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 2017 | 2018 to 2022 | 2013 | 2017 | 2022 | |
| Physicians | 2.8% | 2.1% | 2 | 2 | 2 |
| Family medicine physicians | 2.9% | 1.8% | 1 | 1 | 1 |
| Specialists | 2.6% | 2.4% | 1 | 1 | 1 |
| Regulated nurses | 1.1% | 1.8% | 12 | 12 | 12 |
| Nurse practitioners | 9.6% | 9.2% | <1 | <1 | <1 |
| Registered nurses | 0.3% | 1.3% | 8 | 8 | 8 |
| Licensed practical nurses | 2.8% | 2.6% | 3 | 3 | 3 |
| Registered psychiatric nurses | 1.4% | 1.9% | 1 | 1 | 1 |
| Occupational therapists | 3.5% | 3.2% | <1 | 1 | 1 |
| Physiotherapists | 3.5% | 4.1% | <1 | <1 | <1 |
| Pharmacists | 3.4% | 2.2% | 1 | 1 | 1 |
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 2021 | Change from 2021 to 2022 | Change from 2020 to 2021 | Change from 2021 to 2022 | Change from 2020 to 2021 | Change from 2021 to 2022 | Change from 2020 to 2021 | Change from 2021 to 2022 | |
| NPs | 90 | 121 | 125 | 240 | 25 | 0 | 150 | 76 |
| RNs | 1,127 | -828 | 1,444 | 2,326 | 19 | -695 | 692 | 867 |
| LPNs | 918 | 1,324 | -130 | 825 | 202 | 1,831 | 614 | 1,370 |
| Total | 2,135 (+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.
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.
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.
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.
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.
Canadian Institute for Health Information. Hospital staffing and hospital harm trends throughout the pandemic. Accessed November 14, 2023.
3.
Tomblin-Murphy G, Sampalli T, et al. Investing in Canada’s Nursing Workforce Post-Pandemic: A Call to Action. 2022.
4.
Canadian Institute for Health Information. Taking the pulse: A snapshot of Canadian health care, 2023. Accessed November 14, 2023.