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Take a closer look at health workforce data, including historical trends.

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• In 2022, the suppliesFootnote ii of physicians, regulated nurses, pharmacists, occupational therapists and physiotherapists grew at varying rates. Nurse practitioners (NPs) continued to have the highest annual growth rate at about 9%, while the annual growth rate of registered nurses (RNs) slowed (1.1% in 2022 compared with 2.5% in 2021). On a larger scale, the average annual growth of family physicians and pharmacists slowed over the past 10 years (from 2.9% between 2013 and 2017 to 1.8% between 2018 and 2022 for family physicians, and from 3.4% to 2.2% for pharmacists).
• The long-term care sector continued to see losses in the number of direct care nurses. Approximately 2,500 fewer direct care nurses were employed in long-term care in 2022 compared with 2021 (5.1% decline). The number of RNs in direct care employed in hospitals declined by over 800 (0.6% decline).
• The average full-time-equivalent value for family medicine physicians and specialists — a measure of the average physician practice — rebounded to pre-pandemic levels in 2021–2022 at the pan-Canadian level after dipping the year prior.
• Internationally educated health professionals made up a sizable proportion of the workforce in 2022, with more than a third of pharmacists and more than a quarter of physicians being international graduates. While the proportion of nurses who are internationally educated has traditionally been lower than that of other professionals, in 2022 they made up an average of 12% of newly licensed nurses across the provinces and territories, a 4-percentage-point increase from 2017.
• Surges in health care job vacancies (doubling since the start of the pandemic to 120,140 in 2022–2023) suggest that demand for health care is outpacing the gains in supply. Job vacancies for personal support workers (30,800 vacant positions; 25.7% of all health care vacancies), registered nurses and registered psychiatric nurses (28,000; 23.3%) and selected mental health workers (21,360; 17.8%) accounted for two-thirds of all health care job vacancies in 2022–2023.
• In 2021–2022, an unprecedented amount of hospital overtime was logged by staffFootnote iii (over 26 million hours, equivalent to more than 13,000 full-time positions). The highest rates of overtime were observed in intensive care and in mental health and substance use inpatient units.
• NPs are often an important source of primary care for rural/remote populations, but the proportion of this workforce employed in these areas has been steadily declining over the past decade (18% in 2013 compared with 14% in 2022). For pharmacists, the share of the workforce in rural/remote areas declined only slightly, from 11% to 10% in the same time period, while the proportion of physicians remained stable (about 13% of family medicine physicians and 2% of specialists).
• As the population in Canada ages and needs for health care increase, the number of nurses in direct care roles may not be keeping pace. In 2022, there were 52 nurses in direct care roles per 1,000 older adults in Canada, compared with 59 in 2013. A decline was also observed for family medicine physicians and specialists (from 7.0 to 6.5, and from 6.2 to 5.6, respectively).

Policies targeting recruitment, retention and optimization of scopes of practice have been increasingly adopted across the country.Reference1,Reference2 Here are some examples:

• Almost all provinces and territories have expanded scopes of practice for pharmacists to include assessing and prescribing medication for certain minor ailments, with some jurisdictions empowering pharmacists to renew and extend prescriptions. In some jurisdictions, RNs have also been granted new prescribing powers.
• Efforts to increase physician capacity have taken the form of increasing medical training seats, with some jurisdictions offering tuition bursaries in return for service commitments. While these offerings are associated with a time delay due to the length of physician training, many provinces have established or enhanced incentive programs in rural communities.
• Most jurisdictions have modified policies to expedite registration for health care workers, including provisions and programs to streamline internationally educated nurse entry to the health workforce. A number of provinces have taken their search for health workers abroad.

This interactive tool is ideal for workforce planners, health service managers and analysts who want to easily create customized visualizations. Explore and compare key metrics on supply (i.e., those who are licensed to practise), workforce (i.e., those working in a profession-specific job), direct care and inflow/outflow, as well as provincial and territorial trends for Canada’s physicians, nurses, occupational therapists, physiotherapists and pharmacists. This tool also includes interactive data tables with selected hospital staffing indicators, including overtime rates and sick leave in hospitals, as well new vacancy metrics.

These tables are meant for analysts, researchers and those who want to explore and analyze the aggregate data. There are 10 years of supply, workforce, employment, education and demographic trends for Canada’s nurses, occupational therapists, physiotherapists and pharmacists. Supply and distribution information for physicians is available for both the recent period and a historical span of 51 years. Physician payment and service utilization information is available for both the recent period and a historical span of 24 years.

These notes are meant for all data users. They summarize the sources, definitions, strengths and limitations of the data available.

