November 17, 2022 — At the onset of the COVID-19 pandemic, health care systems rapidly shifted to address emerging and urgent needs of the population. Efforts to monitor and manage the health workforce have been essential for dealing with unprecedented demands on our health care systems. Canada’s health workforce will continue to be a priority in the future as health systems tackle the growing backlog of delayed non-urgent procedures.
I think we need to facilitate good cultures and working relationships, and be nimble… with regard to new models of care or addressing problems in unique and thoughtful ways, and not be scared to be bold. We also need to make sure that we’re good with our data. Sometimes in Canada because we’re so disjointed and patchwork, we don’t collect comparable data, so having benchmarking national standards and having people do those moonshots will make us better. — Dr. Christian Finley, Thoracic surgeon; Expert lead at the Canadian Partnership Against Cancer; Head of Ontario Lung Cancer Screening
Impacts
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
Text version of graph
| 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.
System response
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
Text version of graph
| 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.
Related resources
- 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)
References
- 1.
- Back to Reference 1 in text
- Canadian Institute for Health Information. Virtual care: Impact of COVID-19 on physician practice patterns. Accessed March 24, 2022.
- 2.
- Back to Reference 2 in text
- Canadian Institute for Health Information. Wait times for priority procedures in Canada. Accessed May 10, 2022.
- 3.
- Back to Reference 3 in text
- Canadian Institute for Health Information. Canadian Data Set of COVID-19 Interventions. June 9, 2022.
- 4.
- Back to Reference 4 in text
- World Education Services. Addressing the Underutilization of Internationally Educated Health Professionals in Canada: What the Data Does and Doesn’t Tell Us (PDF). 2022.