time.
Senator Aucoin: Do you track stats about the success of those initiatives?
Dr. Roy: That’s a good question, because of the discussion about evaluation. I’m not sure that’s been evaluated.
At this point in my life, I’m working with people who evaluate projects. I really believe in that. We have to evaluate our projects. I haven’t been involved for some time, but I’m still a member of committees that recruit professors. Some elements were evaluated. We know that most of the eight students who participated each year for 20 years went back to minority francophone communities. We miss some, who stay in Ottawa or at the Montfort hospital. We don’t usually like it when they stay here. The goal is to get them back in their region. We had some very encouraging numbers. I don’t remember exactly, but more than 60% of them went back to minority francophone communities.
Senator Aucoin: You talked about training. I thought you were telling us that the future of the Montfort Hospital was secure.
I’m a lawyer by training, and I’ve often dealt with language rights. The Montfort Hospital hasn’t always been in the position it’s in now. Do you have any guarantees that the Montfort Hospital isn’t going anywhere and that governments will follow through on commitments to ensure teaching and training of doctors and health professionals for the long term?
Dr. Roy: I’m more optimistic than I used to be. I was there during the battle. At one point, there were six family doctors left. I was one of them. The hospital came this close to closing. We fought. We now have an institution that works well in French and trains quite a few francophones.
Can we be sure we’ll be around for the long haul? I’ve learned that we can never have long-term certainty about anything to do with francophone rights. We always have to fight to some degree. Let’s just say things are fairly calm at the moment. The big issue now is attrition and an increasingly anglophone population. I’m not sure how to solve that problem.
We also have to respect the Canadian Charter of Rights and Freedoms. We can’t refuse to care for people. That jeopardizes things for the long term.
Our clinic is smaller, and we have emergencies every day. We have the luxury of choosing our patients, which we don’t like doing. However, the fact is that we exist for francophones, so we have to serve francophones. Nothing is guaranteed. I’m well aware that the situation is always precarious.
Senator Aucoin: Thank you.
The Chair: My first question is for Dr. Poitras. You laid out several possible measures to improve the availability of care in French. Am I right in thinking that there are several initiatives of all kinds put forward by different groups to foster language skills, but that there’s a lack of internal structure to make these initiatives stand the test of time and ensure that training is solidly integrated into university health centres? What are your thoughts on that? I’m asking Dr. Poitras, but this question is for everyone.
Dr. Poitras: I can confirm what you’re saying. We’ve seen some excellent initiatives, but they’re one-off things by individual faculties. There’s no alignment to provide an overarching structure for those efforts.
In my introduction, I mentioned an initiative, which can help us move in that direction, connect a number of those initiatives and provide more structure through solutions that weren’t identified on an individual basis but could be implemented more broadly by all medical faculties and the Association of Faculties of Medicine of Canada. That kind of work is already being done around certain specific problems.
Ms. Barbeau-Rodrigue: I can speak to what’s happening at my university. We were a faculty until 2022, and we’re now a university. We’re now the Northern Ontario School of Medicine University.
We’ve never had funding specifically for francophones, although we’ve always had a francophone admissions stream. Our social responsibility mandate requires us to meet the needs of all northern Ontario populations, including francophones, even though our program has always been taught in English only. It’s bizarre to talk about recruiting francophones, only to teach them exclusively in English.
The university’s Francophone Affairs Unit has been around since 2005, but we haven’t received funding to do anything significant.
We started offering optional sessions to francophone and francophile students.
Since 2022, we’ve taken on the mission of creating what we call the Francophone Curricular Initiative. This is not the full program; it’s sessions that teach the same curriculum anglophone students learn, but in French. It’s one small step, because our anglophone colleagues get scared when we offer too much French, unfortunately.
We’re seeing some pioneers among our francophone students. These examples demonstrate what could happen with more funding and strategic planning.
As Dr. Poitras said, the Association of Faculties of Medicine of Canada believes that having something national in scope would have a huge impact on the delivery of health care in French because more French-speaking health care practitioners could be trained.
The Chair: I asked that question because we have to write a report and make recommendations to the government. You talked about funding, but what’s the best way to build a long‑lasting structure that will ensure the delivery of care in French in the future?
Funding is important, but are there other mechanisms that are important, too?
Ms. Leis: I’d like to refer to the text Dr. Poitras read earlier. I believe the question is this: What can the federal government do about training that’s usually under provincial jurisdiction?
The federal government has a duty to support Canadians via all the services they receive in their language.
The Association of Faculties of Medicine of Canada could say that those faculties have a social responsibility to find ways to provide training in French, identify francophone and francophile students and identify initiatives that can fund their curriculum.
There would have to be a requirement or a mandate that transcends turf wars. This isn’t about having one option or nothing.
In Western Canada, people think there aren’t enough francophones for this to be worthwhile. They think it would be too costly. The minority is never in the right. I think there is a way to figure out how to put pressure on the institutions that train health professionals, including doctors.
The Chair: You didn’t really speak to the issue of mobility or barriers to interprovincial and interterritorial mobility. What are your thoughts on that? That’s a barrier to service delivery in French, because provinces have standards that hinder greater mobility.
