The state of the health workforce in Canada, 2022

The state of the health workforce in Canada, 2022 cyin_master

February 29, 2024 — Moving through and beyond the COVID-19 pandemic has been a time of challenge and innovation, particularly in the area of health human resources. Funding increases, pan-Canadian collaboration and changes in health service delivery across the country have set the stage for new conversations about how to move forward. CIHI has compiled the most recent data on selected health professionals — including physicians, regulated nurses, pharmacists, occupational therapists, physiotherapists and personal support workersFootnote i — to illustrate the current state of the health workforce.

Supply and distribution

Examine trends in the supply and distribution of health care workers across Canada’s health care systems, including physician capacity and the number of nurses who provide direct care to patients in different settings.

Tracking workplace measures

Learn about the experiences of health care workers and the demand for labour in different work environments using data on vacancies, overtime and worker wellness.

Keeping pace with changing population needs

Get insights into the distribution of Canada’s health workforce in relation to the needs of various populations, including those in rural/remote areas and older adults.

Download the data

Take a closer look at health workforce data, including historical trends.

Go to Download the data

Key findings

  • In 2022, the suppliesFootnote ii of physicians, regulated nurses, pharmacists, occupational therapists and physiotherapists grew at varying rates. Nurse practitioners (NPs) continued to have the highest annual growth rate at about 9%, while the annual growth rate of registered nurses (RNs) slowed (1.1% in 2022 compared with 2.5% in 2021). On a larger scale, the average annual growth of family physicians and pharmacists slowed over the past 10 years (from 2.9% between 2013 and 2017 to 1.8% between 2018 and 2022 for family physicians, and from 3.4% to 2.2% for pharmacists).
  • The long-term care sector continued to see losses in the number of direct care nurses. Approximately 2,500 fewer direct care nurses were employed in long-term care in 2022 compared with 2021 (5.1% decline). The number of RNs in direct care employed in hospitals declined by over 800 (0.6% decline).
  • The average full-time-equivalent value for family medicine physicians and specialists — a measure of the average physician practice — rebounded to pre-pandemic levels in 2021–2022 at the pan-Canadian level after dipping the year prior.
  • Internationally educated health professionals made up a sizable proportion of the workforce in 2022, with more than a third of pharmacists and more than a quarter of physicians being international graduates. While the proportion of nurses who are internationally educated has traditionally been lower than that of other professionals, in 2022 they made up an average of 12% of newly licensed nurses across the provinces and territories, a 4% increase from 2017.
  • Surges in health care job vacancies (doubling since the start of the pandemic to 120,140 in 2022–2023) suggest that demand for health care is outpacing the gains in supply. Job vacancies for personal support workers (30,800 vacant positions; 25.7% of all health care vacancies), registered nurses and registered psychiatric nurses (28,000; 23.3%) and selected mental health workers (21,360; 17.8%) accounted for two-thirds of all health care job vacancies in 2022–2023.
  • In 2021–2022, an unprecedented amount of hospital overtime was logged by staffFootnote iii (over 26 million hours, equivalent to more than 13,000 full-time positions). The highest rates of overtime were observed in intensive care and in mental health and substance use inpatient units.
  • NPs are often an important source of primary care for rural/remote populations, but the proportion of this workforce employed in these areas has been steadily declining over the past decade (18% in 2013 compared with 14% in 2022). For pharmacists, the share of the workforce in rural/remote areas declined only slightly, from 11% to 10% in the same time period, while the proportion of physicians remained stable (about 13% of family medicine physicians and 2% of specialists).
  • As the population in Canada ages and needs for health care increase, the number of nurses in direct care roles may not be keeping pace. In 2022, there were 52 nurses in direct care roles per 1,000 older adults in Canada, compared with 59 in 2013. A decline was also observed for family medicine physicians and specialists (from 7.0 to 6.5, and from 6.2 to 5.6, respectively).

Spotlight on workforce policy changes

Policies targeting recruitment, retention and optimization of scopes of practice have been increasingly adopted across the country.Reference1,Reference2 Here are some examples:

  • Almost all provinces and territories have expanded scopes of practice for pharmacists to include assessing and prescribing medication for certain minor ailments, with some jurisdictions empowering pharmacists to renew and extend prescriptions. In some jurisdictions, RNs have also been granted new prescribing powers.
  • Efforts to increase physician capacity have taken the form of increasing medical training seats, with some jurisdictions offering tuition bursaries in return for service commitments. While these offerings are associated with a time delay due to the length of physician training, many provinces have established or enhanced incentive programs in rural communities.
  • Most jurisdictions have modified policies to expedite registration for health care workers, including provisions and programs to streamline internationally educated nurse entry to the health workforce. A number of provinces have taken their search for health workers abroad.

Footnotes

i.

Back to Footnote i in text

Personal support worker data is available for Alberta only.

ii.

Back to Footnote ii in text

Supply refers to selected professionals (physicians, regulated nurses, pharmacists, occupational therapists and physiotherapists) who are eligible to practise (i.e., are licensed) in the given year (including those employed and those not employed at the time of registration).

iii.

