• Health workforce in Canada: Overview
• Canadian Data Set of COVID-19 Interventions

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 of Canada’s physicians, nurses, occupational therapists, physiotherapists and pharmacists. This tool also includes new interactive data tables with selected hospital staffing indicators, including overtime rates and full-time equivalents in hospitals, as well as graduate migration patterns for physicians and nurses.

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 of physicians are available for both the recent period and a historical span of 52 years. For physician payment and service utilization information, data is available for the recent period as well as a historical span of 26 years.

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

The downloads directly below include the 2021 health workforce data that was used to inform the findings in that year’s report. To view the most recent health workforce data on selected professionals and this year’s report, please see The state of the health workforce in Canada, 2022  below.  

Use the links below to access the most recent health workforce data on selected professionals and the 2022 report.

• Health workforce in Canada: Overview

Annual growth rate in supply of selected health care providers over the past 3 years in Canada

Notes
NPs: Nurse practitioners; RNs: Registered nurses; RPNs: Registered psychiatric nurses; LPNs: Licensed practical nurses; OTs: Occupational therapists; PTs: Physiotherapists.
In Ontario, licensed practical nurses are referred to as registered practical nurses.
RPNs are regulated only in the 4 western provinces and Yukon.
For more information regarding collection and comparability of data as well as notes specific to individual provinces and territories, refer to profession-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 (© 2022 iMD Health Global Corp.).

Overall supply measures reflect the total number of health care workers licensed and available to work in a health profession, but only a subset of this workforce is employed in direct patient care. Overall supply numbers provide a high-level sense of workforce capacity, but a closer look at direct care employment numbers provides a deeper understanding of how many people are working in the different sectors of care. Despite growth in overall supply numbers in 2021, some sectors of care saw losses in health workers employed in direct patient care. There were almost 500 fewer registered nurses (RNs) in direct care employment in long-term care (2.2% decline) and over 100 fewer licensed practical nurses (LPNs) in direct care employment in community health agencies (0.8% decline). Throughout the same period, there was an increase in nurses employed in direct patient care in other sectors: there were 1,251 more RNs (6.5% increase) and 667 more LPNs (8.2% increase) employed in direct patient care jobs in settings such as private nursing agencies, occupational health centres and self-employment.

Percentage change in the number of regulated nurses employed in direct care by place of work, 2020 to 2021

Notes
NPs: Nurse practitioners; RNs: Registered nurses; LPNs: Licensed practical nurses; LTC: Long-term care.
Jurisdictions for which data on place of work is not available are not included in this analysis.
In Ontario, licensed practical nurses are referred to as registered practical nurses.
Registered psychiatric nurse (RPN) data is not reported due to data quality issues related to place of work.
For more information regarding collection and comparability of data as well as notes specific to individual provinces and territories, refer to profession-specific methodology notes on CIHI’s website.

Source
Health Workforce Database, Canadian Institute for Health Information.

Many factors contribute to where health professionals practise in Canada. One factor that contributes to a health care provider’s location of practice is their location of training. For physicians, medical graduates tend to remain in the same province when they graduate in bigger provinces. In 2021, about 80% of new graduatesFootnotei in Quebec, Ontario or British Columbia stayed in the province, while only 49% remained in the province if they graduated in Newfoundland and Labrador. New nurse graduates,Footnotei on the other hand, are more likely to remain in province following graduation regardless of the size of the province. In 2021, 93.6% of new RN graduates and 96.6% of new LPN graduates registered in the province where they graduated, regardless of the size of the province.   

In rural and remote regions of Canada, different factors influence location of practice. Fewer physicians per population reside in Canada’s rural/remote regions, which rely on itinerant physicians (non-local physicians on short-term contracts) to provide care to their populations. For example, in 2020–2021, similarly to previous years, about half of family physicians (FPs) were itinerant family physicians (18 out of 43) in Nunavut. Nurse practitioners can help to address this gap and play an important role in the primary care delivery model.Reference1 Because of their additional education and training, NPs can autonomously perform activities such as diagnosing illnesses and ordering tests;Reference2 this expanded scope can reduce pressure on the health care system and, through collaboration with other health care providers, improve access to primary care.Reference1 In the Northwest Territories and Nunavut, there were 72 NPs per 100,000 population and in Yukon, 51 NPs per 100,000. The territories and Newfoundland and Labrador also had the highest ratios of NPs to FPs in the country. Further analyses of rural/remote areas in other jurisdictions will paint a more accurate picture of the pan-Canadian situation. 