Dr. Poitras: By mobility, do you mean student mobility?
The Chair: Yes, student mobility, but also doctors who have completed their training.
Dr. Poitras: It’s important to remember that medical training has two main stages: pre-clerkship and clerkship. This usually takes four or five years. Residency then takes two to five years. There’s a lot of mobility during residency.
Students who have completed their undergraduate work can do their residency anywhere in Canada and go to different universities. These days, that mobility involves an exodus from Quebec, with francophones doing their residency outside Quebec in anglophone or francophile faculties, depending.
There does seem to be a problem with mobility the other way around. We usually have about 80 vacant family medicine residency positions in Quebec, while students in the rest of Canada have trouble finding residencies.
It would be beneficial to improve the French-language aspect for our students in anglophone faculties so they can access that mobility and graduate more doctors with skills in family medicine and other specialties.
The Chair: Thank you for the answer.
Dr. Roy: That was well explained. We don’t have much control over residency.
The CNSF has explored the possibility of subsidizing French‑language residencies. It is quite complicated and very expensive. Residency is paid for by the provinces, which is an obstacle. It is also an obstacle to returning francophones to their region; obviously, these people are 25 or 30 years old.
There’s a competition across Canada, so they have no choice. They apply and indicate where they want to go first, but they may end up somewhere else. Often, they meet the soulmate, and the francophone trained to return to Manitoba will end up in Montreal or elsewhere. It’s a complex situation.
It would take two hours to discuss it with experts, but it would be interesting to perhaps talk about residents.
Doctors are fairly mobile in Canada; there aren’t really any obstacles. It’s not very complicated to work in another province.
Senator Audette: Greetings to my colleague. I’m glad to see you.
Now, my question is for you. Thank you to everyone who has spoken so far.
You mentioned that there are places reserved for First Nations who wish to enter a medical school in Quebec. There are four faculties; I can’t speak for the other territories across Canada.
Today we have to say no. There’s a lot of demand, and that was negotiated in the context of First Nations self-determination to return to their territories due to lack of staff. Was the purpose of this to suggest that faculties make sure they reserve spaces for a francophone student who lives in Manitoba or British Columbia, in the hope that they’ll get a spot or two — I don’t know, it’s up to you to decide — and that the federal government can support that kind of initiative?
I think your measure is good for Quebec, as I see it across Canada. To come back to my original question, is there any hope that this new generation will be able to provide the services to which everyone is entitled, regardless of the language spoken, in this case French?
Dr. Poitras: Yes, Senator Audette. I should point out that quotas also exist for First Nations in other Canadian faculties outside Quebec. My proposal is along those lines, not to reserve a quota for Quebec, but rather in the various English-language faculties. As we were saying earlier, having a quota allows things to be well structured and requires an effort to encourage vocations among students very early in their path, even in high school.
It also means “preparing,” in quotation marks, for their integration into a medical faculty, as well as building a community. As you said, this has been very successful in Quebec. It helps to develop a sense of community among the students, who recognize each other, who can be accompanied by mentors who have followed the same path, and who will persevere in their studies and develop a strong identity and healthy practice within their community. It is also a practice that serves francophone communities, whether in Western Canada, Central Canada or elsewhere.
That’s the spirit of our proposal today. My colleagues Anne and Danielle may want to add to my answer.
Ms. Leis: No, I think you’ve answered the question very well. Sometimes, we have students who speak French, but I think they’re afraid of having an additional workload if they study in French or do extracurricular workshops, on top of the curriculum, which is already very demanding.
If there were more legitimacy in doing a course or part of a course in French, I think it would help students adopt the French fact more easily. At the moment, it’s often seen as an extra burden. It’s nice to have it, but there’s no obligation.
Anything we can do to make training more structured, attractive and desirable, for example, with scholarships or incentives, could help.
Senator Audette: Thank you.
The Chair: Dr. Roy, would you like to answer the question?
Dr. Roy: I’ll be very quick.
As we have shown in New Brunswick — particularly Dr. Aurel Schofield — when people do internships in the regions, they are much more likely to return. The reason is simple. Being a doctor isn’t an easy job, and it requires a lot of skills and sensitivity, and if I say to myself that I would like to go back to work in a clinic in the far north without ever having been there before, I won’t go, because I’ll want to stay safely at home. So we have to think about recruiting in the communities and returning to them. These are key elements that proved so effective in the case of the CNFS.
The Chair: Thank you.
Senator Moncion: I know that at the Northern Ontario School of Medicine, there were designated spaces for Indigenous individuals at the time, but I don’t think there were necessarily any for francophones. So, it was for the best, but there were places that were reserved for Indigenous individuals; it worked, because you still had a good recruitment pool.
Do we have designated places in universities outside Quebec? Is that something that universities with medical faculties might think about putting in place in terms of the number of spaces for francophones and Indigenous individuals, with a slightly smaller number for anglophones?
The Chair: Go ahead, Ms. Barbeau-Rodrigue.
Ms. Barbeau-Rodrigue: Thank you very much.
All medical programs are subject to quotas, which means that each university has a limited number of places.
