From aspiring to graduating and working in a health occupation
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Johanne Plante, Rita Ceolin and Sylvie Ouellette
Centre for Education Statistics
Statistics Canada
Introduction
There has been much talk recently about looming shortages in Canada's supply of individuals working in health occupations. In Canada and internationally, a great deal of work is being done to monitor and understand the degree to which the supply of workers in health occupations is meeting (and will meet) the health needs of the population.
This article presents some of what we currently know to begin to address some of the crucial questions facing Canadians today: Does Canada have enough interested individuals with the right skills who want to work in the health sector? Does it have the infrastructure, capacity, and effective education system to ensure an adequate supply of health workers to meet future health care demands?
Using current major Statistics Canada data sources related to the education of Canadians, this article reveals some important information about what happens before, during and after health education. It focuses on the interest of youth in health occupations, the characteristics of students and faculty in university health programs, the labour market experiences of recent graduates from these programs, as well as the ongoing participation of health workers in formal and informal training.1
Concepts and definitions
Occupation is a standard term used by Statistics Canada and can be used to describe all forms of work. For the purpose of this report, the term "occupation" is preferred to "profession" as it does not imply the application of "professional" standards by a professional organization or other authority. Occupations are classified according to standard classifications (1991 Standard Occupational Classification (SOC 1991) or 2001 National Occupational Classification – Statistics (NOC-S 2001)) depending on the data source.
Health and health-related occupations cover a wide range of occupations related to health services and delivery (excluding veterinarians and veterinary and animal health technologists and technicians). As such, health and health-related occupations include, but are not limited to, practitioners of health care.
Health workers are persons in the health and health-related occupations.
Health and health-related education programs cover a wide range of programs in fields of study leading to occupations related to health services and delivery. These include, but are not limited to, future practitioners of health care. Fields of study data are coded and presented by Statistics Canada according to the Classification of Instructional Programs (CIP), Canada, 2000.
Interest in health occupations
As a starting point in understanding the flow of individuals into and through health education programs, it is important to learn more about the size and nature of the population of individuals who are interested in health occupations and whether their aspirations change over time.
Interest in health occupations
In the Youth in Transition Survey (YITS), youth are asked to report on the kind of career or work they would be interested in having when they are about 30 years old. Responses are then coded according to the 1991 Standard Occupational Classification (SOC 1991). These occupations will therefore reflect knowledge of occupations and may not be accurate at a detailed level. For example, the number of youth interested in being registered nursing assistants or licensed practical nurses (LPN) is small, possibly because a generic response of "nurse" would be coded to registered nurse (RN).
There is a great deal of interest in health occupations among youth. As shown by the Youth in Youth in Transition Survey (YITS) in 2000, over 10% of 15-year-olds said they wanted to work in a health occupation at age 30. There was a notable preference for medicine, with almost 7% wanting to be a doctor (Chart 1).
Chart 1
A substantial proportion of youth aspire to health occupations, 2000
Note: Occupations are defined using the Standard Occupational
Classification (SOC), 1991. "Nurses" refer to the Nurse supervisors
and registered nurses category (e.g., nurse supervisors, registered nurses,
registered psychiatric nurses, etc.).
Source:2000 Youth in Transition Survey, Statistics Canada.
The number of youth interested in health occupations is considerable when taking into account the fact that only 5% of the labour force worked in a health occupation in 2001 and that another 1% worked in health-related occupations; most notably, physicians accounted for less than 1% of the labour force in 2001.2 Nursing comprised a much larger occupational group, accounting for slightly less than 2% of the labour force. Nursing was the desired job expressed by about 1% of 15-year-olds and 2% of 18 to 20 year-olds in 2000.
Health labour force
Using 2001 Census data, Galarneau3 found that about 808,000 persons worked in the health field, accounting for about 5% of the labour force during that year. Health professionals accounted for 57% of all workers in health occupations, the majority being nurses (64%), with physicians — general practitioners and specialists — far behind at 14%.
Women account for a large proportion of health workers. In 2001, nearly four health workers in five were women (79%) compared with slightly less than half in other sectors. The average age of health workers was also generally higher than in other sectors (41.1 years old compared with 38.3 years old). Specialists had the highest average age (45.7) followed closely by head nurses and supervisors (45.4) and general practitioners (45.2).