• ºìÁì½í¹Ï±¨ workforce in Canada: Overview
• Number of physicians and nurses per 10,000 population by health region, 2021

In 2022, the suppliesFootnote i of physicians, regulated nurses, pharmacists, occupational therapists and physiotherapists grew at varying rates; however, the overall supply of these professionals in relation to the size of Canada’s population has remained unchanged over the last 10 years (see table below).

Nurse practitioners (NPs) continued to have the highest growth rate among the professionals presented in this report (about 9% annually for the last 10 years), though they are a relatively small segment of the overall supply of health professionals discussed (less than 1 NP per 1,000 population).

Physiotherapists (PTs), licensed practical nurses (LPNs), occupational therapists (OTs) and registered psychiatric nurses (RPNs) have all seen consistent annual growth: around 4% for PTs, 3% for LPNs and OTs, and 2% for RPNs. Family physicians and pharmacists both had a decline in their average annual growth rate: from 2.9% between 2013 and 2017 to 1.8% between 2018 and 2022 for family physicians, and from 3.4% to 2.2% for pharmacists.

The supply of registered nurses (RNs) — who make up the largest segment of the professionals presented in this report (at 8 RNs per 1,000 population) — saw a substantial uptick in annual growth between 2018 and 2022 (1.3%) compared with between 2013 and 2017 (0.3%). Recently, though, this has been slowing, with annual growth dropping from 2.5% in 2021 to 1.1% in 2022.

These pan-Canadian supply trends vary across jurisdictions. More information is available at provincial/territorial and regional levels in the professional-specific data tables.

Average annual growth rate (2013 to 2017 and 2018 to 2022) and supply per 1,000 population for selected health professionals (2013, 2017 and 2022), provinces/territories with available data

Notes
In Ontario, licensed practical nurses are referred to as registered practical nurses.
Registered psychiatric nurses per 1,000 population is based on population counts for provinces/territories where they are currently regulated (Manitoba, Saskatchewan, Alberta, British Columbia and the Yukon).
Sources
ºìÁì½í¹Ï±¨ Workforce Database, Canadian Institute for ºìÁì½í¹Ï±¨ Information.
Scott’s Medical Database, Canadian Institute for ºìÁì½í¹Ï±¨ Information, with raw data provided by iMD (© 2023 iMD ºìÁì½í¹Ï±¨ Global Corp.).
 

Overall supply numbers provide a high-level sense of workforce capacity, but a closer look at the subset of those who are employed in direct care roles provides a deeper understanding of how many people are working to provide patient care. Shifts in these direct care roles have been particularly notable for nursing professionals.

Despite growth in overall supply of nurses in 2022, key sectors experienced losses in the number of nurses employed in direct care. This means that, overall, more nurses left the sector that year than joined. Compared with 2021, approximately 2,500 fewer nursesFootnote ii were employed in direct care in the long-term care sector (5.1% decline). For the hospital sector, while the total number of nurses in direct care roles remained stable, the number of RNs in these roles declined by over 800 (a 0.6% decrease). Shifts in these settings may be the result of specific challenges, including increased workload and intensity amid sub-optimal staffing levels, leading to burnout and stress.¸éé´Úé°ù±ð²Ô³¦±ð1,¸éé´Úé°ù±ð²Ô³¦±ð2

Direct care nurses in community health agencies increased by 7.1% (a net increase of over 3,300 nurses), surpassing the 3.1% growth observed in 2021. Similarly, the number of nurses providing direct care for other employers, including private nursing agencies and self-employment, continued to increase, from 6.1% growth in 2021 to 9.2% growth in 2022 (a net increase of over 2,300 nurses). These types of work environments and employers may offer more flexibility or control over scheduling.¸éé´Úé°ù±ð²Ô³¦±ð3

Net change in number of nurses working in direct care from previous year, by place of work, provinces/territories with available data, 2021 and 2022

Notes
NPs: Nurse practitioners; RNs: Registered nurses; LPNs: Licensed practical nurses.
LTC: Long-term care.
In Ontario, licensed practical nurses are referred to as registered practical nurses.
Registered psychiatric nurses (RPNs) are regulated only in the 4 Western provinces (Manitoba, Saskatchewan, Alberta, British Columbia) and the Yukon. RPN data is not reported due to data quality issues related to place of work and direct care.
When data on direct care and/or place of work is unavailable for a given nurse type in a province/territory for at least one year of the analysis, it is excluded from all years to ensure comparable trending for that nurse type.
For more information regarding collection and comparability of data as well as notes specific to individual provinces and territories, refer to the professional-specific methodology notes on CIHI’s website.
Source
ºìÁì½í¹Ï±¨ Workforce Database, Canadian Institute for ºìÁì½í¹Ï±¨ Information.
 