At the NOSM University in northern Ontario, there are only two designated spots for Indigenous candidates. Exceptionally, this year, 13 Indigenous students were admitted. It’s the same thing for francophones; the number is limited to 16, but we have 22 francophones who identify as such. So you’re right, we don’t have designated spaces for francophones, but we have always had a lot more than what was recommended in 2005, when a report produced by the community called for seven spaces. So it’s good that we didn’t follow that recommendation, because we would still be at seven spots today.
That’s the reality at many universities, that places are allocated on a quota basis, and it seems to me that some are assigned to Indigenous students. I obviously don’t know all the universities, but they’re starting to do the same thing with black candidates to try to balance the proportions in the classes. So this is a phenomenon that we’re seeing just about everywhere.
On the francophone side, I see this as an even greater challenge because of the lack of training in French, which means that spaces aren’t offered, even though there are francophone students in all the faculties.
The Chair: Thank you.
Senator Moncion: Are there initiatives between French-language universities to have exchanges in medical programs or to obtain expertise?
The University of Sudbury, for instance, offers courses in co‑operation with the University of Ottawa, so that students have access to certain courses. Are there any such opportunities, so that universities offering programs in French can also offer programs remotely? Are there partnerships between universities offering medical training programs to exchange good practices in French?
Ms. Leis: Let me give you an example. The medical terminology certificate that we’re setting up at the University of Saskatchewan is a partnership with the Cité universitaire francophone de Regina, which will be giving upgrading courses in French, and with the University of Manitoba, with Dr. José François. They do upgrading courses in French and medical terminology with their first and second-year students. We could benefit from some of these workshops.
That’s one small example, but generally speaking, in terms of curriculum, I don’t think that exists between English-language universities; each has its own program and teaches it.
The Chair: Thank you.
Dr. Poitras: We’re starting to collaborate more. There is a difficulty, however, in that provincial systems are isolated from one another, and it’s not always easy to exchange students or others. We sometimes come up against certain administrative difficulties, even if there’s a willingness to do things. We also have a project at Laval University to expose our students to internships in areas where French is the minority language. We think this will help them develop an understanding of this reality and then integrate it into their practice, and even make them want to invest in a practice in Saskatchewan or Alberta, for example.
Ms. Barbeau-Rodrigue: I would add that in terms of professional training and maintaining the skills of physicians who are already in practice or are residents, there would probably be more exchanges and sharing between provinces and between institutions. I think it would probably be a little easier than with students.
The Chair: We understand that there are administrative barriers.
Senator Aucoin: I will continue in the same vein with the case of Nova Scotia. I know that the Université de Moncton doesn’t accept francophone students from Nova Scotia. It’s a new faculty of medicine. There are one or two spots reserved at the University of Ottawa and in Sherbrooke, but to my knowledge, Dalhousie University doesn’t have a program in French or any spots reserved for francophones.
As far as I know, there are no exchanges with the University of Ottawa for francophones.
Is there anything to be done in these areas with Canada’s English-language universities, which accept our francophone students because there are no other places in Canada?
Dr. Roy: That is a great question. Clearly, we talked about continuing medical education and professional development; this is already something that is more open-ended, where there are already collaborations, whether it be from an educational point of view — with Manitoba, for example, we’re doing things like that. However, I think it all works out. If there are professionals in practice who know each other and work together, it will be easier to receive students from other provinces for internships, for example. So if we can encourage these partnerships and sharing in the communities, I think we’ll be better off, because that’s what we need.
The Chair: Dr. Roy, Dr. Poitras, Ms. Leis, Ms. Barbeau-Rodrigue, thank you very much for your testimony and your answers, which have shown us just how complex it is to reconcile the different realities of medical training in French. Your comments and suggestions will certainly help us in our report.
Thank you for being here this evening. We’ll suspend briefly to welcome our next panel.
Colleagues, we will now resume our study on minority-language health services under the theme of telemedicine and new technologies.
We now welcome, in person, from the Competition Bureau, Anthony Durocher, Deputy Commissioner of the Competition Promotion Branch, and Flore Kouadio, Acting Senior Competition Law Officer, Competition Promotion Branch.
By video conference, we have Norma Ponzoni, Associate Professor and Clinical Nurse at McGill University, Facilitator of the Telehealth Program at the University of Moncton, and Chadia Kombo, Assistant to the Director of the Clinical and Academic Computerization Division of the Centre hospitalier at the Université de Montréal and Head of the Telehealth Coordination Centre for the RUISSS territory, Université de Montréal, Réseau québécois de la telesanté.
You all have pretty important titles; we’re looking forward to hearing what you have to say.
[English]
Welcome, and thank you for joining us this evening. Let’s start with your opening remarks, to be followed by questions from senators.
[Translation]
Ms. Kouadio, the floor is yours.
Flore Kouadio, Acting Senior Competition Law Officer, Competition Promotion Branch, Competition Bureau Canada: Good morning, Mr. Chair and ladies and gentlemen of the committee. I thank you for inviting us to appear before you today.
[English]
I would like to begin by acknowledging that I am addressing you today on the traditional, unceded territory of the Algonquin Anishinaabe people.
