 Hello and good afternoon everyone. I'm Adrian Dix, BC's Minister of Health and today's MC. Before we begin our event I'd like to acknowledge of course with respect the traditional ancestral territory of the Klusailish people to be here on their lands today. I want to introduce some of the people who are with us today in particular my colleagues in the legislature, Amund Singh, MLA for Richmond Queensborough, MLA for Richmond South Center, and MLA Kelly Green from Richmond-Steveston. As we share some important news all of these MLA's have been strong advocates for the very things that that announcing today. It's also a great honor for me to introduce William Kirsted KC, the Deputy Registrar of the College of Physicians and Surgeons who's with us today in the audience. We're very honored to have Graham for the college. They've done very significant work. I just want to introduce first the guest speakers today, Premier David Ebe, of course, Dr. Ramnik Dossam, the President of the Doctors of BC, and Dr. L who will join us virtually today, a family doctor currently working at the Arbutus family medicine center clinic in Victoria. In September we announced a health human resources strategy which has five actions to strengthen British Columbia's health workforce and build a stronger healthcare system for all of us. Today I'm very glad to be here as we announce some of the next steps in moving forward with our plan and with that I'm honored Premier David Ebe. Thanks very much, Adrienne. It's an honor to join you on the traditional territory of the Coast Salish people. Thank you for the introduction, Adrienne. Thanks here today and friends from the medical profession and the regulator as well. Our shared goal today as every day is to make sure that every British Columbian gets the care they need when they need it. Are the pandemic really exposed some of the challenges in our healthcare system and gave us additional challenges in how we deliver healthcare? The strains that it placed on the system resulted in too many people of family physician among other challenges. I certainly hear that out in the community. As many of you will know my wife is a family doctor and so many times people ask what is she taking new patients and we'll talk about the challenges that they are not having a family doctor and I see it in her work. I see what she does for families, how she connects them to the healthcare system and to experts in medical practice. I understand the urgency that British Columbians face and why they need a family. What BC is experiencing is not unique to our province. Healthcare systems across the country are under this kind of stress. Now some are proposing to respond to this stress that we undercut the principles of universal public health. They promote a pay as you go approach allowing the wealthiest to jump the line to the front by buying their way to the front of the line. It's not right. Buying your way to the front of the line doesn't solve the line it just changes who gets. Universal public healthcare is one of Canada's great achievements. Everyone deserves the best possible healthcare. We can't privatize our way toward a better healthcare system and we can't cut supports and get more doctors. The pandemic also taught us that going alone doesn't work. If we're going to solve these problems we have to find them together. Patients in British Columbia deserve the best whether receiving primary care through that family doctor healthcare system with a doctor nurse medical staff. We're getting acute care in a hospital for complex critical and chronic illnesses. We're making those investments in hospitals and acute care clinics. We're making investments in nurses and other healthcare workers. We've revised the funding model to encourage more family doctors to practice in our province. While many are challenged to find a family doctor, we actually have family doctors who are trained outside of Canada who aren't able to practice family medicine in British Columbia. They lack a pathway to be licensed to practice here. Now when I was in Chilliwack on the leadership campaign I was hosted by a doctor and his wife a dentist and they both worked for the local school board instead of working as in their trained profession. Pathway to practice. We need to fix this. That's why we're taking action to get more internationally trained doctors off the sidelines and into clinics where they're so desperately needed. Today we are expanding the practice. This will make it easier for family physicians trained internationally to be licensed to practice in British Columbia. The program will triple from 32 seats to 96 over the next two years. As well by working with the College of Physicians and Surgeons of BC other international medical graduates will qualify as associate physicians. They will be able to care for patients under the supervision of an attending physician at an acute care facility. We are also working with the regulatory colleges to ensure international medical graduates can start the accreditation process before arriving in the province. And the College of Physicians and Surgeons of BC will prepare bylaw changes to allow doctors trained in the U.S. for three years to practice medicine in community settings, including caring for adult and pediatric patients, as well as providing emergency and urgent care. These changes will be implemented in the coming weeks with the intent to allow these doctors to practice medicine in BC by January. Every step we take gets us closer to our goal. We're working hard to create a British Columbia where everyone can build a good life. I am