Uncertainty must guide health-care workforce plans

Ability to be agile can assuage staffing,

Crisis: Health Workforce is the country's longest-running telenovela.

Each season ends with a cliffhanger: will operating rooms shut down because there are no perfusionists? Why can't Mumbai-trained Ajay get a medical licence? Will all nurses need doctorates by 2035? Can any incentive persuade young physicians to choose full-service family medicine?

It's End Times religion; the Reckoning is always just a few years out. In 2009, the Canadian Nurses Association predicted a shortage of 60,000 nurses by 2022. A 2019 model raised that to 118,000 by 2030.

A 2022 report from Royal Bank of Canada says we are short 14,000 family doctors now and will be 30,000 short by 2028. Manitoba has only half the number of psychologists per capita as the national average. Saskatchewan has but five geriatricians.

There is no shortage of shortage projections; governments, professional associations, academics, think tanks and now banks roll them out regularly to estimate the yawning gap between what we'll need and what we'll have.

And yet the numbers, despite the elegant math, are always wrong. Canada is routinely caught with its pants around its ankles.

Many projections fail the most basic smell test. A full-time family doctor can easily serve a roster of 1,200 patients. To say we're short 14,000 today implies about 16 million people don't have a family doctor. The usual estimate is 6.5 million, and probably half of those don't really care.

Workforce planning seems as dysfunctional as the health system it is supposed to serve, which if nothing else demonstrates admirable consistency. But why?

For one, most projections assume that health-care needs and treatment options evolve gradually, health science education is efficient and workforce deployment is optimal. None of this is remotely plausible. We are in a furious sprint to an uncertain future.

No credible projections are possible without critically examining at least the following issues. What does the population need and how is it changing? Will an aging population need more high-tech medicine or more social, high-touch care? Do we have the right mix of personnel to meet these needs?

Is the current division of labour efficient? Too many medical specialists do work that should be done in primary care. Registered nurses (RNS) do work that licensed practical nurses can do. Few community pharmacists play meaningful roles in drug therapy.

Do health-care professionals spend too much time on redundant paperwork and other tasks that contribute little to better care? Every survey says yes. A shortage of nursing doesn't necessarily mean there is a shortage of nurses.

If RNS could reallocate even 10 per cent of their time from work of little value toward work they are uniquely trained to do, Canada would have the equivalent of 30,000 more nurses without training or hiring a single additional nurse. So it is with doctors.

How will technology change what health-care workers do and how they do it? Artificial intelligence and machine learning already outperform humans in diagnosing many conditions. Virtual care has already replaced many in-person consultations.

Physiological measures (blood pressure, heart rate, breathing) can be taken, transmitted and monitored electronically. If you're betting on how many care processes will be wholly or partly automated, always take the over.

Can health-care workers be trained faster and more efficiently? It should not take six years of post-secondary education to train a physiotherapist. Just because the demand for medical school seats exceeds supply is no reason to require an undergraduate degree as a prerequisite.

Unforeseeable twists will invariably humble the best efforts to forecast future needs. It's easier to learn from history. Lesson No. 1: train too many, not too few. Shortages put patients and providers at risk and drive up wages. Expanded training programs are cheaper than paying $280,000 a year for agency nurses.

Training and deployment approaches are too static and rigid to keep up to the pace of change. They are hardly a sound foundation on which to create the workforce of tomorrow. Projecting requirements 10 years out is a mug's game.

It's time to play a better one that acknowledges uncertainty as the new normal, and agility and lifelong learning as the indispensable new skills.