Transcript Health Human Resources in Canada: Brief Overview and

Overview of Health Human Resource Planning:
A Canadian Perspective
2006 Trilateral Conference
Vancouver, British Columbia, Canada
Dr. Nick Busing
President and CEO
Association of Faculties of Medicine of Canada
Presentation Outline
A View of HHR in
Canada
Thoughts on HHR
Planning
The term “HHR” encompasses all those involved in
the delivery of health care, such as physicians,
nurses, technologists, therapists, and the wide
spectrum of other health care providers.
- Health Canada, Pan-Canadian Health Human Resource Strategy,
2004-2005 Annual Report.
A View of HHR in Canada
Based on the Health Personnel Database (HPDB)
• HPDB is maintained by the Canadian Institute for Health Information
• Data is gathered primarily from professional membership and
regulatory organizations
• HPDB provides basic summary information for 23 health profession
groups
• HPDB describes the following for each health care provider group:
– Brief definition of each provider group, including main responsibilities,
activities and typical practice settings
– Time spent training
– When regulation was introduced, if at all
– The number of providers exiting training
– The total number of providers
– Age and sex demographics
– Key research and reports related to the profession
Number of Health Care Providers, Canada, 2004
Physicians
60,612
Pharmacists
28,537
Medical laboratory technologists
19,401
Dentists
18,313
Dental Hygienists
17,553
Medical radiation technologists
15,693
Physiotherapists
15,607
Psychologists
14,695
Occupational therapists
10,984
Dietitians
7,783
Chiropractors
6,892
Optometrists
3,941
Audiologists
1,178
Midwives
509
0
Source: HPDB, CIHI
Plus 246,575
Registered Nurses
10,000
20,000
30,000
40,000
50,000
60,000
70,000
Percent Change in Number of Health Care
Providers, Canada, 1995 vs 2004
Chiropractors
58.4%
Occupational therapists
56.4%
Dental Hygienists
44.7%
35.8%
Optometrists
Psychologists
33.1%
Pharmacists
28.6%
Physiotherapists
24.3%
Dietitians
24.3%
17.5%
Dentists
Physicians
Medical radiation technologists
Registered nurses
Medical laboratory technologists
10.3%
8.9%
6.2%
1.1%
0% 10% 20% 30% 40% 50% 60% 70%
Note: The number of midw ives grew by 249%, from 146 in 1995 to 509 in 2004
Source: HPDB, CIHI
Number of Graduates in 2004 and Percent Change in
Number of Graduates 1995 vs 2004, Canada
2,000
120.0%
100.0%
Number of Graduates
1,600
80.0%
60.0%
1,200
40.0%
855
725
800
677
631
20.0%
593
439
0.0%
400
195
108
-20.0%
37
2004 Graduates
M
id
wi
ve
s*
ts
pt
om
et
ris
O
Ch
i ro
pr
ac
to
rs
De
nt
i st
s
T
O
Ph
ys
io
th
er
ap
i st
s
Hy
gi
en
i st
s
M
LT
De
nt
al
Ph
ys
i ci
M
RT
-40.0%
an
s
0
% Change in Number of Grads, 1995 vs 2004
Source: HPDB, CIHI
* For midwives, the percent change compares graduating class numbers for 1996 and 2004
% Change in Number of Graduates
1,757
Females as a Percentage of Health Care Provider
Groups, Canada, 2004
Midwives
99.0%
Dietitians
98.0%
Dental Hygienists
98.0%
Registered nurses
95.0%
Occupational therapists
93.0%
Medical laboratory technologists*
81.0%
Medical radiation technologists*
80.0%
Physiotherapists*
79.0%
Audiologists
79.0%
Psychologists*
67.0%
Pharmacists*
57.0%
Optometrists
44.0%
Chiropractors
33.0%
Physicians
32.0%
Dentists*
Source: HPDB, CIHI
*Based on 2001Statistics Canada Census
0%
27.0%
20%
40%
60%
80% 100%
Percentage of Health Care Provider Groups Aged
45+, Canada, 2000
Specialist physicians
49.8%
Family physicians & GPs
49.5%
47.9%
Registered nursing assistants
Denturists
47.0%
Dentists
46.6%
Registered nurses
46.5%
44.0%
Cardiology technologists
36.6%
Medical radiation technologists
Medical laboratory technicians
35.0%
Pharmacists
34.4%
Dietitians and nutritionists
34.1%
Opticians
33.7%
Chiropractors
33.3%
Optometrists
33.2%
30.8%
Medical sonographers
29.2%
Physiotherapists
20.6%
Occupational therapists
15.6%
Dental assistants
0%
10%
20%
30%
40%
50%
60%
Source:
Statistics Canada,
2001 Census
Percentage of Health Care Provider Groups Who
Worked Full-Time for the Full Year, Canada, 2000
70.8%
69.9%
66.0%
64.8%
60.2%
60.1%
56.8%
55.8%
54.0%
53.2%
52.8%
52.6%
52.4%
51.3%
50.9%
49.8%
48.2%
44.5%
Opticians
Denturists
Pharmacists
Chiropractors
M edical radiation technologists
M edical sonographers
M edical laboratory technicians
Optometrists
Physiotherapists
Occupational therapists
Registered nurses
Family physicians & GPs
Cardiology technologists
Dietitians and nutritionists
Specialist physicians
Registered nursing assistants
Dentists
Dental assistants
0%
10%
20%
30%
40%
50%
60%
70%
80%
Not e: Full-year, f ull-t ime is described by St at ist ics Canada as "worked 49 t o 52 weeks in t he ref erence year, most ly f ull t ime". "Full t ime" is def ined as 30
hours or more per week.