dedicated to making sure everyone in this province gets the health care that they need. I would expect no less for my family or for yours. Thank you very much. Thank you very much Premier Ebi. The steps we are taking to remove and removing barriers for more internationally educated doctors to join BC's health system are going to make a big impact. We know our province needs more physicians in the short and in the long term care. And these actions, historic actions today, will help address that need in a meaningful way. There are many reasons why many people such as foreign trained physicians choose to come live and work in BC. Our province has one of the most diverse populations in Canada. Currently there are 4,451 international medical graduates practicing in BC, 2,570 of whom are family doctors, expanding the practice ready assessment program. Which we sometimes call PRABC will simply allow us to welcome more internationally trained physicians who have completed their residency in family medicine outside of Canada to contribute their skills, experience and training in primary care settings across BC. Family physicians who are seeking a pathway to full or provisional licensure to practice medicine in BC can apply to the practice ready assessment program. Those who are successful during the PRABC's assessment process will complete a three-year return of service in communities of greatest need. This means more patients in rural and remote communities will have greater access to the high quality care that they need and in addition underserved communities will be supported in a more significant way. The move from 32 to 96, a tripling of this program is a major investment by the province in the future of public health care and I'm very proud and I know the Premier is, as he has been a consistent advocate on this question, are very proud of this approach. On associate physicians, the new associate physician class introduced by the College of Physicians and Surgeons of BC will allow practitioners with specialty training to contribute their skills and expertise while working under the supervision of a practicing physician until they can become licensed. This will help us increase capacity in high need areas such as acute care. On the accreditation process, Premier E.B. referenced the physician from Pakistan living in the interior BC, I believe, and talked about physician in the Fraser Valley as well. It can be daunting to move to a new country with a guarantee that they will qualify to practice upon arrival. We can help change this by allowing doctors who are considering moving to BC to complete their assessments in their home country. By offering the opportunity to do the assessment before moving, we are removing this uncertainty and helping them feel comfortable as they plan their new life in British Columbia. Lastly, the changes that are being made by the College of Physicians and Surgeons will make it easier for doctors in the United States to work in BC to come and work here right away. This applies to doctors who are certified by the American Board of Medical Specialties and receive three years of accredited specialty training in pediatrics, emergency medicine, or internal medicine. This is extremely good news for British Columbia and reflects the commitment of the College of Physicians and Surgeons to help address some of the challenges facing our healthcare system. None of these changes would be possible without the collaboration and support of our partners at the doctors of BC. They have been a key partner over recent years and months in building the path forward for a stronger healthcare system. And here on their behalf, and we've had a few announcements recently, is Dr. Ramnik Dosanj. I wanted to introduce her now to say a few words. Dr. Dosanj. Thank you, Minister Dix. I also want to acknowledge the land of the Coast Salish people that I am going to announce, and we are very pleased that the provincial government is making it easier for more U.S. and internationally trained family doctors to come to British Columbia and practice. This is something that doctors of BC has long advocated for. We are all well aware of the very real challenges in primary care that have been with us for far too long. So any effort to address these problems is welcome. Patients and doctors need all the help they can get. Increasing the number of family doctors we will allow to come to British Columbia and practice. Fully qualified doctors who have been dreaming about coming here, but have only encountered roadblocks thus far, will not only support our existing family doctors, but will be beneficial for our patients. So many of whom are looking for someone to take care of them now. We welcome this component of a much larger action plan to address challenges with family doctor shortages and lack of patient access. And making it so doctors trained elsewhere can easily move to British Columbia is a great step. I also know in my own journey and my U.S. trained physician, and this is a much needed relief to many of my colleagues looking to come to practice in British Columbia. BC's family doctors have made it clear to us that the challenges in primary care and that we are advocating on their behalf. Doctors of BC has been working collaboratively with the health ministry to bring about the changes to family medicine more appealing. Introducing the new family physician payment model is a huge component to strengthening the primary care in this province and improving the ability of foreign trained doctors to come to British Columbia and practice is another critical component. We also