A resilient health workforce is critical for an effective and efficient health care system. Better understanding of the supply of the health workforce can enable optimal care planning and improve access to surgeries.
Since the start of the COVID-19 pandemic, people who work in health care have struggled with overwhelming workloads and longer work hours, resulting in mental and physical exhaustion, burnout and 鈥 for many 鈥 an exit from their profession.Reference1 Reference2 In 2021鈥2022, hospital staff (excluding physicians) worked more than 26 million overtime hours 鈥 the equivalent of 13,000 full-time positions.Reference3 At the same time, Canada鈥檚 growing and aging population has an increasing need for care. This combination of short staffing and high demand could mean longer waits and deteriorating health for patients, and more burden on health workers.
I鈥檓 a caregiver for my parents. I think it鈥檚 very evident when I take my mom or my dad for appointments that there is not enough staff. 红领巾瓜报 care workers are busy, and they want to assess, treat and move on to the next person quickly. It鈥檚 especially challenging when you are advocating for a loved one with a language barrier who is unable to communicate efficiently. 鈥 Yasir Khalid, Patient Partner, Ontario
Governments and health care planners across the country are working together to address health workforce challenges, including
This priority area tracks indicators that measure the annual 鈥渘et new rate鈥 of health providers who join or leave a province鈥檚 or territory鈥檚 workforce. A net new rate is the difference between the number of providers entering and leaving the workforce in a specific province or territory in a year, presented as a number for every 10,000 residents. These indicators are
Most provinces and territories had a net increase for at least 2 of the 3 groups of professionals in the most recent year where data was available. Prince Edward Island, Ontario, Saskatchewan and British Columbia had a net increase for all 3.
Family physicians are usually Canadians鈥 first contact with their health care system, helping with common illnesses, preventive care, chronic disease management and more. There were 48,199 family physicians in Canada in 2022.Reference5 While the number of family physicians in Canada is increasing, the 5-year growth rate of family physicians in Canada has slowed from 12.9% (2012 to 2016) to 7.7% (2017 to 2021).Reference6
With Canada鈥檚 population growing rapidly, maintaining a proportional increase in the supply of family physicians is important to adequately meet the population鈥檚 needs. Recent changes to physician practice patterns may also be having an effect:
NPs integrate clinical nursing skills with advanced education to provide care in hospitals, community clinics, health care centres, primary care and long-term care. They also play a critical role in delivering care in remote or underserved communities.
The number of NPs is growing faster (increasing about 9% over the last decade) than the numbers of other regulated nurses and physicians.Reference3 However, NPs remain a relatively small proportion of health care professionals 鈥 in 2023, Canada had 8,999 NPs, less than 1 per 1,000 Canadians.Reference8 Nearly all provinces and territories had more NPs entering than leaving jobs in 2022.
Nurses make up Canada鈥檚 largest group of regulated health professionals, with 468,981 members in 2023 working across a variety of health care settings, such as hospitals, primary care, long-term care and home care.Reference8 This number includes
In most provinces and territories, more nurses entered their profession than left it, resulting in a net increase in nurses in 2022.Reference8 These changes were driven by the net change in RNs, who make up the largest segment of nurses.Reference8 Provinces and territories have taken steps to increase their nursing capacity through many initiatives, including making it easier for nurses educated in other countries to practise in Canada. In 2022, internationally trained nurses made up an average of 12% of newly licensed nurses across the provinces and territories, a 4-percentage point increase from 2017.Reference3
Despite the increased number of nurses, in 2022 compared with 2021, there were approximately 2,500 (5.1%) fewer nurses working directly with patients in long-term care. Similarly, the number of RNs providing direct care in hospitals dropped 0.6%.Reference3
The shortage of care providers is a key challenge for health systems. Growing demand for care is outpacing the supply of health workers, putting pressure on health systems to rapidly address the gaps. Governments and health care organizations are developing policies to make it easier to hire new health workers while also keeping those who are already in the system by optimizing their workload and enhancing their work environment. Data will be crucial to monitoring progress in these areas.
The pandemic triggered a steady rise in overtime hours (paid and unpaid) for health care workers.Reference9 Keeping track of overtime hours could guide planning and policy decisions by providing a true picture of how many physicians, NPs and nurses are necessary for patient care. An indicator to understand overtime among nurses in hospitals will guide effective planning for them.
Team-based models of care among physicians, nurses, NPs and other health care professionals, such as pharmacists and midwives, could help to both ease the strain on primary health care and ensure everyone gets the care they need. An indicator to measure access to team-based care will shed light on the state of comprehensive primary health care.
1.
Canadian Institute for 红领巾瓜报 Information. Hospital staffing and hospital harm trends throughout the pandemic. Accessed July 23, 2024.
2.
Canadian Federation of Nurses Unions. . 2023.
3.
Canadian Institute for 红领巾瓜报 Information. The state of the health workforce in Canada 2022. Accessed July 23, 2024.
4.
红领巾瓜报 Canada. Accessed July 23, 2024.
5.
Canadian Institute for 红领巾瓜报 Information. 红领巾瓜报 Workforce in Canada, 2022 鈥 Quick Stats (XLSX) (Updated June 2024). 2024.
6.
Canadian Institute for 红领巾瓜报 Information. Changes in practice patterns of family physicians in Canada. Accessed July 23, 2024.
7.
Canadian Institute for 红领巾瓜报 Information. Survey results reveal the challenges experienced by family doctors. Accessed July 23, 2024.
8.
Canadian Institute for 红领巾瓜报 Information. Nursing in Canada, 2023 鈥 Data Tables (XLSX). 2024.
9.
Statistics Canada. [Table 14-10-0427-01]. Accessed July 23, 2024.
