Nice numbers, but let’s see an HR plan, say health workers

Health professionals welcome $18b but still waiting for hiring, training commitment

Buoyed as they may be by the federal government’s commitment last month to deliver $18 billion to the health system over six years, many health professionals are still cautious about whether the funding will result in a long-term, cohesive strategy to address the shortage of health-care workers.

While much of the discussion at last month’s First Ministers’ Meeting was about reducing wait times for cancer care, heart care, diagnostic imaging, joint replacements and sight restoration, both Ottawa and the provinces said some of the funding would be used to increase the number of health-care workers. As part of the deal struck at the meeting on the future of health care, the federal, provincial and territorial governments said they will make public by 2006 plans for training, recruiting and retaining health professionals.

Of the $18 billion in new funding, $4.5 billion will go into the wait times reduction fund in the first six years; most of this will be used for training and hiring more professionals, according to a Finance Department official.

At the Canadian Nurses Association, executive director Lucille Auffrey said although she was impressed with the level of funding, she was hoping to hear more concrete measures to address the health workers shortage.

Such measures should include an increase in the number of seats in nursing schools, a boost in hiring by the institutions, as well as a reduced reliance on part-time and casual nursing staff, said Auffrey. The Canadian Nurses Association represents 125,000 of Canada’s 230,000 registered nurses.

Across Canada, only about 54 per cent of working registered nurses have full-time jobs, said Auffrey, adding that the number should be around 70 per cent. Staffing policies that over-rely on casual and part-time workers lead to other costs, said Auffrey.

Absenteeism among nurses in 2002 amounted to 19.6 million lost hours of work, “which was equal to 10,800 full-time jobs,” said Auffrey. Overtime hours among nurses in 2002 came up to 15.7 million hours — “that’s 8,643 full-time jobs.” And according to the Canadian Labour and Business Centre, the cost of overtime, absenteeism and replacement wages for nurses in 2002 was between $962 million and $1.5 billion.

“That’s how much it costs the system to not have enough nurses working full time,” said Auffrey. “To me, it’s simple economics. You’re paying more by not having enough workers.”

If more full-time nurses were hired, costs would come down, she said. “You won’t be asking them to work overtime every weekend. People won’t get injured at work because they’re so tired. And they won’t fail to show up to work because they’re burned out.”

Auffrey acknowledged that there’s some validity to hospital administrators’ argument that a certain amount of staffing flexibility is necessary, as demand in this sector can be extremely volatile. But that’s why the association recommends a 70-to-30 full-time to part-time ratio, she said.

“It’s true that (staffing needs) depend on the quality of the patients. But it’s also true that employers have also used the issue of workload to manage their bottom line. By that I mean they diminish the significance of the patients’ conditions, and they under-staff.”

At the Canadian Medical Association, association president and family physician Albert Schumacher said he was disappointed that the health summit wrapped up without any concrete commitment to increasing human resources in the health sector. Canada’s number of physicians per capita is already the lowest among countries in the Organization for Economic Co-operation and Development.

Cutbacks in the 1990s to the number of medical school positions are still causing deficiencies in the health system to the tune of thousands of physicians, said Schumacher. In 1992, medical school enrolment was cut back by 15 per cent. In the last four years, the provinces started to increase enrolment again. This year, Canada’s medical schools saw about 2,050 physicians graduate at the same time that about 2,250 entered medical programs. When a new medical school opens in Sudbury next year, it will add about 50 spots, which means some 2,300 medical students will graduate a year.

Schumacher said schools should be training at least an additional 2,500 medical students a year if the aim is to maintain the physician supply at 80 per cent of the demand, with the remaining 20 per cent met by international medical graduates.

On top of spots in the medical schools, the system has also cut back on resident positions. A couple of decades ago, there used to be 120 resident spots for every 100 grads. This left lots of room for international “medical graduates to go into certified, paid-for, accredited programs side by side with our graduates, do their exams and find work,” said Schumacher.

Currently, however, after cutbacks, there are only about 50 extra resident spots across the country, said Schumacher. As a result, of the 870 international medical students looking for a residency this year, only 87 were accepted.

But to create the needed medical school and residency spots, the system needs to have the right number of teaching faculty and support staff in place, at a cost of about $75,000 a spot, “which accounts for what an average resident would be paid plus the infrastructure, teaching and support that come with it.”

And even if the places needed suddenly appear, without a pan-Canadian strategy, the problem of too few rural and Aboriginal doctors will persist. That’s because the Canadian government has to buy places at medical schools for Aboriginal students, for example, and “they can’t if they’re not at the table where decisions are made about how much the provinces can afford to increase their enrolments.”

Sharon Sholzberg-Grey, president and CEO of the Canadian Healthcare Association, agreed that the bulk of the new health money should go into hiring more health professionals. However, she said she also hopes to see pan-Canadian strategies developed to address long-term human resource needs in the sector. Solutions that involve training, for example, if not developed coast to coast, will only result in provinces poaching workers from each other.

Nationwide strategies are also in order to make use of international medical graduates in an efficient and effective manner, as are strategies that foster professionals of different disciplines to collaborate in patient-centred practice.

“Even though everybody talks about working together in teams, the way that can best be done needs to be developed, almost like a blueprint or a framework,” said Sholzberg-Grey. “I think that’s not as much a money issue as it is a question of having the right atmosphere in the institutions. Is there continuing education? Is there a span of control that needs people’s needs? Are there enough employees so people don’t have to work double shifts?”

For a new collaborative way of delivering care to take shape, money and effort must go into developing best practices for a variety of health services and in a variety of health settings, she added.

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