[Translation]
My name is Flore Kouadio, and I am an Acting Senior Competition Law Officer with the Competition Bureau’s Policy, Planning and Advocacy Directorate. With me today is Anthony Durocher, Deputy Commissioner of the Competition Promotion Branch.
[English]
The bureau is an independent law enforcement agency that protects and promotes competition for the benefit of Canadian consumers and businesses. We do this work because competition drives lower prices and innovation while fuelling economic growth.
[Translation]
We administer and enforce the Competition Act. We investigate and take action against anti-competitive business practices, including price fixing, deceptive trade practices and abuse of dominance. We also review mergers to ensure they do not substantially harm competition. Finally, we promote policies and regulations that foster competition.
In July 2020, the bureau launched a market study of the health care sector in Canada, focusing on how to support digital health services through policies that promote competition. These policies can drive innovation, increase choice and expand access to digital health services across the country.
[English]
Following a public consultation, the bureau identified three main areas of study.
The first one is data and information. The bureau examined ways to improve access, use and sharing of digital medical data and information, including considering how their exchange and interoperability can improve the competitive landscape and accelerate the development and adoption of digital health services.
[Translation]
The second area of the study is goods and services. The bureau examined issues related to the development, approval, procurement and marketing of digital goods and services.
The third area of study concerns health care providers. The bureau examined the capacity of health care providers to deliver digital care to patients and more specifically issues related to billing codes, compensation, licensing and scope of practice.
[English]
It is important to note that the use of official languages in the health sector was not a subject of study.
[Translation]
The bureau’s mandate is limited to protecting and promoting competition. However, a competitive market requires businesses to adapt to the needs of consumers, which may include the languages in which they offer their services.
This leads to more patient-centred health care.
[English]
Before answering your questions, I would like to say that the law requires that the bureau conducts its investigations in private and protect the confidentiality of the information we obtain. This obligation could prevent us from discussing some of our current and previous investigations.
[Translation]
I would like to thank the committee again for the opportunity to appear here today. We will be pleased to answer your questions.
The Chair: Thank you for your opening remarks.
[English]
Norma Ponzoni, Facilitator, Telehealth Program, University of Moncton: Thank you.
Good evening, distinguished senators and colleagues. I have been invited to share my experience as a nurse educator and frontline health care worker in Quebec. I have been a nurse for 26 years, and I am currently an associate professor at McGill University and a nurse clinician at the McGill University Health Centre. In order to situate myself in this conversation, I would also like to disclose that my mother tongue is French.
For Canadians, navigating a health care system where clinicians do not speak their language can be intimidating, fear inducing and, in some cases, life-threatening. Today I’ll present three key recommendations for your consideration.
First, fully consider the effect of new policy changes. In Quebec, there are a number of new political decisions that will likely prove to be harmful to its minority English-speaking community. An example is the recent establishment of santé Québec as a central administrative body for health care management. While this is a well-intentioned strategy to ensure better resource allocation, in reality, this kind of policy does not take our complex fabric into account. The assumption that any health care provider can be switched out to an area where there are service gaps does not take into consideration language proficiency or the professional expertise that has been developed over time in working with particular communities or cultures. As we know, care is relational. Severing these relationships for the sake of mobility can be harmful to the establishment of trust.
Another example is Bill 96, which limits the use of English in certain health care contexts with the office de la Langue française conducting audits to ensure that French is spoken in the workplace. While the protection of the French language is laudable, forcing clinicians to communicate in French in traditionally English-speaking institutions where French is likely a second language to both parties is illogical. More importantly, it is taxing and anxiety provoking for overworked clinicians that have already proven their French-language proficiency to obtain licensure.
I recommend that federal funding be attached to the obligation to consider and mitigate the impact of such policies on the linguistic minority — be that French or English — depending on province.
Second, ensuring the training of health care providers in the language of the linguistic minority. When health care providers are able to communicate with patients in their preferred language, it directly impacts quality of care and overall health outcomes. Moreover, it improves patient safety by reducing misunderstandings and errors. Patients are more likely to share crucial details about their symptoms, medical history and concerns in their preferred language. Sadly, in Quebec, according to Statistics Canada, 40% of health care workers in Montreal and 60% of providers in the rest of the province could not hold a conversation in English.
My personal recommendation here is twofold. First, provide funding for language training to all health care students and providers to ensure that there is adequate proficiency in French and English in provinces such as Quebec, New Brunswick and Manitoba where there are pockets of English or French being spoken by a minority. Second, given the importance of clinical training to the formation of health professionals, consider protecting certain hospitals, clinics and health and social service systems as the training ground for programs offered in the language of the linguistic minority.
Third, fund multilingual resources. We must recognize that millions of Canadians speak neither French nor English as their first language. Offering professional interpretation services, digital translation systems and translating essential health care documents into the most widely spoken languages within a given community would contribute to creating more welcoming environments for all patients. These measures must be available in all health care settings from urban hospitals to rural clinics and Indigenous health centres.
My recommendation here is that the federal government ensure adequate funding for the translation of health-related websites, teaching materials such as pamphlets and posters, manuals that accompany medical equipment, et cetera, and create incentives for this to be done systematically.