know that all BC doctors face additional pressures including administrative burdens that either take valuable time away from their direct patient care during the day or take valuable time away from their families in the evenings. We are advocating on behalf of BC doctors to address these burdens to find better and more efficient ways of dealing with paperwork, charting and electronic medical record components. We are also supportive and working with our government partners on changes to how primary care networks are working. So far BC to admit more doctors in this province who are trained and have worked elsewhere in countries which we know the quality of the education and abilities of these doctors is a very crucial and important step and we welcome it wholeheartedly. Foreign trained and experienced doctors are vital members of the BC's medical profession. Thank you very much for allowing us to be part of this celebration today. Thank you very much Dr. Desange. It's now my honor to introduce someone via Zoom which I know is the favorite part of any presentation in this day and age. But I want to introduce Dr. Yehab Fidel. Dr. Fidel has done his medical training in Qatar and some extra training in geriatrics in the United States. He is now a family doctor in Victoria after completing the practice ready assessment earlier this year. So I want to introduce Dr. Fidel. Hello and good afternoon everyone. Thank you to Premier David Ebe and Minister Dix for inviting me to speak today. My name is Dr. Yehab Fidel and I'm a family physician at the Arbutus Family Medicine Clinic in Victoria. I'm joining you today from the traditional territory of the Laquangen peoples, especially the Songhees and Iskwimals First Nations. Today's announcement is great news for doctors like me who were trained outside of Canada. I completed my family medicine training in Qatar and did also further training in the United States in geriatrics. I was interested in living and working in British Columbia because I wanted to live in a safe place with beautiful nature, a place where everyone is welcomed and respected. After doing my required exams, I came to Vancouver in April. To begin the practice ready assessment where I learned not only about the medical system in Canada but also about indigenous health and cultures in BC. I then moved to Duncan and worked under the supervision of a family physician for 12 weeks until I completed the assessment. In September I started working as a family physician at Arbutus Family Medicine Clinic and I'm very happy to be part of the team and to get to know the community and my new patients. This program fully prepared me to be a successful family physician in British Columbia and I'm very glad to hear it's expansion so that more doctors can live and build their career in BC like myself. Thank you to everyone that made this happen. This is great news for doctors like me and patients alike. Thank you. Well and thank you Dr. Fidel and I think I speak out on behalf of everyone here when I say that BC is lucky to have you and that the expansion of this program and opportunities for internationally trained doctors to work and provide care and particularly in primary care in British Columbia is an important change. It's been a valuable program and it is going to get dramatically bigger over time. I want to say that this of course announcement is part of the government's health human resources plan and particularly as it relates to doctors and family doctors and the need for more doctors you've seen significant change in the last number of months. We started the new to practice contracts. 86 contracts have been signed under the new to practice contracts. Typically that number is about 20 that was put forward and announced and implemented over the summer. In August with Dr. DeSange we met and provided interim funding to support clinics throughout British Columbia. Interim funding that has been is close to fully subscribed a major and important new step. In October we announced our health human resources plan that included 128 new seats at the University of British Columbia. Later in that month we announced our new agreement with the doctors of BC that fundamentally transforms primary care and improves primary patients and for those working in primary care and in team-based care in BC it's it was a result of months of collaboration with the doctors of BC. Today and subsequent to that we signed an agreement with the resident doctors of BC the important component of the future of BC's health care system and today we're making this announcement very much under the impetus of premier EV who made this a fundamental issue for him going forward and so as you see over the last number of months this announcement one of the most significant for the future of the health care system we've seen builds on a base of a series of steps we've taken in this period of pandemic and challenge for the health care system that will make a huge difference for people. So thank you very much for coming today it's now time to take questions I want to invite Premier EV back to the podium and we look forward to taking media questions. Thanks very much Minister Dex happy to take any questions. I think a number of other provinces are doing different things right now for example in British Columbia because we know it's not just we need to build out the whole health care team we made significant changes to make it easier for internationally educated nurses to work in BC those changes have been taken up by other provinces since we've announced them other provinces are obviously taking steps to do this as