Executive summary

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There has been much talk recently about looming shortages in Canada's supply of individuals working in health occupations. To understand the degree to which the supply of workers in health occupations is meeting (and will meet) the health needs of Canadians, Health Canada—through the Advisory Committee on Health Delivery and Human Resources (ACHDHR)—contracted the Centre for Education Statistics at Statistics Canada to study the relationship between education and training and the supply of entrants into health occupations.

Using major Statistics Canada data sources related to the education and training of Canadians, the intent of this second data report from the Health Human Resources and Education Project is to provide a jurisdictional view of the information already released at the national level, as well as to provide information (at the Canada and jurisdictional levels) on additional topics that were identified in the information needs outline that were not covered in the first data report, which was released in 2007. As such, this report reveals some important information about what happens before, during and after health education. It focuses on interest in health occupations, the number of students taking and graduating from postsecondary health programs along with their socio-demographic characteristics and those of the faculty teaching these programs, the labour market experiences of recent graduates from these programs—including their mobility after graduation—as well as the ongoing participation of health workers in formal and informal training.

Interest of youth in health and health-related occupations

Youth is a time when individuals begin to make decisions about and plan for their future career by considering different occupational options. Before deciding to enrol in health and health-related programs, individuals must have certain motivations for their interest in such occupations.

There is a great deal of interest in health occupations among youth as they enter high school. In 2000, about 12% of 15-year-olds in Canada said they wanted to work in a health occupation. Despite the popularity of health occupations as a career choice at age 15, many youth changed their minds as they moved through adolescence. Around the time that they were completing high school (at age 17), only half of those who had wanted to work in health at age 15 still did so. Among Canadian youth aged 18 to 20, 8% aspired to a job in a health occupation. Although this is still a substantial number of youth—given that 5% of the labour force in 2001 worked in health occupations—more research is required to better understand why some youth change their minds about pursuing a career in health. This information will assist health human resource planners in their efforts to promote health occupations as an attractive career choice and to design effective recruitment strategies.

The percentage of youth interested in health occupations did not vary considerably by province, with this figure ranging from 10% in Saskatchewan to 16% in Newfoundland and Labrador for 15-year-olds. As was observed at the national level, interest in health occupations among youth was lower for 18- to 20-year-olds in most provinces.

About three-quarters of Canadian youth who aspired to health occupations were female. This mirrors the demographic profile of the current student body in health fields of study and suggests that the predominately female workforce in health professions will not change in the near future. In 2001, 79% of the overall labour force in health was comprised of women. Across Canada, almost all youth who professed an interest in a career in nursing were women. However, females also accounted for about three-quarters of 15-year-olds who said that they wanted to become physicians. The gender profile of youth who aspired to careers in nursing and medicine did not vary significantly across the provinces.

Canadian youth who were interested in health occupations overall were slightly less likely to come from rural areas than youth overall. Similarly, 15-year-olds who aspired to become physicians were more likely than average to come from urban areas in all provinces. This has implications for health planning for rural areas particularly in light of other studies that suggest that students with a rural background are the most likely to ultimately choose rural practice as a career. According to a recent study, achieving an adequate supply of rural physicians depends in part on ensuring the admission of an adequate number of students of rural origin to medical school.

Prior learning assessment and recognition (PLAR) of foreign credentials

Immigration is an increasingly important component of net population growth in Canada and a large proportion of immigrants make a contribution to the pool of people with postsecondary qualifications. Upon their arrival, however, internationally-trained professionals face an adjustment process both in terms of integrating into society at large as well as finding adequate work. Prior learning assessment and recognition (PLAR) is a particularly important mechanism for the recognition of the international credentials of immigrants who want to work in health occupations.

Of the 9% of immigrants who said they wanted to work in a health occupation before immigrating to Canada, about three-quarters requested an assessment of their foreign credentials with one group or another offering these services, with postsecondary institutions being among the most popular institutions. The proportion of immigrants who requested PLAR with any type of organization within their first two years in Canada was slightly lower in British Columbia (72%) and Ontario (74%) than in Quebec (81%), Alberta (83%) and all other provinces taken together (94%). In Canada, over 70% of immigrants aspiring to a health occupation that requested PLAR obtained a full or partial recognition of their credentials.

