Ontario Registered Nursing Positions Falling

CIHI Report shows Ontario continues to lag behind national RN staffing levels

TORONTO, January 10, 2013 /Canada NewsWire/ - The new report from the Canadian Institute for Health Information (CIHI) shows that the vital ratio of registered nurses to population has stagnated across Canada for the past five years and is lower than those seen in the early 1990s. The Ontario Nurses' Association (ONA) believes this is as a result of RN cuts in provinces such as Ontario.

CIHI's report shows that while there has been an 8-per-cent increase in the total number of regulated nurses employed in Canada between 2007 and 2011, the ratio of RNs to population has remained unchanged because while some provinces have hired RNs, others - such as Ontario - have cut them.

In the past five years, the Ontario ratio has fallen in terms of direct-care RNs and is now third-lowest in the country. More current data from the College of Nurses of Ontario (CNO) explains this further: between 2011 and 2012, 844 RN positions were cut in this province.

"Ontario continues to lag behind almost every province in the country in RN to population ratio," says ONA President Linda Haslam-Stroud, RN. "The RN to population ratio is key to safe patient care because historically, registered nurses are the professionals who are there on the front lines for patients 24/7. Ontario is falling behind in terms of the number of direct care RNs as well, relative to the rest of the country, as health care employers continue to cut RN jobs and look for short-term savings by hiring less-trained, lower-paid staff."

The average Canadian ratio is 785 RNs per 100,000 residents, but Ontario employs just 668 RNs per 100,000 population, (Source: CNO). To meet the Canadian average, the province would have to hire 15,646 more RNs.

"Ontario continues to see the total number of nursing positions fall, a dangerous and unnecessary situation for any Ontarian needing care today," said Haslam-Stroud. "Ontario data show that not only were 844 RN positions eliminated from the Ontario health system, but the number of Ontario RNs employed in non-nursing jobs has increased to just under 5 per cent, the highest level since 2008."

Current levels of health care funding continue to adversely impact Ontarians.

"Keeping RN levels this low simply puts our patients at risk, costs the system more and is a false economy," says Haslam-Stroud. "RN care reduces the rates of death and disease in patients. ONA is calling on the provincial government to commit to increasing the number of RNs working here to ensure the quality patient care Ontarians expect and deserve."

ONA is the union representing 60,000 registered nurses and allied health professionals, as well as more than 14,000 nursing student affiliates providing care in hospitals, long-term care facilities, public health, the community, clinics and industry.

Physician supply still growing faster than Canadian population

Proportion of doctors practising
in rural areas increasing steadily

OTTAWA, November 15, 2012 /Canada NewsWire/ - Over the past five years, physician supply has increased three times faster than the Canadian population—an increase reminiscent of those seen in the 1980s. According to a new report by the Canadian Institute for Health Information (CIHI), the number of physicians rose to more than 72,500 in 2011, representing an increase of 4.1% over 2010.

The 2011 edition of CIHI's annual report Supply, Distribution and Migration of Canadian Physicians shows that, from 2007 to 2011, the number of physicians increased 14%. In comparison, the Canadian population grew only 4.7% over the same time period.

The rise in physician numbers was also seen in each province. Nova Scotia, Newfoundland and Labrador and Quebec demonstrated the highest physician-to-population ratios in the country, with 240, 231 and 231 physicians per 100,000 inhabitants, respectively. Saskatchewan and Prince Edward Island had lower ratios at 181 and 178 physicians per 100,000, but these were still increases from previous years.

Despite the overall growth in the number of doctors, the split between general practitioners (GPs) and medical/surgical specialists has remained relatively stable over the last five years. In 2011, 51% of all Canada's doctors practised family medicine while 49% were medical and surgical specialists.

The overall number of doctors graduating from Canadian universities is also rising steadily across all areas of practice. In 2011, more than 2,500 physicians graduated from Canadian universities; this represents an increase of 4% from 2010. At the same time, the number of internationally trained Canadian physicians is also rising.