In conclusion, the measures I recommend will contribute to a more inclusive and fair health care system for all. Thank you.
The Chair: Thank you, Ms. Ponzoni, for your very clear statement.
[Translation]
Chadia Kombo, Head, Telehealth Coordination Centre for the RUISSS territory, University of Montreal, Réseau québécois de la télésanté: Good afternoon. Honourable senators, I’m pleased to speak to you today on behalf of the Réseau québécois de la télésanté. Our network brings together telehealth respondents from Quebec’s 34 health care institutions, as well as telehealth coordination centres.
The Réseau québécois de la télésanté plays an essential role in the development and implementation of telehealth services in Quebec. As manager of the Telehealth Coordination Centre for the RUISSS territory of the University of Montreal, I am particularly invested in this undertaking.
In Quebec, telehealth is defined as all health and social services activities offered remotely thanks to information and communication technologies. It greatly facilitates access to care, thanks to personalized and appropriate follow-up for patients at home in real time, and it also reduces the length of hospital stays by encouraging patient autonomy and giving them the tools and knowledge they need to manage their own health.
Telehealth enables patients to stay at home; it improves their quality of life by preserving their social ties and saving them money.
It’s crucial to point out that language barriers represent a major obstacle for some patients. Telehealth language barriers can not only limit access to services, but also compromise quality of care and patient satisfaction. Language barriers can have detrimental consequences on the quality of care, and these impacts are magnified in the context of telehealth.
In the context of telehealth patients are often asked to take responsibility for part of their care, for example by taking health samples themselves, such as blood sugar levels for diabetes, which is a chronic disease. They may also be asked to adjust their own treatment according to their symptoms. If the instructions are not understood, the patient may not adopt the right behaviours, and put his or her health at risk.
Mutual understanding between the health care professional and patient is a pillar of the therapeutic relationship.
Telehealth offers many online resources, but these resources must be accessible to all. Patients who are not fluent in the official language may have difficulty navigating these platforms and finding the information they need. This limits their power to act and their feeling of being a player in their own health. Linguistic misunderstandings can also lead to misdiagnoses, which can have serious consequences for patients’ health. Poor communication can lead to treatment non-adherence, reducing the effectiveness of care.
So, the recommendations I want to make today would include having real-time interpretation services to ensure fluid, personalized communication during virtual consultations and promote better understanding of the patient’s needs and appropriate adaptation of care.
However, it is essential to ensure that interpretation services comply with medical data confidentiality and security standards. Telehealth platforms should be equipped with integrated interpretation functionalities. This would facilitate access to this service for both patients and health care professionals.
Establishments should also be able to produce information documents; these should be clear, precise and concise in the different languages, to enable patients to better understand their condition, follow their treatment and make informed decisions about their health.
Online resources should be updated regularly to ensure that they meet the specific needs of each language community.
Thank you.
The Chair: Thank you for your statement. We’re ready to move on to questions and answers from senators and witnesses.
Senator Mégie: My question is for Ms. Kombo, but I thank all the witnesses for coming to help us with our study today.
How long has telehealth officially existed in Quebec? At one point, there were doctors who wanted to use it, but this was long before COVID-19 and it was really difficult, because the Collège des médecins du Québec refused. How long has it been openly accepted?
Ms. Kombo: Telehealth has officially been around for quite a long time, but indeed, we’ve seen an acceleration in the use of telehealth services since COVID-19, particularly teleconsultation. Doctors have become very involved in these services, offering care to patients who need it. Since the health emergency was lifted, we’ve seen a decline in the use of technology to provide patient care.
Senator Mégie: So you did you notice a drop after COVID-19?
Ms. Kombo: Yes, there was a big drop then.
Senator Mégie: Are you aware of how doctors are paid for consultations? That used to be the criticism that explained why they didn’t want to use it.
Ms. Kombo: Exactly. Currently, physicians are paid for teleconsultations through RAMQ; they are also paid for teleinterpretation. For example, radiologists who interpret scans or radiology scans are paid according to the number they examine. That’s how they’re paid. I know there are discussions about doctors getting paid for deferred-time teleconsultation. There’s a difference between real-time teleconsultation, which we’re talking about today, which is recognized teleconsultation, but there were also aspects of deferred-time teleconsultation that posed a problem in terms of remuneration. Last I heard, this should be resolved soon.
Senator Mégie: Thank you. I have one last quick question.
With regard to respect, although you know that there is good respect for confidentiality standards relating to patients’ personal data…. I don’t know how we can go about respecting the standards, especially if we need interpretation; in Quebec we might need interpretation in English for English-speaking communities.
I don’t know if you’re the only one or if others could speak to us about privacy standards in this regard.
Ms. Kombo: Some establishments, at least in the territory I manage a little, had set up interpretation services during the COVID-19 pandemic. In fact, this was a really essential service, and they made agreements concerning this. When we have establishments that would like to extend this kind of service in our network, we put them in touch so that they can develop it in the same way as it has been developed in other facilities.
