Health Workforce Planning in New Brunswick

1. Health Workforce Planningin New Brunswick FLMM LMI Working Group Labour Supply Monitoring and Forecasting Workshop Vancouver, British Columbia October 18th, 2007 James Ayles Coordinator, Health Workforce Information and Analysis

2. Overview • Brief History of HHR Planning in NB • 2003 Health Workforce Studies (Fujitsu) • HHR Unit • Supply & Demand Forecasting Model • Challenges in Using the Forecasting Model • Collaborative Work in Atlantic Canada • Atlantic Health Education/Training Planning Study • Simulation Model • National Initiatives • HHR Modeling Working Group New Brunswick Department of Health

3. HHR Planning – The Early Years • In the 1990s there was little formalized HHR planning • Late 1999s several factors forced the Province to address the supply of health practitioners • Population Health Status (i.e. obesity, diabetes) • Aging Population (client & practitioner) • Urban/Rural (mobility & access) • Language • Access to Specialized Services • Rising Costs (delivery of service, training of professionals) New Brunswick Department of Health

4. HHR Planning – 2000s • Formalised health workforce planning activities emerged as an essential need in the 2000s • Health Human Resources Supply and Demand Analysis • Commonly known as the “Fujitsu Report” (2002) • Studied 28 health occupations and produced 5 year forecasts (10 years for physicians) • Health Workforce Planning Unit established in 2003 • The unit is responsible for forecasting the supply and demand of health human resources, developing and implementing strategies to address human resources shortages, and providing support and advice to the Department in the areas of health professional resources • Provincial Health Plan 2004-2008 “Healthy Futures” • Strategic Priorities: Building Health Human Resources - an appropriate supply and mix of trained health professionals New Brunswick Department of Health

5. Health Workforce Studies (Fujitsu) • Purpose of Health Workforce Studies • To provide essential data/information to inform planning process • To provide a current profile of the Health Workforce and their related practices • To identify future resource requirements • To develop 5/10 year forecasting models New Brunswick Department of Health

6. Approach taken by Consultants • The general approach used for this project consisted of the following steps: • Consultation with Stakeholders • Environmental Scan • Database Design and Development • Forecast Model Design • Supply/Demand Analysis (gaps/shortages) New Brunswick Department of Health

7. SOCIAL SCIENCES Addiction Worker / Counsellor Psychologist (Clinical) Psychometrist Social Worker REHABILITATIVE OCCUPATIONS Audiologist Speech Language Pathologist Occupational Therapist Physiotherapist Rehab Assistant TECHNICAL GROUPS Diagnostic Medical Sonographer ECG Technician EEG Technician Medical Equipment Technician Medical Lab Technologist Medical Lab Specialist Medical Radiation Technologist / Therapist (Nuclear Medicine, X-ray, MRI, Dosimetrist) Respiratory Technologist / Therapist NURSING Licensed Practical Nurse Registered Nurse Clinical Nurse Specialist Nurse Practitioner OTHER OCCUPATIONS Ambulance Attendant / EMT / Paramedic Dietician Public Health Inspector Health Records Technician Health Records Administrator Optometrist Pharmacist Pharmacy Assistant (Technician) Prosthetists Total of 27 Occupations Occupation Specific Approach: Phase 1 New Brunswick Department of Health

8. INDIVIDUAL First Nam, Last Name, Middle Initial Previous Names Home Address (address, city, province/state, postal code, country) Language Proficiency Language Preference (English/French) Gender Occupation Entry to Practice Qualification Highest Level of Education Achieved in Occupation Origin of training (school, province/state, country) Year of grad Credential Certified Name of Registering/Licensing Body Registration # Registration Status Primary field of practice Secondary field of practice Working in Occupation Unemployed Seeking EMPLOYER Employer’s Name/Place of Employment Employer’s Address Employer’s City Employer’s Postal Code Health Sector Health Region FTE – Public Sector Employment Sector Employment Status EDUCATION Entry to practice requirements Inventory of training programs Program entry requirements Program duration Language of program Enrollment capacity of program Total capacity of program Graduation credential Entry Year number enrollments All Years number enrollments Entry Year number of NB students currently enrolled All Years number of NB students currently enrolled Number NB purchased Number grads over last 10 years Recruitment incentives Minimum Data Set: Phase 1 New Brunswick Department of Health