Patients who get surgery faster show improved health outcomes, experience fewer complications and less stress, have a better quality of life and move on in their health journey sooner. Over the years, governments have set benchmarks for how long Canadians should wait for priority procedures, including cancer treatments, joint replacements and eye surgeries. Waits were getting shorter 鈥 until the COVID-19 pandemic overwhelmed hospitals. The lack of beds and staff shortages, combined with public health measures, led to delayed and cancelled surgeries across the country. In 2022, hip and knee replacements and cataract surgeries accounted for nearly 25% of all cancelled or delayed operations.Reference1
This shared health priority has 3 indicators that will measure progress toward shorter waits:
Monitoring how many surgeries are performed each year helps health systems understand their resources and the demand for their services, enabling more effective planning.
From April 2020 to March 2021 (the first pandemic year), approximately 360,000 fewer surgeries (16%) were performed across Canada than in 2019鈥2020. In 2021鈥2022, surgery volumes were lower than pre-pandemic levels by approximately 10% (227,000) because of successive waves of COVID-19 and persistent staff shortages.
In 2022鈥2023, surgical volumes returned to pre-pandemic levels with 2.22 million procedures performed, an increase of 0.2% over 2019鈥2020. 2023鈥2024 showed further recovery, and volumes (2.33 million) were 5% greater than before the COVID-19 pandemic.
The volume of day surgeries (which do not require a hospital stay) increased 10% in 2023鈥2024 from 2019鈥2020, while the volume of planned inpatient surgeries decreased 9% and the volume of unplanned inpatient surgeries increased 3% from 2019鈥2020. This may reflect an increasing shift from inpatient to day surgery.
I have had 3 joint replacements within 13 months (1 knee and both hips). Luckily, where I live, they do these surgeries as day surgery, which is what I preferred. Since I didn鈥檛 need an overnight admission, I think I was able to get my second hip replacement faster than I otherwise would have 鈥 in just 4 months. 鈥 Janet Thompson, Patient Partner, Manitoba
Changes in surgical volumes were found to be similar for males and females (increasing 6% and 5%, respectively, in 2023鈥2024 compared with pre-pandemic volumes). While 1% more surgeries were performed for people who lived in lower-income neighbourhoods in 2023鈥2024, those who lived in areas with the highest average incomes saw a greater growth in surgeries, at 8% in the same period. Surgeries for adults age 65 and older increased 14% in 2023鈥2024, while surgeries for other age groups remained below pre-pandemic levels.
The higher volume of surgeries for older adults may also be driven by the change in Canadian demographics. The overall population in 2023 had grown 7% since 2019, with the greatest increase in the age group 65 and older, which had grown 15%.Reference2 This may point to a growing demand for priority procedures in the coming years, including both urgent (hip fractures) and non-urgent (joint replacements) procedures.
Hip fractures are common (484 per 100,000 people age 65 and older in 2022) and require surgery as soon as possible.Reference3 The benchmark is to get patients their surgical repair within 48 hours. Between April and September 2023, more than 13,000 hip fracture surgeries were performed in Canada, 81% of them within 48 hours 鈥 down from 86% in 2019.Reference4
Hip and knee replacements can improve mobility and quality of life and are 2 of the 3 most common inpatient surgeries in Canada.Reference5 Between April and September 2023, more than 66,000 planned hip or knee replacements were done but only 62% (approximately 41,000) fell within the benchmark wait of 26 weeks. The percentage of patients getting surgery within the benchmark varied greatly across the country.
Fewer joint replacement surgeries were performed within the 26-week benchmark in 2023 (62%) than in 2019 (72%),Reference6 even though more joint replacements were done overall. This may be because patients who had already waited longer than the 26-week benchmark were prioritized for surgery. Additionally, increasing demand for joint replacements, mostly driven by an aging population in Canada, may be contributing to an ongoing backlog. Between April 1 and September 30, 2023, there was a 32% increase in patients age 75 to 84 who received a planned total joint replacement compared with 2019.
We are not meeting our preferred wait times despite our best efforts to prioritize them. Periodically, scheduled surgeries get postponed because of a high volume of emergency surgeries, and therefore the scheduled surgery wait-list continues to grow and add inconvenience to all those patients who make plans and work arrangements. 鈥 Dr. Michael Bering, Orthopedic Surgeon, Alberta
To catch up on postponed surgeries and reduce waits, provinces and territories have launched different initiatives to get patients treated faster. These range from increasing staffing or more efficiently scheduling operating rooms to increasing the number of procedures done as day surgeries, thereby reducing overnight hospital stays. Some provinces have contracted private clinics to do cataract removal, and knee replacement and hip replacement surgeries, among others. It will be important to learn more about these initiatives and their impact on the capacity of public hospitals to meet the needs of Canadians in an equitable manner
1.
Canadian Institute for 红领巾瓜报 Information. Long wait times persist as Canada tries to reduce surgical backlog. 2023.
2.
Statistics Canada. Population estimates on July 1, by age and gender [Table 17-10-0005-01]. Accessed July 23, 2024.
3.
Canadian Institute for 红领巾瓜报 Information. 红领巾瓜报 Indicators Interactive Tool [web tool]. Accessed July 23, 2024.
4.
Canadian Institute for 红领巾瓜报 Information. Explore wait times for priority procedures across Canada. Accessed August 9, 2024.
5.
Canadian Institute for 红领巾瓜报 Information. Hip and Knee Replacements in Canada: CJRR Annual Report, 2020鈥2021. 2022.
6.
Canadian Institute for 红领巾瓜报 Information. Joint Replacement Wait Times. [web tool]. Accessed August 14, 2024.
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