Physician Shortage in Canada: A Review of Contributing Factors

Malko, Andrei V.; Huckfeldt, Vaughn

doi:10.5539/gjhs.v9n9p68

Cited by 36 publications

(33 citation statements)

References 29 publications

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“…Internationally, our study aligns with others that have shown that NPs improve care quality for LTC residents and promote the development of knowledge among healthcare providers [5,22,23,41,74,75]. NPs in our study cared for residents with complex care needs with characteristics that were similar to other LTC residents in Québec with regards to age, sex, diagnosis on admission, and functional autonomy scores [19,31,76].…”

Section: Discussionsupporting

confidence: 85%

“…Because countries must respond to increasing needs of this population, innovative approaches are needed to improve long-term care (LTC) services [2]. Furthermore, as healthcare systems internationally continue to face workforce issues, including shortages of physicians and other care providers in LTC, decision-makers are looking to shift care activities from physicians to nurses and nurse practitioners (NPs) to improve access to and the quality of LTC [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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A mixed methods quality improvement study to implement nurse practitioner roles and improve care for residents in long-term care facilities

et al. 2020

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Background: To better meet long-term care (LTC) residents' (patients in LTC) needs, nurse practitioners (NPs) were proposed as part of a quality improvement initiative. No research has been conducted in LTC in Québec Canada, where NP roles are new. We collected provider interviews, field notes and resident outcomes to identify how NPs in LTC influence care quality and inform the wider implementation of these roles in Québec. This paper reports on resident outcomes and field notes. Methods: Research Design: This mixed methods quality improvement study included a prospective cohort study in six LTC facilities in Québec. Participants: Data were collected from September 2015-August 2016. The cohort consisted of all residents (n = 538) followed by the nurse practitioners. Nurse practitioner interventions (n = 3798) related to medications, polypharmacy, falls, restraint use, transfers to acute care and pressure ulcers were monitored. Analysis: Bivariate analyses and survival analysis of occurrence of events over time were conducted. Content analysis was used for the qualitative data. Results: Nurse practitioners (n = 6) worked half-time in LTC with an average caseload ranging from 42 to 80 residents. Sites developed either a shared care or a consultative model. The average age of residents was 82, and two thirds were women. The most common diagnosis on admission was dementia (62%, n = 331). The number of interventions/resident (range: 2.2-16.3) depended on the care model. The average number of medications/resident decreased by 12% overall or 10% for each 30-day period over 12 months. The incidence of polypharmacy, falls, restraint use, and transfers to acute care decreased, and very few pressure ulcers were identified. Conclusions: The implementation of NPs in LTC in Québec can improve care quality for residents. Results show that the average number of medications per day per resident, the incidence of polypharmacy, falls, restraint use, and transfers to acute care all decreased during the study, suggesting that a wider implementation of NP roles in LTC is a useful strategy to improve resident care. Although additional studies are needed, the implementation of a consultative model should be favoured as our project provides preliminary evidence of the contributions of these new roles in LTC in Québec.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

A mixed methods quality improvement study to implement nurse practitioner roles and improve care for residents in long-term care facilities

et al. 2020

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“…These results are consistent with those of Sibley and Weiner (2011) who found that residents of small cities not adjacent to major centres were most likely to have a regular medical doctor, whereas people residing in most rural communities were less likely to have a regular medical doctor. Similar trends are seen across the country and have been attributed to "a significantly wider scope of practice and need to maintain competence in different clinical areas despite having higher workloads, inaccessibility of CME, having no professional back up and limited specialist consultation" (Malko and Huckfeldt 2017).…”

Section: Figurementioning

confidence: 64%

Geographic accessibility to primary care providers: Comparing rural and urban areas in Southwestern Ontario

Shah

Clark

Seabrook

et al. 2019

Canadian Geographies / Géographies canadiennes

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This research examines geographical accessibility to primary care providers (PCPs) across urban and rural areas of Southwestern Ontario and examines variations in the distribution of PCPs in relation to the senior population (aged 65 years and older). Information about PCP practices was provided by the HealthForceOntario Marketing and Recruitment Agency. Population data were obtained from the 2016 Census of Canada. To calculate scores for accessibility to PCPs (i.e., PCPs/10,000 population), we applied the enhanced 2‐step floating catchment area method with distance decay effect within a global service catchment of 30‐minute drive time. A geospatial mapping approach revealed disparities in the distribution of PCPs with a pattern of higher spatial accessibility in or around major urban areas in Southwestern Ontario. Comparative analyses were performed in association with the seniors’ population to identify how accessibility scores were mismatched with the population needs. The outcome of this study will assist researchers and health service planners to better understand the distribution of existing PCPs to address inequalities, particularly in rural areas.

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“…This mismatch may be attributed to decades of overtraining specialist physicians, which has resulted in undersupply of family physicians [8]. Furthermore, there is a geographic dichotomy: only 10% of the total physician workforce and only 2% of specialized physicians practice in rural Canada where 18% of the population is situated [9].To address this, Health Canada invested $1.8 million in 2010 to review postgraduate medical education in Canada [10]. One of their recommendations was to iteratively re-evaluate medical training programs to ensure the right "physician mix, distribution, and number" of generalist and specialist positions to serve the Canadian population.…”

mentioning

confidence: 99%

Modernising physician resource planning: a national interactive web platform for Canadian medical trainees

Bourcier

Collins

Tanya

et al. 2021

Preprint

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Background: Healthcare systems rely heavily upon human resources to ensure high-quality access to care for the general population. With significant health worker shortages predicted worldwide in the coming decades, maximizing the current workforce by means of a physician resource planning (PRP) strategy that ensures the right number, mix, and distribution of physicians to meet population needs is warranted. In Canada, there is an insufficient number of primary care providers, and disproportionately low numbers of specialist physicians in rural compared to urban regions. Currently, Canadian medical students are not effectively included in PRP strategy and lack the required information for career orientation to help rebalance the population’s workforce needs. This paper aims to present the Health Human Resource (HHR) Platform, a comprehensive web tool that includes relevant workforce data to empower medical students in choosing a discipline based on both personal interests and social accountability.Methods: Physician workforce data were amalgamated from national public agencies. Comments from Canadian residency program directors and useful resources for career planning were collected by the Canadian Federation of Medical Student’s (CFMS) HHR Task Force. This information was consolidated to create the HHR Platform using a DigitalOcean server. The backend database utilizes MySQL, while the frontend utilizes React and Material UI, with additional aspects integrated through Leaflet and Google Charts. Results: A national interactive platform was created that uses a map, comparison table, and trends graph to illustrate over 500,000 unique data points from 37 datasets, including specific information and resources spanning 62 medical specialties from 2015 onwards. There was a 24.6% response rate for program director comments. During the first four months of the HHR Platform launch, there were 2463 different users, of which 998 were returning, with an average of 20.2 users per day spending on average 3 minutes and 4 seconds on the platform.Conclusions: The HHR Platform constitutes a bottom-up national approach to PRP informing medical students on the mix and distribution of physicians needed for a better alignment with residency positions, and ultimately meet the future healthcare demands of the Canadian population.

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Physician Shortage in Canada: A Review of Contributing Factors

Cited by 36 publications

References 29 publications

A mixed methods quality improvement study to implement nurse practitioner roles and improve care for residents in long-term care facilities

A mixed methods quality improvement study to implement nurse practitioner roles and improve care for residents in long-term care facilities

Geographic accessibility to primary care providers: Comparing rural and urban areas in Southwestern Ontario

Modernising physician resource planning: a national interactive web platform for Canadian medical trainees

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