Read the Physician Workforce Plan and Forecast, … · 2.3 Physician Supply in Alberta ......
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Physician Workforce Plan & Forecast | 2017 – 2018
Transcript of Read the Physician Workforce Plan and Forecast, … · 2.3 Physician Supply in Alberta ......
Physician Workforce Plan & Forecast | 2017 – 2018
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Contact: ………………………………………………...........................................
Dr Rollie Nichol Associate Chief Medical Officer Alberta Health Services (AHS)
Southport Tower 10301 Southport Road SW Calgary, Alberta T2W 1S7
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Table of Contents ………………………………………………...........................................
Appendices, Tables & Figures ................................................................................................... 2 Executive Summary ....................................................................................................................................... 4
Chapter 1 ‐ Introduction ............................................................................................................................... 6
1.1 Background and Overview ............................................................................................... 6
1.2 Why is Physician Workforce Planning and Forecasting important? .................................. 7
Chapter 2 ‐ Forecasting Models and Analysis ............................................................................................. 10
2.1 Specialist physicians: Trends and Issues ....................................................................... 10
2.1.1 Specialist Physicians Workforce Data 2016/17 – 2026/27 .................................. 10
2.2 Family Medicine: Trends and Issues .............................................................................. 17
2.2.1 Family Medicine: Current Workforce and Recruitment Plan 2017-2020 ............. 17
2.3 Physician Supply in Alberta ............................................................................................ 20
2.3.1 CPSA licensed versus AHS appointed physicians Type chapter title (level 3) .... 20
2.3.2 Characteristics of Alberta’s Physician Population .............................................. 22
2.4 Environmental Scan/Population Profile: Trends and Issues .......................................... 29
Chapter 3 ‐ Concluding Comments ............................................................................................................ 30
Chapter 4 ‐ Next Steps ............................................................................................................................... 35
Acronyms ................................................................................................................................................... 37
Key Terminology/Definitions ..................................................................................................................... 38
Acknowledgments ...................................................................................................................................... 40
Appendices, Tables & Figures ………………………………………………...........................................Appendices
A RACI Chart B Data Collection Methodologies C Population projections by Zone-Alberta D AHS Appointment & Privileging Data – Family Medicine E AHS Appointment & Privileging Data – Specialist Physicians F Locums G Physician Migration H Results sPWP software application – specialist physicians I Consolidated Summary Provincial and Zone Reports J1 Clinical Risk Groups - Summary J2 Clinical Risk Groups – Development and Evaluation
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Tables Table 1Results need-, supply assessment after 10 years, by category, Alberta, 2016-17 – 2016-27 ..................................................................................................................................... 15 Table 2 Family Medicine: Current Workforce Characteristics 2017 (headcount) .................... 16 Table 3 Family Medicine: Recruitment 2017-2020 ................................................................... 19 Table 4 Zone comparison: CPSA licensed versus AHS appointed physicians (family medicine and specialist physicians ........................................................................................................... 20 Table 5 Total count and percentage of physicians (family medicine and specialist physicians) by zone, by medical staff category, 2017 ................................................................................. 23
Figures Figure 1 Recruitment planning versus workforce planning and forecasting .................................9
Figure 2 Gender distribution physicians (family Medicine and specialists) by zone, Alberta, 2017...............................................................................................................................24
Figure 3 Percentage of AHS appointed physicians (family medicine and specialist physicians) by sex and age group, by zone, Alberta 2017 (excluding locums) .............................................26
Figure 4 Percentage of AHS appointed physicians who did their postgraduate training in Alberta, Canada, International, by zone, Alberta, 2017 (excluding locums) ..........................28
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Executive Summary ………………………………………………...........................................
Physicians working in Alberta Health Services facilities and programs deliver quality medical care to Albertans around the clock, 365 days a year. Understanding the current physician workforce requirements and projections of future need is a key part of AHS’ ongoing service delivery and business planning. To understand the current workforce and future need, AHS representatives in each zone work closely with physician medical leaders and administrative leads. This work is supported by a purpose-built forecasting application for specialists that forecasts over a ten-year horizon and a specifically-designed data gathering template for family physicians with a three-year horizon.
This is the second provincial Physician Workforce Plan & Forecast report developed with the support of the Specialist Physician Workforce Planning (sPWP) Software. The data informing this report has improved significantly in quality over the past two years, and medical leader engagement has increased. Together, this results in a more robust report. Future workforce planning and forecasting work will be impacted by the deliberations of the newly-created Physician Resource Planning Advisory Committee (PRPAC).
Key highlights:
Population/demographics:
o Alberta’s population continues to grow despite the economic downturn.
o Alberta has an aging population and an increasingly diverse population, with large rural and some remote populations.
o Although Alberta’s population is becoming increasingly urban, physicians are still required in the rural areas to maintain appropriate service levels.
o Distribution of physicians remains a challenge in some rural and remote areas of the province where physician recruitment and retention is challenging.
Number of both CPSA licensed and AHS appointed physician counts show similar, though small increases (0.5%).
North, Central and South Zones continue to depend on locum physicians for continuity of services in some locations.
The locum physician population is younger than the overall population, reflecting younger physicians’ stated desire to have experience in a variety of work environments before making a decision regarding practice location.
AHS medical staff has more males than females:
o Family medicine shows a similar balance, other than in Calgary Zone which has a slightly higher proportion of female family physicians.
o The specialist physician workforce continues to have a higher proportion of males than females.
o Female physicians account for more than 50% of the specialists younger than 45.
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22% of the current physician workforce is in the 55-64 and over 65 age groups and may start to reduce or leave practice over the next 10 years. Zones with a higher proportion of their physicians in these cohorts will need to plan for a higher number of exits.
o South and Central Zones have the oldest core specialist physician workforce.
o Edmonton and Central Zones have the oldest core family physician population.
48% of the core physician workforce did their postgraduate training in Alberta and 25% of the total number did this in Canada (excluding Alberta).
