Canada faces future health worker shortages of family physicians, psychiatrists, Personal Support Workers (PSWs), and nurses, according to a report by the C.D. Howe Institute. In Troubles in Canada's Health Workforce: The Why, the Where, and the Way Out of Shortages
authors Don Drummond, Duncan Sinclair and Jillian Gratton find that PSWs and family physician shortages will persist while vacancies and retention of nurses in high-stress positions will worsen.
While the aggregate number of health professionals in Canada has been steady and growing, job vacancy rates for nurses and PSWs in particular have jumped since the pandemic. The persistence of nursing vacancies is not due to workers leaving the health sector, but likely from healthcare workers shifting away from high-stress positions in emergency departments, medical/surgical wards and intensive care units, to positions with better workplace conditions and work-life balance.
"The supply of nurses has increased since 2019, but returnees from retirement are filling critical gaps at the moment and may not stay in the workplace for long," said Drummond. "Depending upon how the data are interpreted returning nurses accounted for half to all the growth in the supply of registered nurses in 2020 and 2021."
Presently, physician shortages in Canada are dominated by family medicine and to a lesser extent psychiatry. The data strongly indicate these gaps will not be filled by the current supply of new entrants into post-graduate training: through-put for training for these fields is slow, anticipated patient needs are growing, and the popularity among trainees of all specialties focused on the diseases and conditions of the elderly among trainees is diminishing.
Finally, while the exact number of PSWs in Canada is not known, employment in the long-term care sector in Canada generally falls well below international benchmarks. Canada has 37 percent fewer long-term care workers per person aged 65 and over compared to the median of OECD countries. The authors estimate that closing the gap would require adding more than 140,000 workers to the long-term care sector, a substantial proportion of which will be for PSWs.
"Increasing the supply of health-sector workers is a necessary but insufficient response to the troubles in the sector," said Sinclair. "Canada's health system's results, its access and outcomes, are mediocre at best despite our devoting one of the highest shares of GDP to healthcare in the world. "Better" needs to receive as much attention as 'more.'"
"Efforts to increase supply of health workers will be futile unless attraction and retention are improved," added Gratton. "Improving working conditions would demonstrate respect for their hard work and should include higher pay for some."
Among the report's recommendations:
- The health system needs a governance structure, starting at the provincial/federal level, to better collect data, analyze present and future challenges and make policy changes.
- The fragmented data from provinces and federal agencies such as the Canadian Institute for Health Information (CIHI), Statistics Canada and Canada Health Infoway need to be consolidated with improved timeliness and more comprehensive coverage.
- Accelerate the rate of development and expansion of Integrated Care Systems and similar care teams to ensure Canadians have ready access 24/7 to a family physician, nurse practitioner, or other provider of primary care services. They should be the "gate-keepers" to all other components of Canada's health system.
- Look to expand the scope of practice of health professionals and providers with a view to minimizing duplication of skills, optimizing productivity and efficiency, and fostering teamwork, substitution, and interdependency among them.
- Promote the training, accreditation and success of students in less popular generalist programs. Enhance the status, professional standing, and compensation of providers of general services in short supply like family medicine, geriatrics, rheumatology and PSWs, and improve working conditions to increase retention.
- Maintain or accelerate recent momentum with the licensing and employment of internationally educated health workers.
- Review the curricula and experiential content of training programs; for example, to better prepare graduates for family and community care roles.
is Fellow-in-Residence, C.D. Howe Institute, and Stauffer-Dunning Fellow, School of Policy Studies, Queen's University.
is Professor Emeritus and former Dean, School of Medicine, Queen's University.
is an RN with an MNSc.