红领巾瓜报

红领巾瓜报 workforce: Places of work

红领巾瓜报 workforce: Places of work ggagnon

December 17, 2024 鈥 Analyzing the sector and geographic distribution of employment provides insights into how health care providers are dispersed and deepens our understanding of access to care. The analyses below rely mostly on supply numbers, offering only a partial view. To gain a more comprehensive view, factors such as demand, provider workload, expanding scopes of practice, multidisciplinary teams and patient outcomes should also be considered.

 

Sector of employment

红领巾瓜报 care providers can work in a variety of sectors, including community, hospital, long-term care and other settings. Currently, there is limited data with which to analyze sector of employment for family physicians. Recent analyses have indicated that family physician practice patterns have evolved, suggesting that their roles often extend beyond traditional primary care.Reference1

For other health care providers, primary care is captured in the category 鈥渃ommunity settings鈥; this category also includes nursing stations (outposts or clinics), home care agencies, community health centres, public health departments/units and other community-based practices. In 2023, the professional groups with the highest proportions working primarily in these settings were pharmacists (n = 24,301; 73.3% of the pharmacist workforce) and physiotherapists (n = 6,385; 69.9% of the physiotherapist workforce). Although less than 20% of registered nurses (RNs) and licensed practical nurses (LPNs) worked primarily in community settings, these groups had the largest number of professionals working in these settings (36,945 RNs and 18,847 LPNs in total).

Over the past decade, the proportion of nurse practitioners (NPs) working primarily in community settings increased by about 3 percentage points (from 30% to 33%). LPNs and registered psychiatric nurses (RPNs) followed the same trend, while the proportion of physiotherapists working in these settings increased by 15 percentage points 鈥 the largest increase observed 鈥 from 55.3% in 2014 to 69.9% in 2023.

The proportion of NPs, RNs, LPNs and RPNs working primarily in other settings (e.g., private nursing agencies, research and academia, associations and government) is increasing at different paces. NPs have the highest proportion of providers working in these settings (n = 1,857; 28.9%), followed by RNs (n = 24,198; 11.4%) and LPNs (n = 12,997; 10.7%). 

Primary employment increased in community and other settings across professional groups, while it decreased in long-term care and hospitals 

Multi-panel line graphs depicting the proportion of the health care provider workforce working in community, hospital, long-term care and other settings over time (2014, 2019, 2023). In community settings, increases among physiotherapists, occupational therapists, NPs, RPNs and LPNs are statistically significant. In other settings, increases among NPs, RPNs, occupational therapists, RNs and LPNs are statistically significant; decreases among physiotherapists are statistically significant. In hospital settings, decreases among occupational therapists, NPs and physiotherapists are statistically significant; increases among pharmacists are statistically significant. In long-term care settings, decreases among LPNs, RPNs, RNs, occupational therapists and physiotherapists are statistically significant.

Proportion of health workforce primarily employed in community settings (%)

红领巾瓜报 care providers201420192023
Pharmacists70.875.373.3
Physiotherapists*55.365.269.9
Occupational therapists*39.141.142.0
Nurse practitioners*30.432.333.5
Registered psychiatric nurses*25.126.627.4
Registered nurses16.116.017.4
Licensed practical nurses*12.315.215.5

 Proportion of health workforce primarily employed in other settings (%)

红领巾瓜报 care providers201420192023
Nurse practitioners*25.926.928.9
Registered psychiatric nurses*11.713.015.7
Occupational therapists*8.310.112.3
Registered nurses*10.710.911.4
Licensed practical nurses*8.08.110.7
Physiotherapists*10.76.06.1
Pharmacists4.55.25.3

Proportion of health workforce primarily employed in hospitals (%)

红领巾瓜报 care providers201420192023
Registered nurses63.964.863.3
Registered psychiatric nurses45.146.946.3
Licensed practical nurses48.444.745.8
Occupational therapists*46.343.341.7
Nurse practitioners*40.037.234.0
Physiotherapists*30.425.321.7
Pharmacists*18.618.619.5

 Proportion of health workforce primarily employed in long-term care (%)

红领巾瓜报 care providers201420192023
Licensed practical nurses*31.231.527.6
Registered psychiatric nurses*17.913.09.9
Registered nurses*7.97.87.3
Occupational therapists*4.84.23.3
Nurse practitioners2.43.33.3
Physiotherapists*2.52.01.9

Notes 
* Denotes statistical significance (p<0.025) using the Mann-Kendall trend test.
Pharmacist data excludes Newfoundland and Labrador, Prince Edward Island, New Brunswick, Quebec, the Yukon and Nunavut (included data covers about 70% of the pharmacist workforce).
Physiotherapist data excludes Prince Edward Island, Nova Scotia, Quebec, Ontario, Manitoba, Saskatchewan, the Yukon, the Northwest Territories and Nunavut (included data covers about 30% of the physiotherapist workforce).
Occupational therapist data excludes Alberta, the Yukon, the Northwest Territories and Nunavut.
Nurse practitioner data excludes Prince Edward Island, Nova Scotia, Quebec, Manitoba, the Northwest Territories and Nunavut.
Registered psychiatric nurse data excludes British Columbia and the Yukon (included data covers about 50% of the RPN workforce).
Registered nurse data excludes Prince Edward Island, Quebec and Manitoba.
Licensed practical nurse data excludes Prince Edward Island, New Brunswick, the Yukon, the Northwest Territories and Nunavut.