Back to Footnote iii in text

Excluding medical personnel.

References

1.

Back to Reference 1 in text

Government of Canada. Federal, provincial and territorial statement on supporting Canada's health workforce. Accessed November 17, 2023.

2.

Back to Reference 2 in text

Canadian Institute for Health Information. Health Human Resources Intervention Scan [internal document]. 2023.

Go in depth: 2022 health workforce data

Go in depth: 2022 health workforce data cyin_master

February 29, 2024 — Take a closer look at the most recent data on selected professionals, including nurses and physicians, with an interactive tool, data tables and detailed methodology notes.

Quick Stats

This interactive tool is ideal for workforce planners, health service managers and analysts who want to easily create customized visualizations. Explore and compare key metrics on supply (i.e., those who are licensed to practise), workforce (i.e., those working in a profession-specific job), direct care and inflow/outflow, as well as provincial and territorial trends for Canada’s physicians, nurses, occupational therapists, physiotherapists and pharmacists. This tool also includes interactive data tables with selected hospital staffing indicators, including overtime rates and sick leave in hospitals, as well new vacancy metrics.

Data tables

These tables are meant for analysts, researchers and those who want to explore and analyze the aggregate data. There are 10 years of supply, workforce, employment, education and demographic trends for Canada’s nurses, occupational therapists, physiotherapists and pharmacists. Supply and distribution information for physicians is available for both the recent period and a historical span of 51 years. Physician payment and service utilization information is available for both the recent period and a historical span of 24 years.

Methodology notes

These notes are meant for all data users. They summarize the sources, definitions, strengths and limitations of the data available.

Supply and distribution

Supply and distribution cyin_master

February 29, 2024 — Health care workers are the foundation of Canada’s health care systems. Understanding how they are distributed, where they provide care and how this is changing is critical to ensuring that the right mix of health care workers is available to meet the needs of Canada’s diverse population.

Overall trends

In 2022, the suppliesFootnote i of physicians, regulated nurses, pharmacists, occupational therapists and physiotherapists grew at varying rates; however, the overall supply of these professionals in relation to the size of Canada’s population has remained unchanged over the last 10 years (see table below).

Nurse practitioners (NPs) continued to have the highest growth rate among the professionals presented in this report (about 9% annually for the last 10 years), though they are a relatively small segment of the overall supply of health professionals discussed (less than 1 NP per 1,000 population).

Physiotherapists (PTs), licensed practical nurses (LPNs), occupational therapists (OTs) and registered psychiatric nurses (RPNs) have all seen consistent annual growth: around 4% for PTs, 3% for LPNs and OTs, and 2% for RPNs. Family physicians and pharmacists both had a decline in their average annual growth rate: from 2.9% between 2013 and 2017 to 1.8% between 2018 and 2022 for family physicians, and from 3.4% to 2.2% for pharmacists.

The supply of registered nurses (RNs) — who make up the largest segment of the professionals presented in this report (at 8 RNs per 1,000 population) — saw a substantial uptick in annual growth between 2018 and 2022 (1.3%) compared with between 2013 and 2017 (0.3%). Recently, though, this has been slowing, with annual growth dropping from 2.5% in 2021 to 1.1% in 2022.

These pan-Canadian supply trends vary across jurisdictions. More information is available at provincial/territorial and regional levels in the professional-specific data tables.

Average annual growth rate (2013 to 2017 and 2018 to 2022) and supply per 1,000 population for selected health professionals (2013, 2017 and 2022), provinces/territories with available data

Professional

Average annual growth rate

Supply per 1,000 population

2013 to 20172018 to 2022201320172022
Physicians2.8%2.1%222
Family medicine physicians2.9%1.8%111
Specialists2.6%2.4%111
Regulated nurses1.1%1.8%121212
Nurse practitioners9.6%9.2%<1<1<1
Registered nurses0.3%1.3%888
Licensed practical nurses2.8%2.6%333
Registered psychiatric nurses1.4%1.9%111
Occupational therapists3.5%3.2%<111
Physiotherapists3.5%4.1%<1<1<1
Pharmacists3.4%2.2%111

Notes
In Ontario, licensed practical nurses are referred to as registered practical nurses.
Registered psychiatric nurses per 1,000 population is based on population counts for provinces/territories where they are currently regulated (Manitoba, Saskatchewan, Alberta, British Columbia and the Yukon).
Sources
Health Workforce Database, Canadian Institute for Health Information.
Scott’s Medical Database, Canadian Institute for Health Information, with raw data provided by iMD (© 2023 iMD Health Global Corp.).
 

Trends in nurses who provide direct care

Overall supply numbers provide a high-level sense of workforce capacity, but a closer look at the subset of those who are employed in direct care roles provides a deeper understanding of how many people are working to provide patient care. Shifts in these direct care roles have been particularly notable for nursing professionals.