well but what we're what we're doing here I think is transformative in a number of ways the practice ready assessment program is a major way that we recruit internationally educated doctors to British Columbia we're tripling that over the next two years a significant change that will make a difference in the lives of a lot of people receiving primary care we're also making it easier for for us trained doctors in the United States many of whom wish to come to Canadian jurisdictions to practice here and we're working with other health ministers so as you'll recall we had a meeting of health ministers last month and in that meeting a lot of the work we did together was to break down those barriers because we don't want this just to be good for British Columbia we want it to be good everywhere so other provinces are doing doing their own work in this area and that's important but we want to be combined this is not this cannot become a battle between Canadian provinces all provinces have to break down barriers across the country we're going to do it and we are doing it together I'm very proud of the work that health ministers are doing and we're also doing some work with the federal government on broader issues of immigration to make it easier for doctors and nurses and allied health workers to come to bc I think the patients have spoken on the legislative law and in May we know that nearly one million patients 20% of our population are without a family doctor and we know that the burdens that our specialists and our consultants are feeling with the increasing waitlist and we see the increased wait time and demand in acute care facilities this is critically important for us to be able to address all of our health care crises and there are multiple crises happening simultaneously and this is again at another collective effort with our ministry partners to move in the direction of addressing the health care human resource issues I think this question might be for the minister I'm wondering what the challenges or barriers were to expanding the number of seats available for the PRA program and what we did to what the province did to address those challenges and I just wanted to confirm that while the PRA program was historically for people in rural and remote communities that now doctors will be placed in urban communities as well that's right it will remain an important program for rural and remote communities the majority of people over the time of the program have been placed for example in the northern and interior health authorities with some in another group being the north of vanguard island or more rural and remote parts of vancouver island so currently there's 32 spaces in the program it will build to 96 of those 32 spaces 16 are reserved for rural and remote areas so it's against a return of service so when people are in the program that you get assigned to specific locations that are of need and 16 are for can be for rural and remote but also for urban and suburban communities of need as we expand out the program obviously we'll be able to continue to fill those rural and remote demands while building on our urban and suburban need so it's a significant thing part of it is resources and we are applying resources in each case so we're building out from 32 to 48 to 96 in two years and that's of course requires and part of the key part of our agreement with the doctors of bc was properly rewarding the extraordinary work that doctors in bc do to support these programs as in addition to all of the other things they do so it requires the application of resources but i think there is a strong need here now the program has proven to be successful it allows us to address specific needs in the present and increase the supply of family doctors and just to put it in context you think there are classes of 188 so when you go from 32 to 96 that's a massive increase just in one component but we also believe on the associate physician side there will be some right now some 300 doctors in bc who don't meet current standards who can meet the standard of an associate physician that gives us an opportunity there and then we also believe by reducing the barriers to us trained doctors and doctors from other countries there's a possibility there so all of these together are a significant change a significant opening up of the system that's needed at this time but what does it require it requires post-secondary education that requires doctors working in bc to support the program and that's why we're so proud of the partnerships we've made thank you for that um my second question we've heard from several internationally educated doctors who described the overall licensure process as very lengthy sort of onerous to the point of being discouraging so for example it can take up to six months to verify credentials it can take up to eight weeks to obtain test scores for someone who was educated in the united kingdom it could be at least a year altogether so aside from being able to begin that process in their home country have there been other efforts to streamline that process yes and there will be more efforts announced as we continue to build on these changes on issues of equivalency between jurisdictions so you see here is a significant change for the united states and we'll build out with other jurisdictions you're quite right people get discouraged in this process and does it work it's working for nurses right now we understand the success of what we announced in February in terms of breaking down the barriers for internationally educated nurses is significant in particular the