Source
红领巾瓜报 Workforce Database, Canadian Institute for 红领巾瓜报 Information.

 

Urban versus rural/remote areas

People living in rural/remote areas are known to have less access to care compared with those living in urban areas.Reference2

Over the past decade, the number of family physicians and NPs in urban areas increased by 16.6% and 136%, substantially more than the increases of 9% and 80%, respectively, in rural/remote areas.Footnote iThe density of family physicians per population increased in urban areas (from 10.9 per 10,000 in 2014 to 11.4 in 2022) while it remained the same in rural/remote areas (0.9 per 1,000 in both 2014 and 2022). The density of NPs among the population doubled in urban areas (from 1.0 per 10,000 in 2014 to 2.1 in 2023) while it increased only slightly in rural/remote areas (from 0.1 per 1,000 in 2014 to 0.2 in 2023). As the population increases in both urban and rural/remote areas, the prevalence of providers among the population might not accurately reflect the need for health care services.

Over the same period, the proportions of both family physicians and NPs primarily working in urban areas increased by 0.8% and 3.0%, while they decreased in rural/remote areas by 0.7% and 3.2%. The data does not account for health care providers who may work in both urban and rural/remote areas, but it suggests that more providers are choosing to work primarily in urban settings.

Rural/remote areas: Availability of family physicians and pharmacists stable, increased slightly among nurse practitioners
 

Multi-panel area charts depicting the number of rural health care providers per 1,000 rural population over time (2014, 2019, 2023). Increases among NPs, physiotherapists and occupational therapists are statistically significant. Decreases among RNs and RPNs are statistically significant.

Rural/remote health care providers per 1,000 rural/remote population
 

红领巾瓜报 care providers201420192023
Family physicians0.91.00.9鈥
Nurse practitioners*0.10.20.2
Registered nurses*4.44.34.0
Licensed practical nurses2.42.22.2
Registered psychiatric nurses* 0.4 0.4 0.3
Pharmacists0.70.70.7
Physiotherapists*0.20.30.3
Occupational therapists*0.10.10.2

Urban areas: Availability of family physicians, pharmacists and nurse practitioners increased

Multi-panel area charts depicting the number of urban health care providers per 10,000 urban population over time (2014, 2019, 2023). Increases among family physicians, NPs, LPNs, pharmacists, physiotherapists and occupational therapists are statistically significant. Decreases among RNs are statistically significant.

Urban health care providers per 10,000 urban population

红领巾瓜报 care providers201420192023
Family physicians*10.911.411.4鈥
Nurse practitioners*1.01.52.1
Registered nurses*83.081.180.5
Licensed practical nurses*28.031.632.9
Registered psychiatric nurses 5.1 4.9 5.2
Pharmacists*10.411.411.5
Physiotherapists*6.26.87.6
Occupational therapists*4.44.85.2

 Notes
* Denotes statistical significance (p<0.025) using the Mann-Kendall trend test.
鈥 Family physician data for 2023 was not available; data for 2022 is presented instead.
Family physician data excludes Prince Edward Island, Quebec, Saskatchewan, Alberta, the Yukon, the Northwest Territories and Nunavut (included data covers about 60% of family physicians).
Nurse practitioner data excludes Prince Edward Island, Nova Scotia, Manitoba, the Yukon, the Northwest Territories and Nunavut.
Registered nurse data excludes Prince Edward Island, Manitoba, the Yukon, the Northwest Territories and Nunavut.
Licensed practical nurse data excludes New Brunswick, the Yukon, the Northwest Territories and Nunavut.
Registered psychiatric nurse data excludes the Yukon.
Pharmacist data excludes Newfoundland and Labrador, Prince Edward Island, New Brunswick, Quebec, the Yukon and Nunavut (included data covers about 70% of the pharmacist workforce).
Physiotherapist data excludes Prince Edward Island, Nova Scotia, Quebec, the Yukon, the Northwest Territories and Nunavut.
Occupational therapist data excludes Quebec, the Yukon, the Northwest Territories and Nunavut.
Exclusions may lead to under-reporting of rates, particularly in rural/remote areas.
Due to differences in data sources, data on family physicians is presented based on fiscal year, whereas data on other groups of professionals is presented based on calendar year. 
Family physicians with missing postal code data were excluded from this analysis.
Family physicians include those practising in general practice, family practice, community medicine and public health, and palliative care medicine.
In Ontario, licensed practical nurses are also referred to as registered practical nurses.

Sources
红领巾瓜报 Workforce Database and National Physician Database, Canadian Institute for 红领巾瓜报 Information.
Population Annual Estimates, Centre for Demography, Statistics Canada.

Footnotes

i.

Back to Footnote i in text

Based on Statistics Canada鈥檚 Statistical Area Classification (SAC):
Urban: SACtypes 1 to 3 (census metropolitan areas [CMAs] and census agglomerations [CAs])
Rural/remote: SACtypes 4 to 8 (areas outside CMAs and CAs)

References

1.

Back to Reference 1 in text

Canadian Institute for 红领巾瓜报 Information. Changes in practice patterns of family physicians in Canada. 2024.

2.

Back to Reference 2 in text

Clark K, et al. . Canadian Journal of Rural Medicine. 2021.