Overview of Health Human Resource Planning: A Canadian Perspective

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

Thoughts on HHR Planning


Presentation Outline

A View of HHR in Canada

A View of HHR in Canada

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 CanadaBased 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

509

1,178

3,941

6,892

7,783

10,984

14,695

15,607

15,693

17,553

18,313

19,401

28,537

60,612

0 10,000 20,000 30,000 40,000 50,000 60,000 70,000

Midwives

Audiologists

Optometrists

Chiropractors

Dietitians

Occupational therapists

Psychologists

Physiotherapists

Medical radiation technologists

Dental Hygienists

Dentists

Medical laboratory technologists

Pharmacists

Physicians

Plus 246,575 Registered Nurses

Plus 246,575 Registered Nurses

Source: HPDB, CIHI

Percent Change in Number of Health Care Providers, Canada, 1995 vs 2004

1.1%

6.2%

8.9%

10.3%

17.5%

24.3%

24.3%

28.6%

33.1%

35.8%

44.7%

56.4%

58.4%

0% 10% 20% 30% 40% 50% 60% 70%

Medical laboratory technologists

Registered nurses


Physicians

Dentists

Dietitians

Physiotherapists

Pharmacists

Psychologists

Optometrists

Dental Hygienists


Chiropractors

Note: The number of midw ives grew by 249%, from 146 in 1995 to 509 in 2004Source: HPDB, CIHI

1,757

855725 677 631 593

439

195108

37

0

400

800

1,200

1,600

2,000

Nu

mb

er o

f G

rad

uat

es

-40.0%

-20.0%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

% C

han

ge

in N

um

ber

of

Gra

du

ates

2004 Graduates % Change in Number of Grads, 1995 vs 2004

Number of Graduates in 2004 and Percent Change in Number of Graduates 1995 vs 2004, Canada

Source: HPDB, CIHI* For midwives, the percent change compares graduating class numbers for 1996 and 2004

27.0%

32.0%

33.0%

44.0%

57.0%

67.0%

79.0%

79.0%

80.0%

81.0%

93.0%

95.0%

98.0%

98.0%

99.0%

0% 20% 40% 60% 80% 100%

Dentists*

Physicians

Chiropractors

Optometrists

Pharmacists*

Psychologists*

Audiologists

Physiotherapists*

Medical radiation technologists*

Medical laboratory technologists*


Registered nurses

Dental Hygienists

Dietitians

Midwives

Females as a Percentage of Health Care Provider Groups, Canada, 2004

Source: HPDB, CIHI*Based on 2001Statistics Canada Census

Source:Statistics Canada,2001 Census

Percentage of Health Care Provider Groups Aged 45+, Canada, 2000

15.6%

20.6%

29.2%

30.8%

33.2%

33.3%

33.7%

34.1%

34.4%

35.0%

36.6%

44.0%

46.5%

46.6%

47.0%

47.9%

49.5%

49.8%

0% 10% 20% 30% 40% 50% 60%

Dental assistants


Physiotherapists

Medical sonographers

Optometrists

Chiropractors

Opticians

Dietitians and nutritionists

Pharmacists

Medical laboratory technicians


Cardiology technologists

Registered nurses

Dentists

Denturists

Registered nursing assistants

Family physicians & GPs

Specialist physicians

Source:Statistics Canada,2001 Census

Percentage of Health Care Provider Groups Who Worked Full-Time for the Full Year, Canada, 2000

44.5%48.2%

49.8%50.9%51.3%52.4%52.6%52.8%53.2%54.0%

55.8%56.8%

60.1%60.2%

64.8%66.0%

69.9%70.8%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Dental assistants

Dentists

Registered nursing assistants


Dietitians and nutritionists

Cardiology technologists

Family physicians & GPs

Registered nurses


Physiotherapists

Optometrists

Medical laboratory technicians

Medical sonographers


Chiropractors

Pharmacists

Denturists

Opticians

Note: Full-year, full-time is described by Statistics Canada as "worked 49 to 52 weeks in the reference year, mostly full time". "Full time" is defined as 30

hours or more per week.

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

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

midwives

technicians/ technologists

Nurse practitioners

psychologists

occupational therapists

dieticians/nutritionists

physiotherapists

pharmacists

Nurses (RN, LPN, RPN)


FP/GPs

Family Medicine Residents Medical, Surgical, Lab Residents

Source: 2004 National Physician Survey, CMA, CFPC, RCPSC.