The proportion of international graduates is highest in the North Zone, followed by Central and South Zone.
o This reflects challenges in recruiting Alberta and Canadian graduates to rural and remote locations.
o Ongoing efforts such as the rural medicine training programs offered in collaboration with the University of Alberta and University of Calgary Faculties of Medicine are underway, and have improved the situation to some extent. The Physician Resource Planning Advisory Committee’s work is anticipated to consider these issues of physician distribution and provide some direction and recommendations for action.
Key areas of need for physicians in the province are:
o Immediate challenges: pediatrics, mental health and addictions (both psychiatry and family medicine with addictions training/experience).
o Longer term: Medicine, emergency medicine, surgery, public health.
Changes in Academic Medicine and Health Services Program (AMHSP), formerly Academic Alternate Funding Plan (AARP), are in process. Approved recruits as at 31 March 2017 are part of the analysis.
AHS continues to develop depth and breadth in its understanding and forecasting of physician workforce needs. This work will continue to evolve over the next period as physician and administrative leaders build greater understanding of the work and underlying concepts.
Distribution of
physicians remains a
challenge in some rural
and remote areas of the
province, where
recruitment and retention
is a challenge
“
“
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Chapter 1 - Introduction
1.1 Background and Overview …………………………………………
Alberta Health Services’ (AHS) Physician Workforce Plan (PWP) and Forecast is developed annually to ensure there are sufficient physician resources to provide quality, sustainable care to meet the health needs of Albertans. This translates into improved health outcomes for patients and families, a valued physician workforce and a financially sustainable health system. In alignment with the AHS People Strategy, the AHS PWP focuses on creating a sustainable workforce, taking into account age and gender groupings, career maturity, population growth, as well as other clinical and non-clinical workforce plans within AHS. With this in mind, alignment between various AHS workforce plans depends on utilizing similar data sets and planning parameters, including AHS service delivery and business plans. The AHS PWP was also developed in order to support AHS’ four foundational strategies:
Build a culture of patient-, family-, and community-centered care to improve patient experience
Improve health outcomes through clinical best practices
Ensure our people feel safe, healthy and valued
Achieve financial sustainability through operational best practices
The Chief Medical Officer (CMO) has committed to developing an annual Provincial Physician Workforce Plan and Forecast report and this commitment is supported by the AHS Medical Staff Rules. An annual updated Provincial PWP and Forecast Report provides a standardized platform of information to support:
Physician resource planning for family and specialist physicians. Connectivity with overall AHS human resource planning (clinical, e.g., nursing,
physiotherapy, respiratory therapy; and non-clinical). Capital planning. Service delivery planning.
Dr. Francois Belanger Vice President & Chief Medical Officer (CMO), AHS ………………………………..
This report helps AHS understand its physician workforce needs and ensure there are sufficient physician resources to provide high quality, sustainable care to Albertans, while also supporting a valued medical staff workforce and a financially sustainable health system.
This planning is an iterative process and will continue to improve with input from medical and administrative leaders from all five AHS Zones.
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AHS’ physician workforce planning and forecasting takes into account the organization’s provincial and zone workforce planning, along with input from the Faculties of Medicine, the Professional Association of Physician Residents of Alberta (PARA), and Medical Students’ Associations. The Physician Resource Planning Advisory Committee (PRPAC) has provided key input in both the assembly of data sets, as well as information regarding AHS recruitment planning.
This plan has taken into account various service delivery models, workforce scenarios, and options discussed with medical leaders. It considers population health need (e.g., demographics), supply assessment (e.g., current workforce, separations, changing gender mix), and reality checks (e.g., changes in service delivery, facility infrastructure restrictions). It also considers physician resource needs in the context of the supply and resource requirements that must be considered in planning for the current and future years. This report’s key objectives are to:
Be used within and outside AHS as a resource in considering physician resource needs for the province.
Meet the information needs of the various stakeholders. See RACI Chart in appendix A for more information about the stakeholders.
Foster greater collaboration and sharing of information between zones and Cancer Control Alberta (CCA), which increases the quality of data.
Guide and stimulate thinking about trends and developments in physician workforce and how they will influence and be influenced by AHS business and service planning and forecasting and trends in other professions.
1.2 Why is Physician Workforce Planning Important? …………………………………………
Workforce planning and forecasting is a forward-looking projection based on assumptions regarding key determinants of population health need, patient service models and workforce supply. It shapes a forecast of workforce needs according to organizational strategy (e.g. patient-centred, economically sustainable, quality, meets policy and objectives). Unlike recruitment planning, workforce planning and forecasting focuses on a longer timeline, looking out as far as 10 years (see figure 1). Planning and forecasting for specialist physicians is typically longer-term, focusing on physician resource needs in all five AHS zones, current and projected population health needs, as well as AHS service delivery and business plans. Physician recruitment planning and forecasting for family medicine focuses on a three-year interval and looks at the physician resource need for each AHS zone in terms of headcount. The combined focus on population health needs, physician resource requirements and service delivery plans helps the five AHS zones in workforce planning by aligning:
Physician recruitment
planning and forecasting
for family medicine
focuses on a three-year
interval and looks at the
needs of each AHS Zone.
“ “
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Efficiency: optimal use of resources to achieve desired outcomes. Effectiveness: resources are targeted to areas shown by research to have best results. Value for money.
This year’s provincial physician workforce planning report has been developed using data and information compiled through three data collection methodologies (for more information see appendix B):
The AHS Specialist Physician Workforce Planning (sPWP) software application, The Family Medicine data collection model, and Recruitment Dashboard.