"Today, we have more physicians than ever before. With the steady influx of new graduates and the rise in internationally trained doctors, this upward trend will continue over the next few years," says Jean-Marie Berthelot, Vice President of Programs at CIHI. "However, while numbers are increasing, they don't tell the whole story. Better understanding of the organization of care, patient needs and physician workload will help determine whether or not increased physician numbers are translating into improved access to health care for all Canadians."

More doctors in rural areas than five years ago

As with the rest of the country, rural areas experienced a rise in physician numbers that outpaced population growth. Between 2007 and 2011, the number of physicians in rural areas increased by almost 10%. In comparison, the rural population grew by only about 2% between 2007 and 2011.

CIHI's study found that approximately 15% of GPs work in rural areas, providing care to the 18% of Canadians who live there.

"The encouraging news is that the gap between the number of urban and rural family physicians is decreasing," says Geoff Ballinger, Manager, Health Human Resources A at CIHI. "Many regions have implemented programs to persuade new graduates to work in rural areas. These initiatives encourage doctors to practise in communities where physician access would otherwise be difficult."

Women make up more than one-third of Canada's physician workforce

The demographic makeup of the workforce is also changing. In 2011, more than 36% of Canada's physicians were women. This represents an increase of 23% from 2007. In comparison, over the same time period, the number of male doctors increased by only 9%.

At a provincial level, Quebec and New Brunswick had the highest percentages of female physicians (42% and 36%) in 2011; Prince Edward Island, Saskatchewan and Manitoba had the lowest (28%, 32% and 32%). Across jurisdictions, the average age of physicians ranged from 48.0 to 51.8.

The report is available from CIHI's website, at www.cihi.ca.

Little change in wait times for Canadians

Knee replacements have longest waits; most radiation therapy provided within benchmarks

OTTAWA, March 22, 2012 /Canada NewsWire/ - A new analysis from the Canadian Institute for Health Information (CIHI) reveals that about 8 out of 10 Canadians receive priority-area procedures—including hip and knee replacements, cataract surgery, hip fracture repair and radiation therapy—within the medically recommended time frames.

Featuring provincial comparisons and trends in wait times, the analysis further reveals the following:

...Almost all (97%) patients receive radiation therapy within the recommended time frame of four weeks;

...Similar proportions of patients receive hip replacement (82%), hip fracture repair (79%) and cataract surgery (82%) within these procedures' respective time frames;

...Knee replacements have the longest wait times, with 75% of patients receiving care within the benchmark time frame.

These results are largely similar to last year's findings.

First ministers named timely access to care a top priority in 2004. They identified priority areas and issued wait time benchmarks for seven procedures. While all patients would ideally receive treatment within these time frames, this may not be achievable or practical. For example, some patients may experience other illnesses or complications while waiting. Others may choose to delay surgery, preferring to schedule it when a family member is available to help with post-treatment care. For reasons such as these, providing care to 90% of patients within the benchmark may be a reasonable target.

From a national perspective, radiation therapy is the only procedure for which 90% of patients receive care within the benchmark time frame. From a provincial/territorial perspective, hip replacement in Ontario is the only procedure to reach the 90% threshold. Examination of wait time trends over the last three years reveals limited improvement toward benchmarks.

"Across provinces, there has been little change in wait times for priority procedures since 2009," says Jeremy Veillard, CIHI's Vice President of Research and Analysis. "These results may seem generally positive, but some patients are still waiting too long for care relative to benchmarks."

Provinces struggle to reduce wait times

This year, a few provinces showed longer wait times for areas such as knee and hip replacements and cataract surgery. British Columbia, New Brunswick and Prince Edward Island now have longer waits for knee replacement. P.E.I. also has longer waits for hip replacement and cataract surgery.

However, two provinces showed wait time improvements for more than one priority area: Saskatchewan for hip and knee replacements and Nova Scotia for hip replacement and radiation therapy.

"It is difficult for provinces to reach the 90% threshold," says Tracy Johnson, Manager of Emerging Issues at CIHI. "Reports like this identify that there are still opportunities to improve access to care."

