Resilient health workforce key to pandemic recovery

When COVID-19 hit, scheduled and non-emergency surgeries such as joint replacements and cataract procedures were cancelled or delayed. Hospitals needed to make room for COVID-19 patients and to prioritize urgent and life-saving procedures. Patients may also have chosen to delay their surgeries. At the same time, the supply and availability of health care workers affected which surgeries could be performed. The pattern repeated as further waves of the virus hit. Each interruption in scheduled surgeries added to the backlog.

Notes
Percentage change in number of surgeries done monthly between March 2020 and September 2022, compared with 2019.

Some data is provisional and subject to change; this data should be interpreted with caution.

Source
Discharge Abstract Database and National Ambulatory Care Reporting System, 2018–2019 to 2022–2023, Canadian Institute for Health Information.
 

To reduce their surgical backlogs, provincial and territorial health systems will have to increase their surgeries above pre-pandemic levels. Modest increases in surgeries — between 1% and 9% — were achieved in several months in Canada (not including Quebec) between March 2021 and June 2022.

Before the pandemic, an international survey showed that Canadians reported waiting longer for non-emergency surgeries than people in other developed countries.Reference1 Health systems across Canada have made significant efforts over the past decade to reduce waits for surgeries, and they’re drawing on what they learned from those successes to address pandemic-related waits.

Notes
n/a: Not available.

At the time of calculation, hospital data was not available for Nunavut (November to December 2019, March 2020, January to March 2021). Quebec is not participating in the joint reporting exercise stemming from A Common Statement of Principles on Shared Health Priorities. Therefore, results are not available for Quebec.

Percentage change in number of surgeries done monthly between March 2020 and September 2022, compared with 2019.

Analysis is based on hospital data submitted as of December 31, 2022. Data for April to September 2022 is provisional and is subject to change; this data should be interpreted with caution.

Source
Discharge Abstract Database and National Ambulatory Care Reporting System, 2018–2019 to 2022–2023, Canadian Institute for Health Information.

Health care workers are the heart of our health care systems. Their supply is a significant factor in how easily Canadians can access primary care and how long patients wait for surgeries and procedures.

During the initial waves of the pandemic, health care workers on the front lines in hospitals and long-term care homes were at high risk of catching the virus and exhausted by caring for sick patients while encased in protective gear. The 18 million overtime hours worked in Canada’s public hospitals in 2020–2021 is the equivalent of more than 9,000 full-time jobs, which gives a sense of the increased workload during the pandemic’s first year. The pressure contributed to burnout and illness, which can have long-term implications for the health of workers and for health care systems.Reference2 Some workers changed jobs and even careers.

Patient access to care was affected by pandemic lockdowns and redistribution of staff and health system resources, resulting in decreases in non-urgent care and scheduled surgeries. All these factors meant most physicians saw fewer patients. In the first year of the pandemic, physicians provided almost 8% fewer health care services in Canada compared with the previous year. During the same period, total physician payments decreased for the first time in 20 years, by 2%.

When this crisis unfolded, the system was adapting in real time… Cardiac procedures, cancer procedures had relatively smaller percentage reductions than [surgeries for] chronic conditions, like arthritis, for hernia, for pediatric. It shows the system was trying to triage to address the most urgent surgical procedures so that anybody whose life was at risk… they were provided with those opportunities. What suffered was things that aren’t imminently life-threatening but are often very disabling.— Dr. David Urbach, Head of the Department of Surgery, Women’s College Hospital, Ontario

In addition to the recent pandemic impact on health workers, Canada’s supply of doctors and nurses, including nurse practitioners, is changing:

• Many Canadians are struggling to access primary care. One of many factors may be the slowed pace of growth in the number of family physicians over the last 10 years. The annual growth rate decreased from about 3% to about 1% between 2012 and 2021. Nurse practitioners — who can provide many, but not all, primary care services — saw a steady annual growth rate of nearly 10% over the same period. There are still far fewer nurse practitioners compared with other professionals such as registered nurses and family physicians. Nurse practitioners can play an important role in delivering primary care services, particularly in rural and remote areas.Reference3
• The number of nurses has increased in most provinces and territories, but the number working in some health care settings has decreased. The number of registered nurses giving direct patient care in long-term care homes, for example, went down about 2% between 2020 and 2021.

Understanding the supply of health care workers at any point in time will require tracking the number of physicians and nurses, including nurse practitioners, leaving and taking direct care roles in each province and territory.

One of the huge issues we have in this country [is that] there is no human health resource plan that’s pan-Canadian. We don’t have the data so we can look [at whether] we need this many nurse practitioners, we need this many nurses, social workers, et cetera, to really understand how to deliver integrated team-based care across the country in a sustainable way.— Dr. Katharine Smart, Pediatrician, Yukon; Past President, Canadian Medical Association

New health human resources indicators will allow for better assessment of the flow of health care workers in to and out of the system, and for planning and monitoring of progress over time.

Improving Canada’s health care systems will depend on getting the right mix and number of health care providers so they’re available when Canadians need them. We know the supply of nurses and physicians is growing overall, but there is much to learn about whether we are educating enough new professionals and how and where they will be needed. We will need to protect providers from burnout, and explore different ways of delivering care that may be able to support health care workers and their work–life balance. We will need a resilient health care workforce to address the surgical backlogs and meet the evolving health care needs of Canadians.

• Access and wait time information at CIHI
• Health workforce at CIHI
• The state of the health workforce in Canada, 2022 
• Health workforce in Canada: In focus (including nurses and physicians)
• Impact of COVID-19 on Canada’s health care systems