Nurse practitioners and family physicians per 100,000 population and NP-to-FP ratios, 2021

 

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Jurisdiction	NPs per 100,000 population	FPs per 100,000 population	NP-to-FP ratio
N.L.	39.38	133.51	0.295
P.E.I.	28.16	109.50	0.257
N.S.	22.98	138.50	0.166
N.B.	19.26	139.76	0.138
Que.	10.91	131.72	0.083
Ont.	24.61	116.15	0.212
Sask.	20.34	105.78	0.192
Alta.	13.48	122.06	0.110
B.C.	12.06	136.50	0.088
Y.T.	51.18	165.17	0.310
N.W.T./Nun.	71.84	100.11	0.718
Canada	18.24	123.77	0.142

Notes
NPs: Nurse practitioners; FPs: Family physicians.
Prince Edward Island data is for 2020.
Workforce count data for NPs in Manitoba is not available.
Northwest Territories and Nunavut data is combined.

Sources
Health Workforce Database, Canadian Institute for Health Information.
Scott’s Medical Database, Canadian Institute for Health Information, with raw data provided by iMD (© 2022 iMD Health Global Corp.).
Statistics Canada. Special tabulation, based on Estimates of population (2016 Census and administrative data), by age group and sex for July 1st, Canada, provinces, territories, health regions (2018 boundaries) and peer groups. 2022.

• Health Workforce in Canada Quick Stats, 2021
• Nurse practitioner scopes of practice, 2020
• Health workforce scopes of practice

Average gross clinical payments ($343,500 at the pan-Canadian level in 2020–2021) decreased in most jurisdictions in 2020–2021 compared with the previous year (-3.4% at the pan-Canadian level), but payments generally were still higher than 5 years ago. Between 2016–2017 and 2020–2021, average payments increased between 3% and 12% in Atlantic Canada, and by 16% in Yukon. Quebec and Ontario also saw increases, albeit slightly smaller at 3% and 2%, respectively. The Prairies and British Columbia saw decreases over the same time frame, ranging from -1% to -5%.

Average clinical payments to physicians, 2016–2017 and 2020–2021

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Jurisdiction	2016–2017	2020–2021
N.L.	$273,899	$283,461
P.E.I.	$378,280	$405,100
N.S.	$265,431	$298,543
N.B.	$302,132	$313,140
Que.	$328,360	$338,538
Ont.	$346,660	$351,992
Man.	$360,287	$349,274
Sask.	$359,775	$351,790
Atla.	$385,522	$367,230
B.C.	$289,850	$286,413
Y.T.	$275,715	$320,164
Canada	$340,989	$343,528

Source
National Physician Database, Canadian Institute for Health Information.

The predominant method of reimbursement for physicians’ clinical activity in Canada is fee-for-service (FFS), but other models exist, such as salary, sessional payments, capitation and other contracts. Any non-FFS payments are referred to here as alternative payment plans (APPs).

In 2020–2021, there was a 70/30 split for FFS and APP payments (70% FFS; 30% APP). The split has been stable at the pan-Canadian level for the past 10 years, with some jurisdictional variations. While FFS accounts for approximately 70% of total clinical payments, almost all physicians (96%) received at least some payment through FFS. APPs accounted for about 30% of total clinical payments, and about two-thirds of physicians (64%) received at least some payment through APPs.

Share of physician payments by type of payment, 2020–2021

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Jurisdiction	APP clinical payments	FFS clinical payments	Percentage of physicians who received any APP payments	Percentage of physicians who received any FFS payments
N.L.	36.2%	63.8%	51%	89%
P.E.I.	40.2%	59.8%	83%	88%
N.S.	67.0%	33.0%	97%	56%
N.B.	35.6%	64.4%	70%	90%
Que.	22.8%	77.2%	89%	99%
Ont.	37.0%	63.0%	45%	98%
Man.	29.3%	70.7%	71%	91%
Sask.	44.0%	56.0%	49%	62%
Atla.	14.1%	85.9%	26%	83%
B.C.	19.2%	80.8%	60%	95%
Y.T.	43.1%	56.9%	57%	99%
Canada	29.5%	70.5%	64%	96%

Source
National Physician Database, Canadian Institute for Health Information.

