james ayles english
TRANSCRIPT
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
New Brunswick Department of Health 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
Occupation Specific Approach: Phase 1
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
New Brunswick Department of Health 8
Minimum Data Set: Phase 1
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
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
Physician Specialties: Phase 2
Family/General PractitionersSpecialists*
*Specialists includes:1. Anesthesia2. Anatomical Pathology3. Cardiology4. Cardiovascular & Thoracic Surgery5. Dermatology6. Diagnostic Radiology7. Emergency Medicine8. Gastroenterology9. General Pathology10. General Practice/ Family Practice11. General Surgery12. Geriatric Medicine13. Hematological Pathology14. Hematology15. Infectious Diseases16. Internal Medicine17. Medical Microbiology18. Medical Oncology
19. Neonatology20. Nephrology21. Neurology22. Neurosurgery23. Nuclear Medicine24. Obstetrics / Gynecology25. Ophthalmology26. Orthopedic Surgery27. Otolaryngology28. Pediatrics29. Physical Medicine & Rehab30. Plastic Surgery31. Psychiatry32. Radiation Oncology33. Respiratory Medicine34. Rheumatology35. Thoracic Surgery36. Urology37. Vascular Surgery
New Brunswick Department of Health 14
Minimum Data Set: Phase 2
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
New Brunswick Department of Health 15
Minimum Data Set: Phase 2
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
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
Base Stock ofPhysicians, by
specialty
New Entrants fromMedical Schools
(PGME)
InterprovincialMigration
Immigration
Retirements
Deaths
InterprovincialMigration
GAINS EXITS
Weighted SupplyFactors (+/-)
EmigrationInternational Medical
Graduates
New Brunswick Department of Health 19
Forecast Model (Demand): Phase 2
Aggregate all General/Family practice services annually from all regions.
Calculate per capita use
of services by age and sex.
Multiply per-capita rates by each health region’s population (2001 census) to estimate population-based demand for GP/FP services.
Compare actual service to expected demand in each base year to assess regional variation/access.
Multiply per-capita rates by each health region’s projected population (annually to 2013)
Compare estimated demand for services for base year’s projected population (from 1996 census) to estimated demand for services by future years’ projected populations) to estimate changes in population-based demand for GP/FP services.
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 AssociationPhysician Supply – PRET
Canadian Nursing AssociationNurse 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
Thank You