That’s the way we do it, but we’ve heard that these interpretation services are expensive, because these people have to be available 24/7, because you never know when a person will need this service. Some establishments have had to cut back on these services and use technologies that provide real-time interpretation. We know that on Teams or Zoom, this service could be developed, but it requires an investment.
Senator Mégie: Thank you very much.
[English]
The Chair: Ms. Ponzoni, you spoke about certain barriers coming from the provincial legislation. Would you consider that new technologies could better respect patients’ language rights? You didn’t speak about that. In Quebec, for example, would the new technologies serve the issues that you raised?
Ms. Ponzoni: New technologies such as?
The Chair: For translation, for example, to ensure that you have services so that English-speaking Quebecers could be served in their language. What is your point of view about the use of new technologies, and, if it is relevant, what can the federal government do to help that?
Ms. Ponzoni: I did talk about the digital translation devices that have been shown to be effective in helping clinicians offer care or to discuss and have a conversation with patients in the situation of a linguistic minority. The problem is when clinicians have very little or no proficiency, for example, in English, it is hard to tell if the translation that is being offered by a device is correct or not. I would hesitate to be solely reliant on a device when I couldn’t really tell the reliability of what is being said.
The Chair: Are there certain regions in Quebec that services in English are more difficult than others?
Ms. Ponzoni: Even on the Island of Montréal, often we have to refer our patients to community care services, or CLSCs, in a particular region, in the east of the island, for example, where English services aren’t necessarily guaranteed or clinicians will really have a hard time addressing English patients’ needs.
The Chair: Thank you for those answers.
[Translation]
Senator Moncion: My question is for Competition Bureau Canada.
I’d like to talk about medical records. I think you mentioned them when you talked about digital information sharing. I know that, for example, doctors who have all kinds of scans and follow-ups done are the owners, if you will, of all the tests they’ve had done for their patients, unless I’m mistaken.
Personally, at the moment, the only information I have access to is blood test results. With the company I deal with, LifeLabs, that’s the only information I have at the moment, and my doctor receives the results of all the other tests. So if I go to another city and have an emergency there, I’ll probably have to take all those tests again, whereas if I had access to my medical records in one place, doctors could see how recent the information is. I’d like to hear from you about the competition that exists between doctors over ownership of all these tests.
Ms. Kouadio: In our first report, we addressed the issue of sharing digital health data and information. Sharing can take place between health care professionals, but also between doctor and patient. One of our recommendations was to facilitate data sharing. The competition we found at the time of our market research revealed that 86% of family physicians providing primary care services were collecting and using electronic medical records, but only 25% were sharing information.
Our recommendation in the first report was to have measures that would facilitate information sharing between patients and physicians and also between physicians. One of the aspects to consider is that, at the time of the study, there were mainly three companies designing and producing these systems: TELUS Health, QHR Technologies and WELL Health Technologies Corp. were the most dominant on the market.
Through pro-competitive policies that would facilitate data sharing between patients, physicians and the various systems that health care providers use, it would be possible for new companies to enter the market more easily.
Senator Moncion: As for banking, financial institutions want to keep their customers’ information and don’t want to share anything, but laws have been passed so that we have open banking systems, where all a person’s financial information belongs to them and they can choose to share with the financial institution of their choice. I’d like to hear what you have to say about this concept.
I understand you’re with Competition Bureau Canada. I don’t know if this still exists, but is it something that could be regulated and implemented in the Canadian health care system?
Anthony Durocher, Deputy Commissioner, Competition Promotion Branch, Competition Bureau Canada: It’s a very interesting parallel with banking. On the one hand, data exchange promotes competition and innovation, but we must always recognize that this must be done securely and effectively to protect confidential information. If we look at both medical and financial information, these need to be well protected so that people are confident.
For several years now, we’ve been promoting the importance of having a regulatory framework for open banking to promote competition. It’s an issue we’re following very closely. Since the publication of our report, we’ve noticed in recent years in the digital health care sector that there is a certain window of opportunity to take steps to ensure that all levels of government fully understand the importance of sharing digital data. For example, Bill C-72, which is still very recent, had some very positive aspects in terms of recognizing the importance of health data sharing.
Senator Moncion: Except that once again they failed to include linguistic components to recognize the rights of francophones in this bill. We have that information. Still, there’s a certain openness on this.
With regard to data ownership, do you intervene on this, or do you only get involved in competition that takes place between different companies?
Mr. Durocher: We intervene in competition between companies in particular. Often, there are also questions of intellectual property, and these are complex issues involving the application of the Competition Act when it comes to determining who owns the data. These issues are often settled in litigation. The question is whether the data belongs to the consumer, the patient or a company. It’s a very specific question. These are quite complex issues that pertain to intellectual property.
Senator Moncion: Thank you.
Senator Aucoin: Since your report and since the introduction of Bill C-72, have you noticed if there have been any discussions, or if the companies that had this data have established better collaboration? Can the Competition Bureau do more to encourage data sharing?