• ºìÁì½í¹Ï±¨ Workforce in Canada, 2022 — Quick Stats (XLSX) (Updated June 27, 2024)
• ºìÁì½í¹Ï±¨ workforce: Data tables
• Number of physicians and nurses per 10,000 population by health region, 2021

Having a clear picture of the number of vacant positions in health care can be used to track labour market demand and point to gaps in health workforce capacity. This information is a critical measure to support informed workforce planning. ºìÁì½í¹Ï±¨collaborated with Statistics Canada to develop a set of pan-Canadian health care job vacancy metrics for different health professionals.Reference1

In 2022–2023, there were an average of 120,140 health care job vacanciesFootnotei across the 4 quarters of the fiscal year. This reflects a doubling of vacancies from 2019–2020 (prior to the onset of the COVID-19 pandemic) and a quadrupling since 2015–2016. Job vacancies were highest for personal support workersFootnoteii (30,800 vacant positions; 25.7% of all health care vacancies), followed by registered nurses and registered psychiatric nurses (28,000; 23.3%) and selected mental health workersFootnoteiii (21,360; 17.8%). Collectively, these professionals accounted for two-thirds of all health care job vacancies in 2022–2023. 

All provinces experienced growth in health workforce–related job vacancies in 2022–2023 compared with the previous year, but there was variation in the size of that growth. The largest vacancy rate increases were observed in Prince Edward Island (56.3%) and Saskatchewan (51.7%), while the smallest were observed in British Columbia (6.7%) and Alberta (8.0%).

Monitoring vacancy metrics can further our understanding of the dynamics around supply of and demand for health professionals. These measures can inform initiatives to improve education and training programs, as well as recruitment and retention strategies. To explore vacancy metrics for different health professionals in more detail, explore the ºìÁì½í¹Ï±¨ Workforce Quick Stats (see Related resources below).

Overtime metrics can give a sense of staff workload. These trends indicate that Canada’s health systems are over capacity trying to address population health needs, which can result in a cycle of burnout and increased stress for health care workers. 

ºìÁì½í¹Ï±¨ spending records show that, overall, hospital staff (excluding physicians) performed more than 26 million hours of overtime in 2021–2022.Reference2 The number of overtime hours worked by nurses and other hospital health workers (excluding physicians and management staff) on inpatient units reached 14.2 million, as highlighted in Hospital staffing and hospital harm trends throughout the pandemic. This represents a 53% increase from the previous year and is equivalent to over 7,000 full-time positions. 

Overtime was most prevalent on mental health and substance use units — out of a total 23.2 million hours worked on those units in 2021–2022, there were 1.9 million overtime hours (8%). The pandemic led to worsened mental health and psychological distress for many Canadians,Reference3 which may have been a contributing factor to pressures felt in these units. 

Intensive care units (ICUs) ranked second in terms of overtime rate — out of a total 30.7 million hours, there were 2.2 million overtime hours (7.3%) worked in 2021–2022. The increased need for overtime on ICUs was likely driven by the COVID-19 pandemic. Patients admitted to ICUs require specialized care that can be more resource-intensive in terms of the need for highly trained providers, the use of specialized technology and continuous close monitoring of patients.Reference4 This type of care can be more difficult to backfill (either internally through upskilling or through use of private agency staff), which can place higher demands on existing staff.Reference4

ºìÁì½í¹Ï±¨ care worker sick time and the number of workplace mental health and violence reportsReference5 are also on the rise. In the first year of the pandemic, lost-time claims (including claims due to illness, injury and workplace violence) submitted to insurance for those working in the health care and social assistance sector increased by almost 25,000 (a 50% increase compared with 2019).Reference5 For professional occupations in nursing, lost-time claims nearly doubled from 2019 to 2020, reaching over 11,000.Reference5

In hospitals, 2021–2022 saw an uptick in rates of sick leave taken by staff (excluding physicians) following a 5-year period of stability. More than 14 million sick time hours were logged on nursing inpatient units in 2021–2022, a 17% increase over the previous year. This is a substantial change compared with the annual average growth of about 3% between 2017–2018 and 2020–2021.Reference6 Sick leave hours reported on ICUs and obstetric units made up a larger percentage of total worked hoursFootnoteiv compared with those reported on other inpatient units in 2021–2022 (6.5% for both, compared with an average of 6% across other inpatient units).Reference2

To fill the resulting staffing gaps during the pandemic, hospitals increasingly relied on the use of agency health workers. Before the pandemic (between 2017–2018 and 2019–2020), the annual average growth of agency staff hours worked in hospitals was about 8%; this increased to 32% between 2020–2021 and 2021–2022, reaching a total of 4.8 million hours.