Although a majority of health workers (57%) were employed full time in 2001, health workers were more likely than those in other sectors to work part time (28% compared with 21%). The greater prevalence of part-time work may be related to the difficulty nurses experience in obtaining full-time positions, as well as to the large proportion of women in health occupations. The unemployment rate for health workers in 2001, on the other hand, was considerably lower than for other workers (1.9% compared with 5.6%).
The median employment income of health workers was about $32,400 in 2001. Among health workers, professionals showed the highest median income with $42,000, followed by technical personnel ($32,000) and support personnel ($21,000).
Similar to what was observed in the health labour force, about three-quarters of the youth who aspired to health occupations were female. Youth who were interested in health occupations were also more likely to be visible minorities, to have at least one parent with a postsecondary education and were more likely to come from families with higher incomes. Moreover, many of these youth appeared to have the necessary qualifications. For example, they had higher-than-average reading, mathematics and science skills and their grades reflected this (Chart 2).
Chart 2
Youth who aspired to health occupations had higher than average grades, 2000
Note: Occupations are defined using the Standard Occupational Classification (SOC), 1991. "Nurses" refer to the Nurse supervisors and registered nurses category (e.g., nurse supervisors, registered nurses, registered psychiatric nurses, etc.), while "Non health" refers to the All other occupations category.
Source:2000 Youth in Transition Survey, Statistics Canada.
Between the ages of 15 and 17, however, many youth changed their aspirations. Asked again at age 17 what job they would like at age 30, about 60% of youth cited a different occupation from the one reported at age 15. This could be for several reasons: as youth grow older they may become aware of new occupations that were previously unknown to them. In addition, at 15, youth may have a 'dream job' in mind, but, as they get closer to making postsecondary educational choices, their aspirations may become more realistic and focussed.
This change in aspirations is also true for those who first aspired to a health occupation. Twenty-six percent still reported the same occupation when asked again two years later; another 20% reported a different occupation in health; 32% reported a non-health occupation; and 22% did not respond or said they did not know. Overall, almost half of the 15-year-olds who had said they wanted to work in health no longer did so at age 17. On the other hand, 8% of the youth who had earlier aspired to a non-health occupation had changed their minds and were now interested in health. More research is required to fully understand the factors related to gaining and losing interest in health occupations and whether these youth will realize their aspirations.
Immigrants - another source of students in college and university health education programs
Immigration is an increasingly important component of net population growth in Canada4 and a large proportion of immigrants make a contribution to the pool of people with postsecondary qualifications. According to the 2003 Longitudinal Survey of Immigrants to Canada (LSIC), about 4% of immigrants who arrived in Canada between October 2000 and September 2001 said they wanted to work in health-related occupations before immigrating. Many need additional education to practice in Canada and about one-third asked to have their existing foreign credentials assessed by an educational institution during their first two years in the country.5 Most of these individuals already had a college or university education and over seven in ten obtained a full (36%) or partial (35%) recognition of their credentials.
However, results from LSIC also showed that a large proportion (67%) of immigrants seeking a health occupation when they decided to immigrate to Canada did not apply to have their credentials assessed with a postsecondary institution during their first two years of arrival. Several reasons prevented them from going through the prior learning assessment and recognition (PLAR) process, but the most often-stated reasons were that they did not know where to go or how to get their credentials checked or they believed their credentials would not be accepted (Chart 3).
Chart 3
For immigrants wanting to work in health, the main reason for not having credentials checked with a postsecondary institution is a lack of knowledge, 2003
Source: Longitudinal Survey of Immigrants to Canada, Wave 2, Statistics Canada. 2003.
Faculty in university health education programs
Educators have an impact on both the capacity and the quality of health-related education programs. According to data from the University and College Academic Staff System (UCASS), of the 37,000 full-time university teachers in Canada in 2003/04, about 21% were teaching primarily a health-related subject and men represented about 62% of these. Most of the university full-time academic staff had a doctorate or a professional degree and, depending on their work arrangement (or on their type of appointment), some may have been engaged in the practice of a health-related occupation as well as in the teaching of a health-related subject at the university.
