Ongoing pandemic-driven pressures impact activities and workload of health care workers across Canada

The pandemic is placing unprecedented demands on Canada’s health care systems and a new report from the Canadian Institute for Health Information (CIHI) examines the impacts on the supply and distribution of health care workers across the country, along with physician payments and utilization.

Data shows that in 2021, average overtime hours among health care workers were the highest they have been in over a decade. More than 236,000 (21%) employees in health occupations worked overtime, averaging about 8 hours per week of paid overtime. Paramedics, salaried family physicians and respiratory therapists had some of the highest proportions of people working overtime, according to Statistics Canada’s Labour Force Survey from July 2022.

Due in large part to COVID-19–related public health measures, between 2020 and 2021, physicians provided nearly 8% fewer health services in Canada — including about a 7% decrease for those in family medicine and about a 9% decrease for specialists. A steep decrease was observed in the first quarter of 2020–2021 with a steady recovery throughout the rest of the year. Generally, service volumes approached pre-pandemic levels by the fourth quarter (January to March) of 2020–2021. In parallel, for the first time in 20 years, Canada saw a decrease in total physician payments (-2%).

In addition to creating new pressures on health care workers, the pandemic exposed pressures that have been building steadily over the last decade. The average annual growth of the supply of primary care physicians slowed from 3.4% between 2012 and 2014 to 1.3% between 2019 and 2021. At the same time, nurse practitioners (NPs) became one of the fastest-growing group of health care professionals, with supply rates increasing by nearly 10% over the same time periods. The use of NPs can reduce pressure on health care systems and improve access to primary care, particularly in rural and remote settings.

Pressures are being felt by health care workers across the spectrum of care and across all jurisdictions. Between 2020 and 2021, there were declines of almost 500 registered nurses (RNs) in direct care employment in long-term care and more than 100 licensed practical nurses (LPNs) in direct care employment in community health agencies. At the same time, there was an influx in the number of nurses in direct patient care in settings such as private nursing agencies or self-employment, with increases of over 1,200 RNs and over 600 LPNs in these kinds of jobs.

Quotes

“The pandemic has intensified structural pressures on our health systems, and everyone across the country is working hard to address health workforce challenges. It will be important to continue to strengthen Canada’s health workforce data foundation to help find evidence-based solutions that drive toward improvements in staff health and wellness as well as patient health outcomes overall.” — Deborah Cohen, Director, Pharmaceuticals and Health Workforce Information Services, CIHI

“Access to primary care is in such a desperate state that patients are having to go to emergency departments, which puts even more pressure on staff that are already stretched too thin. Emergency medicine is very much a team sport; front-line nurses, emergency physicians and clerical staff are all in moral distress trying to manage the massive wait times patients face in emergency.” — Dr. Douglas Sinclair, Vice-President, Medicine, Quality and Safety, IWK Health Centre

“Health care is a complex issue. There is no fast fix, but there is work being done with the provinces and territories to look at the entire health workforce. Solutions include things such as integrating internationally educated nurses much more quickly, looking at nurses that have left the profession to recruit them back and retaining nurses by making working conditions better.” — Dr. Leigh Chapman, Chief Nursing Officer of Canada