Staffing challenges combined with the negative mental health impacts on staff stemming from increased amounts of overtime can lead to a cycle of burnout and understaffing. These issues can have a domino effect on patient care, including creating the potential for unintended harm to occur. Across Canada, the rate of hospital harm increased to 5.9% in 2020–2021 and 6% in 2021–2022 and 2022–2023 after remaining stable between 5.3% and 5.4% since 2014.Reference7

These trends warrant careful monitoring as the demands on the health workforce grow. More detailed data on provider experiences, including by profession and area of practice, is needed to support the development of targeted retention strategiesReference8 to address specific areas of strain across the system, promote overall wellness of the health workforce and improve quality of care. 
 

• ºìÁì½í¹Ï±¨ Workforce in Canada, 2022 — Quick Stats (XLSX) (Updated June 27, 2024)
• Hospital staffing and hospital harm trends throughout the pandemic
• Defining ºìÁì½í¹Ï±¨ Workforce Vacancies in Canada (PDF)

The vast majority of Canadians reside in urban areas.Reference1 When rural/remote communities experience health worker staffing shortages, backfilling vacancies can be more challenging with a smaller pool of resources to draw from.

Over the last decade, the proportion of nurses working in rural or remote areas has declined (from 11.1% in 2013 to 9.6% in 2022; see the figure below). Nurse practitioners (NPs) have the largest proportion of their workforce working in rural and remote areas (1 in 7 NPs compared with about 1 in 10 other nurse types) and are often an important source of primary care in these areas. But these numbers have been declining: in 2013, 18% of NPs were employed in a rural/remote area, compared with 14% in 2022.

On the other hand, the proportion of family medicine physicians in rural and remote areas has remained stable at about 13% over the course of the decade. Many of Canada’s rural/remote regions rely on itinerant physicians (non-local physicians on short-term contracts) to provide care to their populations. For example, in 2022, similar to previous years, more than two-thirds of family physicians in Nunavut were itinerant.

About 10% of pharmacists in Canada practised in rural/remote areas in 2022 — only a slight decline over the last decade, down from 11% in 2013. In several jurisdictions, pharmacists’ scope of practice has recently been expanded to allow them to prescribe for or treat certain minor ailments, which may help improve access to care.Reference2

Proportion of providers working in rural/remote areas, selected health professionals, provinces/territories with available data, 2013 to 2022

Notes 
NPs: Nurse practitioners; RNs: Registered nurses; LPNs: Licensed practical nurses; RPNs: Registered psychiatric nurses; OTs: Occupational therapists; PTs: Physiotherapists. 
* The data shows a statistically significant downward trend over time (p<0.01). 
In Ontario, LPNs are referred to as registered practical nurses. 
RPNs are regulated only in the 4 Western provinces (Manitoba, Saskatchewan, Alberta, British Columbia) and the Yukon. 
When data on geography is unavailable for a given type of professional in a province/territory for at least one year of the analysis, it is excluded for all years to ensure comparable trending for that type of professional. 
For more information regarding collection and comparability of data as well as notes specific to individual provinces and territories, refer to the professional-specific methodology notes on CIHI’s website.

Sources 
ºìÁì½í¹Ï±¨ Workforce Database, Canadian Institute for ºìÁì½í¹Ï±¨ Information. 
Scott’s Medical Database, Canadian Institute for ºìÁì½í¹Ï±¨ Information, with raw data provided by iMD (© 2023 iMD ºìÁì½í¹Ï±¨ Global Corp.).

Canada’s population is aging and will have a greater demand for health care in the future.Reference3 Despite increases in the overall supply of nurses, the number working in direct care roles has not kept pace with the growth of the aging population.

In the last decade, the number of nurses working in direct care roles per 1,000 older adults in Canada (age 65 and older) decreased from 59 to 52. This was mostly driven by a decrease for registered nurses, who represent the largest group of regulated nurses and declined from 44 per 1,000 older adults in 2013 to 36 in 2022. Small declines were also observed over the same time period for licensed practical nurses (from 17 to 16 per 1,000), while registered psychiatric nurses remained stable at about 3 per 1,000 older adults. On the other hand, NPs, who make up the smallest group of regulated nurses, steadily increased from less than 1 per 1,000 older adults in 2013 to 1 per 1,000 in 2022.

