james ayles english

Health Workforce Planningin New Brunswick

FLMM LMI Working Group

Labour Supply Monitoring and Forecasting Workshop

Vancouver, British Columbia

October 18th, 2007

James Ayles

Coordinator, Health Workforce Information and Analysis

New Brunswick Department of Health 2

Overview

Brief History of HHR Planning in NB 2003 Health Workforce Studies (Fujitsu)

HHR Unit Supply & Demand Forecasting Model Challenges in Using the Forecasting Model

Collaborative Work in Atlantic Canada Atlantic Health Education/Training Planning Study Simulation Model

National Initiatives HHR Modeling Working Group


HHR Planning – The Early Years

In the 1990s there was little formalized HHR planning

Late 1999s several factors forced the Province to address the supply of health practitioners Population Health Status (i.e. obesity, diabetes) Aging Population (client & practitioner) Urban/Rural (mobility & access) Language Access to Specialized Services Rising Costs (delivery of service, training of professionals)


HHR Planning – 2000s

Formalised health workforce planning activities emerged as an essential need in the 2000s

Health Human Resources Supply and Demand Analysis Commonly known as the “Fujitsu Report” (2002) Studied 28 health occupations and produced 5 year forecasts (10 years for

physicians)

Health Workforce Planning Unit established in 2003 The unit is responsible for forecasting the supply and demand of health human

resources, developing and implementing strategies to address human resources shortages, and providing support and advice to the Department in the areas of health professional resources

Provincial Health Plan 2004-2008 “Healthy Futures” Strategic Priorities: Building Health Human Resources - an appropriate supply

and mix of trained health professionals


Health Workforce Studies (Fujitsu)

Purpose of Health Workforce Studies

To provide essential data/information to inform planning process

To provide a current profile of the Health Workforce and their related practices

To identify future resource requirements

To develop 5/10 year forecasting models


Approach taken by Consultants

The general approach used for this project consisted of the following steps:

Consultation with Stakeholders

Environmental Scan

Database Design and Development

Forecast Model Design

Supply/Demand Analysis (gaps/shortages)


Occupation Specific Approach: Phase 1

SOCIAL SCIENCES Addiction Worker / Counsellor Psychologist (Clinical) Psychometrist Social Worker

REHABILITATIVE OCCUPATIONS Audiologist Speech Language Pathologist Occupational Therapist Physiotherapist Rehab Assistant

TECHNICAL GROUPS Diagnostic Medical Sonographer ECG Technician EEG Technician Medical Equipment Technician Medical Lab Technologist Medical Lab Specialist Medical Radiation Technologist /

Therapist (Nuclear Medicine, X-ray, MRI, Dosimetrist)

Respiratory Technologist / Therapist

NURSING Licensed Practical Nurse Registered Nurse Clinical Nurse Specialist Nurse Practitioner

OTHER OCCUPATIONS Ambulance Attendant / EMT /

Paramedic Dietician Public Health Inspector Health Records Technician Health Records Administrator Optometrist Pharmacist Pharmacy Assistant (Technician) Prosthetists

Total of 27 Occupations


Minimum Data Set: Phase 1

INDIVIDUAL First Nam, Last Name, Middle Initial Previous Names Home Address (address, city, province/state, postal

code, country) Language Proficiency Language Preference (English/French) Gender Occupation Entry to Practice Qualification Highest Level of Education Achieved in Occupation Origin of training (school, province/state, country) Year of grad Credential Certified Name of Registering/Licensing Body Registration # Registration Status Primary field of practice Secondary field of practice Working in Occupation Unemployed Seeking

EMPLOYER Employer’s Name/Place of Employment Employer’s Address Employer’s City Employer’s Postal Code Health Sector Health Region FTE – Public Sector Employment Sector Employment Status

EDUCATION Entry to practice requirements Inventory of training programs Program entry requirements Program duration Language of program Enrollment capacity of program Total capacity of program Graduation credential Entry Year number enrollments All Years number enrollments Entry Year number of NB students currently enrolled All Years number of NB students currently enrolled Number NB purchased Number grads over last 10 years Recruitment incentives