Source:
Statistics
Canada,
2001 Census
2004 National Physician Survey
• This survey provides insights on the extent to
which various health care providers work
together (from a physician perspective)
• Separate surveys were mailed to all licensed
physicians and all physicians in postgraduate
training
• Licensed physicians were asked about sharing
patient care with other providers
• Residents were asked who they plan to share
care with
2004 NPS: Percent of Second Year Residents Who Plan to Share
Care with Various Health Care Providers, Canada, 2004
FP/GPs
Specialist physicians
Nurses (RN, LPN, RPN)
pharmacists
physiotherapists
dieticians/nutritionists
occupational therapists
psychologists
Nurse practitioners
technicians/ technologists
midwives
0%
10%
20%
30%
40%
Family Medicine Residents
Source: 2004 National Physician Survey, CMA, CFPC, RCPSC.
50%
60%
70%
80%
90%
100%
Medical, Surgical, Lab Residents
2004 NPS: Percent of Second Year Family Medicine Residents Who Plan to Share Care
with Various Health Care Providers and the Percent of Licensed Family Physicians Who
Share Care With Various Health Care Providers, Canada, 2004
FP/GPs
Nurses (RN, LPN, RPN)
Specialist physicians
dieticians/nutritionists
pharmacists
physiotherapists
psychologists
technicians/ technologists
occupational therapists
Nurse practitioners
midwives
0%
10%
20%
30%
Family Medicine Residents
Source: 2004 National Physician Survey, CMA, CFPC, RCPSC.
40%
50%
60%
70%
80%
90%
Licensed Family Physicians
100%
2004 NPS: Percent of Licensed Physicians Who Share
Care with Various Health Care Providers, Canada, 2004
Specialist physicians
Nurses (RN, LPN, RPN)
FP/GPs
pharmacists
technicians/ technologists
dieticians/nutritionists
physiotherapists
occupational therapists
psychologists
Nurse practitioners
midwives
0%
10%
20%
Family Medicine Physicians
Source: 2004 National Physician Survey, CMA, CFPC, RCPSC.
30%
40%
50%
60%
70%
Medical, Surgical, Lab Physicians
80%
90%
Interprofessional Education for Collaborative
Patient-Centred Practice (IECPCP)
• The IECPCP initiative is part of Health Canada’s
Pan-Canadian HHR Strategy
• Some of the project goals are to…
– foster interprofessional education for collaborative
patient-centred practice;
– promote teaching from an interprofessional
collaborative patient-centred perspective;
– increase the number of health professionals trained
for collaborative patient-centred practice, and
– facilitate interprofessional collaborative care in both
the education and practice settings.
Interprofessional Education for Collaborative
Patient-Centred Practice (IECPCP)
• The project has gathered information on IE in Canada
using survey and key informant methodologies
• In its first cycle the project has funded 11 IE projects,
including:
– Creating an Interprofessional Learning Environment through
Communities of Practice: An Alternative to Traditional Preceptorship
– Structuring Communication Relationship for Interprofessional Teamwork
(SCRIPT)
– Interprofessional Education for Geriatric Care
– The McGill Educational Initiative on Interprofessional Collaboration:
Partnerships for Patient-Family Centred Practice
– Seamless Care: An Interprofessional Education Project for Innovative
Team Based Transition Care
• Visit http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/interprof/index_e.html for
more information
Thoughts on HHR Planning
Thoughts on HHR Planning
HHR Planning Often Focuses on Headcounts
First Time Admissions to MD Programs, Canada, 1990/91 - 2005/06
2,400
Number of first time MD admissions
2,300
2,200
2,100
2,000
1,900
1,800
1,700
1,600
1,500
19
90
/0
1
19
91
/9
2
19
92
/0
3
19
93
/9
4
19
94
/9
5
19
95
/9
6
19
96
/9
7
19
97
/9
8
19
98
/9
9
19
99
/0
0
20
00
/0
1
20
01
/0
2
20
02
/0
3
20
03
/0
4
20
04
/0
5
20
05
/0
6
1,400
Source: AFMC, Canadian Medical Education Statistics, 2006.