The number of family medicine physicians and specialists per 1,000 older adults declined between 2013 and 2022, but only slightly (from 7.0 to 6.5, and from 6.2 to 5.6, respectively). Pharmacists saw a similar small decline over the decade, moving from 6.7 to 6.3. 

The number of occupational therapists (OTs) and physiotherapists (PTs) providing direct care per 1,000 older adults has remained stable since 2013 (around 1.6 and 2.6, respectively). Most OTs (81%) and PTs (92%) work in direct care roles, with OTs primarily practising in hospitals (41%) or community health settings (43%) and PTs in community health settings (64%) in 2022.

Number of direct care providers per 1,000 older adults, selected health professionals, provinces/territories with available data, 2013 to 2022

Notes
NPs: Nurse practitioners; RNs: Registered nurses; LPNs: Licensed practical nurses; RPNs: Registered psychiatric nurses; OTs: Occupational therapists; PTs: Physiotherapists.
* The data shows a statistically significant trend over time (p<0.01). For RNs, LPNs, RPNs, family physicians, specialists and pharmacists, it is a significant downward trend. For NPs, it is a significant upward trend.
Older adults are those age 65 and older.
When data is unavailable for a given type of professional in a province/territory for at least one year of the analysis, it is excluded for all years to ensure comparable trending for that type of professional.
When the population of provinces/territories for which the data is unavailable exceeds 35% of the total population, no overall result is reported.
The denominator for the calculation of number per 1,000 older adults includes only the population for provinces/territories for which there is corresponding data in the numerator.
For more information regarding collection and comparability of data as well as notes specific to individual provinces and territories, refer to the professional-specific methodology notes on CIHI’s website.

Professional-specific data notes 
Nurses:
In Ontario, LPNs are referred to as registered practical nurses.
RPNs are regulated only in the 4 Western provinces (Manitoba, Saskatchewan, Alberta, British Columbia) and the Yukon.
Includes nurses who are employed in roles where they provide direct care or services to clients. 
Physicians:
Saskatchewan’s and Alberta’s family physician counts are calculated using fee-for-service data and do not include those physicians exclusively on alternative payment plans. 
As part of the agreement between the Government of Quebec and CIHI, the data transmitted by Quebec and held by ºìÁì½í¹Ï±¨may be used only for specific purposes and is not included in this analysis. 
The Northwest Territories does not submit specialty-level data to the National Physician Database. 
Nunavut does not submit data to the National Physician Database. 
OTs and PTs:
Incudes OTs and PTs who are employed in roles where they provide direct care or services to clients. 
Pharmacists:
Includes pharmacists who are employed in the profession (workforce).

Sources
ºìÁì½í¹Ï±¨ Workforce Database, Canadian Institute for ºìÁì½í¹Ï±¨ Information.
National Physician Database, Canadian Institute for ºìÁì½í¹Ï±¨ Information.

The currently available data can support more granular analyses required to understand these gaps, as trends may vary by geography. For example, while the proportions of nurses and pharmacists working in rural/remote areas have declined over the last 10 years, region-specific assessments of population needs, models of care and scopes of practice can help bridge the gap between workforce supply and the demand for care among concentrations of older populations in those areas. 

In general, accelerated aging of the population places more pressure on health care systems, and Statistics Canada estimates that a quarter of Canada’s population will be 65 or older by the year 2051.Reference3 The 2021 Commonwealth Fund Survey found that 30% of older adults in Canada are living with at least 3 chronic conditions and 47% take 4 or more prescription medications regularly.Reference4 Additionally, 3 out of 5 needed to see or had seen a specialist in the last 2 years.Reference4

Personal support workers (PSWs) are frequently primary caregivers to people in long-term care and home care, and likely make up Canada’s largest group of health professionals.Reference5 A ºìÁì½í¹Ï±¨pilot project that used data from Alberta’s ºìÁì½í¹Ï±¨ Care Aide Directory revealed that the province had more PSWs (39,396) than registered nurses (36,302) in 2022. This is likely an underestimate as it accounts only for PSWs who work in the public sector. With Canada’s aging population as well as efforts to reduce health care costs, the demand for these professionals has increased. A growing number of jurisdictions across the country are working to develop and improve PSW data capture, which is crucial for understanding the pan-Canadian state of this largely unregulated workforce.Reference6

• ºìÁì½í¹Ï±¨ Workforce in Canada, 2022 — Quick Stats (XLSX) (Updated June 27, 2024)
• ºìÁì½í¹Ï±¨ workforce: Data tables
• Number of physicians and nurses per 10,000 population by health region, 2021