Health Estimates Thursday April 5 - physicians, peer support workers, psychologists and nurse practitioners

Snow Lake - Physician recruitment and community involvement

From the start of Estimates 

Mr. Goertzen: While I'm awaiting my staff–assuming that I still have some–I'll just quickly on the record put some information on that was relation to the last question by the member for River Heights (Mr. Gerrard) on Snow Lake and the doctor issues within Snow Lake.

      So certainly we recognize that one of the physicians in Snow Lake has tendered their resignation. There are–has been work with the northern regional health authority in terms of actively securing a permanent replacement for the individual who's resigned. And they're looking at ways to fill any service gaps that might exist.

      I do understand that the northern regional health authority will be attending a meeting with the mayor and the council of Snow Lake and the newly established Snow Lake health care task force. That meeting is scheduled to take place on April 16th and there'll be representatives from the NRHA board there, as well.

      So that's just by way of update for the member for River Heights, who had asked that question right at the end of Estimates yesterday, I believe.

Hon. Jon Gerrard (River Heights): I thank the minister for his comments on Snow Lake and the situation there, which you made at the beginning of the–of this Estimates.

      One of the things which I think is pretty important, in terms of physician recruitment and planning, is that there be a plan to have physicians there long term and not just for locums to fill in. And so I was pleased to hear that the minister had indicated that there was a plan for a long-term physician at Snow Lake. And that is really what is needed.

      What I noted, in talking with people from a number of communities, is that there's quite a variety or a–varied success in recruiting and retaining doctors. That, for example, Swan River has done quite well, but communities like The Pas and Flin Flon and Snow Lake are struggling.

      I would like to–the minister to clarify his views on what his perspective is on the role of the people who are involved in the local municipality and in community groups in helping in this process of physician recruitment and retention?

Mr. Goertzen: It's a good question for the member for River Heights (Mr. Gerrard)–not to lay value on his previous questions, but this one in particular is a good question, I think, because, you know, how communities are involved is critical.

      Now I think it's important that there is involvement across the system. You know, we learn from things that go well and don't go well. The regional health authorities do–I think Shared Health will have a renewed role in the issue of doctor recruitment and learning from what’s working across the province, and sharing that information, perhaps helping through the gathering of that information.

      But communities do play a significant role. The member knows, being a doctor himself, that you can't force people to practise in certain communities. You can't force somebody to be in a community long   term. There can sometimes be contractual obligations, but, ultimately, doctors have the ability–particularly because they're in high demand–to practise, not just anywhere in the province but anywhere in Canada. And, in some instances, depending on the countries, in any country in the world.

      So, you know, that is a challenge for sure. And I've certainly heard from many communities, including my home community, about those challenges. So local communities have a particular role, I believe, in looking at attracting doctors who are going to see it as beneficial to be in those communities, whether that's the nature of the practice that they're going to be involved with, and having those discussions about the nature of the practice.

      They–you know, they have a particular role in ensuring that doctors who are coming in feel not just welcomed in the practice of medicine but welcomed in the community. I mean, we all make decisions about where we're going to live, to a large extent, based not just on our occupation but on the community themselves.

      And I've talked to international medical graduates, in particular, who've come from different countries. Sometimes they go into small communities, and it's a very different world than where they may have come from. There might be, you know, significant cultural differences, faith differences, many differences that can make it difficult to keep a doctor.

      Now I'm from rural Manitoba, so I always think it's the best place to live. But not everybody has the same views that I do on that or anything else. But,  you know, coming from a country that might be  entirely different–or a part of our country that might be entirely different–into a rural community causes its own challenges. And anything that local communities can do to alleviate those challenges, either on the practice side or on the practical side, the life side, is certainly going to mean that they're going to have more success. If a person grows up in that community and is looking to come back, well, obviously a lot of that falls away because, you know, I think the best opportunity that local communities or areas have of keeping doctors, or when those doctors have a history in those areas, that just makes sense, but that's not always practical. So, when doctors are coming from other areas of the country or the world, it is certainly a big part that communities are able to break down some of those barriers that might exist from a family situation or from a lifestyle situation.

Mr. Gerrard: I thank the minister for his comments, and I think it's particularly important that communities do have a role. Part of the reason for raising that is that I heard from some community members that they were being told by their regional health authority that the doctor recruitment was a regional health authority issue and the community should stay out of it completely. That's not my view, and I'm glad that the minister has put it–his view clearly on the table.