triple track initiative and the uh bursaries that have been put forward that have reduced the cost of that we've already seen that that success and be happy to share some of the information on that for nurses we believe that these changes will have the same positive effect uh for doctors and so we've got to continue to move through that working with the college of physicians and surgeons and we will and we are the next question is for Catherine dibb radio canada concretely come on so reponder a do you know the patient who had to put a medicine family a constant term of change but it's a change my condom on the top in a certain manner second affidavit see my apres second affidavit if they could let the travail on the keep the medicine is in the premier and the other is a change my fundamental And we see this in all areas, but today to triple the number of doctors who will be in British Columbia who are facing a return of service is an important change. The contact with the doctors in British Columbia is a fundamental progress that changes the system, what is essential to maintain and retain our current doctors and to promote the profession of British Columbia. All the changes of the college we are in today will also have a significant effect. So in all areas, we are making important changes. And for the past four years, we have created 1,200 positions in the teams, a little bit everywhere in the British Columbia, which add to the care for people. Finally, I would say we are living a period of COVID-19. It is very difficult. It is a period of the pandemic. We have been living with it for two and a half years now. It has had a profound effect on all elements of our health system. The work of our professionals and our workers has been extraordinary for a few years. And we still have to prepare for today and for the future. And these changes today will help us a lot in doing this. Yes, I have a second question. We know that the staff opinion in the health sector is well-respected here as elsewhere. And I was asking myself, for the other health professionals, like nurses, nurses, etc., will we also do this kind of program? Will we recognize equivalences from people trained abroad, such as nurses? We will have something new soon. I would say this year. We made a change in February. And it is already a success in the system. So it was in February for nurses who were first in the field. We added 604 seats in our universities for nurses as well. 336 places for other health professionals. And so this work continues. We have a Health Human Resources Plan, which is in 15 elements. In 15 actions. Today it is an action. We have done the plan for a few months. Next we'll move to questions on the line. And first we have Brenna Owen, Canadian Press. Hi there. It's a little bit hard to hear, but I think I just heard my name. I was just wondering about the 96 seats. Just to clarify, like is that annually there will be 96 seats that folks cannot buy for? Yes. Did you have follow-up? Okay. And I was just wondering, Minister Dix, you said 300 people in BC was the estimate that might be eligible for the associate physician class. I'm wondering if there's a gauge around how many people who aren't already in the province might expect to be engaging with that program or with that new class. Well, I think people who aren't in BC are in many respects the focus of the practice ready assessment program of the changes that we're working on with the college, which are significant historic changes and reflect the commitment of the government and of the doctors at BC, but the college of physicians and surgeons to progress. And then potentially, of course, there are many more. That number would be much higher. What we want to do is build into the healthcare system a significant role for associate physicians that allows them to grow in terms of their professional status, but also to provide support and care now. And that's why those changes are in place. So that's our estimate of people who are currently would be eligible for that program but are not eligible to practice as doctors in BC. This is sometimes a discussion. Sometimes I've heard numbers of thousands. It's clearly hundreds, but this will, again, be another element to support our healthcare system now and into the future. And so I think it makes a lot of sense. And that's why I'm so appreciative of the College of Physicians and Surgeons moving so quickly to ensure that associate doctors can work in BC. And the first will be working in December. Next question goes to Mary Brooks from Island Social News. Go ahead, Mary. Hi, I'm Island Social Trends. So this sounds like good news, bringing more doctors into the system. I'm just wondering if you have any desired allotment toward the different health authorities and urban centers, particularly Metro Vancouver and Greater Victoria? Yes, so I went through this a little bit in the previous answer. The practice-ready assessment program, which is one of the initiatives put forward today, has traditionally been focused on rural and remote areas. So people will come here. Not all of them stay in those communities, but they stay in those communities for three years against a return of service for being part of the program. And then obviously they're available either in that community or elsewhere. And so if you look at the practice-ready assessment program, the 32 now, half of them are reserved for rural and remote areas, and half can go to rural and remote areas or urban areas of need. So clearly this is going to be helpful in communities such as Victoria, where we have people often talk about a