In this second forecast developed with the sPWP software application, there has been progress in analytical understanding and use of physician workforce planning in both medical leaders and administrators. The data in this report is not perfect, but has improved in quality since the previous report. Forecasts continue to be focused on specific needs and are presented over a 10-year horizon. There has been closer collaboration between the zones and CCA and this will, on an ongoing basis, result in more accurate data as data depth and richness and experience with forecasting approaches improves. Additional data has been collected from the AHS Appointment & Privileging database, the College of Physicians & Surgeons of Alberta (CPSA) provincial listing database, the Alberta Health Interactive Health Data Application (IHDA), and the Canadian Institute for Health Information (CIHI).
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Figure 1: Recruitment Planning Versus Workforce Planning and Forecasting
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Chapter 2 – Forecasting Models and Analysis
2.1 Specialist Physicians: Trends and Issues …………………………………………
AHS continues to mature in its analytical support and build capacity for physician workforce planning. Greater engagement of Department Heads/Section Chiefs and evolving zone knowledge of the specialist physician workforce planning software application has had a positive impact on the quality of the data. One area this can be seen is the increased accuracy in FTE counts this year over last year; this is one driver of differences in initial workforce FTE counts.
2.1.1 Specialist Physician Workforce Data 2016/17 – 2026/27 …………………………………………
The sPWP software application forecasts support conversations at both the zone and provincial levels about specialist physician workforce planning and forecasting. Forecasts are based on population health need and the supply/resource requirements that must be considered in planning for the current and coming years. The results of these zone and provincial conversations are presented in the tables “Results Need-, Supply Assessment after 10 years, by Category” (see table 1 for the province wide results and the tables in appendix H for the results for each of the five zones). For more information about this software application, factors impacting forecasting calculations, the drivers and guiding principles see appendix B.
In the tables:
The data represent the clinical FTEs worked; research, academic administration and clinical teaching (other than at the bedside) are not included.
When work commitments of community physicians were unknown, their proportional FTE was put on 1 FTE. In the next round, more research will be done to agree on an estimated FTE for community physicians, including pediatricians, radiologists, and obstetricians/gynecologists working in the community.
The categories presented are based on Royal College of Physicians and Surgeons of Canada (RCPSC) specialty groupings. For example, medicine includes subspecialties such as cardiology and nephrology as well as pain medicine. For more information about which RCPSC specialties are included in the different categories, see appendix I.
Reality checks: in this report, planning variables are used to adjust the application-calculated forecasts to, for example, anticipate changes in the workforce related to the introduction of a new service delivery model or to correct for facility capacity.
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Alberta Table 1 presents consolidated specialist physician forecast data from all the five zones. See appendix H for more information about the consolidated specialist physician forecast data per zone and how to interpret the outcome. Public Health Forecasts for Public Health are provided only at a provincial level rather than a zone level. In consultation with the Senior Medical Officer of Health, this year’s forecast workforce need for the province is based on population health requirements for the coming 10 years. Planning variables have been used in this forecast to correct for the existing under capacity in the current workforce related to the Alberta population health need and to project the average annual provincial population growth rate of 1.6% (see appendix C). Supporting information about the under capacity in their current workforce is presented in their AHS Workforce Plan for Public Health & Preventive Medicine Specialists report. Note: The data collected – in headcount - from the AHS Appointment & Privileging database
does not include the 20 public health physicians (as on March 31, 2017). Their proportional FTE is included in the specialist physician workforce plan and forecast.
Oncology specialties The forecasts for the RCPSC specialties of radiation oncology, medical oncology, pediatric hematology/oncology, gynecologic oncology, and general surgical oncology are done by Cancer Control Alberta (CCA). Their focus for this year has been to create as accurate an overview as possible of the current workforce in these specialties. CCA did not anticipate any significant changes generated by CCA business, service model- and/or infrastructure capacity variables. Further work to incorporate these aspects into their forecasting will occur in the coming year. In the next round, CCA will have greater engagement with Zone medical leaders regarding work commitments for pediatric hematology/oncology, gynecologic oncology, and general surgical oncology in other departments/sections. This will require coordination and further conversations with the zones and the joint Departments leaders to ensure that all sides can support the forecasts. Services and programs provided to patient populations from outside Alberta, and services provided outside AHS facilities
Additional work is required to account for service responsibilities and services provided to patient populations from outside Alberta. Currently, the workforce requirements to meet this need are excluded from the analysis and projections developed using the Specialist Physician Workforce Planning Application.
Further work needs to be done to determine an estimated FTE for specialist physicians who only work in the community.
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Diagnostic Imaging The impact of current negotiations with the Diagnostic Imaging group for services within AHS facilities is currently unknown and will be included in next year’s forecast. Lab Medicine & Pathology Additional work is required to understand the lab medicine and pathology workforce needs at a provincial as well as zone level. Over the next year, further work will occur with the provincial lead for lab medicine and pathology services. Z1 South Zone South Zone has adjusted their forecast workforce need to reflect their significant under-capacity in meeting zone population health needs with their current physician workforce in Family Medicine –EM, Pediatrics and Psychiatry. A new service delivery model changing their level of critical care from basic to tertiary is being introduced in the 2017-18 fiscal year; this requires coverage by specialist critical care physicians. South Zone also has shortfalls in Cardiology, Endocrinology and Metabolism, Gastroenterology, Hematology, Internal Medicine, Nephrology, Neurology, Physical Medicine and Rehabilitation, and Rheumatology; patients requiring timely intervention are referred out of the zone. South Zone is challenged by its operational focus at two different geographical sites –East and West site. Both sites have similar basic service profiles, although Lethbridge may receive more transfers from Medicine Hat for specialty services. This means that service provision may require different FTEs than the forecast shows to maintain services and appropriate call schedules. See appendix H for more information. Z2 Calgary Zone Some questions have arisen about the chosen forecast methodologies regarding a couple RCPSC specialties related to Pediatrics and the agreement to default the proportional FTE to 1.0 for a community physician from whom their FTE is unknown. More investigation is needed to come to a provincial approach. Changes in Academic Medicine and Health Services Program (AMHSP), previously Academic Alternate Relationship Plans (AARP), are in process and may impact future Physician Workforce Plan and recruitment data. Changes in service delivery will increase the forecast physician workforce need for the following specialties:
Specialist areas of
greatest need
provincially: Addictions
& Mental Health,
Pediatric Generalists.