9. Data Sources: Phase 1 • Service Provider Database • HRDB (data warehouse of public sector employees) • Professional Health Associations/Colleges • Maritime Provinces Higher Education Commission • Academic Institutions • Statistics Canada • Canadian Institute for Health Information New Brunswick Department of Health

10. Forecasting Model (Supply): Phase 1 Supply-Side = Current Stock • Inventory Database – Occupations Subsystem + Increments • New Entrants • Inventory Database – Education Subsystem • Reserve Pool • Inventory Database – Occupations Subsystem • Net Migration • Statistics Canada, CIHI - Exits • Statistics Canada, CIHI ± Weighted Supply Factor • Perceived Impacts New Brunswick Department of Health

11. Forecasting Model (Demand): Phase 1 Demand-Side = Current Stock • Inventory Database – Occupations Subsystem + Vacant Positions in System + Planned New Positions - Planned Reduction in Positions ± Weighted Demand Factors • Age Structure of Population • Health Status • Utilization Profile • New Trends and Technology New Brunswick Department of Health

12. Gap Analysis: Phase 1 • Developed forecasts for 20 of the 27 occupations. • The remaining occupations did not have sufficient numbers to forecast • Key Deliverable • “Health Human Resources Supply and Demand Analysis” (November 2002) • http://www.gnb.ca/0051/pdf/HRStudy/SupplyandDemandAnalysis.pdf New Brunswick Department of Health

13. Family/General Practitioners Specialists* *Specialists includes: 1. Anesthesia 2. Anatomical Pathology 3. Cardiology 4. Cardiovascular & Thoracic Surgery 5. Dermatology 6. Diagnostic Radiology 7. Emergency Medicine 8. Gastroenterology 9. General Pathology 10. General Practice/ Family Practice 11. General Surgery 12. Geriatric Medicine 13. Hematological Pathology 14. Hematology 15. Infectious Diseases 16. Internal Medicine 17. Medical Microbiology 18. Medical Oncology 19. Neonatology 20. Nephrology 21. Neurology 22. Neurosurgery 23. Nuclear Medicine 24. Obstetrics / Gynecology 25. Ophthalmology 26. Orthopedic Surgery 27. Otolaryngology 28. Pediatrics 29. Physical Medicine & Rehab 30. Plastic Surgery 31. Psychiatry 32. Radiation Oncology 33. Respiratory Medicine 34. Rheumatology 35. Thoracic Surgery 36. Urology 37. Vascular Surgery Physician Specialties: Phase 2 New Brunswick Department of Health

14. Individual First Name, Last Name, Middle Initial Gender Date of Birth License Number Billing Number/Service Provider Number Practice Location Mother Tongue Language Fluency 1 (Oral Proficiency) Language Fluency 2 (Written Proficiency) Preferred Working Language Language Of Majority of Medical Training Occupation Specialty Primary Secondary* Practice Specialty Post Graduate Fellowship 1, 2, 3, 4 Functional Specialty #1, 2, 3, 4, 5 Basic Medical School Origin of training (school, province/state, country) Year of grad PGME Origin of training (school, province/state, country) Year of grad Certified Billing Eligibility Status Total Medicare Billings (FFS) Licensure Status Total Salary payments Total Sessional payments Total Alternate payments Total ‘Other’ payments FTE Calculation Range of clinical and non clinical practice activities Size of the practice Days seeing scheduled patients New patients added in past 12 months Practice capacity Average number of patients seen/week by Family Physician Average number of patients seen/week by Specialist Average hours per week in clinical practice FP On-call Categories Specialist On-call Categories On call commitment: Average number of hours on- call per month Intensity of on- call work Leave time for CME Leave time for other reasons than CME Maternity leave taken in the past 2 years Planned workload increase Planned workload decrease Magnitude of planned increased work Magnitude of planned work reduction Locum coverage for planned absences from practice Interdisciplinary Practice Patterns 1, 2, 3 Percentage of patients who are non NB residents Location of patients who are non NB residents Average wait time for elective consults Average wait time for urgent consults Practice Activities Health Sector Priorities for Action impacting Recruitment/retention General Comments on Factors impacting physician recruitment /retention Minimum Data Set: Phase 2 New Brunswick Department of Health