population or an increasing number of citizens over 75, but also an increasing number of older family doctors, for example, in those communities. So clearly Victoria is a place, and you heard it earlier, which is a place where people in the practice-ready assessment program will practice because there's significant need there. Mary, did you have a follow-up? Yes, thanks. It was actually hard to hear some of the earlier audio. So these specialties in pediatrics, ER, and internal that you mentioned earlier, that sounds like hospital focus. Would that be, again, toward urban? And also, are you looking for physician specialties in the mental health and opioid crisis area? Well, yes. And we're working significantly on those investments in those areas that are significant and massive. And if you look at the increase, we have the largest family medicine program in Canada now. Some of the most significant increases have been in those areas already and will continue to be a focus for ourselves and our partners in health care. So I think the short answer to that question is, we'll see some of that as well, I would argue, though. And I think Dr. Sasanju would agree with this. The core of primary care is providing care for mental health and addiction services. So when we built out primary care networks together in their 59 in the province and hired net new, 1200 new workers, including doctors, nurses, allied health professionals, the largest group of workers hired under that have been to support mental health and addictions, including counseling services and others. So meeting that demand is, I think, critically important and that's what we need to do. The next question goes to Andrew Ross, CBC News. Go ahead, Andrew. Hi, it's actually Josh Grant with CBC, just calling from Andrew's old desk. I just also have a question just to get some more clarification. I mean, you're opening up 92 spots in the practice ready assessment program. How long does it take physicians on average to get through all of these pre-screening requirements and how, I mean, you're hoping to have doctors practicing in January, but I mean, how long does it take for different people to get through the program and is this like, as was mentioned previously, 92 new doctors in BC every year, hopefully? Is that the goal? Under that program, yes. The goal is obviously more than that. And there's two reasons for that. One, we need to build out the number of both family doctors and doctors in our system as we do nurses, as we do health sciences professionals, as we do health care workers. I won't bore you with the long list of things we're doing in those areas. But what this involves is a relatively short preparation and then three years of work in the community in terms of return of service. These are individuals eligible for those programs who have done their full training elsewhere. And so you've heard from our doctors today the process, which is a relatively short process to get forward and into physicians' offices across the province. So this is, and this will be a continuing process as we go to year to year to year. And we know we're successful in this program because we've done it for a number of years with 32. And we believe, and we know we have the capacity to build that out and that's what we're going to do. Do you have a follow-up, Josh? Just as a follow-up, I just want to repeat the question my colleague asked earlier in French. We know a million people are hoping to get a family doctor or waiting to get a family doctor. Don't have one right now. All of these programs together you're looking at, you know, maybe a few hundred people able to care for patients directly in addition per year. What other options are you looking at to really tackle that massive shortfall of family doctors here in BC? This is some great initiatives announced today. I'm just wondering how you're looking at such a high number of people waiting. So I think it's important to understand the numbers. In 2003, there were about 300,000 people in BC without a family doctor. When I became Minister of Health, that number had climbed to more than 900,000. And so it's been a period of time. In fact, the number of people without a family doctor increased in every Canadian community health service for British Columbia, which is the main way we judge that in every year from 2003 on. And it only stabilized with some of the measures we took in 2018 and 2019. With the pandemic, there have been new challenges. But if you look at our agreement with the doctors, you'll see that a doctor will be responsible depending on the level of complexity of the patients for more than 1,200 patients. And so when you talk about adding doctors every year, that's what you're talking about in terms of attachment of patients. It can be a significant thing. In addition, our doctors are working and part of our agreement with the doctors of BC and part of the work we've been doing is working in teams. So we've, in the past four years, doubled the number of nurse practitioners in our system, dramatically increased the number of nurses that work with doctors and now are adding associate physicians to that, to build out team-based care in communities which can mean counselors, it can mean allied health workers, it can mean dieticians, it can mean nurses and, of course, doctors. So all of these steps, it is a range and a significant primary care plan. And then I think we laid out during this announcement the six or seven or eight major steps we've taken, most notably our agreement with the doctors of BC, but also increase in nursing spaces, support for nurses and other