Canada needs national solution to health HR planning: Report

Governments, stakeholders need to work together to fill shortages

Governments and health professional associations need to work together to do pan-Canadian health human resources (HHR) planning that doesn’t rely on poaching professionals from other jurisdictions to fill shortages, according to the author of a new report.

In the past, HR planning in the health-care sector was very compartmentalized, focusing on one profession in isolation, said Tom McIntosh, lead author of the Canadian Policy Research Network report

“As a result you ended up with these rather complicated, sophisticated models but they all rested on the assumption that nothing else in the system would change,” said McIntosh, who is also a professor of political science at the University of Regina. “The reality is nothing in the health-care system ever holds steady like that so all of those models sort of came up short.”

The failure of these models has led to the current shortages of health professionals, such as doctors and nurses, which ratcheted up the competition between provinces for scarce resources, said McIntosh.

“You have provinces, in effect, trying to do their HR planning on the basis of how many of profession X can we steal from other provinces,” he said.

Part of the solution lies in opening up HHR planning to include all health professions. Instead of focusing on the doctor shortage in a particular region and trying to attract more doctors, the problem might be better solved by hiring more nurse practitioners or physicians’ assistants, said McIntosh.

A holistic approach

Instead of looking at professions and jurisdictions in isolation, governments and associations need to take a more holistic approach. McIntosh found a great deal of support for this approach while interviewing 35 representatives of health-care professions and government for his report.

To do that effectively, there has to be a mechanism in place that would bring together all levels of government and various stakeholders to discuss HHR issues, share and analyse data and work together on solutions, said McIntosh.

“It’s really an attempt to create some space to have a kind of conversation that governments and professional organizations don’t often have because they’re always trying to protect their own turf, protect their own interests,” he said.

Three different models

While everyone McIntosh spoke with was in favour of such a mechanism, they disagreed on what it should look like. The report presents three different models.

The first option would have the federal government, through the Advisory Committee on Health Delivery and Human Resources, set the research and analysis agenda. Stakeholder groups would only have an informal, advisory role in this model.

In the second option, both the federal committee and stakeholder groups would form an advisory committee who would provide input and direction on the research and analysis done within an existing organization, such as the Canadian Institute for Health Information.

In the third option, the existing members of the federal committee as well as stakeholder organizations would jointly set the research and analysis agenda.

Not surprisingly, governments favoured the first option, while health-care associations preferred the third, said McIntosh.

“Governments want a body that answers directly to governments and stakeholders are tired of being on the outside looking in,” he said.

A body that is only accountable to government will get bogged down in political agendas that change with every election, said Pamela Fralick, chair of the Health Action Lobby (HEAL), an Ottawa-based coalition of 36 health professional associations including the Canadian Medical Association and the Canadian Nurses Association.

“We don’t feel that would serve Canadians best,” she said.

With the second option, Fralick worries the body would be lost in the larger organization and wouldn’t get the support it needs. Instead, HEAL, and many of the other health stakeholders McIntosh spoke with, prefer the third option.

“It’s accountable to all the stakeholders, not just governments. It does serve as that hub, that centre of excellence if you will, around the issues (of HHR),” said Fralick.

Reducing reliance on foreign professionals

Some of the key areas that need to be addressed in HHR planning include how to make Canada as a whole, not just individual provinces and territories, less reliant on other countries for health-care professionals, said Fralick.

One of the ways to do this is to create educational institutions that provide health-care programs in rural areas and encourage people, including Aboriginals, from these areas to attend, said Don Juzwishin, chief executive officer of the Canada Health Council.

Studies by the Canada Health Council show when people are trained in their local communities, they are more likely to practice there than if they trained outside their communities, said Juzwishin.

As part of the multi-professional planning aspect, Juzwishin would like to see more encouragement of inter-disciplinary teamwork, which could start by bringing various disciplines together in the schools and then continue in inter-disciplinary practices.

Because health care is under provincial jurisdiction, a federal body will never be able to control all HHR planning, or even necessarily prevent provinces from stealing professionals from each other, said Juzwishin.

“However, what one could envision is a co-operative model whereby the leadership could be taken at the national level to facilitate co-ordination amongst the 10 provinces and the three territories to try and come up with a comprehensive plan,” he said.

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