Health Estimates Monday April 9 - Nurse and Physician Locums - Telehealth

Below are questions which I asked to the Minister of Health in Estimates on Monday April 9

The Use of Locums for Nurses and Doctors

Hon. Jon Gerrard (River Heights): First of all, a comment. The minister said that he thought doctors were sometimes working in teams. You know, in my experience in traveling around the province, I would guess that probably 95‑plus per cent of physicians are working in some sort of health‑care team, maybe it's even considerably higher than that. There are very few who don't, in some fashion.

      Now, one of the concerns which came up repeatedly as I have talked with people is the use of locums versus permanent doctors and nurses, and rural communities complained that they were too often supported by locums, whether it was nurses or   physicians, as opposed to having permanent physicians and nurses, and I think that it would be important to have an approach to recruitment both for nurses and physicians that emphasized the use of people who were permanent health professionals in communities and rooted in the communities rather than locums who are temporary. It's much harder to build teams when you are–have a system based on locums.

      For example, when I was in Thompson, people were very upset that there was no consistency in their family physician and felt that the whole approach to recruiting and retaining doctors needs to focus on having long‑term doctors rather than short‑term doctors. What's your response?

Mr. Goertzen: I just want to make sure that there's clarity between me and the member for River Heights (Mr. Gerrard), not that we've ever not had clarity on an issue, but the issue that I was talking about, you know, in terms of doctors working in teams, yes, of course they work in teams. This particular was–particular comment was about in rural communities where there's sometimes more of a rotation of a team of doctors who can be rotating through a community and have an agreement that they be part of working in a community at some point and then moving on to a different location then coming back to that community. So it was more about that type of a team that I was referring about, not to suggest that doctors don't, of course, almost always practise as part of a team.

      So I want to make sure that me and the member for River Heights aren't misunderstanding each other.

Mr. Gerrard: Okay. I would ask the minister what he is doing in terms of locums versus permanent doctors and nurses in terms of recruitment.

Mr. Goertzen: So I mean the issue of recruitment is always a challenge and I know how frustrating it is when an individual loses their family doctor. I've experienced that myself, where I've lost a family doctor because they've gone on to a different kind of practice or they have decided to retire or one instance where they had a loved one in their family who was ill and they needed to deal with that. And so there are a variety of different reasons why people have a difficult time getting access to a family doctor in a variety of different settings, and it's not all about being remote or being rural, although that is a particular concern, for sure.

      And, you know, I know there's a number of different efforts going on. One that has been pointed out to me in particular is the distributed medical education program, about having those doctors who are training to be doctors do some of that work and that education in the rural communities. There's a number of sites in Manitoba where that happens so they can experience what working in a medical environment in a rural or remote community is, to try to encourage them, once they're done their practice–or, sorry, once they're done their education, potentially establish a practice there. You know, there are a number of nurse training programs that have the same sort of model about trying to expose nurses to what a rural or remote practice is.

      The member will know, having been a doctor of some renown himself, it's not possible to force someone to work into a community, but there are many things you can do to expose them to a community and to try to encourage them to be a part of that community long-term, and those are just two examples of the sort of things that are happening.

Telehealth

Mr. Gerrard: Yes. I want to talk for a moment about and ask questions about Telehealth. Notwithstanding the 164 sites that the minister talked about, we heard in Thompson that there are far too many unnecessary visits for five minutes to see a specialist which should be handled over Telehealth.             One man said he had 10 trips to Winnipeg, most of which were not necessary and could be easily handled, so there's a big gap which exists from practice now to what practice could be.

      There's also a need, I heard in Thompson, to have Telehealth from Thompson to link with nurses in smaller communities in the North–Thicket Portage–but really there are many communities in the North which could be connected to Telehealth with Thompson with significant benefit. There's an importance to local health care and to the quality of health care when you can link a nurse to a physician.

      And, lastly, you know, the world outside Manitoba is moving to a world in which laptops are used broadly for Telehealth and, you know, if every doctor's laptop was used for Telehealth and set up that way, we'd have, you know, 2,000-plus sites and we'd have a much more connected world for doctors and be able to, you know, be able to access services more quickly through Telehealth processes.