Several reasons prevented some of the immigrants from going through the PLAR process, but the most often stated reasons were that they did not know where to go or how to get their credentials checked or they believed they would not be accepted.

Full-time faculty in university health education programs

Educators may have an impact on both the capacity and the quality of health-related education programs. Of the 38,600 full-time university teachers in Canada during the 2004/2005 academic year, about one-fifth principally taught a health-related subject, and men accounted for 61% of these. The proportion of full-time university faculty teaching principally a health-related subject varied widely by province, from about 9% in Prince Edward Island to about 31% in Newfoundland and Labrador. This is not surprising given that the size and number of health education programs offered may vary widely from one province to another.

Most of the university full-time academic staff reported having a doctorate or a professional degree and, depending on their work arrangement (or on their type of appointment), some may be engaged in the practice of a health-related occupation as well as in the teaching of a health-related subject at the university. Similar to what was observed for university faculty in other fields, full-time university faculty in health are ageing and one in three continues to work after age 55. The average age varies between 44 and 51 years in all health-related subjects. This was true across the provinces.

Students in university health education programs

In 2005/2006, there were 60,900 students enrolled in health education programs at the bachelor and other undergraduate, master's and doctoral levels of study, accounting for 7% of all students at these levels. Over the previous academic year, health programs showed relatively stronger growth than overall enrolment at the bachelor and other undergraduate degrees and master's degree levels. At the doctoral level, growth rates were similar to growth rates in overall enrolment. In 2005/2006, at the bachelor and other undergraduate degrees level, the number of students enrolled in health programs increased 8% over the previous year, while the number of health students increased 9% at the master's level and 7% at the doctoral level. This enrolment growth occurred in a broader context of growing employment in the health care sector.

The total number of students enrolled in university health programs varied across the provinces. This reflects the number of health programs offered, their location and size. In 2005/2006, at the bachelor and other undergraduate degrees level, the size of health programs (in terms of total enrolment) ranged from about 300 students in Prince Edward Island to 19,300 students in Ontario. At this level of study, Quebec (13,000), Ontario (19,300), and British Columbia (3,500)—the three largest provinces in terms of population—accounted for 70% of all students enrolled in health programs in the country. However, Alberta accounted for a larger proportion (9%) of all health students in Canada than did British Columbia (7%). Similarly, Quebec, Ontario, and British Columbia accounted for about two-thirds (69%) of all health students at the master's and doctoral levels in Canada.

Graduates from health education programs and activities after study

Monitoring the number and characteristics of individuals graduating from health programs is essential as new graduates are a major source of supply of new personnel for health occupations.

In 2005, 14,600 students graduated from health education programs at the bachelor and other undergraduate, master's and doctoral levels in Canada, an 11% increase over the previous year. Not surprisingly, about two-thirds of university graduates from health education programs were coming from the three largest provinces: Quebec, Ontario and British Columbia.

Health graduates were generally more likely to have had some previous postsecondary education and / or full-time work experience and, as a result, tended to be older than graduates from other programs.

As there is a clear demand for their skills, graduates from health programs tend to make quick transitions into the labour market. Results from the first data report entitled "Educating Health Workers: A Statistical Portrait," released in 2007, showed that over nine in ten health graduates from the class of 2000 who had not gone on to additional studies were employed two years after graduation, most of them in a full-time position. The situation was about the same five years after graduation, ranging from about 92% of health graduates at the college level to slightly more than 99% at the doctoral level.

The success of health graduates with regard to their transitions in the labour market can indicate whether they will remain in the occupation in the long-term. Thus, information on the short-term outcomes of graduates can also lead to important information for recruitment and retention. The report finds that there was a high rate of retention of health graduates in health occupations. More than nine in ten university health graduates who reported working in a health occupation two years after graduation were still doing so three years later. The situation was about the same at the college level.

There was some variation with regard to retention in health occupations across the provinces. Among university health graduates, about 86% of them from New Brunswick reported that they were still working in a health occupation five years after graduation, while this was the case for more than 95% of health graduates in Newfoundland and Labrador (98%) and Quebec (97%). The situation was similar for college health graduates. About 82% of health graduates from the Northwest Territories reported that they were still working in a health occupation in 2005, while this was the case for around 95% of them in Prince Edward Island (95%), Nova Scotia (98%) and Saskatchewan (96%).