Despite growth in overall supply of nurses in 2022, key sectors experienced losses in the number of nurses employed in direct care. This means that, overall, more nurses left the sector that year than joined. Compared with 2021, approximately 2,500 fewer nursesFootnote ii were employed in direct care in the long-term care sector (5.1% decline). For the hospital sector, while the total number of nurses in direct care roles remained stable, the number of RNs in these roles declined by over 800 (a 0.6% decrease). Shifts in these settings may be the result of specific challenges, including increased workload and intensity amid sub-optimal staffing levels, leading to burnout and stress.Référence1,Référence2

Direct care nurses in community health agencies increased by 7.1% (a net increase of over 3,300 nurses), surpassing the 3.1% growth observed in 2021. Similarly, the number of nurses providing direct care for other employers, including private nursing agencies and self-employment, continued to increase, from 6.1% growth in 2021 to 9.2% growth in 2022 (a net increase of over 2,300 nurses). These types of work environments and employers may offer more flexibility or control over scheduling.Référence3

Net change in number of nurses working in direct care from previous year, by place of work, provinces/territories with available data, 2021 and 2022

Text version of graph

Type of nurse

Hospital

Community health agency

Nursing home/LTC

Other settings/employers

Change from 2020 to 2021Change from 2021 to 2022Change from 2020 to 2021Change from 2021 to 2022Change from 2020 to 2021Change from 2021 to 2022Change from 2020 to 2021Change from 2021 to 2022
NPs9012112524025015076
RNs1,127-8281,4442,32619-695692867
LPNs9181,324-1308252021,8316141,370
Total2,135 (+1.2%)617 (+0.3%)1,439 (+3.1%)3,391 (+7.1%)246 (+0.5%)2,526 (-5.1%)1,456 (+6.1%)2,313 (+9.2%)

Notes
NPs: Nurse practitioners; RNs: Registered nurses; LPNs: Licensed practical nurses.
LTC: Long-term care.
In Ontario, licensed practical nurses are referred to as registered practical nurses.
Registered psychiatric nurses (RPNs) are regulated only in the 4 Western provinces (Manitoba, Saskatchewan, Alberta, British Columbia) and the Yukon. RPN data is not reported due to data quality issues related to place of work and direct care.
When data on direct care and/or place of work is unavailable for a given nurse type in a province/territory for at least one year of the analysis, it is excluded from all years to ensure comparable trending for that nurse type.
For more information regarding collection and comparability of data as well as notes specific to individual provinces and territories, refer to the professional-specific methodology notes on CIHI’s website.
Source
Health Workforce Database, Canadian Institute for Health Information.
 

Physician practice trends

With almost 5 million Canadians reporting that they do not have regular access to a primary health care provider,Reference4 it is important to monitor trends in physician practice.

Full-time equivalent (FTE) measuresFootnoteiii can be used to understand physician workload. For example, one physician may practise part time (an FTE of <1.0) while another may practise full time (an FTE of 1.0). Understanding these values can help to provide a more precise measure of overall physician capacity and are more informative than basic heads counts.

At the pan-Canadian level, the average FTE for both family medicine and specialist physicians rebounded in 2021–2022 after dipping the year prior. The average specialist had an FTE of 0.86 between 2014–2015 and 2019–2020, compared with 0.89 in 2021–2022. The average family medicine physician had an FTE of 0.9 between 2014–2015 and 2019–2020, compared with 0.89 in 2021–2022. 

Footnotes

i.

Back to Footnote i in text

Supply refers to selected professionals (physicians, regulated nurses, pharmacists, occupational therapists and physiotherapists) who are eligible to practise (i.e., are licensed) in the given year (including those employed and those not employed at the time of registration).

ii.

Back to Footnote ii in text

For trends in nurses who provide direct care, nurses includes NPs, RNs and LPNs. RPNs are excluded due to data quality issues with place of work and direct care.

iii.

Back to Footnote iii in text

FTE values consider the fact that not all physicians have equal capacity to provide care (e.g., some may work part time or be semi-retired, some may focus on research, some may have a full patient roster). They are a helpful measure of average physician practice or workload relative to what is considered a full load and can be calculated with physician payment information. Physicians within the lower and upper payment benchmarks are counted as 1 FTE, while those with lower payments are considered to be less than 1 FTE and those with higher payments are considered to be more than 1 FTE. These benchmarks can be calculated at the jurisdictional level, as well as by specialty. More information on FTEs is available in the National Physician Database data tables (XLSX) and National Physician Databasemethodology notes (PDF).

References

1.

Back to Reference 1 in text

Boamah SA, Weldrick R, Havaei F, Irshad A, Hutchinson A. Experiences of healthcare workers in long-term care during COVID-19: A scoping review. Journal of Applied Gerontology. 2023.

2.

Back to Reference 2 in text

Canadian Institute for Health Information. Hospital staffing and hospital harm trends throughout the pandemic. Accessed November 14, 2023.

3.

Back to Reference 3 in text

Tomblin-Murphy G, Sampalli T, et al. Investing in Canada’s Nursing Workforce Post-Pandemic: A Call to Action. 2022.

4.

Back to Reference 4 in text

Canadian Institute for Health Information. Taking the pulse: A snapshot of Canadian health care, 2023. Accessed November 14, 2023.