      I'd be interested in the minister's comments.

Mr. Goertzen: Well, I mean I appreciate the member raising this question. He raised a specific issue in question period in relation to this and I don't know the specific details about the case that the member raised in question period.

      I understand from officials that the most significant user of and most significant area of use for Telehealth is oncology, and we do believe that through Shared Health and working together to have clinical standards that are aligned and having a system that is working more closely together through Shared Health that we'll be able to increase and expand the use of Telehealth, so that's one benefit of it. And I think I referred, at the end of last week, to the member, that we expected that Shared Health would have a significant role in that, and that's certainly been confirmed to me. I know the member raised that particular issue during question period. I'm still open to hearing the details of–if not the individual's name, then certainly, you know, when that occurrence happened so that we can look into it more specifically for him.

Health Care in South-western Manitoba - long-term vision

Mr. Gerrard: I want to move on to southwestern Manitoba. There's been quite a bit of news coverage about the future of health care in Boissevain, Deloraine, Melita, Killarney area. I wonder what–if the minister would tell us what his long-term vision is for health care in that area.

Mr. Goertzen: Well, I think the long-term vision for health care in Westman is as it is in all parts of Manitoba. We'd like to see a system that is sustainable and predictable, that people know how to access care and where to access care. I mean, I realize living in rural Manitoba that the concerns that exist in rural Manitoba are different than the concerns that exist in Winnipeg. When we talk about, you know, what's happening in Winnipeg, people are often saying, well, we're, you know, we're wondering what the wait time is going to be when we get to an emergency room. In rural Manitoba, it's not how long is the wait going to be when we get to  the emergency room, it's whether or not that emergency room is going to be open.

      There are multiple facilities, more than a dozen, well more than a dozen, that have been temporarily closed in rural Manitoba for the last 17 years, at least, and maybe longer, and people who are living in rural Manitoba don't know is their facility going to be open, what kind of service are they going to get in that facility? So my vision for, and our government's vision for, Westman and for rural health care more generally is so that there would be certainty for those who are living in rural Manitoba. What is going to be open? What are the services that are provided in those facilities?

      Now, there's always going to be debate about whether or not, you know, that's enough, whether or not there's enough of a particular medical experience that you can have in rural communities, and that can be a challenge. I live in Steinbach. I've lived there my entire life. I would love if the Health Sciences Centre was downtown Steinbach, so I could access all of the trauma services that they have in downtown Steinbach if I was–needed one or for a friend or a loved one–had one. But I recognize that that's not realistic and that's not reality.

      So what is it that we can provide to those who are living in different areas where it can be difficult to have specialities or certain services, and how can we do it in a predictable way so that those who are living in those areas know where to go, know what they're going to get when they get there, and, if they can't get there or those services aren't the right services, do they have access to an ambulance service which is predictable? And that's a big part of the Reg Toews report from 2013, which the member from River Heights demanded, demanded very passionately in this House, be implemented up until the fact–up until the point where he had to little bit of pushback in certain communities and then he didn't implement it anymore. But the reason why the Toews report is important is because it provides the backbone for the medical service.

      So government's vision, I think, for health care, both in Westman and across the province is, predictable emergency services through EMS, a community that understands what kind of service they can provide in their particular health centre that they might have and when those centres are going to be open. That doesn't exist now, and it hasn't existed in 17 years.

Mr. Gerrard: The Toews report, as the minister knows, is supposed to be based on further consultation with communities. Part of the reason that I've emphasized telehealth is that, really, it's about better care, the ability to do more locally and to help health professionals locally do better care and to do more of it locally.

      Just a heads up in terms of tomorrow, I will have a couple of questions for you that may require a little bit of looking into. One is the status of the self regulation for radiation therapists; and, two, is the status of help for health professionals, paramedics and others in terms of PTSD. There was a focus on this some time ago, but I just want an update on terms of where we stand currently because I've heard some concerns about the accessibility for help in this area.

Mr. Chairperson: Order.

      The hour being 5 p.m., committee rise