Health care always has been and always will be a labour-intensive industry. Canada, like most developed countries, spends a large proportion of health care spending on training and paying health care professionals.
The Canadian Institute for Health Information (CIHI) reported that between 1998 and 2008, total public sector spending grew at about 7% per year. In other words, over the course of a decade, public spending on health care doubled from about $60 billion to $121 billion. And from 2008 to 2012, public spending grew by another 20% (to $145 billion).
This analysis also showed that a significant portion of the increase went to higher wages for a larger workforce. Again, using CIHI’s figures, more than 360,000 regulated nurses were employed in Canada in 2011, an increase of more than 8% since 2007. This was nearly twice the rate of population growth in Canada.
There is a growing recognition that we could get a better return on our health human resource investments by organizing professionals to work more effectively. Primary health care teams are a good example of this.
We need to reframe our approach and our thinking to see the health workforce as the means; and, where the end is better health outcomes for Canadians, not just more care provided by more professionals.
So, how is Canada doing in its drive to achieve a high-performing health system through its people?
I will present three pressing policy challenges, each of which stems from a mismatch between our health care needs and our supply of health professionals – and what may be needed to solve them from re-occurring.
Reliance on internationally-trained professionals
Canada has long relied on internationally trained doctors and nurses to staff our health care systems, particularly in rural and remote areas. While recent data are hard to come by, it is clear that our system is reliant on international graduates. In the 2010 National Physicians Survey, about 1 in 6 physicians reported that they completed their medical education outside Canada or the US. This in itself is not bad, but when we rely continuously on foreign nationals to meet our needs, then we and their governments have a problem.
Does Canada aim to become self-sufficient in its supply of health care professionals or will we continue our system of international recruitment? If we continue to recruit, how will we direct international graduates to where they are most needed?
The solution is a commitment to self-sufficiency with both the health and education and training sectors developing a joint plan to help Canada achieve this.
Underutilization of specialist physicians
The second issue is one that was unheard of even five years ago: under- and unemployed specialist physicians. It takes large amounts of resources to train a medical specialist, which yields a “zero return” if they cannot practice due to a lack of capacity in acute care or other systems. We’re hearing stories in the media of eager young surgeons who can’t get operating room time, while patients wait for care.
A number of stakeholders are calling for better national human resource planning and better information for medical students to give them a clearer picture of their chances of landing a job in particular specialties, and in specific regions of the country.
The solution is better modelling of provincial needs and matching with specialist supply. Medical school seats and post-graduate training slots are adjusted accordingly.
Struggle to recruit a workforce for home care
The final issue speaks to our ability to care for the growing number of Canadian seniors. In our recent report we found that that seniors and their families want to receive care at home, most provincial systems are investing in home care services. Canada certainly needs to boost its home care services, as they are integral to a high-performing health care system today. But staffing these services presents huge challenges that run the gamut of human resource issues. From compensation, to education and training, to quality assurance and working conditions, the home care sector struggles to find staff to meet their clients’ needs.
Personal support workers (aka community health workers or continuing care assistants) provide most home care services, particularly for long-term clients. Personal support workers are unregulated and their training currently varies between provinces and territories.
The solution is to designate this sector as a growth sector, allocate additional training funds, upgrade quality improvement programs and realign the compensation and benefits regime to give this sector a higher status within the health care system.
Canada’s goal remains a high-performing health care system. To arrive there we need to tackle our health human resource challenges in a way that is strategic. In saying that, any approach has to be explicit, proactive, measured and bolstered by a common evidence base.
In my next blog post I’ll outline some of the steps we, as a country, need to take to improve the management of our health human resources with the goal of attaining the high-performing health care system that all Canadians want.