CIHI's new interactive display enables better tracking of progress and benchmarking over time

The launch of CIHI's interactive wait times display depicts four years of comparable provincial data. This unique tool is easy to use and will help decision-makers

...Analyze data for trending over time or in a specific time frame, all with one click;

...Refine data to the provincial level with a simple click; and

...Access pan-Canadian, at-a-glance performance information for all priority-area benchmarks.

The report, interactive data display and the following figure and table are available from CIHI's website, at www.cihi.ca.

One-third of physicians 65 and older still working full time

Older family physicians more likely to narrow scope of practice than retire

OTTAWA, April 7, 2011 /Canada NewsWire/ - More than 1 in 10 Canadian physicians is age 65 and older, but many doctors remain active in clinical practice after reaching the traditional retirement age, according to a study released today by the Canadian Institute for Health Information (CIHI). In 2009, 12% of the active physician population was at least 65, up from 9% five years earlier. However, one-third of doctors in their senior years were still working full time.

CIHI data also shows that older physicians no longer classified as full time still carried, on average, 40% of a full workload.

"One in five active physicians in Canada is over the age of 60. With so many doctors about to reach their so-called retirement years, some Canadians have expressed concern about whether they will continue to have access to the medical services they need in the coming years," says Michael Hunt, Director of Pharmaceuticals and Health Workforce Information Services at CIHI. "However, our study shows that physicians do not tend to retire, in the conventional sense, when they reach age 65. Instead, they slowly wind down their practice over the years. In addition, thanks to an influx of new medical school graduates, the number of active physicians working in Canada is on the rise, and the average age of physicians is stabilizing."

Older family physicians lessen workload, narrow practice

The report, Putting Away the Stethoscope for Good? Toward a New Perspective on Physician Retirement, found that rather than leave the workforce completely, many older physicians lessen the intensity of their clinical practice. In 2007, 7% of physicians age 55 and older, and close to 12% of physicians age 65 and older, became minimally active; that is, they worked 33% or less of their previous workload.

Although there were no major differences between family physicians in different age groups with respect to clinical activities, such as office assessment and mental health care, the older general practitioners became, the less likely they were to provide certain services. For example, fewer than 35% of female family physicians age 65 to 69 provided hospital inpatient care, compared with 59% of those younger than 40. Similarly, 56% of male family physicians age 65 to 69 provided services requiring advanced procedural skills, compared with 77% of those age 40 to 44. This shift in scope of practice was also evident in family physicians providing obstetrical and anesthetic services and happened faster among female physicians than among their male counterparts.

More physicians intend to retire than actually leave the workforce

According to the 2007 National Physician Survey, just more than 3% of all physicians reported that they planned to retire in each of the two years following the survey. However, CIHI's study found that estimates of actual retirement rates were significantly lower, with less than 1% of doctors (between 0.54% and 0.79%) retiring annually from the workforce in this period.

"In the physician workforce, retirement is not a sudden event," says Dr. Raymond Pong, a researcher at the Centre for Rural and Northern Health Research at Laurentian University and author of the study. "Instead, we see a transition to retirement, with doctors progressively taking on less work and carefully choosing the work that they do take on. It's a process that can extend over months and, in some cases, years. As the proportion of older physicians increases, understanding what they do, how much they do and how long they stay active is going to become very important for workforce planning."

Quick facts on physician retirement

...In 2009, one-third of physicians age 65 and older were still working full time.

...In 2009, there were approximately 68,100 active physicians working in Canada, one-tenth (12%) of whom were 65 and older, up from 9% in 2004.

...In 2007, more than 7% of physicians age 55 and older, and close to 12% of those age 65 and older, became minimally active; that is, they worked 33% or less of their previous workload.

...The older general practitioners became, the less likely they were to engage in such activities as hospital inpatient care, obstetrics, anesthesia and services requiring advanced procedural skills.

...In 2007, while just more than 3% of surveyed physicians reported that they planned to retire in each of the two years following the survey, the estimated average annual retirement rate was actually well under 1% annually.

