Health-care labour shortage a long time coming, requires shift to team-based care

Nurses tend to a COVID-19 patient in the Intensive Care Unit at the Bluewater Health Hospital in Sarnia, Ont., on Tuesday, January 25, 2022. THE CANADIAN PRESS/Chris Young

OTTAWA — Nearly two and a half years since the onset of the COVID-19 pandemic, the staffing conundrum initially driven by high infection rates has evolved into an acute labour challenge.

Herb Emery, the Vaughan Chair in regional economics at the University of New Brunswick, said when it comes to staff shortages, the pandemic was "like the straw that broke the camel's back."

"These emerging shortages have been present for decades," Emery said. "So, no one should be surprised that we're short on doctors that we're short on nurses."

In recent weeks hospitals across the country have taken drastic measures to cope with the staff shortages, including temporarily closing emergency departments.

The labour shortage is not unique to health care. Nationwide Statistics Canada says about one million jobs sit empty. But the shortages in health care are the most pronounced.

Statistics Canada said job vacancies in health during the first quarter of this year were nearly double what they were two years ago. Nurses and nurses aides were among the top ten occupations with the largest job vacancy increases over that period.

Emery says shortages in healthcare are a result of policies introduced in the 1980s and 1990s that were aimed at cutting healthcare costs. Doctors, who are paid with a fee-for-service compensation structure, were identified as a major driver of elevated costs for health care and policies were introduced to limit the supply of doctors, he said.

The Canadian Institute for Health Information said in a 2002 report that policies like reduced medical school enrolments and restrictions on international medical graduates contributed to a smaller inflow of new doctors.

On the nursing side, Emery said the stress of the pandemic and increased workloads has led to high rates of retirement and exits from the profession, and enrolment in nursing schools hasn't been high enough to compensate for the outflow of nurses.

Some experts say one solution could be a move toward a team-based approach to care that ensures health-care professionals working at their skill level. This would mean relieving doctors of tasks nurses or pharmacists could take on while having nurses only doing work that requires nursing training.

Armine Yalnizyan, an economist and Atkinson Fellow on the Future of Workers, has been calling on provinces to develop a plan to address today's healthcare problems, including outlining a health human resources strategy.

"You get the most expensive parts of the system being overworked to doing stuff they shouldn't be doing, like cleaning rooms or moving patients down the hall on a gurney," Yalnizyan said.

The idea of changing the scope of practice for healthcare workers is far from new. In 2002, Royal Commission on the Future of Health Care in Canada, also known as the Romanow Report, highlighted the need for this shift in practice.

"Changes in the way health care services are delivered, especially with the growing emphasis on collaborative teams and networks of health providers, means that traditional scopes of practice also need to change.," the report said. "This suggests new roles for nurses, family physicians, pharmacists, case managers and a host of new and emerging health professions."

Emery said the fee-for-service compensation structure for physicians is a barrier to moving toward team-based care.

"What 1/8fee-for-service 3/8 discourages is having a nurse do some of the tasks that they're qualified to do and can do quite well because the doctor whose office they're working in can't bill for that," Emery said.

Moving to team-based care would also require the restructuring of collective agreements, he said, which dictate "who does what" in hospitals.

"There are things that can be done, but they're politically contentious," Emery said.

In Ontario, the provincial government has said it's considering healthcare privatization as a solution to the challenges faced in hospitals. The suggestion has led to considerable backlash from politicians in the opposition as well as advocates.

However, Emery says privatization in this context refers to the delivery of services, not how the services are paid for.

"It's really about, I think, changing the site of where care is provided from settings which tend to have more rigid rules on who can do what to whom and on what basis, to a setting where there's more potential to have that scope of practice, team-based care, and basically get more patients seen with the same numbers of doctors and nurses."

Yalnizyan says the health-care system has been coping with low staffing levels for far too long because of a lack of funding.

"It isn't just a question of not preparing for the future. It's being absolutely committed to not spending money," she said.

However, Emery warns that more funding won't solve the underlying issue, which is how workers are allocated within the system.

Not addressing these issues, he says, is what led to these shortages and healthcare strain in the first place.

"The frustrating part is now that it's hit, we're sort of wringing our hands saying, `well, what do we do,' because there's no easy fix in the short-run," Emery said.

This report by The Canadian Press was first published Sept. 5, 2022.