Internationally educated health professionals

Internationally educated health professionals ggagnon

February 29, 2024  — Understanding the sources of Canada’s health workforce and the streams through which people enter health professions can help planners assess future education and recruitment strategies to meet growing population needs.

Supply of internationally educated health professionals

Internationally educated health professionals (IEHPs) have long made up a considerable proportion of our health workforce, with Canada sitting slightly above the Organisation for Economic Co-operation and Development (OECD) average for internationally educated supply.Reference1  As health worker shortages became a key challenge during the pandemic and have continued to be a major issue for health system recovery, many jurisdictions have taken steps to further bolster their workforce capacity by tapping into this resource through expedited or streamlined registration.Reference2 

In 2022, pharmacists had the largest proportion of IEHPs (of those professionals discussed in this report) — more than a third of licensed pharmacists in Canada were internationally educated. This was followed by physicians, with 27% of the workforce being international medical graduates. 

Professional

2013

2022

Number internationally educated Percentage of total supplyNumber internationally educated Percentage of total supply
Physicians19,62525%24,96727%
Family medicine physicians11,02828%14,30331%
Specialists8,59723%10,66423%
Regulated nurses31,3658%43,26710%
Nurse practitioners1725%3665%
Registered nurses26,2519%33,05910%
Licensed practical nurses4,5834%9,7167%
Registered psychiatric nurses3597%n/rn/r
Occupational therapists1,0617%1,2396%
Physiotherapists2,60613%6,46923%
Pharmacists7,34327%12,46935%

Notes
n/r: 2022 data for registered psychiatric nurses (RPNs) is not reported due to data quality issues for location of graduation.
RPNs are currently regulated in the 4 Western provinces (Manitoba, Saskatchewan, Alberta, British Columbia) and the Yukon. 

In Ontario, licensed practical nurses are referred to as registered practical nurses.
When data on location of graduation is unavailable for a given type of professional in a province/territory for at least one year of the analysis, it is excluded from all years to ensure comparable trending for that group. 

Sources
Health Workforce Database, Canadian Institute for Health Information.
Scott’s Medical Database, Canadian Institute for Health Information, with raw data provided by iMD (© 2023 iMD Health Global Corp.). 

 

The proportion of internationally educated nurses (IENs) in Canada has traditionally been lower compared with that of pharmacists and physicians. Despite this, IENs made up a larger percentage of those entering the nursing profession in 2022 compared with previous years. In 2017, IENs made up, on average, 8% of the newly licensed nursesFootnotei  in Canada. In 2022, IENs represented an average of 12% of new nurses across the provinces and territories, an inflow of over 5,000 IENs.

Ontario (22%) and Nova Scotia (19%) had the largest proportions of IENs in their supply of newly licensed nurses in 2022. The Atlantic provinces saw some of the largest increases relative to previous years.

More information on distribution of IEHPs across jurisdictions is available in the professional-specific data tables.

Percentage of new regulated nurses who are internationally educated, by province/territory, 2013, 2017 and 2022

Text version of graph

Jurisdiction201320172022Difference between 2022 and 2013–2021 is statistically significant (p<0.01)?
Pan-Canadian average7%8%12%Yes*
N.L.1%2%4%No
P.E.I.8%4%11%No
N.S.5%8%19%Yes*
N.B.2%1%13%Yes*
Que.7%6%13%Yes*
Ont.16%13%22%Yes*
Man.13%13%14%No
Sask.8%12%14%No
Alta.8%10%8%No
B.C.10%8%10%Yes*
Y.T. (NPs and RNs)4%5%8%No
N.W.T. (LPNs)0%17%12%No
N.W.T./Nun. (NPs and RNs)5%11%8%No

Notes
* In 2022, the proportion of new nurses who were internationally educated showed a statistically significant difference (p<0.01) compared with the previous 9 years (2013 to 2021).
NPs: Nurse practitioners; RNs: Registered nurses; LPNs: Licensed practical nurses.
New regulated nurses are those who were licensed to practise in the reference year but not the year prior.
Canada does not currently have a national unique identifier for nurses; therefore, we are unable to discern whether a nurse obtaining a licence for the first time in a given province or territory was licensed in a different province or territory before that.
Regulated nurses are NPs, RNs, LPNs and registered psychiatric nurses (RPNs). RPNs are regulated only in the 4 Western provinces (Manitoba, Saskatchewan, Alberta, British Columbia) and the Yukon. 
Data for Nunavut is not available.
In Ontario, licensed practical nurses are referred to as registered practical nurses.
For more information regarding collection and comparability of data as well as notes specific to individual provinces and territories, refer to the professional-specific methodology notes on CIHI's website.

Source
Health Workforce Database, Canadian Institute for Health Information.

Assessing potential capacity

While Canada leverages internationally trained professionals to create sufficient health workforce supply for the country, not all landed immigrants with international health education are currently employed in health care. 