The report and the following figures and tables are available from CIHI's website, at www.cihi.ca

Nearly two-thirds of seniors using five or more types of prescription drugs

Drugs to treat cardiovascular conditions top the list in both use and cost for public drug programs


OTTAWA, March 18, 2010 /Canada NewsWire Telbec/ - Almost two-thirds (62%) of Canadians age 65 and older living in the community in six provinces are using five or more classes of prescription drugs, according to a study released today by the Canadian Institute for Health Information (CIHI).

The study, Drug Use Among Seniors on Public Drug Programs in Canada, 2002 to 2008, examined public drug claims for more than one million Canadian seniors in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Prince Edward Island. The study found that in 2008, slightly more than one in five (21%) of these seniors were using 10 or more types of prescription drugs, and just more than 1 in 20 (6%) were using 15 or more different classes of drugs.

"Public-sector spending on prescribed drugs in Canada reached an estimated $11.4 billion in 2009, and we know that seniors account for a large portion of these expenditures," says Jean-Marie Berthelot, Vice President, Programs, CIHI. "With the aging of Canada's population, it is important to understand which drugs are being used most often by seniors and which account for the highest proportions of public drug program expenditure. This information helps to inform decisions about the future planning and delivery of public drug programs."

Older seniors were more likely to be multiple-drug users, with about one-third (29%) of seniors age 85 and older submitting claims for 10 or more types of drugs in 2008, compared to fewer than one in five (17%) seniors age 65 to 74.


Drugs for treatment of chronic illnesses most commonly used


CIHI's study shows a number of the most commonly used drug classes are for the treatment of chronic conditions in general, and cardiovascular conditions in particular, such as high blood pressure and heart failure. Examples of these drug classes include ACE inhibitors (for example, ramipril), beta blocking agents (for example, metoprolol), dihydropyridine calcium channel blockers (for example, amlodipine) and thiazide diuretics (for example, hydrochlorothiazide).

Statins (for example, atorvastatin), used to treat high cholesterol, were the most commonly used drug class among seniors younger than 85, with two out of five (40%) seniors age 65 to 84 using them. Statin use dropped in seniors age 85 and older, to about one in four (24%). ACE inhibitors, used to treat heart failure and high blood pressure, were the most commonly used among those 85 and older, used by almost one-third (32%) of these seniors. Proton pump inhibitors (for example, omeprazole), used to treat acid reflux disease, were another frequently used drug class.

"The prevalence of many chronic diseases increases with age, which may be contributing to the high number of drugs used by seniors," says Dr. Angela Juby, Associate Professor, Division of Geriatric Medicine at the University of Alberta. "Drug numbers per se are not as important as drug appropriateness. We know some chronic diseases, such as osteoporosis, are being under-treated. Therapy with multiple drugs is necessary to effectively manage chronic conditions; however, it is most important to consider the potential risks, including adverse effects and interactions between drugs or between drugs and diseases."

Top 10 drugs account for half of public program spending on seniors


The top 10 drug classes, in terms of drug program spending, accounted for almost half (48%) of public drug spending on seniors in the six provinces studied.

Public drug program expenditures were highest for statins, which accounted for 14% of total program spending on seniors. Proton pump inhibitors, used for acid reflux disease, accounted for the second-highest share, at 7% of total spending, followed by dihydropyridine calcium channel blockers, used for high blood pressure, which also accounted for 7% of total spending.

The drug class that experienced the fastest spending growth over the study period was tumour necrosis factor alpha inhibitors (anti-TNF drugs, such as etanercept), which treat conditions such as rheumatoid arthritis and Crohn's disease. Total drug spending on this class of drugs increased by an average of 58% annually from 2002 to 2008, and accounted for 2% of total program spending on seniors in 2008. The study also found that four of the fastest growing drug classes are used to treat cardiovascular conditions and two are used to treat chronic lung conditions like emphysema and chronic bronchitis.


About CIHI


The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada's federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI's goal: to provide timely, accurate and comparable information. CIHI's data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.