The higher likelihood of employment combined with higher earnings compensates for the fact that health graduates were more likely to have student debt and they tended to owe more. In spite of this, they were no more likely than their counterparts from other programs to still owe high amounts on their student loan five years after graduation.

When considering health human resource planning and management in Canada, health care planners look for ways to develop policies and strategies that attract health professionals, promote satisfying work opportunities and create and maintain stimulating, safe and secure work environments. Recruitment initiatives that encourage migration between and within provinces / territories are under way across the country.

Mobility of students and graduates from health education programs

In Canada, about 22,900 or 9% of all graduates (college and university levels) had left their province of graduation for another jurisdiction two years after graduation. Health graduates represent about 8% of this out-migration. When adding graduates from selected health-related education programs such as psychology, social work and health and physical education / fitness, this proportion rises to about 16%. This higher mobility among graduates from selected health-related programs may either be explained by mutual recognition agreements put in place by federal / provincial and territorial governments to enhance interprovincial / territorial mobility or by the non-regulated working environment for some of these occupations.

University health graduates were about three times more likely than their college counterparts to have migrated out of their province of graduation two years later. Among 2000 university health graduates, about 12% had left their province of graduation for another jurisdiction two years after graduation. This compares to about 4% for their counterparts at the college level.

With about 19% and 11% respectively, New Brunswick and Alberta gained the most overall from mobility as a result of net in-migration of university health graduates. At the university level, the only other province with gains from net overall migration is Ontario, albeit with a much lower rate (6%).

Many provinces experienced substantial net losses due to mobility of university health graduates. They include Nova Scotia (37%), Saskatchewan (19%) and British Columbia (4%). Since health education programs are concentrated in some provinces, the net loss of graduates in some of these provinces might be related to the large number of out-of-province students that come into these provinces to study. Newfoundland and Labrador did not experience any net losses due to health graduate mobility.

Further research would be needed to understand the reasons why such mobility is occurring. Some of the aspects that could be examined are: recruitment practices, type of incentives, locations of practical (clinical) placements, work conditions, and earnings. A provincial analysis of where health graduates are going would further contribute to the understanding of migration patterns among health graduates. Conversely, it would also be important to know the reasons why graduates would return to or remain in their point of origin (including, but not limited to, the lack of portability of credentials).

Adults' literacy skills and ability to use information and communications technologies (ICT)

Information and communications technology, as well as globalization, are forcing economies into a growing reliance on versatile and highly literate workers. Literacy skills are thus essential for individuals to realize their full economic and social potential. Results from the International Adult Literacy and Skills Survey (IALSS) showed that, although the ability to use information and communications technologies was substantially lower for adults in health occupations than for their counterparts in other occupations, a majority of them reached the necessary threshold of competence in prose, document, numeracy and problem solving needed to support the acquisition of additional knowledge and skills throughout their lives.

Among adults in health occupations, scores for the perceived usefulness of computers and acceptable levels of proficiency in prose, document, numeracy and problem solving varied widely across provinces and territories

Continuing education in the workplace

The ability and willingness of adults to continue learning throughout their lives has been identified as a critical element in Canada's economic future. The need for new skills in the economy has had a profound impact on jobs in most, if not all, industries and occupations. With advances in health care knowledge and technology, it is particularly important that adults working in health occupations be able to maintain and upgrade their skills and knowledge through continuing education.

Traditionally, many of these new skills would have been provided by "new" workers, both young adults and immigrants entering the labour force. However, the demographic reality is that smaller cohorts of young workers will be entering the workforce in coming years and, as the work force ages, the potential for skill shortages grows. The "upskilling" of workers already in the labour force is widely seen as an important measure to meet these needs.

Recognizing this need for ongoing learning, employers often encourage and support continuing education. This is particularly true in health occupations where regulatory frameworks often require ongoing maintenance or upgrading of skills.

In 2003, six in ten workplaces in the health care and social assistance sector supported training activities for their employees. Not surprisingly, larger workplaces or workplaces which introduced innovations during the year were more likely than others to support training activities. Overall, about 60% of adults in health occupations participated in formal job-related training in 2002, twice the rate observed for all other occupations.