Regional centres
experience challenges
maintaining sufficient
specialists in
Anesthesia, OB/Gyn, and
Medicine.
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New and expanded services for Dermatology, Rheumatology, Gastroenterology, Hematology and Respirology, including enhanced Gastroenterology outreach in Southern Alberta, and increased capacity for Hematology created by the new Cancer Centre.
Services required by refugees and new immigrants have an impact on the forecast workforce need for Gastroenterology, Respirology and Hematology.
Forecast adjustments for Anesthesiology and some surgical subspecialties reflect a continuation of current capacity with no planned additions to ORs or surgical facilities. See Appendix H for more information. Z3 Central Zone Central Zone has a significant under-capacity in the following areas:
Pediatrics: resulting in lengthy wait-times and referral out of the zone for services. Planning variables have been used to correct the forecast for the use of short-term locums covering for long-term vacancies.
Psychiatry, Pathology, Surgery (i.e. General Surgery, Ophthalmology, Orthopedic Surgery, Otolaryngology – Head and Neck Surgery, Plastic Surgery, Urology), Neurology, Gastroenterology, and Respirology: resulting in longer wait times and referrals outside the zone.
The following service delivery changes increase the anticipated physician workforce need captured in the forecast:
Anesthesiology: The Red Deer Regional Hospital Centre (RDRHC) will open two new obstetrical operating rooms (ORs) in April 2017.
A trend of increasing high-risk obstetrical referrals to Obstetricians from Family Medicine call-groups.
New Psychiatry programs in Gender clinic and opiate treatment as well as referrals from outside Central Zone to the Centennial Centre for Mental Health and Brain Injury (CCMHBI).
See appendix H for more information.
Z4 Edmonton Zone
Changes in Academic Medicine and Health Services Program (AMHSP), former Academic Alternate Funding Plan (AARP), are in process. Approved recruits as at 31 March 2017 are part of the Physician Workforce Plan and recruitment data. The Department of Anesthesia has been understaffed in the Edmonton Zone for several years. Due to successful recruitment efforts, the Edmonton Zone anticipates closing the gap on the staff shortage in the 2017-2018 fiscal year. No adjustment has been made in the 10 year forecast need as it aligns with the plans for the Department of Surgery. See appendix H for more information. Z5 North Zone
The North Zone used planning variables to adjust their forecasted workforce need to correct for their current under capacity in some RCPSC specialties and to allow for additional physicians in key areas to reduce wait times, including:
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Adjustments to reflect an immediate increase in capacity for Psychiatry services to
reduce wait times and improve service delivery, meet mental health needs related to the 2016 wildfires, and broaden the scope of practice and availability of service in rural areas.
Some adjustments have been made in Obstetrics & Gynecology to account for additional capacity required to address wait lists.
North Zone will continue to work with their medical leaders to anticipate changes generated by business-, service delivery models, and infrastructure capacity planning impacting their future physician workforce need. See appendix H for more information.
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Table 1: Results Need – Supply Assessment after 10 Years, by Category, Alberta 2016/17 – 2026/27
Alberta A B C D E F G H
Category
Current
Workforce Results NeedPlanning
(reality check)Replacement
Need
Net New
(B + C)
Forecast Total
FTE Recruitment
(D+E)
Forecasted Total
Workforce at the end
of 10 yrs
(A+E)
Total Average
increase per year
(F/10)
Anesthesiology 313.62 104.52 (2.45) 93.60 102.07 195.67 415.69 19.57
Cancer 74.70 32.25 ‐ 26.77 32.25 59.02 106.95 5.90
Diagnostic
Imaging385.30 63.07 8.70 106.70 71.77 178.47 457.07 17.85
Emergency
Medicine411.26 177.32 14.75 73.78 192.07 265.85 603.33 26.58
Lab Medicine &
Pathology213.76 60.86 10.10 85.80 70.96 156.77 284.72 15.68
Medicine 992.59 317.22 66.49 317.20 383.71 700.91 1,376.30 70.09
Obstetrics &
Gynecology190.13 13.64 6.15 56.55 19.79 76.34 209.92 7.63
Pediatric
surgery11.35 2.91 0.50 7.26 3.41 10.66 14.76 1.07
Pediatrics 425.04 177.09 15.84 139.07 192.93 332.00 617.97 33.20
Psychiatry 485.72 129.84 30.00 186.23 159.84 346.07 645.56 34.61
Public Health 17.10 3.93 9.90 6.34 13.83 20.17 30.93 2.02
Surgery 564.74 184.72 (22.90) 217.65 161.82 379.47 726.56 37.95
All categories 4,085.31 1,267.39 137.08 1,316.93 1,404.47 2,721.40 5,489.78 272.14
Source sPWP software application (June 22, 2017) Notes: 1. Cancer Control Alberta (CCA) did the provincial forecasts for the RCPSC specialties of radiation oncology, medical oncology (both are part of the
category Cancer), gynecologic oncology (part of the category Obstetrics & Gynecology), pediatric hematology/oncology (Pediatrics), and general surgical oncology (Surgery).