Thoughts on HHR Planning
Even Basic Adjustments Can Change The
Headcount Picture
2.00
1.95
1.90
1.85
1.80
Crude phys to pop ratio
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1.75
1993
Phys per 100,000 population
Adjusted* Physician Supply: # MDs per 1,000 Population
Adjusted phys to pop ratio*
* Adjusted for age-sex of patients and age-sex of physicians
Source: Canadian
Institute for Health
Information
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re
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*
Thoughts on HHR Planning
International Indicators Highlight Physician Resource
Challenges in Canada
Physicians per 1,000 Population, OECD Countries, 1995 and 2004
5
4
3
USA
1995
2004
UK
CAN
2
1
0
Thoughts on HHR Planning
Comparison of Medical School Opportunity
First Year Medical School Positions Per 100,000 Population, 2005
14
12.9
12
10
8
7.1
7.1
6
4
2
0
Canada
United Kingdom
United States
Source: Personal communication with CMA.
Note: UK data based on acceptances into pre-clinical medicine; US data based on medical school and osteopathic acceptances.
Thoughts on HHR Planning
International Medical Graduates Play an Important
Role in Canada’s Physician Supply
Percent of Physicians Who Are IMGs, by Province/Territory, 2006
60%
55.5%
50%
42.9%
40%
35.6%
31.8%
31.3%
28.3%
30%
27.8%
24.7%
23.5%
26.4%
24.0%
23.1%
18.8%
20%
11.2%
10%
Source: CMA Masterfile, January 2006, Canadian Medical Association
N
CA
NU
NT
YK
BC
AB
SK
B
M
O
N
Q
C
NB
NS
PE
NL
0%
Thoughts on HHR Planning
IMG Trends Vary Within the Physician Workforce
Percent Increase/Decrease in the Number of IMG Physicians Compared to 1996
15.00%
10.00%
5.00%
0.00%
1996
1997
1998
1999
2000
2001
2002
2003
-5.00%
-10.00%
-15.00%
Med-Surg-Lab Physicians
Source: Supply, Distribution and Migration of Canadian Physicians, CIHI.
Family Physicians
2004
Thoughts on HHR Planning
The Number of Physicians Leaving Canada Has Declined
400
340
319
227
218
334
256
291
240
317
200
55
0
-80
-164
-200
-400
-600
1996
-658
1997
-209
-262
-420
-568
-726
-275
-320
-431
-508
-800
-244
-249
-500
-584
1998
Moved abroad
1999
-609
2000
2001
Returned
Source: Supply, Distribution and Migration of Canadian Physicians, CIHI
2002
2003
Net
2004
Thoughts on HHR Planning
There is Still Much to Learn About the Things
Health Care Providers Do
Thoughts on HHR Planning
Many Individuals and Organizations Have a Hand
in HHR Planning
Individual Patients &
Practitioners
Health Care Facilities
(clinics, hospitals, nursing
homes, etc)
Provincial/Territorial
Governments
Training Institutions
HHR Planning
Federal Government
Health Quality
Councils
(colleges, universities, etc)
• The establishment of goals,
policies, and procedures to
direct all those involved in the
delivery of health care.
Teaching
Hospitals
• An orderly arrangement of the
wide spectrum of health care
providers.
• Having in mind an orderly
arrangement of all health care
providers.
Regional Health
Authorities
Regulatory
Authorities
Health Care Research ,
Information & Service Agencies
Professional Associations
(CIHI, CHSRF, CHEPA, CHSPR, MCHP,
CaRMS, OPHRDC and many more)
(membership, certifying &
accrediting agencies, etc)
Thoughts on HHR Planning
Example of Possible HHR Planning Roles
Agency
HHR Planning Role
Local health care facility
Coordinate care of individual patients in
multidisciplinary environment
Regional Health Authority
Evaluate patient needs within region; Work with
local health care facilities to ensure delivery of
service; Implement recruitment/retention strategies
Provincial/Territorial Government
Establish RHAs to carry out regional health care
delivery; Establish HHR regulatory frameworks;
Establish and manage health care programs and
systems; Work with colleges & universities to set
quotas for health care provider training
Provincial/Territorial Regulatory Authorities
Assess credentials; Issue licenses
National Government and Professional Agencies
Set standards for certification; Accredit training
institutions; Compile national level data and
information for planning purposes
THANK YOU
Overview of Health Human Resource Planning:
A Canadian Perspective
2006 Trilateral Conference
Vancouver, British Columbia, Canada
Dr. Nick Busing
President and CEO
Association of Faculties of Medicine of Canada