Mr. Durocher: As for collaboration between companies, we don’t know the file very well. To a certain extent, the Competition Bureau Canada doesn’t want companies to collaborate too much and compete with each other. We’ve noticed a little more cooperation between governments. Last October, federal, provincial and territorial health ministers approved a joint action plan on health data and digital health, which includes interoperability standards. The basis for information exchange is to have systems where we can talk to each other and where a common technology facilitates the exchange of information. This is exactly what we see with open banking. Everyone has to get along. It’s the plumbing behind the system. These are pretty positive steps that show we’re starting to prioritize exchange between systems.
Senator Aucoin: Thank you. My question is for the people who are on the video conference. You talked about artificial intelligence and a decline in telemedicine. Is there any reason to consider whether there might be a way of making telemedicine more widely used? We know that it can be much cheaper and, up to a point, more efficient. Can you comment?
Ms. Kombo: In our network, we’re looking at how we can get users on board with telemedicine, but more broadly with telehealth.
When the pandemic started, everyone got on board. We saw large numbers. Teleconsultation proved that it could be a sustainable service, and above all, patient users were very satisfied with it, but we’re now facing a downturn.
When we interviewed clinicians to understand what was behind this decline, red tape was often mentioned. It’s much easier for a doctor to pick up the phone and call his patient than to use Teams, which is the Quebec government’s preferred tool for everything to do with teleconsultation. We know that Teams is cumbersome and has many features, which makes it difficult for doctors to sign up. You have to send links by e-mail. We have people whose literacy level may be low, or who have problems with the internet, or who don’t have the technological tools needed to benefit from video teleconsultation. The patient must have the appropriate equipment. These are the obstacles that will make doctors or professionals use the telephone more.
What we’ve shown in our network is that the telephone can’t be put on the same level as a video consultation. There’s the whole non-verbal or visual side of the patient that’s not taken into account by the telephone. What’s more, a video teleconsultation is a set time; it’s like an appointment. It’s exactly the same as when a patient has a medical appointment and goes to see his or her doctor. The telephone is spontaneous. The patient may be doing something else. When we call, if there’s a language difficulty, it will be exacerbated by the fact that we lack visuals.
All the steps we want to put in place to increase the use of telehealth run up against change management, but also against a paradigm that assumes doctors can offer these services. Some things could help. When we train professionals, we should integrate this notion of telemedicine or telehealth into academic training. This is not currently offered to either doctors or nurses, who are the main users of this tool with their patients.
Senator Aucoin: Thank you.
The Chair: Ms. Ponzoni, I’d like to hear what you have to say about the telehealth program at the Université de Moncton. You would have worked on setting up this program. How was the program developed, why was it developed and who was involved in its creation? You were very important in setting up this program. Could you tell us about it?
[English]
Ms. Ponzoni: The program was developed with a colleague of mine, Dr. Antonia Arnaert, at the request of the University of Moncton to be able to offer content on telehealth to their francophone students. My colleague had a certain expertise in telehealth, so together we built these educational modules that are offered as professional development for health professionals in New Brunswick.
If I could also address the previous question, it’s important to also consider the digital literacy and the age of the users on the receiving end. The health professionals being trained to use something like Teams is important, but on the receiving end, the digital literacy of users is not always adequate to ensure good communication or even to be able to connect with patients reliably. In addition, some programs will offer iPads or other devices to help them connect, but that’s also not guaranteed. Not all programs offer technology to the users, so access to computers or even smartphones is not a guarantee in terms of the users’ budgets, for example.
[Translation]
The Chair: You are right to raise that issue. Are there any other comments about access problems in remote regions, including internet access? What can you tell us about that? Who wants to answer? It is a real issue, and you can’t have one without the other.
Ms. Kombo: There is an internet access problem with patients. Some programs offer patients tablets with mobile data. Even that is not enough. There are patients who cannot access telehealth. There is an entry barrier that already makes telehealth services inequitable. Some patients are excluded. Even programs that offer tablets with mobile data cannot provide the service if there is no coverage in the region. Teams sucks up a lot of data, but that is the platform chosen by the ministère.
These populations should benefit from telemedicine. We developed a grid to keep track of the money patients save by not having to go to a medical service that could be hundreds of kilometres away from where they live. We realize that patients save a lot of money by not travelling. Unfortunately, we have no solution for the people who pay the most, because they are out of internet range. The challenge remains.
The Chair: What would you recommend to the federal government in this area? Do you have a recommendation that we could pass on?
Ms. Kombo: It would be finding a solution to bring the internet to them. I know there has been talk of using satellites for northern regions. That was one avenue on the table. Unfortunately, once again, the funding is not there. Northern populations would greatly benefit from the telehealth services provided in urban areas, but they have no access because they are out of internet range.
My recommendation would be to explore the avenue of satellites to provide these services to remote regions.
The Chair: Thank you.
I will continue with the people from the Competition Bureau Canada. Is this a competition problem or not? What can you tell us about it? Internet access is a major issue. I won’t mention the situation in my own province. Too often, there is a lack of competition. Cellphones are a prime example. What can you tell us about this issue?
Mr. Durocher: Competition in the telecom sector remains one of our bureau’s priorities. It is also one of the areas where we receive the most complaints by Canadians. Our role is to protect and promote competition. We make recommendations to the CRTC about the regulatory framework for internet and wireless in order to promote competition and find the right balance between affordability and incentives to invest, especially in remote regions.