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


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

midwives

Nurse practitioners



psychologists

physiotherapists

pharmacists




FP/GPs

Family Medicine Residents Licensed Family Physicians

2004 NPS: Percent of Licensed Physicians Who Share Care with Various Health Care Providers, Canada, 2004


0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

midwives

Nurse practitioners

psychologists


physiotherapists



pharmacists

FP/GPs



Family Medicine Physicians Medical, Surgical, Lab Physicians

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

http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/interprof/index_e.html

Thoughts on HHR Planning HHR Planning Often Focuses on Headcounts

1,400

1,500

1,600

1,700

1,800

1,900

2,000

2,100

2,200

2,300

2,400

Nu

mb

er o

f fi

rst

tim

e M

D a

dm

issi

on

s

1990

/01

1991

/92

1992

/03

1993

/94

1994

/95

1995

/96

1996

/97

1997

/98

1998

/99

1999

/00

2000

/01

2001

/02

2002

/03

2003

/04

2004

/05

2005

/06

First Time Admissions to MD Programs, Canada, 1990/91 - 2005/06

Source: AFMC, Canadian Medical Education Statistics, 2006.

Thoughts on HHR PlanningEven Basic Adjustments Can Change The

Headcount Picture

1.75

1.80

1.85

1.90

1.95

2.001

99

3

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

Ph

ys

pe

r 1

00

,00

0 p

op

ula

tio

n

Crude phys to pop ratio Adjusted phys to pop ratio*Source: Canadian Institute for Health Information* Adjusted for age-sex of patients and age-sex of physicians

Adjusted* Physician Supply: # MDs per 1,000 Population

Thoughts on HHR PlanningInternational Indicators Highlight Physician Resource

Challenges in CanadaPhysicians per 1,000 Population, OECD Countries, 1995 and 2004

0

1

2

3

4

5

Greec

eIta

ly

Belgium

Switzer

land

Icela

nd

Czech

Rep

ublic

Norway

Austri

a

Franc

e

Germ

any

Portu

gal

Spain

Hungar

y

Sweden

*

Denmar

k*

Luxe

mbo

urg

Irelan

d

Austra

lia*

Poland

*

United S

tate

s

Finlan

d

United K

ingdom

New Zea

land*

Canada

Mex

icoKor

ea

Turke

y*

1995 2004

USAUK

CAN

Thoughts on HHR PlanningComparison of Medical School Opportunity

First Year Medical School Positions Per 100,000 Population, 2005

7.1

12.9

7.1

0

2

4

6

8

10

12

14

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

42.9%

18.8%

28.3%

23.5%

11.2%

24.7%

31.8%

55.5%

24.0%

27.8%26.4%

35.6%

31.3%

23.1%

0%

10%

20%

30%

40%

50%

60%

NL PENS NB QC ON

MB SK AB BC YK NT

NUCAN

Source: CMA Masterfile, January 2006, Canadian Medical Association

Thoughts on HHR Planning IMG Trends Vary Within the Physician Workforce

Source: Supply, Distribution and Migration of Canadian Physicians, CIHI.

Percent Increase/Decrease in the Number of IMG Physicians Compared to 1996

-15.00%

-10.00%

-5.00%

0.00%

5.00%

10.00%

15.00%

1996 1997 1998 1999 2000 2001 2002 2003 2004

Med-Surg-Lab Physicians Family Physicians

-726-658

-568 -584

-420

-609-500

-320-262

218 227319 340

256334 291

240317

-508-431

-249 -244-164

-275-209

-80

55

-800

-600

-400

-200

0

200

400

1996 1997 1998 1999 2000 2001 2002 2003 2004

Moved abroad Returned Net

Source: Supply, Distribution and Migration of Canadian Physicians, CIHI

Thoughts on HHR Planning The Number of Physicians Leaving Canada Has Declined

Thoughts on HHR PlanningThere is Still Much to Learn About the Things

Health Care Providers Do

Thoughts on HHR PlanningMany Individuals and Organizations Have a Hand

in HHR PlanningIndividual Patients &

PractitionersHealth Care

Facilities (clinics, hospitals, nursing homes,

etc)Training Institutions

(colleges, universities, etc)

Regional Health Authorities

Regulatory Authorities

Professional Associations(membership, certifying & accrediting agencies, etc)

Health Care Research , Information & Service Agencies

(CIHI, CHSRF, CHEPA, CHSPR, MCHP, CaRMS, OPHRDC and many more)

Health Quality Councils

Provincial/Territorial Governments

Federal Government

HHR Planning

• The establishment of goals, policies, and procedures to direct all those involved in the delivery of health care.

• An orderly arrangement of the wide spectrum of health care providers.

• Having in mind an orderly arrangement of all health care providers.

TeachingHospitals

Thoughts on HHR PlanningExample 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

Overview of Health Human Resource Planning:A Canadian Perspective

2006 Trilateral ConferenceVancouver, British Columbia, Canada

Dr. Nick BusingPresident and CEO

Association of Faculties of Medicine of Canada

THANK YOU

Overview of Health Human Resource Planning: A Canadian Perspective

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