The issue of ageing faculty is a central concern facing the management of universities. The group of teachers who are now preparing for retirement were hired in the 1970s, at a time of significant growth in the postsecondary system. As the youth population declined in the 1980s, slowing enrolment growth meant fewer university faculty were hired during this period. Looking ahead, large numbers of university faculty hired during the 1970s enrolment boom are in a position to retire over the next decade, at the same time that the population of 19- to 24-year-olds is projected to increase.6
Similar to what is observed for university faculty overall, full-time university faculty who teach primarily in a health-related subject are ageing, with the average age varying between 47 and 51 in all health-related subjects in 2003/04; close to one in three were aged 55 years or older (Table 1).
Source: 2003/04 University and College Academic Staff System, Statistics Canada.
Students in university health education programs
Health education programs seek to meet the needs of youth and internationally-trained health workers, in addition to older Canadians who return to college or university to upgrade their skills or credentials, pursue new health studies, or take courses as part of their ongoing training.
As shown by the Postsecondary Student Information System (PSIS), there were approximately 46,700 students enrolled in health education programs in Canadian public universities at the bachelor's and other undergraduate degrees level in 2004/05, representing about 7% of enrolment at this level. Students pursuing health education programs accounted for a slightly larger proportion of the student body at the master's level (8%) than at either the undergraduate or doctorate levels (6%). This suggests that students in health education programs were more likely to advance to the master's level than their counterparts in other fields of study. This may be related to several factors, including an increasingly complex health working environment and enhanced entry-to-practice educational requirements, especially for advancement to senior level management and to administrative, teaching and advanced practice positions (e.g., clinical nurse specialists, nurse practitioners).
In health education programs, results from PSIS showed that women accounted for four out of every five students at the bachelor's and other undergraduate degrees (81%) and master's levels (79%) and almost two-thirds (63%) of enrolment in health education programs at the doctorate level (Chart 4).
Chart 4
Women make up the majority of health students, 2004/05
Students in health education programs were also more likely than students overall to have some previous postsecondary experience and/or full-time work experience. As a result, students enrolled in and graduating from health education programs tend to be older than average.
Labour market experiences of recent graduates from health education programs
As shown by the National Graduates Survey (NGS) (Class of 2000), there were approximately 270,000 graduates from Canadian public colleges and universities (bachelor, masters' and doctoral graduates) in 2000. Graduates from health education programs at the college level accounted for 14% of the estimated 100,000 college graduates, while graduates from bachelor health education programs represented about half as many as in college (7% of the 130,000 bachelor graduates).
Similar to what was observed for students enrolled in health education programs, the majority of health graduates in 2000 were women - close to 90% for college graduates, 80% for bachelor and master's graduates and more than half of doctoral graduates.
Results from NGS also showed that health graduates were more likely to have some previous postsecondary education (Chart 5) and/or full-time work experience, tend to be older than graduates overall, and were more likely to be married.
As there is a clear demand for their skills, graduates from health education programs tend to make quick transitions into the labour market. Within two years of graduating, over three-quarters of health graduates were employed in a health occupation and some others worked in related fields. Almost all health graduates (99%) who had not gone on to additional studies were employed two years after graduation, most of them in a full-time position. Moreover, even just two years after graduation, when some, particularly doctors, are still in residency or entry-level positions, they tended to earn more than graduates overall (Chart 5).
A higher likelihood of employment combined with higher earnings compensates for the fact that health graduates are more likely to have student debt and tend to owe more than graduates in other fields. However, they were less likely to report difficulties repaying their loans, were just as likely to have paid off their loans two years after graduation, and were just as likely to expect to have their loans repaid within five years of graduating.
Chart 5
Health graduates working full-time generally earn more two years after graduation, 2002
Source:National Graduates Survey (Class of 2000), Statistics Canada.
Ongoing participation of health workers in formal and informal training
The ability and willingness of adults to continue learning throughout their lives has been identified as a critical element in Canada's economic future. The need for new skills in the economy has had a profound impact on jobs; in most, if not all, industries and occupations. With advances in health care knowledge and technology, it is particularly important that adults working in a health occupation be able to maintain and upgrade their skills and knowledge through continuing education.