2. Data collection for Public Health is done provincially by Provincial Medical Affair
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Table 2: Family Medicine: Current Workforce Characteristics 2017 (headcount)
Z1 South Zone Z2 Calgary Zone Z3 Central Zone Z4 Edmonton Zone Z5 North Zone Total Alberta
Total AHS
Appointed
Core
Workforce
Total AHS
Appointed
Core
Workforce
Total AHS
Appointed
Core
Workforce
Total AHS
Appointed
Core
Workforce
Total AHS
Appointed
Core
Workforce
Total AHS
Appointed
Core
WorkforceNumber (headcount) of AHS appointed physicians 297 273 1,322 1,270 449 375 626 593 407 340 3,101 2,851
Current vacancies 3 9 21 12 40 85
% between the age of 55‐64 21% 22% 21% 22% 22% 24% 24% 25% 17% 17% 21% 22%
% of 65 and older 8% 8% 9% 9% 10% 11% 12% 13% 6% 5% 9% 10%
Total number of exits in fiscal year 2016‐2017 15 33 30 24 13 115
% Female 35% 36% 53% 53% 30% 30% 44% 44% 32% 32% 44% 44% Sources: a) AHS Appointment & Privileging Database as on March 31, 2017
b) Data collected by the zones as on March 31, 2017 Notes: 1. Total AHS appointed: all AHS appointed family medicine physicians, including locums (Locum Tenens and Probationary physicians in the locum stream) 2. Core workforce:
a. Consists of all the AHS primary appointed family medicine physicians, excluding locums (Locum Tenens and Probationary physicians in the locum stream) b. Data provided by the zones: includes AHS primary appointed family medicine physicians and long-term locums (family medicine physicians who are working in the same role for more than 12 months); excludes short-term locums (family medicine physicians who are working in the same role for less than 12 months), long-term LOAs and family medicine physicians who have a primary appointment in Emergency Medicine & family medicine physicians who have a supplementary appointment in Emergency Medicine and work in a 24 hours on-site emergency coverage facility
3. Current vacancies: unfilled positions as on March 31, 2017 4. Total number of exits in fiscal year 2016-2017: All exits of family medicine physicians due to retirement, relocation, termination, etc.
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2.2 Family Medicine: Trends and Issues …………………………………………………………………………… There is currently no software application supporting a data-driven forecast for family medicine, therefore, forecasting is limited to a three-year horizon. Headcount data is collected from the AHS Appointment & Privileging Application and from the zones. The results of this data collection are shown in tables 2 and 3. All data collected is as of March 31, 2017 and confirmed with the zones. For more detailed information about the numbers of family medicine core workforce - excluding locums - and the total AHS appointed family medicine workforce – including locums, see appendix D.
2.2.1 Family Medicine: Current Workforce & Recruitment Plans 2017 - 2020 ……………………………………………………………………………
Current workforce (headcount) Table 2 gives an overview of the current AHS primary appointed family medicine physicians by zone and province as on March 31, 2017. There has been a small year over year increase of 1% in the total number of AHS appointed family medicine physicians. Calgary (2.2%) and Central (1.6%) Zones show the highest increase in their workforce. The only decline in family medicine workforce is seen in the North Zone (-2.9%).For more information about family medicine data regarding long-term versus short-term locums in the five zones and urban versus rural in South and Calgary Zone, see appendix D. Observations:
North Zone had the highest proportion of vacancies (12%) and the lowest proportion of their core workforce in the age group of 55-64 showing a younger than average family physician population.
Central and Edmonton Zones had the highest proportion of their core workforce in the age group 65 and older, showing that they have older family physician populations than other zones.
Central Zone had the highest proportion of family physician exits in fiscal year 2016-2017 (8%).
Calgary Zone had the highest proportion of female family medicine physicians.
The group should assess existing, evidence-based quality metrics within the area of practice through reviews of literature and databases.
North Zone had the
highest proportion of
Family Medicine
vacancies and a younger
than average family
physician population.
“
“
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Recruitment Needs 2017-2020 (headcount)
Table 3 shows the zone family medicine headcounts, vacancies and planned recruitment over the next 3 years (as at March 31, 2017).
For more information about family medicine data regarding Urban versus Rural in Calgary Zone, see appendix D. Observations and trends
Calgary and North Zones have the highest number of planned recruitments over the next three years. This is in line with their estimated exits over the same period and higher numbers of new positions.
The North Zone (38%) and Central Zone (16%) have the highest planned recruitments as a proportion of their core workforce, showing the significant challenges in family physician workforce in those two zones.
Only Calgary and North Zones show an estimated recruitment deficiency meaning they do not anticipate being able to fill all vacancies.
In Calgary Zone, the opioid dependency crisis primarily requires family doctors with experience in addiction medicine who are able to initiate and maintain opiate substitution treatment rather than specialist psychiatrists. Initiatives to provide opiate substitution at specific AHS sites, in addition to the opening of private opiate dependency clinics are expected to narrow the service gap.
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Table 3: Family Medicine: Recruitment 2017 – 2020 (headcount)
Total number of recruits commenced in fiscal year 2016/17 15 71 29 20 18 153
Current vacancies (a) 3 9 21 12 40 85
Estimated exits (attrition) in next 3 years (b) 26 83 25 25 55 214
Forecast most likely new positions created (net new) in 3 yrs (c ) 6 74 15 4 33 132
Total recruitment needed (a+b+c) 17 166 61 41 128 413
Reality check:
Recruitment target in year 1 (2017‐2018) 3 42 25 12 57 139
Recruitment target in year 2 (2018‐2019) 6 45 20 3 33 107
Recruitment target in year 3 (2019‐2020) 8 30 16 1 38 93
Total recruited in 3 yrs (2017‐2020) 17 117 61 16 128 339
Recruitment deficiency 0 49 0 25 0 74
AlbertaZ1 South Zone Z2 Calgary Zone Z3 Central Zone Z4 Edmonton Zone Z5 North Zone
Notes: 1. South Zone: was successful in recruiting family physicians in the 2013‐2016 period. Therefore, of the 26 estimated exits (attrition) in the next 3 years, only 8 require replacement. 2. Number of recruits commenced: Total number of recruits who have received their CPSA independent practice permit and commenced 3. Current vacancies: Family medicine positions vacant (unfilled) as at March 31, 2017 4. Estimated exits (attrition) in next 3 years: Expected exits of family medicine physicians due to retirement, relocation, termination, etc. for the fiscal years t1, t2, t3. 5. Forecasted most likely new positions created (net new) in next 3 years: Total of any position that is not a replacement due to retirement, relocation, termination, etc. for the fiscal years t1, t2, t3. 6. Total recruitment needed: Current vacancies + estimated exits (attrition) in next 3 years + forecast new positions created (net new) in 3 years. 7. Recruitment target in year t1, t2, t3 (2017‐2018): How many (headcount) of the total recruitment needed does the zone plan to recruit in year t1, t2, t3. 8. Total recruited in 3 years (2017‐2020): Sum of recruitment targets in the years t1 + t2 +t3 9. Recruitment deficiency: Total recruitment need minus total recruited in the years t1 + t2+ t3 = Difference between recruitment need after 3 years and recruitment ability.
