Gender, workforce and health system change in Canada Andrea Porter and Dr. Ivy Bourgeault Canadian Institute for Health Information November 2017 cihi.ca @cihi_icis
Outline Canadian context Health care providers in Canada Big picture Questions 2
Canadian context 2016 population = 35,151,728 16.6% under 15 years of age 16.9% over 65 years of age 10 provinces; 3 territories 83.2% of population live in urban areas 14 unique health systems 70% publicly funded; single payer public insurance system Universal coverage = medically necessary hospital and physician services, and dentistry performed in hospital Health care professions regulated in each province/territory 3
Labour force in Canada Labour force Employed in health care sector Employed in all other sectors Health sector employment male female Source: Labour force survey estimates (LFS), Statistics Canada, 2017. 4
Proportion of female health care providers Dentists General practitioners and family physicians Specialist physicians Psychologists Pharmacists Social workers Physiotherapists Licensed practical nurses Registered nurses and registered psychiatric nurses 20% 23% 25% 33% 52% 46% 51% 61% 54% 72% 70% 79% 79% 87% 89% 95% 90% 93% 0% 25% 50% 75% 100% Source: LFS, Statistics Canada. 5 2016 1987
Canadian MD Graduates and Residencies MD degrees awarded Residencies 100% 100% 80% 60% 96 94 92 88 68 56 50 50 60 55 80% 60% 61 58 55 53 50 55 55 55 54 53 40% 20% 4 6 8 12 32 44 50 50 40 45 40% 20% 39 42 45 47 50 45 45 45 46 47 0% 1940 1950 1960 1970 1980 1990 1996 2000 2005 2016 0% 1991 1994 1997 2000 2004 2007 2010 2013 2014 2015 Female Male Female Male Source: Canadian Medical Education Statistics, 2017. Source: The Canadian Post-M.D. Education Registry, 2016. 6
Workload (average FTE) among physicians 1.20 1.00 0.80 0.66 0.88 1.06 0.83 0.81 0.97 0.60 0.40 0.20 0.00 Family medicine Medical specialists Surgical specialists Female Male Source: National Physician Database, CIHI. 7
Health care providers in teaching/faculty positions 100% 75% 70.0% 82.4% 93.7% 50% 25% 0% 50.0% 50.0% 30.0% 17.6% 6.3% Dentistry Medicine Pharmacy Registered Nursing Female Male Sources: The Association of Canadian Faculties of Dentistry; Association of Faculties of Medicine of Canada; Association of Faculties of Pharmacy of Canada; Health Workforce Database (HWDB), CIHI. 8
Percentage of women in leadership positions in Canada Health ministers 27% Deans of Dentistry, Medicine & Pharmacy 30% Health CEOs 66% Health care and social assistance sectors 83% Nurse aides, orderlies and patient service associates 87% 0% 25% 50% 75% 100% Sources: Provincial/territorial & federal governments of Canada; The Association of Canadian Faculties of Dentistry; Association of Faculties of Medicine of Canada; Association of Faculties of Pharmacy of Canada;; Statistics Canada, 2012 General Social Survey; Canadian Medical Education Statistics; Canadian provincial/national associations, regulatory authorities; Statistics Canada, Labour Force Survey. 9
Health care providers in leadership positions 50% 40% 41.1% 30% 20% 10% 6.3% 7.9% 6.5% 10.9% 8.1% 12.4% 19.4% 0% Registered Nurses/Nurse Practitioners Registered Psychiatric Nurses Occupational Therapists Pharmacists Female Male Source: HWDB, CIHI. 10
Emerging focus on delivering care in community Growth of regulated nurses working in community 60,506, 15%, of workforce, in 2016; average annual growth 2.4% Nurse-led clinics; New roles; Evolving prescribing by RNs/NPs Increase in number of pharmacists employed in community 22,828, 76.5%, of workforce in 2016; average annual growth 6% Expanding scope of practice among Pharmacists: Immunizations, Prescription renewal, Prescribing for minor ailments, Order and interpret lab tests, etc. Expanding scopes of practice in paramedicine 11 In-home monitoring; rural house calls
The big picture Canada s health workforce is composed largely of women, and is becoming even more so How can policy support the gendered experience in education, migration, and employment of health care providers? Working patterns of women and men within professions differ How can policy support balance between work and family life with patient/client needs? High levels of segregation along gendered lines, especially at leadership levels How can policy support the integrations of more women in leadership roles? 12
Contact us Andrea Porter Manager, Health Workforce Information Canadian Institute for Health Information (CIHI) APorter@cihi.ca 13 Ivy Bourgeault Professor, Telfer School of Management CIHR Chair in Gender, Work and Health Human Resources University of Ottawa Ivy.Bourgeault@uOttawa.ca