15. EDUCATION Name of Institution Location of Institution Program Name Length of Program Program Entry Requirements Language of program Accredited Y/N Clinical training Attrition Rate Credential awarded Pending changes to program Number of Enrollments Gender of students enrolled Number of designated seats in the program for NB students Number of NB students enrolled Gender of NB Students enrolled Mother Tongue of NB students enrolled Language Fluency of NB students enrolled (Working Proficiency) Preferred Working Language of NB students enrolled Program capacity Number graduates over last 10 years Age of Graduates Recruitment incentives offered to new grads Where do students go to work after graduation Minimum Data Set: Phase 2 New Brunswick Department of Health

16. Data Sources: Phase 2 • Medicare Registration System • New Brunswick Physician Survey • Response Rate (56%) • GP/FPs (55%) • SPs (58%) • MDSS – Physician Utilization System • Canadian Institute for Health Information • Canadian Post-MD Education Registry (CAPER) • Association of Canadian Medical Schools New Brunswick Department of Health

17. Forecast Model: Phase 2 • Supply-side / Physician Workforce Analysis • forecast physician supply based on current stock, gains, and exits over a 10-year forecast horizon • Demand-side / Needs Analysis • based on current utilization of physician services, by age and gender, and taking into consideration population changes over a 10-year forecast horizon • Gap Analysis / Identification of Imbalances and Physician Requirements • comparison of present and future physician workforce compared against present and future needs/demand over a 10-year forecast horizon  New Brunswick Department of Health

18. Forecast Model (Supply): Phase 2 New Brunswick Department of Health

19. Forecast Model (Demand): Phase 2 New Brunswick Department of Health

20. Gap Analysis: Phase 2 • Key Deliverable • “Setting a New Direction for Planning the New Brunswick Physician Workforce” (September 2003) • http://www.gnb.ca/0051/pdf/HRStudy/DirectionPhysicianWorkforce.pdf • Appendix H: Detailed GP/FP demand methodology • Appendix I: Detailed General Surgery demand methodology New Brunswick Department of Health

21. Stakeholder “Buy-in” • The two studies were well received by stakeholders • Occupations, where there was limited data, have approached the department looking for assistance in collecting the data necessary for their inclusion in the next iteration New Brunswick Department of Health

22. Fujitsu Studies were the Basis for … • Components of the Provincial Health Plan • Integrated Health Human Resources Plan • Physician Resource Strategy • Nursing Resource Strategy • Allied Health Resource Strategy • Partnership: Atlantic Health Human Resources Association • Atlantic Health Education Training Planning Study New Brunswick Department of Health

23. Atlantic Health Education/Training Planning Study • New Brunswick – Fujitsu Studies • Nova Scotia, PEI, and Newfoundland & Labrador – conducted similar studies • Critical Mass Needed to Train an Adequate Supply of Health Professionals • Utilizing the results of the 4 studies tried to determine what was that critical mass and what would be required in the future New Brunswick Department of Health

24. Atlantic Health Education/Training Planning Study • Atlantic Advisory Committee on HHR • Health & Post Secondary Education • Council of Atlantic Premiers - Secretariat • HRSDC Funded the Atlantic Study • Produced a simulation tool • Supply • Demand (Population & Productivity) • “Policy Tester” • Report available at • http://www.ahhra.ca New Brunswick Department of Health

25. National Initiatives • F/P/T Advisory Committee on Health Delivery & Human Resources • Planning sub-committee • HHR Modeling Working Group • Mandate – knowledge transfer • F/P/T representatives and research organizations • HHR Modeling Definitions and Principles • Workshops – 2005 & 2007 New Brunswick Department of Health

26. Other Models • Canadian Medical Association • Physician Supply – PRET • Canadian Nursing Association • Nurse Practitioners – Based on Atlantic Simulation tool New Brunswick Department of Health

27. Commitment to your Investment • Many models are used once and then discarded • Fujitsu Model was designed to be updated & reused • Physicians – updating now • All other professions in 2008 • Model Maintenance • Assumptions • Data Sources New Brunswick Department of Health

28. Thank You