Traditionally, many of these new skills would have been provided by "new" workers, both young adults and immigrants entering the labour force. However, the demographic reality is that smaller cohorts of young workers will be entering the workforce and, as the workforce ages, the potential for skill shortages grows. The "upskilling" of workers already in the labour force is widely seen as an important measure to meet these needs.7
Recognizing this need for ongoing learning, employers often encourage and support continuing education. This is particularly true in health occupations where regulatory frameworks often require ongoing maintenance or upgrading of skills.
As shown by the 2003 Workplace and Employee Survey (WES), about 45% of the workplaces in the health care and social assistance sector supported formal training activities for their employees during 2003. Not surprisingly, larger workplaces or workplaces which introduced innovations during the year were more likely than others to support training activities.
After entering the labour market, health workers continue to upgrade their skills, even when not required to by their employer or regulatory bodies. Support for formal training is high among health employers and their employees take advantage of it. According to the 2003 Adult and Education Training Survey (AETS), about 60% of adults in health occupations participated in formal job-related training in 2002, twice the rate of other occupations. The main reason they cited for taking this training was to perform their jobs better. And, while most courses were supported by employers, few of the courses taken were actually required by them. At the same time, however, about one-third of adults in health occupations reported having unmet training needs, reporting that there was training that they wanted or needed, but were unable to take.
Concluding remarks
Although we have good information on the individuals who are interested in health education and who ultimately pursue it and enter health occupations, further research is required to explore the formation of youth aspirations for health occupations and what factors or barriers might prevent qualified youth from pursuing health education. Moreover, there is very little information about health education programs themselves. What are the constraints to increasing capacity in health education programs in postsecondary institutions? What factors or barriers influence the recruitment of students in health education programs and retention of students in their programs or in health education overall? To what extent do financial and institutional constraints limit enrolment or affect student learning in health education programs? What is the effect of the availability of clinical placements (training) on enrolment and learning? What factors limit the availability of clinical training? Why do so many health workers report unmet training needs? Are internationally-trained health workers correct in believing that their credentials would not be accepted and what barriers prevent them from undertaking the necessary steps to get their credentials recognized or to upgrade their credentials in order to work in Canada?
In addition to questions related to the number of individuals completing health education, there are additional questions about who these individuals are. While visible minority students are overrepresented among the youth who want to work in health, they are underrepresented among those who graduate from health education programs in Canada. Do they face different barriers that need to be addressed? Similarly, why are rural youth less interested in health occupations? What barriers do they face? And who are the individuals who do decide to work in rural areas after they complete their programs? In particular, what do we know about health education for Aboriginal students who might be able to meet health care needs in Aboriginal communities? These are some of the questions that need to be addressed in ongoing research in order to fully understand the role that health education programs can play in improving the supply of health workers in Canada.
References and notes
A more detailed statistical portrait of health workers in Canada was released in the Daily on August 13, 2007. See Allen Mary, Rita Ceolin, Sylvie Ouellette, Johanne Plante and Chantal Vaillancourt. 2007. Education Health Workers: A Statistical Portrait. Statistics Canada Catalogue number 81-595-MIE2007049.
Statistics Canada. 2001. Occupation - 2001 National Occupational Classification for Statistics (523), Class of Worker (6) and Sex (3) for Labour Force 15 Years and Over, for Canada, Provinces, Territories, Census Metropolitan Areas and Census Agglomerations, 2001 Census - 20% Sample Data. Topic-based Tabulations: Canada's Workforce: Paid Work. Statistics Canada Catalogue number 97F0012XCB2001021.
Galarneau, Diane. 2003. Health care professionals. Perspectives on Labour and Income, Volume 16 number 1. Statistics Canada Catalogue number 75-001-XIE. Ottawa.
Statistics Canada. 2007. "Population and dwelling counts", The Daily, March 13.
Prior learning assessment and recognition (PLAR) is a particularly important mechanism for the recognition of the international credentials of immigrants who want to work in health occupations
Statistics Canada and Council of Ministers of Education, Canada. 2006. Education Indicators in Canada. Report of the Pan-Canadian Education Indicators Program 2005. Statistics Canada Catalogue number 81-582-XPE.
Peters, Valerie. 2004. Working and Training: First Results of the 2003 Adult Education and Training Survey. Education, Skills and Learning – Research Papers, number 015. Statistics Canada Catalogue number 81-595-MIE2004015.
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