E-Health - Flin Flon, Telehealth, Tracking Specialist referrals

      My next question actually has three parts to it which are linked but somewhat separate. The first part is related to a Flin Flon situation where there seems to be a problem in the communication between the eHealth system of Saskatchewan and the comparable ability or access to medical records here in Manitoba, and if the minister would undertake to at least have a look at that situation in Flin Flon, because physicians cover many patients in Creighton, which is just across the border from Flin Flon, and that it's important that they have access to the eHealth information about those patients from Saskatchewan.

      Second, and a linked question, because it really talks in part to the information technology aspect, is that when I was in The Pas there was a resident there who was sent to Winnipeg for an appointment only to arrive in Winnipeg to find the doctor was on vacation. He wasted 18 hours spent travelling. There was a waste of $3,000 in transportation costs, and all this was completely unnecessary actually because the problem could easily have been handled over Telehealth and so I think that it is important that we move forward in a much more effective way on Telehealth because it has the benefit of people getting more health care locally and eventually helping people in terms of time and in the system in terms of costs.

      And the third point relates to the tracking system for referrals to specialists. I have been asked on more than one occasion why the health–Manitoba Health doesn't operate a system like Canada Post and FedEx where it's very easy to find out, in their case where your parcel is, but in a resident's case for Manitoba where their referral is, and I wonder what the minister is doing in terms of such a tracking system for specialist referrals so that people can find out where they are at any given point in time.

Mr. Goertzen: I thank the member for those observations and questions.

      So, on the issue particularly of Flin Flon, we'll have department officials take a look at that and respond back to the member next week, I believe–or will endeavour to respond back to the member next week.

      The issue of Telehealth appointments driving from The Pas to Winnipeg and then finding out a doctor is on vacation–well, I don't know the specifics of it, so I'm not going to–I assume it is as the member has presented, I have no reason to believe otherwise, but it's hard for me to comment on a situation I really don't know the details of.

      The general premise of that, though, is an important point that I think is–goes to the–one of the reasons of Shared Health and trying to break down some of those barriers that exist between regional health authorities. Like, I was saying to the member for Minto (Mr. Swan) before, one of the things that concerned me and surprised me when I became Minister of Health is really how much in isolation the Winnipeg regional health–or, the regional health authorities worked and didn't have the kinds of communications that I might have expected between them. And I don't think that was because they chose not to; it's simply how the system developed. And there just lacked that communication between having shared health. To look at the system as a whole and the planning of health care provincially but the delivering of it locally, I think, will help with some of those issues.

      I'm not Pollyannaing. You know, it's a big health-care system. There are thousands and thousands of employees. There are thousands of visits a day. There are hundreds of different scenarios every day. Will there be mistakes made in the health-care system? There will. I'd love to be able to promise the member that those mistakes will go away with the creation of Shared Health or anything else; that's just not the case. It's a human system, and there will be human mistakes and human errors within that system for as long as me and the member are here in the Legislature, and long after we've left this place.

      But he's right in that there has to be work to ensure that's minimized. I think the Shared Health will help that in breaking down some of those barriers. And, when it comes to technology and telehealth, I'm not as familiar with the tracking system either with Canada Post or FedEx or other systems. But I do think that that kind of technology is something that will be better tested through an entity like Shared Health when it's looking across the province and looking at how services are flowing between regional health authorities, as opposed to simply within regional health authorities.

Peer Support Workers, Psychologist and Nurse Practitioners

Mr. Gerrard: Yes, now, I'm next going to ask about   three sort of critical groups of health-care professionals.

      One is peer support workers, who have potentially a very important role in mental health. Two is we have a deficit, very clearly, in psychologists in Manitoba, and what the minister's plan is. And three: to date, it seems to me very important that we have an approach to integrating nurse practitioners into our provincial health-care system. But I haven't heard the minister's plans for that, and I would be very interested in what they are.

Mr. Goertzen: You know, so, on the issue of nurse practitioners–you know, one of the things that we have mandated Shared Health to do is to do a better job of looking at the scope of practice for not just nurse practitioners but for all those who are working within the health-care system.

