Keeping pace with changing population needs
Keeping pace with changing population needs ggagnonFebruary 29, 2024 — Demographics and where people live impact health care needs across the population. Understanding how health care workers are distributed across different regions of the country and what populations they serve can help decision-makers and planners ensure that the right mix of health providers is keeping pace with changing population needs.
Supply and distribution across urban and rural/remote populations
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
Text version of graph
| Type of professional | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | Statistically significant downward trend (p<0.01)? |
|---|---|---|---|---|---|---|---|---|---|---|---|
| All nurses | 11.1% | 11.0% | 10.2% | 10.3% | 10.2% | 10.1% | 9.9% | 9.8% | 9.7% | 9.6% | Yes* |
| NPs | 17.7% | 17.2% | 17.1% | 17.4% | 16.3% | 15.7% | 15.7% | 14.7% | 13.9% | 14.1% | Yes* |
| RNs | 9.7% | 9.5% | 9.2% | 9.3% | 9.2% | 9.3% | 9.1% | 9.0% | 8.9% | 8.8% | Yes* |
| LPNs | 14.7% | 14.7% | 12.3% | 12.3% | 12.1% | 11.9% | 11.5% | 11.4% | 11.2% | 11.1% | Yes* |
| RPNs | 14.4% | 14.0% | 13.6% | 14.3% | 14.7% | 13.8% | 13.8% | 13.4% | 12.7% | 12.2% | Yes* |
| Family physicians | 13.5% | 13.3% | 13.4% | 13.1% | 13.2% | 13.2% | 13.1% | 12.8% | 12.9% | 12.8% | Yes* |
| Specialists | 2.3% | 2.3% | 2.3% | 2.3% | 2.2% | 2.2% | 2.2% | 2.2% | 2.2% | 2.2% | No |
| Pharmacists | 11.4% | 11.0% | 10.9% | 10.7% | 10.4% | 10.3% | 10.3% | 10.2% | 10.1% | 9.8% | Yes* |
| OTs | 5.4% | 5.5% | 5.6% | 5.2% | 5.4% | 5.2% | 5.2% | 5.2% | 5.0% | 5.2% | Yes* |
| PTs | 6.8% | 6.4% | 6.5% | 6.5% | 6.7% | 6.4% | 6.4% | 6.4% | 6.4% | 6.2% | No |
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.).
ºìÁì½í¹Ï±¨ workforce trends and Canada’s aging population
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
Text version of graph
| Type of professional | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | Statistically significant trend (p<0.01)? |
|---|---|---|---|---|---|---|---|---|---|---|---|
| NPs | 0.6 | 0.6 | 0.7 | 0.7 | 0.8 | 0.8 | 0.8 | 0.9 | 0.9 | 1.0 | Yes (upward)* |
| RNs | 43.7 | 43.8 | 42.9 | 41.8 | 40.8 | 39.7 | 38.5 | 37.5 | 37.1 | 36.1 | Yes (downward)* |
| LPNs | 16.8 | 17.0 | 17.0 | 17.0 | 16.7 | 16.4 | 16.5 | 16.5 | 16.2 | 15.9 | Yes (downward)* |
| RPNs | 3.0 | 3.0 | 2.9 | 2.8 | 2.8 | 2.6 | Not available | 2.6 | 2.6 | 2.6 | Yes (downward)* |
| Family physicians | 7.0 | 7.0 | 6.9 | 6.9 | 6.6 | 6.7 | 6.6 | 6.5 | 6.3 | 6.3 | Yes (downward)* |
| Specialists | 6.2 | 6.1 | 6.1 | 6.1 | 5.9 | 5.9 | 5.8 | 5.8 | 5.6 | 5.6 | Yes (downward)* |
| Pharmacists | 6.7 | 6.8 | 6.8 | 6.8 | 6.8 | 6.7 | 6.6 | 6.4 | 6.4 | 6.3 | Yes (downward)* |
| OTs | 1.6 | 1.6 | 1.6 | 1.6 | 1.6 | 1.6 | 1.6 | 1.6 | 1.6 | 1.6 | No |
| PTs | 2.4 | 2.5 | 2.5 | 2.6 | 2.5 | Not available | Not available | 2.6 | 2.6 | 2.6 | No |
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
Related resources
References
1.
Statistics Canada. . Accessed November 17, 2023.
2.
Canadian Institute for ºìÁì½í¹Ï±¨ Information. ºìÁì½í¹Ï±¨ Workforce Intervention Scan [internal document]. 2023.
3.
Statistics Canada. . The Daily. April 27, 2022.
4.
Canadian Institute for ºìÁì½í¹Ï±¨ Information. How Canada Compares: Results From the Commonwealth Fund’s 2021 International ºìÁì½í¹Ï±¨ Policy Survey of Older Adults in 11 Countries. 2022.
5.
Canadian Institute for ºìÁì½í¹Ï±¨ Information. Personal support workers. Accessed January 18, 2024.
6.
Canadian Institute for ºìÁì½í¹Ï±¨ Information. Recommendations for Advancing Pan-Canadian Data Capture for Personal Support Workers (Updated July 2023). 2023.