Our bureau’s role in terms of protecting competition is to implement the Competition Act. There are many aspects. First of all, we do merger reviews to prevent excessive market power.
For example, we recently filed an application to the tribunal to block the transaction between Shaw and Rogers. Unfortunately, we lost the case and the transaction was allowed to go ahead. That is the kind of implementation I was referring to.
The Chair: Why did you lose?
Mr. Durocher: We asked them to block the merger. The Competition Tribunal determined that the merger caused no substantial reduction in competition. We appealed the decision, but unfortunately, the Federal Court upheld it.
The Chair: Thank you for the information.
Senator Moncion: I will continue in the same vein, and then I will have a few questions for the Competition Bureau representatives.
You mentioned the quality of the interpretation for people online. You said that interpretation was important and that it should be done by humans, not machines. We have heard from witnesses from the North who work with the Inuit. They often use iPads, and they told us that the interpretation worked very well for their work with the Inuit.
Why does the interpretation work with the Inuit but not at the CLSCs for people who do not speak the language, as Ms. Ponzoni mentioned? Why couldn’t the iPad interpretation service work in this case?
Ms. Ponzoni: The service could work if we had access to the technology. The problem right now is that access to computers isn’t even guaranteed.
Senator Moncion: Even at the CLSCs?
Ms. Ponzoni: Yes. They have no access to the technology at the moment.
Senator Moncion: The Inuit have access, but anglophone patients wanting to be served in their own language at a CLSC do not? There really is a barrier within the province.
The people who talked to us were Inuits from Quebec, if I’m not mistaken. There seems to be a gap between the services provided to Indigenous and Inuit people and those provided to Quebec anglophones.
Ms. Ponzoni: These tools would be very useful for francophone clinicians to provide services to anglophone patients. There is more money allocated to regions in northern Quebec, where there is a larger Indigenous population. For the most part, they only speak English or their second language is English. The challenge is to ensure good communication with the clinicians, who often come from McGill University.
Senator Moncion: Thank you.
Ms. Kombo, you mentioned that the quality of the interpretation on the iPads was poor. Am I mistaken? Did you mention that earlier?
Ms. Kombo: The quality on the iPads is not so much a problem. We noticed that there is a funding problem for human interpreters. Some services use technologies that work well for French and English. However, for other languages, we have interpretation concerns. If the patient and the health care professional do not speak the same language, there could be problems. Some services, such as West-Central, have bought technology and are very happy with it, because it even does Punjabi translation.
Senator Moncion: I was just about to ask you that question. Which languages?
Ms. Kombo: Since they have a large population from India, a lot of people speak Punjabi. That was a real issue for these patients. Every time, they had to yell into the mike to find a Punjabi speaker who could lend a hand. That led to confidentiality problems, because they were not certified interpreters. They were just people who spoke the language and translated what the doctor and patient were saying. If the person did not understand the context, it could skew the translation.
Senator Moncion: Okay, thank you.
Senator Aucoin: You mentioned that some people were happy with it and others were not. Have you conducted surveys or done studies to measure the level of satisfaction and, if it is low, to find out why? Do you have specific, scientific data that could give a clearer idea of the situation?
Ms. Kombo: In terms of telehealth?
Senator Aucoin: Yes.
Ms. Kombo: At the CHUM, where I work, we did a survey among 72 reporting doctors. The technology was the issue that came up most often. By that I mean Teams, which is the one promoted by the Government of Quebec. The Teams platform is for collaborative work. For professionals working together or with the office staff, the system works great and is easy to use. The doctors tell us they work on the frontlines. Oftentimes, they turn on Teams and see the green check mark because they have no meetings. However, they work on the frontlines. They can get texts and calls that come at the wrong time and interrupt their work. Unfortunately, we have no solution to offer them. We tell them to set aside time slots for teleconsultations. For people on the frontlines, it might be inconvenient to turn on Teams. If they set aside a half-day where they are available for teleconsultations, the system could be beneficial. That is what we recommended to them.
There is also all the behind-the-scenes support. As Ms. Ponzoni said earlier, we provide technical support for doctors. However, if a patient has an appointment for a teleconsultation but cannot get online, it is cancelled.
Senator Aucoin: That’s actually what I am trying to understand. Do you have data that could explain why people are excluded? Is it about language or technology? That’s what I was referring to. Do you have data that could tell us why it works or not?
Ms. Kombo: The data we have stem from what we did with the CHUM. The Quebec institute for excellence in health and social services also published a study that brought up linguistic barriers, which could certainly answer your question.
Senator Aucoin: Could you send us the data?
Ms. Kombo: Of course.
Senator Aucoin: Thank you.
The Chair: We have reached the end of the meeting. While we recognize that health care services are provincial and territorial jurisdiction, there are challenges that pertain to the role of the federal government.
You have given us some potential solutions. After the meeting, if you have other recommendations that are specifically intended for the federal government, feel free to send them to our committee.
Thank you for being here today. Thank you to the Competition Bureau Canada for their insights. Thank you and good evening.
(The committee adjourned.)