Health Workforce Demographics

The term health workforce generally refers to those individuals who provide health care to the public. This includes, physicians, nurses, allied health professionals (such as pharmacists, psychologists and physiotherapists), dentists, and technical staff (such as laboratory technicians).

Alberta’s health workforce had over 86,000 people in 2019 and was made up of many different professional groups. The Canadian Institute for Health Information (CIHI) is a federal agency that tracks health workforce numbers across Canada for over 30 health professions. The following figure shows the distribution of the Alberta Health Workforce in 2019.

The regulated nursing workforce makes up by far the largest group, followed by physicians, social workers and pharmacists.

Regulated nurses are comprised of 4 professional groups:

• Nurse practitioners
• Registered nurses
• Registered psychiatric nurses
• Licensed practical nurses

Within the regulated nursing workforce, two thirds are Registered Nurses (67.3%) and almost one third are Licensed Practical Nurses (29.1%). The numbers of Nurse Practitioners and Registered Psychiatric Nurses are relatively small.

The Canadian Institute for Health Information does not have numbers for Health Care Aids, who make up a growing proportion of the health workforce, especially in long-term care.

Almost four out of five health-care workers are women (78.8%). The proportions range from 39.2% for physicians to 100% of midwives. The proportion of females training to become physicians is rising, while the nursing professions are seeing an increase in males joining their ranks.

Growth Trends in Alberta’s Health Workforce from 2015-2019

Alberta has seen a steady increase in the number of health-care providers over the past few years. Regulated Nurses grew by 9.4%. Within the regulated nursing profession, Nurse Practitioners (37.9%) and Licensed Practical Nurses (25.8%) experienced the biggest workforce growth since 2015. The growth in Nurse Practitioners is important from a rural perspective as some strategies aim to specifically attract Nurse Practitioners to rural communities.

Similarly, the number of Midwives and Physician Assistants grew by 48.8% and 80%, respectively since 2015. However, their overall numbers remain low. The majority of midwives continue to practice in urban areas.

Compared to 2015, the increase in number of specialist physicians was higher (16.6%) compared to family physicians (7.4%), and the number of physicians in Alberta is now evenly split between family medicine physicians and specialists.

Allied health providers also grew over the past five years (see Figure below for details).

The increase was not only in total numbers of health-care workers, but also in the number of workers per 100,000 population. This is important – as Alberta’s population continues to grow, the health workforce supply must keep up. This means that across Alberta, more health providers are available to care for Albertans.

The health workforce in Alberta has been growing over the past years. The growth numbers are promising; however, health providers across most professional groups are overrepresented in urban areas. That is, compared to the proportion of Canadians living in rural areas (which was about 20.5% in 2019), far less than 20% of most health professionals have taken up rural practice.

In 2019 the percentage of the health workforce that worked in rural areas was:

Having fewer health-care providers limits access to health care for rural residents and contributes to health inequalities.

Recent years have seen increases in health-care providers such as Physicians and Nurse Practitioners in rural communities. For example, between 2015 and 2019, physicians in rural areas increased by 7%. This is far more than the rural population grew during the same period. That means that in 2019, there are more health care providers per rural population than in 2015.

The increase in rural health-care providers might be the result of greater investments in strategies to educate providers for rural practice and to attract and retain them to rural communities.

Many Indigenous communities are served by far fewer medical professionals per capita than non-Indigenous communities across Canada. At the same time, Indigenous peoples are under-represented in almost all science, technology, engineering, and mathematics (STEM) fields and the health sciences. In the short term, training more Indigenous health providers can help to address these shortages and support the local economy. In the long term, more Indigenous health providers will improve awareness, challenge assumptions, change norms, and create a more culturally safe health-care system.

Read about Dr. Esther Tailfeather, a family physician and community activist working on the Blood Reserve in southern Alberta. She eloquently speaks to the health issues of Indigenous peoples and their ongoing challenges with accessing culturally appropriate care. She makes a plea for more Indigenous health providers that understand the impact of poverty and trauma on Indigenous health and who can advocate for the needs of their people.

Alberta Health Services (AHS) has a dedicated strategy for recruiting Indigenous peoples to health care positions using talking circles, career events, and summer camps for interested youth. Networking and collaborating with Indigenous communities is a big part of their strategy. There are different opportunities for students to get work experience in health care. AHS is also developing a special section on their recruitment website for Indigenous applicants.

For the National Indigenous Peoples Month celebrations 2021, AHS gave a virtual presentation on all their Indigenous Talent Acquisition efforts.

At the University of Calgary, there is a special program within the Faculty of Medicine to support Indigenous learners and confront issues faced by Indigenous people in the health-care system. The Indigenous Health Program helps Indigenous learners apply to medical school and supports their journey to become a physician. It also provides training on Indigenous health to all health providers in training at the Cumming School of Medicine.

Similarly, the University of Alberta offers the Indigenous Health Initiatives Program to encourage greater enrollment of First Nations, Inuit and Metis students in faculty of medicine and dentistry programs. Since its inception in 1988, the Indigenous Health Initiatives Program (IHIP) has been a leader in the recruitment and retention of Indigenous students, representing a wide range of Indigenous communities.

You can also learn more about Indigenous health-care workers across Canada, by exploring this interactive blog from CBC Indigenous.

Idle No More produced this fireside chat video for Indigenous health providers to share information with Indigenous communities about the COVID-19 pandemic:

In September 2019, the Alberta Government committed more funding to hire Nurse Practitioners (NPs) to work in primary care settings in rural and underserved areas. NPs are considered independent practitioners. This means they can have their own health practices, much like a Physician General Practitioner. The number of NP-led clinics in Alberta is increasing, although many are located in urban areas. One rural example is the Warburg clinic which is part of the Leduc Beaumont Devon Primary Care Network (LBD PCN). In Slave Lake’s Family Care Centre, NPs work alongside physicians to care for their community.

Milk River and Bassano both have Physician Assistants to help care for local residents.

The health workforce is complex. It is made up of a mix of regulated and unregulated workers, and also unionized and non-unionized workers that offer health services under various public and private funding arrangements.

Having the right numbers of each type of health-care provider now and in the future is critical for high quality health care and to meet the health needs of people. Health workforce planning, also referred to as Health Human Resources Planning, is an important role for provincial governments. Planning for the right number of health providers is very complex and requires careful analysis of supply and demand. Population trends, such as changes in demographics (e.g. aging of the population) and migration patterns across geographic areas, determine the demand for health services and the required health workforce. Analysis of the past and current numbers of health providers and future trends is the supply side of health human resources planning.

Apart from having sufficient health care providers, they also need to be in the right place. Across Canada and most developed countries, health care providers are much more numerous per 100,000 population in urban areas than rural areas. This contributes to health inequity for rural communities.

Policy-makers and health services planners have several tools to create a balance between supply and demand, including in rural areas. These include:

• Educating more health providers for rural practice such as proposed by the Rural Road Map.
• Creating strategies to attract and retain health care providers to rural communities.
• Creating services delivery models that make better use of existing resources through integration and collaboration between health providers from different backgrounds.
• Helping rural residents stay healthy by introducing strategies that influence the social determinants of health and thus reduce demand for health care.