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2.3 Physician Supply in Alberta ………………………………………………...........................................
This section focuses on key trends and issues which will impact the future physician workforce in Alberta, such as demographic changes, specific population health issues, changes in service delivery or infrastructure planning. Data collected from the AHS Medical Staff Appointment & Privileging Application focuses on the zones’ core physician workforce; it excludes physicians with locum tenens appointments and those whose primary appointment is in another zone.
2.3.1 CPSA Licensure versus AHS-appointed Physicians ………………………………………………...........................................
Table 4: Zone Comparison: CPSA-licensed versus AHS-appointed Physicians (family medicine and specialist physicians)
ZoneCPSA Licensed
PhysiciansAHS Appointed Physicians
Difference CPSA Licensed less
AHS Appointed
Core
WorkforceLocums Only
Total
Appointed
Core
Workforce
Total
Appointed
Z1 South 565 518 60 578 47 (13)
Z2 Calgary 4,485 3,254 179 3,433 1,231 1,052
Z3 Central 682 585 130 715 97 (33)
Z4 Edmonton 3,788 2,631 201 2,832 1,157 956
Z5 North 528 483 121 604 45 (76)
Unknown 377 ‐ ‐ ‐ 377 377
Total 10,425 7,471 691 8,162 2,954 2,263
Sources: a) CPSA Listings (file date March 29, 2017) b) AHS Appointment & Privileging database (Data extracted on March 31, 2017)
Notes: 1. The total CPSA licensed physician count includes those who reside outside Alberta; these appear in the
Unknown count. 2. The CPSA count of licensed physicians by zone is based on the address they have on file for the individual
physician. AHS Appointed location is the zone where the physician has their primary appointment. 3. AHS Appointee counts those from Active, Locum Tenens, Probationary (both Active and Locum), and
Community medical staff categories. 4. AHS appointed physicians:
a. Core workforce: consists of all AHS appointed physicians in the zone, excluding locums (Locum Tenens and Probationary Locums)
b. Locums only: the number of physicians holding Locum Tenens medical staff appointment or a Probationary appointment in the locum tenens stream
c. Total appointed: total AHS appointed physicians, including locums (Locum Tenens and Probationary Locums)
5. Public Health physicians in AHS are appointed to the Provincial Department of Public Health, and are therefore not included in this table. On March 31 2017, there were 20 AHS appointed Public Health physicians. AHS medical staff counts by zone exclude these physicians as they are part of the provincial department. For more detailed information see paragraph 2.1.1.
21
CPSA licensed physicians Across Alberta, the number of CPSA-licensed physicians is increasing. In 2016/17 CPSA-licensed physicians increased by 0.5% from 10,378 to 10,425. Broken down by Zone:
South Zone did not show any increase in their AHS-appointed physician workforce, but they have the highest increase in CPSA licensed physicians, from 553 to 565 (2.2%).
The Calgary Zone (from 4,448 to 4,485) and Edmonton Zone (from 3,758 to 3,788) show small increases of 0.8% each.
Central and North Zone have decreases in their CPSA licensed physicians, respectively -1.4% (from 692 to 682) and -4.5% (from 553 to 528).
Total AHS appointed physicians (headcount) As of March 31, 2017, AHS had a total of 8,162 physician members of the medical staff, including locums (Locum Tenens and Probationary Locums) and excluding those whose primary appointment is in the Provincial Department of Public Health. This represents a small increase of 0.5% when compared with the2016 total appointee figure of 8,118. Of the 8,162 total physician members of the medical staff, 8.5% (691) work exclusively as locum tenens, leaving 7,471 as the core AHS workforce. Locum tenens physicians fill a crucial role, supporting programs while recruitment of a permanent physician is underway, and working as a replacement when permanent physicians are on leave or are ill. North and Edmonton Zones have the greatest changes with North showing a 2% decrease (from 617 to 604) in number of physicians and Edmonton a 1.7% increase (from 2,785 to 2,832). The other zones show a slight increase. CPSA licensed versus AHS appointed physicians The difference between the total CPSA-licensed and AHS-appointed physician counts reflects: a) In total, the number of physicians licensed in
Alberta who do not have an AHS Medical Staff Appointment and who therefore do not work in AHS facilities or have a connection to an AHS clinical department;
b) By zone, licensed physicians vs. AHS appointed physicians and the CPSA’s use of the physician’s recorded address vs. AHS’ use of the zone where the physician holds their primary appointment in allocating a physician to a zone.
As of March 2017:
10,425 licensed
physicians in AB
8,162 are AHS medical
staff
Of these, 691 are locum
physicians
“
“
22
Calgary and Edmonton Zone comparison Overall, there are 697 more CPSA-licensed physicians in Calgary Zone than Edmonton Zone (see table 4). Looking at family medicine physicians only:
Calgary has 501 more CPSA licensed family physicians than Edmonton (see appendix D).
Excluding locums, Calgary Zone has 677 more AHS appointed family medicine physicians than Edmonton Zone.
