overview of health human resource planning: a canadian perspective
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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
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
Medical radiation technologists
Physicians
Dentists
Dietitians
Physiotherapists
Pharmacists
Psychologists
Optometrists
Dental Hygienists
Occupational therapists
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*
Occupational therapists
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
Occupational therapists
Physiotherapists
Medical sonographers
Optometrists
Chiropractors
Opticians
Dietitians and nutritionists
Pharmacists
Medical laboratory technicians
Medical radiation technologists
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
Specialist physicians
Dietitians and nutritionists
Cardiology technologists
Family physicians & GPs
Registered nurses
Occupational therapists
Physiotherapists
Optometrists
Medical laboratory technicians
Medical sonographers
Medical radiation technologists
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)
Specialist physicians
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
Source: 2004 National Physician Survey, CMA, CFPC, RCPSC.
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
midwives
Nurse practitioners
occupational therapists
technicians/ technologists
psychologists
physiotherapists
pharmacists
dieticians/nutritionists
Specialist physicians
Nurses (RN, LPN, RPN)
FP/GPs
Family Medicine Residents Licensed Family Physicians
2004 NPS: Percent of Licensed Physicians Who Share Care with Various Health Care Providers, Canada, 2004
Source: 2004 National Physician Survey, CMA, CFPC, RCPSC.
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
midwives
Nurse practitioners
psychologists
occupational therapists
physiotherapists
dieticians/nutritionists
technicians/ technologists
pharmacists
FP/GPs
Nurses (RN, LPN, RPN)
Specialist physicians
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
Thoughts on HHR Planning
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
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