Section 9
Summary and concluding remarks

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This publication presents some of what we currently know to begin to address some of the crucial questions facing Canadians today: Do Canada and the different jurisdictions have enough interested individuals with the right skills who want to work in health? Do they have the infrastructure, capacity, and effective education system to ensure an adequate supply of health workers to meet future health care demands?

This study, an examination of current major Statistics Canada data sources related to the education of Canadians, has revealed some important information about what happens before, during and after health education. It focused on interest in health occupations, the characteristics of students, graduates and faculty in university health programs, the labour market experiences of recent graduates from these programs, the adult's literacy skills and ability to use information and communications technologies, as well as the ongoing participation of health workers in formal and informal training.

There is a great deal of interest in health occupations among youth pursuing high school study. In 2000, about 12% of 15-year-olds in Canada said they wanted to work in a health occupation. By the time they are out of high school, however, many youth changed their minds and only half of those who wanted to work in health still do. Among 18- to 20-year-olds in Canada, 8% aspired youth aspired to a job in a health occupation. But this is still a substantial number of youth given that 5% of the labour force in 2001 worked in health occupations. The loss of interest in health occupations as youth move into the latter part of their teens was also reflected across most of the provinces.

More research is required to fully understand the factors that are related to gaining and losing interest in health occupations and whether these youth will realize their aspirations. Possible factors that can be explored include changes in academic performance over time, growing awareness of other occupations available, changing perceptions about realistic occupational choices, and changing life experiences.

The vast majority of Canadian youth who aspired to health occupations are female. This mirrors the demographic profile of the labour force in 2001 where 79% of workers in health occupations overall are women. This means that the predominately female makeup of the health sector in general will likely not change in the near future.

In all provinces, youth who were interested in health occupations overall were slightly less likely to come from rural areas than youth overall. This is also the case among those who wanted to become physicians.

Immigrants are another potential source of health care workers. Upon their arrival however, internationally-trained professionals face an adjustment process both in terms of integrating into society at large as well as finding adequate work. 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. Of the 9% of immigrants who said they wanted to work in health occupations before immigrating to Canada, about three-quarters requested an assessment of their foreign credentials with one group or another offering these services, with postsecondary institutions being among the most popular institutions in all provinces. Most of these individuals are in the prime working-age group of 25 to 44 and already have a college or university education. It is not surprising then that over 70% obtained a full or partial recognition of their credentials.

Health programs seek to meet the needs of these youth and internationally-trained health workers, in addition to older Canadians who return to college or university to upgrade their credentials, pursue new health studies, or take courses as part of their ongoing training. There are multiple pathways into and through health studies. Students in health programs are more likely to have some previous postsecondary experience and / or full-time work experience. As a result, students enrolled in and graduating from health programs tend to be older than average.

Graduates from health education programs are less likely to immediately pursue additional education. Instead, they tend to make quick transitions into the labour market. Within two years of graduating, over three-quarters of health graduates are employed in a health occupation.

The labour market outcomes of health graduates show that there is a clear demand for their skills. Almost all health graduates who have not gone on to additional studies are employed two years after graduation, most of them in a full-time position. Retention in health occupations is also high among health graduates. More than nine in ten university health graduates who reported working in a health occupation two years after graduation were still doing so three years later. The situation was about the same at the college level. Moreover, even just two years after graduation, graduates from health education tend to earn more than graduates from other programs.

Higher likelihood of employment combined with higher earnings compensates for the fact that health graduates were more likely to have student debt and they tended to owe more. In spite of this, they were no more likely than their counterparts from other programs to still owe high amounts on their student loan five years after graduation.

When considering health human resource (HHR) planning and management in Canada, health care planners look for ways to develop policies and strategies that attract health professionals, promote satisfying work opportunities and create and maintain stimulating, safe and secure work environment. In Canada, about 23,800 or 9% of all graduates (college and university levels) had left their province of graduation for another jurisdiction two years after graduation. Health graduates represent about 8% of this out-migration. When adding graduates from selected health-related education programs such as psychology, social work and health and physical education / fitness, this proportion rises to about 15%.

The final episode in this story of health education has to do with ongoing training of health workers. Although the ability to use information and communications technologies was substantially lower for adults from health occupations than for their counterparts from other occupations, a majority of them had the "desired" level of competence in prose, document, numeracy and problem solving to acquire additional knowledge and skills throughout their lives. In fact, after entering the labour market, health workers continue to upgrade their skills, even when not required. Support for formal training is high among health employers and their workers take advantage of it. About 60% of adults in health occupations participated in formal job-related training in 2002, twice the rate observed for all occupations.

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 why youth lose interest in health education and what factors or barriers 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 postsecondary institutions, what factors or barriers influence the recruitment of students, effective training, retention of students in their programs or in health education overall, and positive labour market transitions after graduation? To what extent do financial and institutional constraints limit enrolment or affect student learning? 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?

In addition to questions related to the how many individuals complete 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 programs. 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.