According to Statistics Canada, more than 250,000 landed immigrants who are IEHPs were living in Canada in 2021, but many were not working in the health sector.Reference3  Roughly 67% of IEHPs who had trained in medicine were working in health care, compared with 95% of physicians who had trained in Canada. Similarly, 69% of IEHPs who had trained in nursing were employed in a health occupation, compared with 87% of Canadian-educated nurses.Reference3  

Further, when IEHPs are employed in the health sector, it may not be in the profession in which they are trained. For example, only 42% of IEHPs who had trained in nursing were employed as registered nurses, registered psychiatric nurses or licensed practical nurses. Among those trained in medicine, only 41% practised as a general practitioner, family physician, or clinical or laboratory specialist.Reference3  Future strategies to bring those not employed in their trained profession into the workforce will be valuable for boosting capacity in Canada’s health care systems. 

Top occupations of internationally educated health professionals who are employed in Canada, by field of study, 2021

Text version of graph

In 2021, these were the top occupations of internationally educated health professionals, by their field of study:

Studied nursing: RN or RPN, 34%; PSW, 21%; LPN, 8%; Other, 37%

Studied medicine: GP or FP, 28%; Clinical or laboratory specialist, 13%; RN or RPN, 4%; PSW, 4%; Sonographer, 3%; Other, 48%

Studied pharmacy: Pharmacist, 46%; Pharmacy assistant, 9%; Pharmacy technician, 5%; Other, 40%

Studied dentistry: Dentist, 25%; Dental assistant, 13%; Dental hygienist, 7%; Dental technician, 7%; Other, 48%

Notes
RN: Registered nurse; RPN: Registered psychiatric nurse; LPN: Licensed practical nurse; GP: General practitioner; FP: Family physician; PSW: Personal support worker.
Internationally educated health professionals are defined as landed immigrants who hold a post-secondary certificate, diploma or degree from outside Canada in a health field of study and who reported it as their highest certificate, diploma or degree. Temporary residents and Canadian-born people who received their highest certificate, diploma or degree in health in a foreign country are excluded. 
PSWs include nurse aides, orderlies and patient service associates. 
RPNs are regulated only in the 4 Western provinces (Manitoba, Saskatchewan, Alberta, British Columbia) and the Yukon.

Source
Adapted from Statistics Canada. Internationally educated health care professionals in Canada: Sociodemographic characteristics and occupational distribution. Accessed November 7, 2023. This does not constitute an endorsement by Statistics Canada of this product.

Footnotes

i.

Back to Footnote i in text

Canada does not currently have a national unique identifier for nurses; therefore, we are unable to discern whether a nurse obtaining a licence for the first time in a given province or territory was licensed in a different province or territory before that.

References

1.

Back to Reference 1 in text

Organisation for Economic Co-operation and Development. International migration of doctors and nurses. In: Health at a Glance 2023: OECD Indicators. 2023.  

2.

Back to Reference 2 in text

Canadian Institute for Health Information. Health Workforce Intervention Scan [internal document].  2023.

3.

Back to Reference 3 in text

Frank K, Park J, Cyr P, Weston S, Hou F. Internationally educated health care professionals in Canada: Sociodemographic characteristics and occupational distribution. Economic and Social Reports. 2023.

Tracking workplace measures

Tracking workplace measures ggagnon

February 29, 2024 — The COVID-19 pandemic exacerbated the cycle of staffing challenges and health care worker burnout. Understanding labour demand through vacancy rates, workplace overtime hours and the experiences of health workers is key to developing targeted retention strategies that promote worker wellness and improve quality of both employment and patient care.

Monitoring health care job vacancies

Having a clear picture of the number of vacant positions in health care can be used to track labour market demand and point to gaps in health workforce capacity. This information is a critical measure to support informed workforce planning. CIHI collaborated with Statistics Canada to develop a set of pan-Canadian health care job vacancy metrics for different health professionals.Reference1

In 2022–2023, there were an average of 120,140 health care job vacanciesFootnotei across the 4 quarters of the fiscal year. This reflects a doubling of vacancies from 2019–2020 (prior to the onset of the COVID-19 pandemic) and a quadrupling since 2015–2016. Job vacancies were highest for personal support workersFootnoteii (30,800 vacant positions; 25.7% of all health care vacancies), followed by registered nurses and registered psychiatric nurses (28,000; 23.3%) and selected mental health workersFootnoteiii (21,360; 17.8%). Collectively, these professionals accounted for two-thirds of all health care job vacancies in 2022–2023. 

 

All provinces experienced growth in health workforce–related job vacancies in 2022–2023 compared with the previous year, but there was variation in the size of that growth.

Monitoring vacancy metrics can further our understanding of the dynamics around supply of and demand for health professionals. These measures can inform initiatives to improve education and training programs, as well as recruitment and retention strategies. To explore vacancy metrics for different health professionals in more detail, explore the Health Workforce Quick Stats (see Related resources below).

Monitoring overtime hours

Overtime metrics can give a sense of staff workload. These trends indicate that Canada’s health systems are over capacity trying to address population health needs, which can result in a cycle of burnout and increased stress for health care workers. 