Data Sources: Phase 1

Service Provider Database HRDB (data warehouse of public sector

employees) Professional Health Associations/Colleges Maritime Provinces Higher Education

Commission Academic Institutions Statistics Canada Canadian Institute for Health Information


Forecasting Model (Supply): Phase 1

Supply-Side = Current Stock

Inventory Database – Occupations Subsystem

+ Increments New Entrants

Inventory Database – Education Subsystem Reserve Pool

Inventory Database – Occupations Subsystem Net Migration

Statistics Canada, CIHI

- Exits Statistics Canada, CIHI

± Weighted Supply Factor Perceived Impacts


Forecasting Model (Demand): Phase 1

Demand-Side =Current Stock

Inventory Database – Occupations Subsystem

+ Vacant Positions in System+ Planned New Positions- Planned Reduction in Positions± Weighted Demand Factors

Age Structure of Population Health Status Utilization Profile New Trends and Technology


Gap Analysis: Phase 1

Developed forecasts for 20 of the 27 occupations.

The remaining occupations did not have sufficient numbers to forecast

Key Deliverable “Health Human Resources Supply and

Demand Analysis” (November 2002) http://www.gnb.ca/0051/pdf/HRStudy/SupplyandDemandAnalysis.pdf


Physician Specialties: Phase 2

Family/General PractitionersSpecialists*

*Specialists includes:1. Anesthesia2. Anatomical Pathology3. Cardiology4. Cardiovascular & Thoracic Surgery5. Dermatology6. Diagnostic Radiology7. Emergency Medicine8. Gastroenterology9. General Pathology10. General Practice/ Family Practice11. General Surgery12. Geriatric Medicine13. Hematological Pathology14. Hematology15. Infectious Diseases16. Internal Medicine17. Medical Microbiology18. Medical Oncology

19. Neonatology20. Nephrology21. Neurology22. Neurosurgery23. Nuclear Medicine24. Obstetrics / Gynecology25. Ophthalmology26. Orthopedic Surgery27. Otolaryngology28. Pediatrics29. Physical Medicine & Rehab30. Plastic Surgery31. Psychiatry32. Radiation Oncology33. Respiratory Medicine34. Rheumatology35. Thoracic Surgery36. Urology37. Vascular Surgery



Individual First Name, Last Name, Middle Initial Gender Date of Birth License Number Billing Number/Service Provider Number Practice Location Mother Tongue Language Fluency 1 (Oral Proficiency) Language Fluency 2 (Written Proficiency) Preferred Working Language Language Of Majority of Medical Training Occupation Specialty Primary Secondary* Practice Specialty Post Graduate Fellowship 1, 2, 3, 4 Functional Specialty #1, 2, 3, 4, 5 Basic Medical School Origin of training (school, province/state, country) Year of grad PGME Origin of training (school, province/state, country) Year of grad Certified Billing Eligibility Status Total Medicare Billings (FFS) Licensure Status Total Salary payments Total Sessional payments Total Alternate payments

Total ‘Other’ payments FTE Calculation Range of clinical and non clinical practice activities Size of the practice Days seeing scheduled patients New patients added in past 12 months Practice capacity Average number of patients seen/week by Family Physician Average number of patients seen/week by Specialist Average hours per week in clinical practice FP On-call Categories Specialist On-call Categories On call commitment: Average number of hours on- call per month Intensity of on- call work Leave time for CME Leave time for other reasons than CME Maternity leave taken in the past 2 years Planned workload increase Planned workload decrease Magnitude of planned increased work Magnitude of planned work reduction Locum coverage for planned absences from practice Interdisciplinary Practice Patterns 1, 2, 3 Percentage of patients who are non NB residents Location of patients who are non NB residents Average wait time for elective consults Average wait time for urgent consults Practice Activities Health Sector Priorities for Action impacting Recruitment/retention General Comments on Factors impacting physician recruitment /retention



EDUCATION Name of Institution Location of Institution Program Name Length of Program Program Entry Requirements Language of program Accredited Y/N Clinical training Attrition Rate Credential awarded Pending changes to program