This highlights a key difference in their family medicine physician populations which is also reflected in AHS appointment counts. Historically, the Edmonton and Calgary Zone approaches to medical staff appointments and connections with family physicians have been different. The majority of community family physicians in Calgary Zone are appointed to the AHS medical staff. Historically, Edmonton Zone has not appointed exclusively community based physicians to the AHS medical staff. Edmonton has recognized the need for a stronger relationship with community based physicians and is committed to working towards building that relationship. Further, Calgary Zone has more Family Medicine physicians in total (according to the CPSA register), a larger rural area, and more Family Medicine physicians with an AHS Medical Staff community appointment. For more family medicine data information, such as distribution of medical staff categories by zone, gender distribution and age groups, see appendix D. Comparing their specialist physician populations:
Comparison of the total CPSA licensed specialist physicians (5,180) with the total AHS appointed specialist physicians (5,061) – including locums -, shows a difference of 2% (appendix E) vs. the family medicine difference of 69%. This reflects the greater dependency between specialist physicians and AHS in which AHS provides facilities and infrastructure in which specialists provide patient care.
2.3.2 Characteristics of Alberta’s Physician Population ………………………………………………...........................................
As mentioned earlier in the report, data collected from the AHS Appointment & Privileging (headcount) focuses on the core workforce of the zones and excludes locum tenens appointees. More information can be found in Appendix F about the physician workforce including locums, and the added value of locums for the zones.
23
Table 5: Total count and percentage of physicians (family medicine and specialist physicians by zone, by different medical staff categories, 2017)
Z1 South Z2 Calgary Z3 Central Z4 Edmonton Z5 North Total Alberta
Count % Count % Count % Count % Count % Count %
Active 403 70% 2,701 79% 477 67% 2,262 80% 310 51% 6,153 75%
Locums 60 10% 179 5% 130 18% 201 7% 121 20% 691 8%
Probationary 93 16% 313 9% 97 14% 345 12% 171 28% 1,019 12%
Community 22 4% 240 7% 11 2% 24 1% 2 0% 299 4%
Total 578 100% 3,433 100% 715 100% 2,832 100% 604 100% 8,162 100%
Source AHS Appointment & Privileging Database (as on March 31, 2017) Notes:
1 Includes all physicians who have a primary appointment in the specified zone. 2 Public Health physicians in AHS are appointed to the Provincial Department of Public Health, and are
therefore not included. On March 31 2017, there were 20 AHS appointed Public Health physicians. Their proportion al FTE is included in the specialist physician workforce plan and forecast. For more detailed information see paragraph 2.1.1.
3 AHS Medical Staff Appointments are in one of the following categories1: Active, Locum Tenens, Probationary, and Community. For administrative purposes, the Probationary Medical Staff Category is separated into Probationary Active and Probationary Locum.
4 In this report, Locums includes the Medical Staff Categories: Locum Tenens and Probationary Locums. 5 Probationary: refers only to physicians in the Probationary Active stream.
Gender distribution Zones with a higher proportion of female physicians will need to take into account the fact that female physicians work fewer hours a week on average during parts of their career than their male colleagues2. Even though the proportion of female physicians is lower than male in the physician core workforce across the province (figure 2), the impact of the proportion younger than 45 (52%) must be considered by all zones as they plan their workforce needs. In particular, North and South Zones could feel the impact of the fact that of all their female physicians, respectively 68% and 57% are younger than 45 (figure 3). See appendix F for more information.
1 Alberta Health Services (2011). The Alberta Health Services Medical Staff Bylaws. 2 a. Canadian Medical Association – CMA (2014). Average Hours Worked Per Week by Physicians, by Sex and
Broad Specialty, 2014 [online]. Available at https://www.cma.ca/Assets/assets‐library/document/en/advocacy/35‐Chart‐AvgHrs.pdf [Accessed 31 July 2017].
b. Canadian Medical Association ‐CMA (2014). Average Hours Worked Per Week by Physicians, by Sex, 1982‐2014. National Physician Survey [online]. Available at: www.nationalphysiciansurvey.ca [Accessed 31 July 2017].
24
Figure 2: Gender distribution of physicians (family medicine and specialist physicians), by Zone, Alberta 2017 (excluding locums)
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Unknown
Male
Female
Source AHS Appointment & Privileging Database (as on March 31, 2017) Notes: Includes:
1 Family medicine and specialist physicians who have a primary appointment in the specified zone. 2 Public Health physicians in AHS are appointed to the Provincial Department of Public Health, and are
therefore not included. On March 31 2017, there were 20 AHS appointed Public Health physicians. For more detailed information see paragraph 2.1.1.
3 Data includes three medical staff categories: active, probationary active and community. 4 Data excludes two medical staff categories: locum tenens, probationary locums.
25
Specialist Physicians Proportions of female specialist physicians across the province are relatively smaller than the male population in all zones. Calgary is somewhat of an outlier, with its female specialist proportion above 35%. See appendix E for more information.
Proportions of female specialist physicians across the province are relatively smaller than the male population in all zones. Calgary is somewhat of an outlier, with its female specialist proportion above 35%. See appendix E for more information. Family medicine
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
Z1 South Z2 Calgary Z3 Central Z4 Edmonton Z5 North Total Alberta
Specialist Physician Gender Distribution by Zone
Female Male Unknown
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Z1 South Z2 Calgary Z3 Central Z4 Edmonton Z5 North Total Alberta
Family Physician Gender Distribution by Zone
Female Male Unknown
26
In general, the core workforce shows a higher proportion of male versus female family medicine physicians, with the exception of the Calgary Zone which has a higher proportion female family physicians (53%). See appendix D for more information. The gender distribution remains similar to the data from 2016. Only Edmonton (+1.4%) and North Zones (+1.6%) show a slight increase in the proportion of female physicians. Figure 3: Percentage of AHS appointed physicians (family medicine and specialist physicians), by sex and age group, by zone, Alberta 2017 (excluding locums)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Female
Male
Total
Female
Male
Total
Female
Male
Total
Female
Male
Total
Female
Male
Total
Female
Male
Total
Z1 South
Z2 Calgary
Z3 Central
Z4Edmonton
Z5 North
Alberta
Over 65
Youngerthan 45
45‐54
55‐64
Source: Appointment & Privileging Database, data extracted on March 31 2017 Notes:
1. Includes family medicine and specialist physicians who have a primary appointment in the specified zone. 2. The 20 physicians with a primary appointment in the Provincial Department of Public Health on March 31,
2017, are not included in this analysis as they cannot be assigned to one zone. Their proportional FTE is included in the specialist physician workforce plan and forecast. For more detailed information see paragraph 2.1.1.