Health spending records show that, overall, hospital staff (excluding physicians) performed more than 26 million hours of overtime in 2021–2022.Reference2 The number of overtime hours worked by nurses and other hospital health workers (excluding physicians and management staff) on inpatient units reached 14.2 million, as highlighted in Hospital staffing and hospital harm trends throughout the pandemic. This represents a 53% increase from the previous year and is equivalent to over 7,000 full-time positions. 

Overtime was most prevalent on mental health and substance use units — out of a total 23.2 million hours worked on those units in 2021–2022, there were 1.9 million overtime hours (8%). The pandemic led to worsened mental health and psychological distress for many Canadians,Reference3 which may have been a contributing factor to pressures felt in these units. 

Intensive care units (ICUs) ranked second in terms of overtime rate — out of a total 30.7 million hours, there were 2.2 million overtime hours (7.3%) worked in 2021–2022. The increased need for overtime on ICUs was likely driven by the COVID-19 pandemic. Patients admitted to ICUs require specialized care that can be more resource-intensive in terms of the need for highly trained providers, the use of specialized technology and continuous close monitoring of patients.Reference4 This type of care can be more difficult to backfill (either internally through upskilling or through use of private agency staff), which can place higher demands on existing staff.Reference4

Health worker wellness

Health care worker sick time and the number of workplace mental health and violence reportsReference5 are also on the rise. In the first year of the pandemic, lost-time claims (including claims due to illness, injury and workplace violence) submitted to insurance for those working in the health care and social assistance sector increased by almost 25,000 (a 50% increase compared with 2019).Reference5 For professional occupations in nursing, lost-time claims nearly doubled from 2019 to 2020, reaching over 11,000.Reference5

In hospitals, 2021–2022 saw an uptick in rates of sick leave taken by staff (excluding physicians) following a 5-year period of stability. More than 14 million sick time hours were logged on nursing inpatient units in 2021–2022, a 17% increase over the previous year. This is a substantial change compared with the annual average growth of about 3% between 2017–2018 and 2020–2021.Reference6 Sick leave hours reported on ICUs and obstetric units made up a larger percentage of total worked hoursFootnoteiv compared with those reported on other inpatient units in 2021–2022 (6.5% for both, compared with an average of 6% across other inpatient units).Reference2

To fill the resulting staffing gaps during the pandemic, hospitals increasingly relied on the use of agency health workers. Before the pandemic (between 2017–2018 and 2019–2020), the annual average growth of agency staff hours worked in hospitals was about 8%; this increased to 32% between 2020–2021 and 2021–2022, reaching a total of 4.8 million hours.

Staffing challenges combined with the negative mental health impacts on staff stemming from increased amounts of overtime can lead to a cycle of burnout and understaffing. These issues can have a domino effect on patient care, including creating the potential for unintended harm to occur. Across Canada, the rate of hospital harm increased to 5.9% in 2020–2021 and 6% in 2021–2022 and 2022–2023 after remaining stable between 5.3% and 5.4% since 2014.Reference7

These trends warrant careful monitoring as the demands on the health workforce grow. More detailed data on provider experiences, including by profession and area of practice, is needed to support the development of targeted retention strategiesReference8 to address specific areas of strain across the system, promote overall wellness of the health workforce and improve quality of care. 
 

Footnotes

i.

Back to Footnote i in text

Health care jobs refers to occupations “concerned with providing health care services directly to patients and occupations that provide technical support to medical staff”1 as well as psychologists; social workers; family, marriage and other related counsellors; social and community service workers; and home support workers, housekeepers and related occupations.

ii.

Back to Footnote ii in text

For the purpose of this report, the personal support worker occupational grouping is defined as Statistics Canada’s National Occupational Classification (NOC) 3416 and 4412.

iii.

Back to Footnote iii in text

For the purpose of this report, mental health workers include psychologists; social workers; family, marriage and other related counsellors; and social and community service workers.

iv.

Back to Footnote iv in text

Sick leave hours as a percentage of total worked hours is calculated as sick leave hours divided by the sum of sick leave hours, regular worked hours and overtime hours. The result is then multiplied by 100 to be represented as a percentage.

References

1.

Back to Reference 1 in text

Statistics Canada. Guide to the Job Vacancy and Wage Survey, 2023. Accessed November 17, 2023.

2.

Back to Reference 2 in text

Canadian Institute for Health Information. Canadian MIS Database. 2023.

3.

Back to Reference 3 in text

Guerrero MD, Barnes JD. Profiles of mental health and their association with negative impacts and suicidal ideation during the COVID-19 pandemic: A Canadian perspective. Health Reports. 2022.

4.

Back to Reference 4 in text

Royal Society of Canada. COVID-19 Pandemic: The Impact on Canada’s Intensive Care Units. 2022.

5.

Back to Reference 5 in text

Association of Workers’ Compensation Boards of Canada. National Work Injury, Disease and Fatality Statistics. 2023.

6.

Back to Reference 6 in text

Canadian Institute for Health Information. Health Workforce in Canada, 2022 — Quick Stats. 2023. 

7.

