When health ministers from across Canada met in mid-October, staffing was the top issue on their agenda, for good reason. The opening line of a recent House of Commons committee report states: “Canada’s health workforce is in crisis.”
Some positive strides were made at that meeting, particularly a commitment to prioritize retention of health-care workers.
However, the overall data is not pretty. Here are a few examples:
- Health-care vacancies tripled from around two per cent in 2015-16 to around six per cent in 2022-23.
- Nursing vacancies are forecast to rise to almost 120,000 by 2030.
- An estimated 6.5 million Canadians are without a regular primary-care provider.
What is worse, health-care workforce shortfalls are self-perpetuating: With too few staff, workers worry about patient safety, which results in rising stress levels, burnout and lower retention rates.
Looking ahead, the need to look after Canada’s aging population will further increase staffing demands.
COVID-19 exacerbated pre-existing shortages, but governments can influence key workforce drivers such as training and remuneration. The federal government committed $1.7 billion to increase personal support workers’ wages, while most provinces, such as Nova Scotia, have introduced further financial incentives for staff.
The October meeting highlighted enduring concerns at all levels of government. Although some positive steps were agreed upon – indicating progress on multiple fronts – workforce shortages are so severe that greater impetus is needed from Canadian governments. This will require better use of emerging technologies, policy innovation, virtual care for rural areas and better health-care leadership.
Some progress is being made
First, the positive steps: the meeting’s decision to prioritize retention is excellent. It is instantaneous compared with recruitment. It offers better value because existing staff members have experience within their organization and employers have a moral obligation to care for existing staff. Research also demonstrates that retention is the top priority for local leaders.
COVID-19 reminded policy-makers that health-care worker retention is not automatic. Some workers opted for early retirement, part-time work, private agency work or even working in the U.S., citing insufficient or inflexible shift scheduling.
England’s recent workforce plan for the National Health Service aims to “ensure up to 130,000 fewer staff leave the NHS over the next 15 years” by “improving culture, leadership, and wellbeing.”
Retention is not just a numbers game. Staff see corporate strategies for what they are. Therefore, policies must be grounded in genuine care for staff members’ welfare.
Many provinces already incentivize retention. This includes Ontario, which makes it hard to rationalize that government’s arguments against higher wages for nurses.
Second, at the October meeting, discussions addressed how to accelerate the integration of staff from other provinces and abroad. There are definite upsides, but it is a double-edged sword. Having talented health-care staff sitting on the sidelines waiting for paperwork makes no sense. However, all provinces are facing shortages. Frictionless movement would make it even easier for neighbouring provinces to poach staff from each other.
In this context, recruitment incentives risk creating an expensive race to the bottom. For example, Ontario currently offers a signing bonus of up to $25,000 to nurses recruited from another province. This further highlights the need to prioritize retention because it is more collaborative. As an example, in Australia’s national medical workforce strategy, the first priority is to “collaborate on planning and design.”
When it comes to international recruitment, there is a contradiction in governments committing to “ethical recruitment” while simultaneously making it “easier for foreign trained health workers to immigrate.”
The assumption is that it is primarily the manner of international recruitment – rather than the level – that determines its morality. But this is not clearly so.
The International Council of Nurses states, “higher-income, richer countries (undertake) global shopping trips to address shortages (because) they failed to recruit enough of their own.” Africa “shoulders over 22 per cent of the global burden of disease, but (has) only three per cent of health workers.”
Ethically, Canada should moderate reliance on immigration, even if domestic training costs more.
For example, England’s workforce plan for its National Health Service commits to training “more NHS staff domestically” and to “reduce reliance on international recruitment.”
Third, governments are making commitments toward better data and planning, which are both necessary and positive.
Without knowing how many staff we need – or have (!) – it is harder to plug the gaps. Numerous organizations have suggested improving Canada’s health-care data capabilities. In the Netherlands, for example, improved workforce planning has reduced the shortage of family physicians.
Some immediate steps are needed
The October meeting included many positive steps, and the discussions were particularly collaborative. Still, the scale of the workforce crisis is significant. As such, Canada needs to turbocharge its workforce policies.
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Here is where to start:
First, the technology used to reduce staff administrative burdens needs an upgrade.
Family doctors spend up to 40 per cent of their time on administrative tasks. While clinicians might (justifiably) roll their eyes at the notion of new technology saving time, AI-enabled software can already automatically transcribe patient-physician interactions, enabling physicians to fully engage with patients during appointments.
To encourage adoption of technologies that deliver a clear “win-win” for patients and staff, financial support should be provided to smaller health-care practices around upfront capital costs.
Second, innovative best practices should be shared far and wide.
Various reports highlight that Canada struggles to spread innovation. The late Monique Bégin, a former federal health minister, once described Canada as “a nation of perpetual pilot projects.” This observation was also referenced in Dr. David Naylor’s government-commissioned report on health-care innovation in 2015.
Of course, innovation dissemination is not simply a “copy and paste” across jurisdictions. Rather, it involves identifying successful interventions, considering local circumstances and creating opportunities (while sidestepping added obligations). The C.D. Howe Institute recently highlighted promising initiatives in Ontario, including a greater role for nurse practitioners. Alberta has recently approved a similar policy.
While governments set policy, much innovation occurs at the local level. For example, the Humber River Hospital in Toronto has achieved significant improvements through bottom-up, staff-led innovation.
Third, virtual care can be used to improve access to health services in rural and remote areas.
Geographical staffing inequalities are significant, and they restrict patient care in some regions. For example, rural areas have 18 per cent of Canada’s population but only eight per cent of all physicians.
Virtual care is a cost-effective means of mitigating this staffing imbalance. RAND Europe estimates that virtual care could save Canada up to $150 million annually from fewer unnecessary emergency room visits and missed appointments. There would also be significant potential economic benefits from reduced personal travel time.
For example, in the Carrier Sekani First Nations communities of B.C., primary virtual-care services improved access: 77 per cent of survey respondents who used telehealth options stated they saw their doctor more regularly and 82 per cent indicated they were able to attend more appointments.
To support morale, health-care leaders should consider measures to increase a sense of unity through, for example, greater alignment of salaries (or salary growth) between management and frontline staff.
One example of a bold response to a similar situation occurred in New Zealand in 2020, when then-prime minister Jacinda Ardern and her cabinet ministers temporarily reduced their salaries in solidarity with frontline workers.
Overall, the October meeting in Canada highlighted considerable progress around health-care staffing. Key members of the federal and provincial governments appear to be listening and responding.
But the remaining challenges ahead are monumental and growing. Turbocharging our workforce policy is critical.
If there were ever a time to “go big,” it’s now.