Consultations and visitsReference 2 accounted for almost three-quarters of clinical services and two-thirds of clinical payments. The average cost per service was $73.45 for 2020–2021, a 2.9% increase over the previous year. The average cost per service was impacted by multiple factors, including FFS rate changes and shifts in the volume of services provided. For example, the volume of major assessments dropped by 24% while other assessments decreased by 5.9%. Major surgery services fell by 9.4% compared with drops of 20.8% in minor surgery and 19.9% in diagnostic and therapeutic services. Fluctuations in service volumes changed the distribution of more expensive and less expensive services, contributing to the overall increase in the average cost per service over the previous year.

The average cost per service varied considerably across the different specialty groups. Costs ranged from $52.36 and $56.02 for dermatology and family medicine to $213.46 and $238.50 for thoracic/cardiovascular surgery and neurosurgery, respectively.

Average cost per service by specialty, 2020–2021

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Group	Specialty	Average cost per service
Family medicine	Family medicine	$56.02
Medical specialties	Internal medicine	$90.02
	Cardiology	$87.42
	Gastroenterology	$112.03
	Neurology	$115.44
	Psychiatry	$110.31
	Pediatrics	$88.65
	Dermatology	$52.36
	Physical medicine	$97.26
	Anesthesia	$190.58
Surgical specialties	General surgery	$134.78
	Thoracic/cardiovascular surgery	$213.46
	Urology	$85.69
	Orthopedic surgery	$126.81
	Plastic surgery	$119.78
	Neurosurgery	$238.50
	Ophthalmology	$66.91
	Otolaryngology	$69.92
	Obstetrics/gynecology	$90.40
Total physicians	Not applicable	$73.45

Source
National Physician Database, Canadian Institute for Health Information.

• A profile of physicians in Canada, 2022

In 2020–2021, health care workers’ overtime rates in hospitals were higher than in previous years. More than 18 million overtime hours were recorded in Canada’s hospitals in 2020–2021, up by 15% over the previous year. These overtime hours alone translate to over 9,000 full-time equivalents (FTEs). More than half of the hospital overtime hours in 2020–2021 were for nursing inpatient services, where nursing staff along with a host of other personnel performed 9,771,633 overtime hours (equivalent to 5,011 FTEs).

In response to COVID-19, many surge capacity initiatives were put in place to help control health workforce overtime requirements. In the early days of the pandemic, many non-urgent procedures and surgeries were postponed to accommodate COVID-19–related care in hospitals.Reference 2 Other surge capacity initiatives included calls for retired or non-practising health care workers to temporarily return to practice, reducing or removing isolation requirements for asymptomatic employees and redeploying health care workers to maintain staffing levels in hospitals.Reference 2 During this time, data suggests that hospitals relied more on agency staff to fill gaps than in years prior: in 2020–2021, these workers logged 3.7 million hours, a 5.5% increase from the previous year.

Share of overtime hours by hospital service area, provinces and territories with available data, 2020–2021

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Hospital service area	Share of overtime hours
Nursing inpatient services	53.8%
Ambulatory care services	16.2%
Administrative and support services	14.0%
Diagnostic and therapeutic services	11.8%
Community health services	3.4%
Research, education and other services	0.8%

Notes
Data is available for all provinces and territories except Quebec and Nunavut.
Data reflects hospital activity of medical and operational support staff (MOS) and unit-producing personnel (UPP) as reported to the Canadian MIS Database (CMDB) by ministries and departments of health. Excludes medical personnel.
Data for units within nursing inpatient services reflects activity by all MOS staff and UPP on those units, not just nurses.
Data for units within community health services expenses in this analysis represents only the amounts reported in hospital facilities and any allocation from shared and centralized services. Examples include case management, walk-in clinics, chronic disease screening and surveillance services, and community-based mental health clinics. Community health services are delivered and reported differently in each jurisdiction and may be reported in facilities other than hospitals.
Variables and concepts used to capture information on the CMDB are based on the Standards for Management Information Systems in Canadian Health Service Organizations (MIS Standards: 2019, 2016, 2013, 2011 and 2009; and MIS Guidelines: 2006 and 2004).
For more information about the CMDB and MIS Standards, including definitions, please refer to the CMDB user guide on CIHI’s website (cihi.ca).

Source
Canadian MIS Database, 2020–2021, Canadian Institute for Health Information.

