The Committee recognizes that there are many challenges facing health human resources (HHR) in Canada, which represent the basis for its current study. Statistics Canada defines HHR as paid health care providers within health care systems that are responsible for the delivery of high quality, safe, effective and patient-centred care to Canadians, a definition that is based upon the National Occupational Classification (NOC).[3] It is important to note that HHR refers to a comprehensive range of health professionals, not all of which are directly involve in health care delivery, such as: physicians, nurses, midwives, chiropractors, naturopathic doctors, dentists, pharmacists, laboratory workers, environmental and public health professionals, health statisticians, epidemiologists, health information managers, health economists, and community health workers.[4] The World Health Organization (WHO) utilizes an even broader definition of HHR, considering a health care provider to be anyone engaged in actions whose primary intent is to enhance health, regardless of whether they are paid to do so.[5] This broader definition results in the inclusion of a wider range of persons, such as volunteer and family care givers. This report is based upon the WHO’s broader conception of HHR that includes health professionals that are both paid and unpaid.

According to Canadian Institute for Health Information (CIHI, HHR represent the single greatest cost to health care systems: approximately 60 to 80 cents of every health care dollar in Canada is spent on HHR, which does not include the costs of educating those health professionals.[6] This means that of the $160 billion spent in Canada on health care in 2007, $96 to $128 billion went towards HHR.[7]

However, the ability of health care systems to provide Canadians with high quality and safe health care is dependent in part upon having “[…] the right mix of health care providers with the right skills in the right place at the right time.”, as well as other determinants of health.[8]

Yet Canada has been experiencing HHR shortages in many professions for a number of years. For example, it is estimated that in 2007 there was a shortage of nearly 11,000 full-time equivalent Registered Nurses (RNs) in Canada.^[9] The Canadian Medical Association further estimates that between 4 and 5 million Canadians currently do not have access to a family physician.[10]

It is important to note that CIHI has reported that between 2003 and 2007, there have been varied increases in a number of health occupations, including physicians, nurses, occupational therapists, midwives, and pharmacists, among others.[11] However, HHR shortages are still projected to continue due to a variety of factors including the aging of the health workforce population, reduction of working hours by health care providers to support greater work life-balance, and workplace issues that lead to absenteeism and high rates of staff turnover.[12]

In addition, rural and remote areas in Canada face particularly acute HHR shortages. This is due to migration patterns among health care providers, who, like the general population, tend to migrate to centres experiencing greater amounts of economic growth.[13] For example, from 1991 to 2001, physicians, medical laboratory technologists, and dental assistants tended to move away from rural areas.[14] The situation is even more difficult in on reserve First Nations and Inuit communities and the North, where primary care is mainly delivered by RNs and as a result, these population groups must also travel great distances to receive acute and tertiary care.[15]

Though Canada has historically relied on internationally educated health professionals (IEHPs) to address shortages in its workforce, these health professionals are also facing difficulties in having their credentials recognized and experience delays in integrating into the Canadian health care system.[16] For example, 50% of International Medical Graduates who apply for postgraduate training in Canada each year represent those that are applying to the system for the second time, because they did not receive a position the first time that they applied.[17]