Mr. Chairman, I am very pleased to participate in this debate. First I want to say a few words about the brain drain that is concerning many people in the country.
Looking at the figures from various departments and from the Dominion Bureau of Statistics we find that 117,000 immigrant professional workers came to Canada between the years 1946 and 1953. Graduate nurses formed the largest proportion, numbering one in every six persons who came to Canada as immigrant professional workers.
I shall relate my figures to four classes of people with whom we are dealing. They can all be classified as health personnel. I shall quote statistics with regard to dentists, laboratory technicians and assistants, graduate nurses, and physicians and surgeons. In the years 1953 to 1963, 420 dentists, 4,428 laboratory technicians and assistants, 15,359 graduate nurses and 5,032 physicians and surgeons came to Canada as immigrants. It is
Health Resources Fund interesting to note that the doctors and dentists usually came from countries other than the United Kingdom or the United States while laboratory technicians and nurses came mostly from the United Kingdom.
Moving to the question of emigration, which concerns people in Canada even more than immigration, we find that of the professional workers leaving Canada one-quarter are graduate nurses. Using the same four groups of people and the same years, 1953 to 1963, we find that 104 dentists, 3,390 laboratory technicians and assistants, 13,963 graduate nurses and 2,630 physicians and surgeons emigrated from Canada. Therefore, out of the total number of professional emigrants from Canada almost 25 per cent were graduate nurses, 6.1 per cent were laboratory technicians, and almost 5 per cent were physicians and surgeons. We see from the figures the gradually increasing numbers of doctors who are emigrating to the United States. In 1953 doctors represented 4 per cent of professional emigrants and in 1963 this figure had risen to 7 per cent.
Comparing the figures of immigration to Canada and emigration from Canada one sees that there was a net outflow from Canada to the United States in all of the above occupations. Therefore Canada has been losing to the United States but fortunately, as was mentioned by the hon. member for Saskatoon, Canada has been gaining back these groups in that more have emigrated from other countries in the world at large. If one takes the net inflow of these occupations to Canada and subtracts the people in these groups who leave this country to go to the United States, it will be seen that in those years Canada has actually gained 316 dentists, 1,038 laboratory technicians, 1,396 graduate nurses and 2,402 physicians and surgeons.
It is interesting to note that the figures show that one out of every five doctors practising now in Canada is a foreign born, post-war immigrant, as is one dentist out of every 20 and one graduate nurse of every eight. Bringing the value of all this education down to dollars and cents, the figures would indicate a value in the neighbourhood of $450 million.
The brain drain is of great concern to the people of Canada and to the government. I can only reiterate what the hon. member for Saskatoon has already said, that without immigrant doctors coming to Canada our medical profession would have been stretched very far and thin.
June 14, 1966
Health Resources Fund
Interestingly enough, the educational level is higher among the people coming to Canada than among those who are leaving. It should also be noted that Canada gains a great deal from Canadians who are studying abroad as more Canadians study abroad than people from abroad study in Canada. This situation, however, is rapidly reaching a balance.
One of the things we must concern ourselves with is why Canadians with professional training emigrate to the United States. Generally speaking, if one delves into the reasons why people wish to emigrate to the United States one finds that the reasons given are, first, the climate, second, larger incomes in the United States and, third, the fact that some immigrants use Canada as a stepping stone to get into the United States because that country will not allow them to come in directly from their own countries.
For the professional groups the reasons for emigrating are somewhat different. The first reason is the better opportunity in the United States, both in terms of salary and the research facilities which are available; second, because of the free flow of skilled people between Canada and the United States it is often easier for those people to move north or south than it is to move east or west and remain in Canada and, third, again there is the question of climate. Unfortunately we do not have very much control over that. The brain drain is very serious and we all hope that the provisions made by the government in the measure before the house will tend to reverse the trend.
I now want to talk about doctors who are trained in Canada. The medical association is greatly concerned with problems related to this matter and a short time ago published two special editions of their journal which were devoted to medical education. I should like to quote an abstract from "Medical Education, Part I", found in the Canadian Medical Association Journal dated April 2, 1966.
Enrolment in the 12 Canadian medical schools in 1965-66 reached a new high of 4,023, an increase of 3.8 per cent over 1964-65. The percentage of women among medical students (11.4 per cent) was close to that for the preceding two years. The decline in the numbers of students from outside Canada continued into the present year; in 1965-66, 9.1 per cent of medical students were non-Canadian. This decline has been primarily in the number of students from the U.S.A. The number of students from commonwealth countries has shown a steady increase over the seven year period under review; in 1965-66 they make up nearly one-half of all nonCanadian students. It was noted that 27 per cent
of overseas students came to Canada under governmental or intergovernmental sponsorship. Of the Canadian students, 95 per cent came from the "home" provinces of the medical schools.
[DOT] (4:50 p.m.)
It is interesting to compare standards of training in Canada with those of the United States. It is apparent that one of our needs is a better staffing of medical faculties. A comparison between the student-faculty ratio in Canada and the United States reveals a sharp contrast. In the United States there are 6.6 faculty members for every student while in Canada the ratio is 1 to 2.2. Thus the United States has roughly three times as many fulltime faculty members for every student.
It has been said in various publications that a student taking a medical course should have an I.Q. of between 120 and 125. This would encompass approximately 6 per cent of Canadians. I should like to refer to another interesting statement in the Medical Journal. It is from an article entitled "Canadian Applicants For Medical Schools in Canada, 1965-66". The conclusion reached by the author of the article is that it is erroneous to believe there is a surplus of well qualified Canadian applicants at the present time.