Back to Reference 7 in text

Canadian Institute for Health Information. Hospital staffing and hospital harm trends throughout the pandemic. Accessed November 14, 2023.

8.

Back to Reference 8 in text

Government of Canada. Nursing retention toolkit: Improving the working lives of nurses in Canada. Accessed November 14, 2023.

Keeping pace with changing population needs

Keeping pace with changing population needs ggagnon

February 29, 2024 — Demographics and where people live impact health care needs across the population. Understanding how health care workers are distributed across different regions of the country and what populations they serve can help decision-makers and planners ensure that the right mix of health providers is keeping pace with changing population needs.

Supply and distribution across urban and rural/remote populations

The vast majority of Canadians reside in urban areas.Reference1 When rural/remote communities experience health worker staffing shortages, backfilling vacancies can be more challenging with a smaller pool of resources to draw from.

Over the last decade, the proportion of nurses working in rural or remote areas has declined (from 11.1% in 2013 to 9.6% in 2022; see the figure below). Nurse practitioners (NPs) have the largest proportion of their workforce working in rural and remote areas (1 in 7 NPs compared with about 1 in 10 other nurse types) and are often an important source of primary care in these areas. But these numbers have been declining: in 2013, 18% of NPs were employed in a rural/remote area, compared with 14% in 2022.

On the other hand, the proportion of family medicine physicians in rural and remote areas has remained stable at about 13% over the course of the decade. Many of Canada’s rural/remote regions rely on itinerant physicians (non-local physicians on short-term contracts) to provide care to their populations. For example, in 2022, similar to previous years, more than two-thirds of family physicians in Nunavut were itinerant.

About 10% of pharmacists in Canada practised in rural/remote areas in 2022 — only a slight decline over the last decade, down from 11% in 2013. In several jurisdictions, pharmacists’ scope of practice has recently been expanded to allow them to prescribe for or treat certain minor ailments, which may help improve access to care.Reference2

Proportion of providers working in rural/remote areas, selected health professionals, provinces/territories with available data, 2013 to 2022

Text version of graph

Type of professional2013201420152016201720182019202020212022Statistically significant downward trend (p<0.01)?
All nurses11.1%11.0%10.2%10.3%10.2%10.1%9.9%9.8%9.7%9.6%Yes*
NPs17.7%17.2%17.1%17.4%16.3%15.7%15.7%14.7%13.9%14.1%Yes*
RNs9.7%9.5%9.2%9.3%9.2%9.3%9.1%9.0%8.9%8.8%Yes*
LPNs14.7%14.7%12.3%12.3%12.1%11.9%11.5%11.4%11.2%11.1%Yes*
RPNs14.4%14.0%13.6%14.3%14.7%13.8%13.8%13.4%12.7%12.2%Yes*
Family physicians13.5%13.3%13.4%13.1%13.2%13.2%13.1%12.8%12.9%12.8%Yes*
Specialists2.3%2.3%2.3%2.3%2.2%2.2%2.2%2.2%2.2%2.2%No
Pharmacists11.4%11.0%10.9%10.7%10.4%10.3%10.3%10.2%10.1%9.8%Yes*
OTs5.4%5.5%5.6%5.2%5.4%5.2%5.2%5.2%5.0%5.2%Yes*
PTs6.8%6.4%6.5%6.5%6.7%6.4%6.4%6.4%6.4%6.2%No

Notes 
NPs: Nurse practitioners; RNs: Registered nurses; LPNs: Licensed practical nurses; RPNs: Registered psychiatric nurses; OTs: Occupational therapists; PTs: Physiotherapists. 
* The data shows a statistically significant downward trend over time (p<0.01). 
In Ontario, LPNs are referred to as registered practical nurses. 
RPNs are regulated only in the 4 Western provinces (Manitoba, Saskatchewan, Alberta, British Columbia) and the Yukon. 
When data on geography is unavailable for a given type of professional in a province/territory for at least one year of the analysis, it is excluded for all years to ensure comparable trending for that type of professional. 
For more information regarding collection and comparability of data as well as notes specific to individual provinces and territories, refer to the professional-specific methodology notes on CIHI’s website.

Sources 
Health Workforce Database, Canadian Institute for Health Information. 
Scott’s Medical Database, Canadian Institute for Health Information, with raw data provided by iMD (© 2023 iMD Health Global Corp.).

Health workforce trends and Canada’s aging population

Canada’s population is aging and will have a greater demand for health care in the future.Reference3 Despite increases in the overall supply of nurses, the number working in direct care roles has not kept pace with the growth of the aging population.

In the last decade, the number of nurses working in direct care roles per 1,000 older adults in Canada (age 65 and older) decreased from 59 to 52. This was mostly driven by a decrease for registered nurses, who represent the largest group of regulated nurses and declined from 44 per 1,000 older adults in 2013 to 36 in 2022. Small declines were also observed over the same time period for licensed practical nurses (from 17 to 16 per 1,000), while registered psychiatric nurses remained stable at about 3 per 1,000 older adults. On the other hand, NPs, who make up the smallest group of regulated nurses, steadily increased from less than 1 per 1,000 older adults in 2013 to 1 per 1,000 in 2022.

