Health Human Resources

Audited Entities

• Ministry of Health and Long-Term Care
• HealthForceOntario Marketing and Recruitment Agency

Audit Scope and Objectives

• To assess whether the Ministry of Health and Long-Term Care, in conjunc­tion with the Agency, had adequate systems and procedures in place to:
  • identify and assess the appropriateness of the mix, supply, and distribution of qualified health care professionals to help meet the current and future needs of Ontarians across the province;
  • ensure that strategy initiatives were delivered in accordance with established regulatory requirements, applicable directives and poli­cies, and agreements; and
  • measure and report regularly on the progress of the strategy’s objectives.

Audit Criteria

• Not publicly available.

Main Audit Findings

• Overall, Ontario has seen an 18% increase in physicians from 2005 to 2012 and a 10% increase in nurses from 2006 to 2012. While the initiatives increased enrolment, created more postgraduate training positions and attracted more doctors and nurses from other jurisdictions, Ontario has not met its goal of having the right number, mix and distri­bution of physicians in place across the province to meet the population’s future health-care needs.
• Many specialists trained in Ontario do not stay and practice here. Retention statistics show that, on average, 33% of Ontario-funded surgical specialist graduates left the province each year between 2005 and 2011. The lack of full-time employment opportunities for graduating residents of certain surgical specialties may lead to more physicians deciding to leave the province, despite long wait times for these services.
• The Agency provides temporary physician or “locum” coverage in eligible communities across the province to support access to care. However, vacancy-based locum programs meant as short-term measures continued to be used for long periods of time.
• Over four fiscal years, $309 million was dedicated to hir­ing 9,000 new nurses. While the system was unable to hire that many nurses in the four years, it had increased the number of nurses by more than 7,300 and the Ministry was on track to achieve its goal within five years.
• Although the physician forecasting model built in partnership with the Ontario Medical Association was a positive step in determining physician workforce requirements, it is ham­pered by the limited reliability and availability of data. These limitations make planning the optimal number, mix and distribution of phys­icians with appropriate funding, training and deployment difficult.

Selected Audit Recommendations

• To better meet the health-care needs of Ontar­ians, the Ministry, in conjunction with the Agency, should:
  • compare the existing mix and distribution of physicians across the province to patient needs and consider what measures it can take to reduce any service gaps;
  • continue to work with medical schools and associations to encourage more medical students to select fields of study and geographic areas in which to practice that are in demand; and
  • assess the effectiveness of its various phys­ician initiatives in meeting the health-care needs of underserved areas.
• To provide an appropriate level of nursing ser­vices and thereby improve access to care across the health sector, the Ministry should:
  • monitor nursing employment trends and assess the outcome of its nursing initiatives in transitioning graduating nurses to perma­nent full-time employment; and
  • assess the reasons for declining participa­tion rates of nurse graduates in its Nursing Graduate Guarantee Program, and take steps to improve program effectiveness, including encouraging participation in the program across sectors.
• To provide reasonable and reliable forecasts of the requirements for physicians and nurses and to better ensure effective health human resources planning, the Ministry should conduct assessments of employment trends, the supply and projected needs for health services, and the associated health workforce requirements to best meet those needs cost-effectively.

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