Overtime hours among health care workers have been linked to decreases in physical and mental health and well-being, which can have long-term implications for the health of the health workforce and for health service delivery.Reference 3 A recent Statistics Canada survey on experiences of health care workers during the COVID-19 pandemicReference 4 showed that about 9 in 10 nurses (92.0%) reported feeling more stressed at work than before the pandemic. Increased stress was also reported by other health professionals including physicians (83.7%), personal support workers (PSWs) or health care aides (83.0%), and other health care workers (83.0%).

Among nurses not intending to retire, almost 1 in 4 (24.4%) intended to leave their job or change jobs in the next 3 years.Reference 4 Data on vacancy rates in Canada shows that in the fourth quarter of 2021 (October to December), job vacancies in the health care and social assistance sector reached an all-time high of 126,000, almost double the number of vacancies seen 2 years prior (64,000).Reference 5 Hospitals and nursing and residential care facilities had the largest increases in job vacancies during this period compared with other sub-sectors.

Calling nurses resilient is patching up the problem. If nurses are resilient, they can manage working short, they can return to work after a death in the waiting room, they can stay longer than 12 hours when there is no replacement coming. We don’t want to be resilient. We want safe staffing levels, safe patient care and safe work environments. The environment in the ER has taken away our ability to care for patients and families the way we want to, and the way they deserve to be cared for.— Claire Marshall-Catlin, Emergency department nurse, Vancouver

Personal support workers

PSWs, also referred to as health care aides or personal care providers, play a vital role in the long-term care (LTC) sector, providing support to residents in their daily activities and maintenance of their physical and mental health. PSWs were thus a key part of the COVID-19 response as LTC homes faced challenges in sustaining care for one of Canada’s most vulnerable populations during the early waves of the pandemic.

The recent survey on the experiences of health care workers during the COVID-19 pandemic Reference 6 found that about 2 out of 5 PSWs (41.5%) reported feeling more stressed than before the pandemic. 82.5% indicated that the pandemic caused them to experience difficulties in a range of interpersonal, health and financial areas including balancing caregiving responsibilities, meeting financial obligations and emotional distress. Among those intending to leave or change jobs in the next 3 years, 37.7% reported stress or burnout as the primary reason.

As Canada’s health care systems move toward system recovery over the coming months and years, health system planners are fortifying both recruitment and retention efforts to ensure a safe and healthy health workforce for the future.

• Health Workforce in Canada Quick Stats, 2021 (XLSX)
• Trends in Hospital Spending, 2005–2006 to 2020–2021

Changes in physician services

Trends in physician service utilization can provide insight on the impact of COVID-19 on our health care systems. There was a 7.9% drop in service volumes from 2019–2020 to 2020–2021. By comparison, there was a 1.2% increase in service volumes from 2018–2019 to 2019–2020. The most significant drop occurred between April and June during the first wave of the COVID-19 pandemic. During that time, 26% fewer services were delivered than during the same period the year before.

While there was rapid adaptation to virtual careReference 1 over the course of the pandemic, the impact on the provision of physician services and the feasibility of changing to virtual delivery has varied across the different specialty groups. In 2020–2021, the volume of services for family medicine and psychiatry decreased by 7% and 2%, respectively, compared with decreases of 11% and 12% for orthopedic surgery and ophthalmology. While movement to virtual care has been observed, further work is required to measure patient and provider preferences as well as the quality and effectiveness of care.

There was an initial drop in physician service delivery and a steady recovery throughout the year when looking at the year-over-year change by fiscal period. Generally, service volumes approached pre-pandemic levels by the fourth quarter (January to March) of 2020–2021. Family physicians delivered 21% fewer services during the first quarter, but that rebounded to only 1% fewer services during the fourth quarter. Recovery varied across the different specialty groups: psychiatry saw 10% fewer services over the first quarter and 5% more services during the fourth quarter, while ophthalmology specialists delivered 48% fewer services over the first quarter and 13% more services during the fourth quarter.

These trends may have implications in health system recovery. CIHI’s latest report on wait times for priority proceduresReference 2 demonstrated that although in 2021 fewer surgeries were performed, Canadians waited longer compared with 2019. The sharp change in service delivery for orthopedics (-39% in Q1 and 6.1% in Q4) requires future monitoring to see the potential impact on wait times for procedures such as hip and knee replacements. Similarly, it will be important to assess whether the decrease in service volumes for pediatrics (-25% in Q1 and -5.5% in Q4) will have impacts on patient outcomes for children and youth.