I find his conclusion surprising because I had thought there were more well qualified Canadians wishing to take up medicine than were able to do so in the light of our limited facilities. Approximately 10 per cent of all medical students drop out before graduation. There are now 12 medical schools in Canada and two are in the course of construction, in Sherbrooke and Hamilton. It is estimated that we need 440 new doctors each year in order to keep pace with our population growth. We need another 400 to replace doctors who die, retire or fall ill. This means we must find a total of 840 new doctors each year, and we graduate approximately 850 a year. This number is, therefore, only sufficient to keep pace with events, which is not good enough for a country that boasts of an extremely high standard of medical practice, especially bearing in mind recent developments in technology.
Another difficulty which is becoming apparent concerns the role of the general practitioner. In Canada the general practitioner seems to be disappearing. Some people predict he will eventually disappear completely. General practitioners now account for approximately 40 per cent of the total number of doctors, the remainder being specialists of some kind. However, I am glad to say that
June 14, 1966
Health Resources Fund
general practitioners usually spend more than one year at the present time in postgraduate training. In fact, the average is two years.
This brings me to the special concern felt because of the shortage of doctors in rural areas. Not only are more specialists being trained today but general practitioners are increasingly being drawn to practices in well established urban localities rather than in rural areas as was the case years ago. It was common to find efforts to attract doctors to rural communities. A community would provide rent-free facilities and other benefits of a fringe nature to encourage doctors to come to the area.
In 1960 the ratio of doctors to patients in Canada was approximately one to 904. Some people think this ratio should be one in every 750. The ratio of dentists to patients is roughly one to 3,000 and most dental authorities think it should probably be one to 2,000. There is one nurse for every 260 of the population and most authorities think the proportion should be one to every 200. So there is a need to train more and more people in these fields and we certainly welcome the grants which the federal government intends to make available to help provide training facilities.
It has been estimated, I hope accurately, that with the help of the increased facilities provided by the medical schools the medical student population should double by 1970. This should be the aim, and if it means the spending of even more money by the federal government then I would certainly support it.
One important aspect of this whole subject concerns wages and salaries. In the last Civil Service Commission circular, a copy of which goes to members of parliament, I noticed an advertisement for an elevator maintenance and inspection officer for which post the salary offered was $9,000 a year. But for chemists, bacteriologists and pharmacists the salary offered was approximately $7,000 a year. I am not against paying a reasonable wage to an elevator inspector or maintenance officer but I suggest that a qualified chemist, bacteriologist or pharmacist should certainly command a higher salary than persons in that category. I am sure the hon. member for Simcoe East could give even more surprising examples. When I graduated from the University of Toronto in 1951 the salary paid to junior internes by the Toronto General Hospital-it was not even called a salary; it was called an honorarium-amounted to $100 a year, the price per day of a pack of
cigarettes for a person in a highly responsible position and on call 24 hours a day.
I am glad to say that the situation has altered. Nevertheless, salaries have still not reached a level appropriate to the work these doctors are doing, the hours they must put in and the responsibility they carry. The same is true of nurses and other trained personnel.
Before closing I should like to make six recommendations. I am aware that most of them do not fall within the jurisdiction of the federal government but I put them forward, in the hope that those concerned will take cognizance of them and follow them up in order that sufficient health personnel may be available in Canada when we put a full medical care scheme into effect.
My first suggestion, to which I have already referred, is that higher salaries be paid to doctors and nurses in their training period. Though Canadian hospitals may pay $100 a month, one can pick up journals carrying advertisements for positions in the United States where internes are paid $5,000 and more. If we are to have Canadian doctors we must encourage them to stay in Canada.
[DOT] (5:00 p.m.)
My second suggestion is that refresher courses be made available for general practitioners. More and more general practitioners are taking advantage of such facilities as now exist. In fact, it is now insisted that doctors in general practice should devote a certain amount of time to training each year. I should like to encourage the further training of general practitioners in the practice of medicine before they actually go out into practice, and this again means giving these people a reasonable wage while they are taking this extra training.
The third point I wish to mention is that I notice that in the Hall commission report and in other reports there is reference to dental and nursing aides or assistants. Certainly in the field of dentistry a dental aide could buff teeth and do other jobs that take up so much of a dentist's time, and many of the duties of nursing could be performed by a nursing aide. I would like to see medical technicians trained to do the relatively simple medical tasks that are time consuming for a doctor or a graduate nurse. I speak of such things as vaccination procedures, taking blood pressures and blood samples. These could be done equally well by trained aides as by graduate doctors and nurses.
June 14, 1966
Health Resources Fund
My fourth point is that we should encourage more postgraduate training in medical science. In this connection I would like to read from a Medical Journal abstract under an article headed, "Canadian-Trained Basic Medical Scientists", in the issue of April 9. 1966:
Questionnaire returns from doctoral degree holders revealed that citizenship status at the time of graduation is positively related to migration; migration rates were lowest for Canadian-horn and highest for landed immigrants and foreign students. Geographic mobility during training was also found to be a significant factor which increased the propensity to migrate.
Topic: HEALTH RESOURCES FUND
Subtopic: ASSISTANCE TO PROVINCES FOR HEALTH TRAINING AND RESEARCH FACILITIES