The number of family medicine physicians and specialists per 1,000 older adults declined between 2013 and 2022, but only slightly (from 7.0 to 6.5, and from 6.2 to 5.6, respectively). Pharmacists saw a similar small decline over the decade, moving from 6.7 to 6.3. 

The number of occupational therapists (OTs) and physiotherapists (PTs) providing direct care per 1,000 older adults has remained stable since 2013 (around 1.6 and 2.6, respectively). Most OTs (81%) and PTs (92%) work in direct care roles, with OTs primarily practising in hospitals (41%) or community health settings (43%) and PTs in community health settings (64%) in 2022.

Number of direct care providers per 1,000 older adults, selected health professionals, provinces/territories with available data, 2013 to 2022

 

Text version of graph

Type of professional2013201420152016201720182019202020212022Statistically significant trend (p<0.01)?
NPs0.60.60.70.70.80.80.80.90.91.0Yes (upward)*
RNs43.743.842.941.840.839.738.537.537.136.1Yes (downward)*
LPNs16.817.017.017.016.716.416.516.516.215.9Yes (downward)*
RPNs3.03.02.92.82.82.6Not available2.62.62.6Yes (downward)*
Family physicians7.07.06.96.96.66.76.66.56.36.3Yes (downward)*
Specialists6.26.16.16.15.95.95.85.85.65.6Yes (downward)*
Pharmacists6.76.86.86.86.86.76.66.46.46.3Yes (downward)*
OTs1.61.61.61.61.61.61.61.61.61.6No
PTs2.42.52.52.62.5Not availableNot available2.62.62.6No

Notes
NPs: Nurse practitioners; RNs: Registered nurses; LPNs: Licensed practical nurses; RPNs: Registered psychiatric nurses; OTs: Occupational therapists; PTs: Physiotherapists.
* The data shows a statistically significant trend over time (p<0.01). For RNs, LPNs, RPNs, family physicians, specialists and pharmacists, it is a significant downward trend. For NPs, it is a significant upward trend.
Older adults are those age 65 and older.
When data is unavailable for a given type of professional in a province/territory for at least one year of the analysis, it is excluded for all years to ensure comparable trending for that type of professional.
When the population of provinces/territories for which the data is unavailable exceeds 35% of the total population, no overall result is reported.
The denominator for the calculation of number per 1,000 older adults includes only the population for provinces/territories for which there is corresponding data in the numerator.
For more information regarding collection and comparability of data as well as notes specific to individual provinces and territories, refer to the professional-specific methodology notes on CIHI’s website.

Professional-specific data notes 
Nurses:
In Ontario, LPNs are referred to as registered practical nurses.
RPNs are regulated only in the 4 Western provinces (Manitoba, Saskatchewan, Alberta, British Columbia) and the Yukon.
Includes nurses who are employed in roles where they provide direct care or services to clients. 
Physicians:
Saskatchewan’s and Alberta’s family physician counts are calculated using fee-for-service data and do not include those physicians exclusively on alternative payment plans. 
As part of the agreement between the Government of Quebec and CIHI, the data transmitted by Quebec and held by CIHI may be used only for specific purposes and is not included in this analysis. 
The Northwest Territories does not submit specialty-level data to the National Physician Database. 
Nunavut does not submit data to the National Physician Database. 
OTs and PTs:
Incudes OTs and PTs who are employed in roles where they provide direct care or services to clients. 
Pharmacists:
Includes pharmacists who are employed in the profession (workforce).

Sources
Health Workforce Database, Canadian Institute for Health Information.
National Physician Database, Canadian Institute for Health Information.

The currently available data can support more granular analyses required to understand these gaps, as trends may vary by geography. For example, while the proportions of nurses and pharmacists working in rural/remote areas have declined over the last 10 years, region-specific assessments of population needs, models of care and scopes of practice can help bridge the gap between workforce supply and the demand for care among concentrations of older populations in those areas. 

In general, accelerated aging of the population places more pressure on health care systems, and Statistics Canada estimates that a quarter of Canada’s population will be 65 or older by the year 2051.Reference3 The 2021 Commonwealth Fund Survey found that 30% of older adults in Canada are living with at least 3 chronic conditions and 47% take 4 or more prescription medications regularly.Reference4 Additionally, 3 out of 5 needed to see or had seen a specialist in the last 2 years.Reference4

Personal support workers (PSWs) are frequently primary caregivers to people in long-term care and home care, and likely make up Canada’s largest group of health professionals.Reference5 A CIHI pilot project that used data from Alberta’s Health Care Aide Directory revealed that the province had more PSWs (39,396) than registered nurses (36,302) in 2022. This is likely an underestimate as it accounts only for PSWs who work in the public sector. With Canada’s aging population as well as efforts to reduce health care costs, the demand for these professionals has increased. A growing number of jurisdictions across the country are working to develop and improve PSW data capture, which is crucial for understanding the pan-Canadian state of this largely unregulated workforce.Reference6