Canada’s health systems over capacity, marked by job vacancies, millions of hours in overtime

System responding with innovations, collaboration through new entity Health Workforce Canada 

By Health Workforce Canada

Across the country, responses to health workforce challenges during and after the pandemic have included innovations in how service is delivered, expanded scopes of practice and a renewed focused on team-based care. New pan-Canadian collaborations have started to move the country into an action-oriented space that will serve to address the health workforce crisis now and into the future.

The most recent report on selected health professionals released by the Canadian Institute for Health Information (CIHI) paints a picture of overburdened health systems, with hospital staff filling an unprecedented amount of overtime hours, and the number of job vacancies doubling since the beginning of the pandemic. 

“The COVID-19 pandemic exacerbated the cycle of staffing challenges and health care worker burnout,” CIHI said in its report. “Understanding labour demand through vacancy rates, workplace overtime hours and the experiences of health workers is key to developing targeted retention strategies that promote worker wellness and improve quality of both employment and patient care.”

Key findings of the CIHI report include:

  • The number of jobs left unfilled has quadrupled since 2015, and doubled since the start of the COVID-19 pandemic to 120,140 positions in 2022-23. One quarter of vacancies were for personal support workers, followed by registered nurses, registered psychiatric nurses and mental health workers. All provinces experienced growth in vacancies in 2022-23 compared with the previous year. 
  • In 2021–22, 26 million hours of overtime, equivalent to more than 13,000 full-time positions, were filed by hospital staff, excluding physicians. The highest rates were in intensive care and mental health and substance use units. The number of overtime hours worked by nurses and other hospital health workers on inpatient hospital units (not including physicians and management) reached 14.2 million.  
  • Despite growth in the overall supply of nurses in 2022, 2,500 fewer nurses were providing direct care in long-term care and there were also 800 fewer registered nurses working in hospitals, with workload and burnout possible factors.
  • There was an increase of 7.1 per cent or more than 3,300 direct care nurses in community health agencies the same year, where they may experience more flexibility and better schedules.

“Without question, the people working in  Canada’s health systems are feeling overburdened, however this is also a time of innovation, where governments, health system leaders, policy makers and people on the frontlines are identifying and implementing new ways to meet needs,” said Deb Gordon, Interim CEO of Health Workforce Canada, a new independent organization created to support partners in addressing health workforce challenges and allow for critical long-term planning.

CIHI reports that policy changes are taking place across the system including important innovations such as:

  • Allowing pharmacists to assess and prescribe medication for minor ailments in most jurisdictions, with some jurisdictions empowering pharmacists to renew and extend prescriptions 
  • New prescribing powers for registered nurses in some jurisdictions, 
  • More medical training seats, with some jurisdictions offering tuition bursaries in return for service commitments and incentive programs in rural and remote communities 
  • Modified policies in most jurisdictions to expedite registration for health care workers, including streamlining entry for internationally educated nurses 

“These policy changes across the country are a signal that Canada is taking health workforce challenges seriously,” said Gordon. “Health Workforce Canada will work closely with all health system stakeholders, including CIHI, to improve the collection and sharing of data and information as well as practical solutions to address health workforce challenges now and in the future.” 

You can read the CIHI report in its entirety, and download the data here.