Number of Enrollments Gender of students enrolled Number of designated seats in the

program for NB students Number of NB students enrolled Gender of NB Students enrolled Mother Tongue of NB students enrolled Language Fluency of NB students

enrolled (Working Proficiency) Preferred Working Language of NB

students enrolled Program capacity Number graduates over last 10 years Age of Graduates Recruitment incentives offered to new

grads Where do students go to work after

graduation


Data Sources: Phase 2

Medicare Registration System New Brunswick Physician Survey

Response Rate (56%) GP/FPs (55%) SPs (58%)

MDSS – Physician Utilization System Canadian Institute for Health Information Canadian Post-MD Education Registry

(CAPER) Association of Canadian Medical Schools


Forecast Model: Phase 2

Supply-side / Physician Workforce Analysis forecast physician supply based on current stock, gains, and exits over

a 10-year forecast horizon

Demand-side / Needs Analysis based on current utilization of physician services, by age and gender,

and taking into consideration population changes over a 10-year forecast horizon

Gap Analysis / Identification of Imbalances and Physician Requirements comparison of present and future physician workforce compared against

present and future needs/demand over a 10-year forecast horizon


Forecast Model (Supply): Phase 2

Base Stock ofPhysicians, by

specialty

New Entrants fromMedical Schools

(PGME)

InterprovincialMigration

Immigration

Retirements

Deaths

InterprovincialMigration

GAINS EXITS

Weighted SupplyFactors (+/-)

EmigrationInternational Medical

Graduates


Forecast Model (Demand): Phase 2

Aggregate all General/Family practice services annually from all regions.

Calculate per capita use

of services by age and sex.

Multiply per-capita rates by each health region’s population (2001 census) to estimate population-based demand for GP/FP services.

Compare actual service to expected demand in each base year to assess regional variation/access.

Multiply per-capita rates by each health region’s projected population (annually to 2013)

Compare estimated demand for services for base year’s projected population (from 1996 census) to estimated demand for services by future years’ projected populations) to estimate changes in population-based demand for GP/FP services.


Gap Analysis: Phase 2

Key Deliverable “Setting a New Direction for Planning the

New Brunswick Physician Workforce” (September 2003)

http://www.gnb.ca/0051/pdf/HRStudy/DirectionPhysicianWorkforce.pdf

Appendix H: Detailed GP/FP demand methodology

Appendix I: Detailed General Surgery demand methodology


Stakeholder “Buy-in”

The two studies were well received by stakeholders

Occupations, where there was limited data, have approached the department looking for assistance in collecting the data necessary for their inclusion in the next iteration


Fujitsu Studies were the Basis for …

Components of the Provincial Health Plan

Integrated Health Human Resources Plan Physician Resource Strategy

Nursing Resource Strategy

Allied Health Resource Strategy

Partnership: Atlantic Health Human Resources

Association Atlantic Health Education Training Planning Study


Atlantic Health Education/Training Planning Study

New Brunswick – Fujitsu Studies

Nova Scotia, PEI, and Newfoundland & Labrador – conducted similar studies

Critical Mass Needed to Train an Adequate Supply of Health Professionals

Utilizing the results of the 4 studies tried to determine what was that critical mass and what would be required in the future


Atlantic Health Education/Training Planning Study

Atlantic Advisory Committee on HHR Health & Post Secondary Education Council of Atlantic Premiers - Secretariat

HRSDC Funded the Atlantic Study Produced a simulation tool

Supply Demand (Population & Productivity) “Policy Tester”

Report available at http://www.ahhra.ca


National Initiatives

F/P/T Advisory Committee on Health Delivery & Human Resources Planning sub-committee

HHR Modeling Working Group Mandate – knowledge transfer F/P/T representatives and research organizations HHR Modeling Definitions and Principles Workshops – 2005 & 2007


Other Models

Canadian Medical AssociationPhysician Supply – PRET

Canadian Nursing AssociationNurse Practitioners – Based on Atlantic

Simulation tool


Commitment to your Investment

Many models are used once and then discarded

Fujitsu Model was designed to be updated & reused

Physicians – updating now All other professions in 2008 Model Maintenance

Assumptions Data Sources

Thank You

james ayles english

Health & Medicine