Percentage change in physician service volume, by specialty and quarter, 2020–2021

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Specialty	Q1	Q2	Q3	Q4
Family medicine	-20.6	-3.8	-2.7	-1.2
Psychiatry	-9.6	-3.1	-0.2	5.4
Pediatrics	-25.5	-6.7	-8.2	-5.5
Orthopedics	-38.9	-5.7	-3.6	6.1
Ophthalmology	-48.1	-4.1	-5.8	14.0
Total physicians	-25.8	-4.5	-3.0	2.2

Source
National Physician Database, Canadian Institute for Health Information.

Recruitment and retention efforts

Since the start of the pandemic, federal and provincial/territorial governments have announced several multi-million-dollar funding initiatives focused on recruiting and retaining health care workers. By improving working conditions for existing health care workers and creating more opportunities for students, new graduates and internationally trained workers, these interventions aim to ensure a sufficient supply of health care workers — in both the short and long terms — to meet health care demands. For example, the federal government developed and funded an accelerated program of free training for 4,000 new personal support workers, funded enhancements to education and training for staff, and supported improvement of infection prevention and control measures in long-term care.Reference 3

At the provincial/territorial level, many governments have offered cash bonuses, hourly wage increases or compensation for sick time and/or childcare for those in the health care sector.Reference 3 Many jurisdictional regulatory bodies have also put out calls for retired or non-practising health care providers to return to the workforce on a temporary basis to support the COVID-19 response. These and other recruitment and retention strategies are intended not only to assist in creating financial incentives for workers but also to support better work–life balance and optimize models of care for the future.

Augmenting the supply of internationally trained health professionals

Internationally trained health professionals have long made up a significant portion of the health workforce in Canada. In 2021, approximately one-quarter of the physician workforce (26.2%) was internationally educated. Physiotherapists and pharmacists also had large proportions of internationally educated professionals (22% and 34%, respectively). In comparison, smaller proportions of occupational therapist and regulated nurse workforces were internationally educated (6% and 9%, respectively).

There were also variations in the internationally educated health workforce at the jurisdictional level. For example, internationally trained pharmacists accounted for generous proportions of Ontario’s and Alberta’s supply in 2021 (48% and 34%, respectively), while in the Atlantic provinces, they accounted for less than 6%. Similar trends can be seen in other professions, with Ontario and British Columbia relying more on internationally trained occupational therapists and physiotherapists compared with Quebec and New Brunswick.

Location of graduation for supply of selected health professionals, provinces and territories with available data, 2017 and 2021

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Health professionals	Year	Location of graduation: Canada	Location of graduation: International
Occupational therapists	2017	93%	7%
	2021	94%	6%
Pharmacists	2017	68%	32%
	2021	66%	34%
Physicians	2017	73%	27%
	2021	74%	26%
Physiotherapists	2017	83%	17%
	2021	78%	22%
Regulated nurses	2017	92%	8%
	2021	91%	9%

Note
Excludes professionals where country of graduation is unknown.

Sources
Health Workforce Database, Canadian Institute for Health Information.
Scott’s Medical Database, Canadian Institute for Health Information, with raw data provided by iMD (© 2022 iMD Health Global Corp.)

Some studies suggest that there may be a significant number of internationally trained health care workers who are living in Canada but are not licensed to practise.Reference 4 During the pandemic, governments have intensified efforts to leverage this group to increase capacity.Reference 3 The federal government announced funding for programs aimed at helping internationally trained nurses become licensed and start working. Additionally, since the end of 2020, several provinces (Prince Edward Island, Ontario and Manitoba) have announced changes to remove barriers to workforce entry for certain health care professions, by easing registration requirements and establishing bridging programs.

Maintaining appropriate and safe staffing levels in health care requires continuous monitoring and planning, particularly factoring in the potential long-term impacts of the COVID-19 pandemic on the workforce and the population. Standardized pan-Canadian data is essential for accurate monitoring, and CIHI will continue its work in enhancing standards, filling data gaps and working with key partners.

• Nursing in Canada, 2022 — Methodology Notes (PDF)
• Occupational Therapists in Canada, 2022 — Methodology Notes (PDF)
• Pharmacists in Canada, 2022 — Methodology Notes (PDF)
• Physiotherapists in Canada, 2022 — Methodology Notes (PDF)
• Health workforce scopes of practice, 2021
• NPDB data tables (ZIP)
• SMDB data tables (ZIP)