healthcare workers and to keep care facilities with better security and safety and the increase in allied health spaces as all, since I became Minister of Health, we've added 38,000 net. This is net new healthcare workers, doctors and nurses and health sciences professionals. And you know what, that's pretty good. That's impressive in these times and these challenges. We've got to do it again and then we've got to do it again in the five years after that, in the five years coming up in the five years after that and that's net new workers. So that's why we have a health human resources plan, not with one action with 75 and we laid that out earlier this year. We have time for one last question today and that's going to go to Jane Scripnik from Black Press. Hey there, thanks for making my question. I'm just wondering whether there is actually a waitlist for the practice ready assessment program and if so, how many people are on it and if not, if you have an idea of how many people are still looking to take part in it? Well, I think it's clear that we could take more doctors into the program and that's why we're increasing the number of spaces and there's a, each year there's a new group that comes into the program and is practicing and it builds year on to year such that we have hundreds of doctors in BC now who've worked through the practice ready assessment program and the majority of which did their program, the return of service in the northern and interior health authority. So we think that there's demand for people to come to BC. We think the situation in primary care with our partnership with the doctors at BC is stronger than it's ever been and we're going to be able to recruit more people to come to BC and this is a straightforward and an important way for people from all over the world who are qualified to come to BC and provide care for British Columbians as soon as possible. It's been effective for a long time. We're now saying it will be three times as effective as we add three times as many people in the program. Jane, do you have a follow-up? Yeah, thank you. I'm also hoping to clarify on the restricted registration program, is that something entirely new or is it just something you're expanding upon? In terms of the associate physician program, I think that program is new and one of the challenges and one of the things that Premier E.B. has clearly said to me is we need to address some of these issues where we have people with a very significant health care training who are not working in health care in our province and we talked about this in case of specific people and one of the advantages for Premier E.B. working in the leadership campaign is meeting people around the province and this is a key issue that was brought to his attention in that time. And so I think, I myself think that the associate physician program practice ready assessment addresses pathways for one group of doctors. The changes we've made with the college of physician surgeons are going to make a big difference with U.S. trained doctors. The changes we've made in terms of being able to assess in your home country are going to make a difference for a whole bunch of other group of doctors and for associate physicians, particularly for people who've trained as doctors and are working in B.C. it will provide a pathway and work that recognizes their skills in the health care system under the supervision of doctors. All of these are significant steps forward and I'm looking forward and I know we are to their success. This is something I'm going to ask Premier E.B. to come back to close is something that people have been talking about for a long time. We talked about 300,000 people who had a family doctor in 2003 and getting worse every year after that and almost no action was taken. The government announced in 2011 they were going to find 2009 it was in fact former health minister who announced that and then at the end of that program they abandoned the program that was supposed to deliver a family doctor to everybody. We're waiting a long time for these changes. The changes that we worked on together with the doctors of B.C. are fundamental changes that have been that I think a fair person would say could have been implemented a long time ago we did it together in partnership now and they're going to make a big difference. We've got a lot of work to do though and we're going to keep doing that work and I want to invite Premier E.B. back up to say a few final words. Thank you very much Minister Dix and thank you to Mr. Kirstad QC Eric Casey, pardon me from the College of Physicians and Surgeons from Doctors of B.C. What you've heard today is cooperation between the registrar between the doctors and the Ministry of Health to make sure we don't leave any health professionals sitting on the sideline while families are looking for a doctor. Getting those doctors into work to the extent that they're able to do so as quickly as possible and focusing on making sure they're delivering care for British Columbians is what underlines this announcement and we need to continue that work because of province not just in the area of medicine but across a number of skilled trades I want to congratulate the leaders of the medical health profession Doctors of B.C. and the College for working proactively on this for recognizing where British Columbians are what they need and really getting out ahead to make sure that these physicians are able to do that work for British Columbians. Thank you very much for your work and thank you Minister Dix and my colleagues for your advocacy on this important issue.