      I can tell you that the most common request that I get from each of the different associations representing the different health-care providers–nurses, doctors, allied professionals–is related to scope of practice, you know. And often, you know, they're advocating that their scope of practice be increased, but sometimes they're advocating that others in the professions don't have their scope of   practice increased. So there's an element of competition, as–I might say within the practice. The member will know that, being a doctor himself.

      What I've asked from Shared Health is that we have a plan that looks at it more comprehensively not simply as one-offs between different professions, to see what does the system need and who are the people within the system who can deliver that. So that's not limited to places like Westman, where, you know, there was discussion within the wait times task force about paramedicine and what role–increased role could paramedics play; looking at the scope and practice of nurse practitioners–where could they play a greater role within the delivery of health care, both in Winnipeg but in rural Manitoba. I mean, that will be a mandate–is a mandate specifically of Shared Health: to try to align the need with the areas of practice that individuals can provide within the health-care system.

      On the issue of peer support and psychological services, you know, certainly they've been identified. I think Dr. Peachey identified the issue of psychological services and the need in Manitoba. Peer support has been raised to me in different ways from different advocates within the system and the need–or the desire to have them–peer support on the mental health side, particularly in emergency rooms, you know, if discussions continue on that. The member will know that there is a number of different discussions happening, not the least of which are the bilateral–not the least of which is the bilateral agreement with the federal government. And while that plane hasn't landed, certainly the issue of peer support is not a stranger to those discussions.

Pharmacists as part of the local health team in rural communities

Mr. Gerrard: The minister has talked about sort of central planning and local delivery of services and having health-care teams which function well locally is tremendously important.

      One of the key people in local, rural community health-care teams is the pharmacist, and yet some of the changes that the minister has made have actually cut the local pharmacist off the health-care scene as it applies to patients in–or individuals who are in personal care homes.

      And so I wonder if this is an oversight or, you know, what the minister's plans are in this respect.

Mr. Goertzen: I do very greatly value the role of pharmacists in Manitoba. We've had good discussions with pharmacists. I think that, you know, when it comes to–my understanding is sort of per  capita the number of pharmacists in Manitoba compared to other jurisdictions, we do very well; we rank very high in terms of the number of pharmacists that we have in our province, which probably speaks to the ability for them to work and serve in the province of Manitoba, speak well of that, the fact that we have, from my understanding, a high ratio of pharmacists compared to population.

      There may be a couple of things the member's speaking to. The one issue is the pan-Canadian agreement to have a reduction in the cost of certain generic drugs, generic drugs that are highly prescribed in Manitoba. That would result in a savings of about $11 million in Manitoba. That money is essentially all being reinvested in new drugs, in higher cost drugs in the Pharmacare program.

      You know, I have heard some concerns from pharmacists in relation to that. The reality is, you know, what goes in negotiation that happened nationally resulted in a reduction of costs of some generic drugs. I'm not sure that the solution to that is just simply overcharging Manitobans for drugs. I mean, we–I think it was important that we sign on to   the reduction of costs for those drugs for Manitobans. To do otherwise we'd have probably had the member rightfully standing in his place in   question period and saying why are you overcharging people for drugs in Manitoba.

      So–but those savings are being reinvested in drugs and so–in more high-class drugs which are coming onto the formulary, so that's positive, I think. Both are positive. On the one end there's a reduction of costs for Manitobans; on the other end there are drugs that are needed for certain illnesses that are coming online.

      The member may also be alluding to the issue of contracting. He'll know, I–you know, a tender went out for that particular service. I don't get into the middle of tenders. I think I remember the member for River Heights (Mr. Gerrard) standing and bemoaning the NDP's role in the Tiger Dam scandal when it came to the lack of tendering and then the interference of a minister in the relation to that particular product being served. He would have been well to stand up and criticize me if I jumped in the middle of a tender process to try to direct the result of it. I did not do that.

      The company that won the tender has been providing that service in Manitoba for quite a while in the Winnipeg Regional Health Authority, I understand, and also in the Interlake regional health authority, and I believe that that contract had been awarded under Dave Chomiak when he was the Health minister.

      So I'm not sure if the member is asking me not to pass savings onto consumers or seniors, in many cases, for drugs. I'm not sure if he was asking me that I should have jumped in the middle of try to gerrymander a tendering process. I'm certainly not prepared to gerrymander a tendering process nor have seniors pay more than they need to for their drugs.

Mr. Chairperson: The hour being 5 p.m., committee rise.