3. Includes the following medical staff categories: active, probationary active and community. 4. Excludes the medical staff categories: locum tenens, probationary locums. 5. Age Unknown is included in the calculation, but not shown in the table.
Physician Populations are aging Figure 3 shows that overall, the province needs to plan that close to 30% of its current physician core workforce (age groups over 65 and 55-64) will leave practice or start to reduce practice in anticipation of retirement over the next 10 years. See appendix F for more information.
27
Zones with a large proportion of their physicians in these two age groups will need to plan for a higher number of physicians leaving the workforce, thereby increasing their recruitment need. Understanding this and the specific groups impacted will be key to planning physician recruitment strategies over that term. Central Zone’s relatively older physician population (37% in age groups 55-64 and over 65) means they will experience an earlier impact, while North Zone may see a lower impact as their physician population is comparatively younger (see appendix F for more information). Specialist physicians The South and Central Zone have the oldest specialist physician core workforce. The proportional age distribution is similar for the other three zones, with the exception of the North Zone which has the lowest proportion of specialist physicians 55-64 and over 65 (appendix E). Proportions of specialist physicians are not significantly changed since the 2016 report. For more information about specialist physicians, see appendix E. Family medicine physicians Family physician age distributions have not changed significantly since the 2016 report. Edmonton and Central Zone have the oldest family medicine core workforce, and will need to consider the impact of their relatively older physician population when planning their recruitment efforts. North and South Zones have relatively younger family medicine physician populations (both have 49% of their core workforce in the age group younger than 45). For more information about family medicine physicians (including and excluding locums), see appendix D.
28
Post Graduate Training: Alberta, Canada, and International Medical Schools Figure 4: Percentage of AHS appointed physicians who did their postgraduate training in Alberta, Canada, International, by zone, Alberta 2017 (excluding locums)
0%10%20%30%40%50%60%70%
Alberta
Canada (exclAlberta)
International
Unknown
Source: Appointment & Privileging Database, data extracted on March 31 2017 Notes:
1. Includes family medicine and specialist physicians who have a primary appointment in the specified zone. 2. Public Health physicians in AHS are appointed to the Provincial Department of Public Health, and are
therefore not included in the zone analysis. On March 31, 2017, there were 20 AHS appointed Public Health physicians. Their proportional FTE is included in the specialist physician workforce plan and forecast. For more detailed information see paragraph 2.1.1.
3. Includes the following medical staff categories: active, probationary (active stream) and community. 4. Excludes the medical staff categories: locum tenens, probationary locums.
Specialist physicians: Alberta, Canada, and International Medical Schools Of the total number of AHS appointed specialist physicians (excluding locums): 45% did their postgraduate training in Alberta, 30% in Canada (excluding Alberta), 24% outside Canada (international). For specialist physicians who did their postgraduate training outside Canada, the majority trained in US, followed by South Africa and the UK. North Zone has the highest proportion of specialist internationally trained physicians (48%), followed by Central (30%) and South (29%). The Edmonton and Calgary Zones have the highest proportion of specialist physicians who did their postgraduate training in Alberta, respectively 50% and 44%. For more information, see appendix E. Family medicine physicians: Alberta, Canada, International Medical Schools
29
Of the total number of AHS appointed family medicine physicians (excluding locums): 51% did their postgraduate training in Alberta, 16% in Canada (excluding Alberta), 32% outside Canada. For family medicine physicians who did their postgraduate training outside Canada, the majority did their training in South Africa, followed by the UK and then the US. North (68%), Central (59%) and South Zones (41%) have a high proportion of their family medicine physicians who did their postgraduate training outside Canada. For more information, see appendix D. Physician Migration According to the Canadian Institute of Health Information (CIHI)3, Alberta had a net gain in 2015of 10 physicians from interprovincial migration (all family physicians). Primary provincial sources of physicians moving to Alberta were Ontario and Saskatchewan for specialist physicians and Ontario and BC for family medicine physicians. Primary destinations for those leaving the province were BC and Ontario for both specialist and family physicians (appendix G).
2.4 Environmental Scan/Population Profile: Trends and Issues ………………………………………………...........
Alberta’s population is growing and aging
By 2026, Alberta’s population is expected to grow to approximately 5 million people, with an expected average annual growth rate of 1.6%.
Calgary Zone and Edmonton Zone had the highest annual population growth rates, at 1.9% and 1.6% respectively.
Between 2016 and 2026, the number of Albertans over 65 will increase by 55%, with the greatest growth occurring in Calgary Zone, followed by the North-, Edmonton-, Central-, and South Zones.
See appendix C for more information. Alberta has diverse community needs The 2016-17 AHS Health Plan & Business Plan4 notes that the province has an increasingly diverse population, with large rural and some remote populations. Certain geographical areas within Alberta have higher proportions of different ethnicities, different population structures and, therefore, unique health service needs requiring tailored approaches to health care delivery.
3 CIHI (2015). Supply, Distribution and Migration of Physicians in Canada: Data Tables. Available at: http://www.cihi.ca/hhr. 4 Alberta Health Services (2016). AHS Health Plan & Business Plan 2016‐17.
By 2026, Alberta’s
population is expected to
grow by 5 million people.
Over the next decade, the
number of Albertans over
65 will increase 55%.
“ “
30
Chapter 3 – Concluding Comments
This is the second provincial Physician Workforce Plan & Forecast report developed with the support of the Specialist Physician Workforce Planning (sPWP) Software. The data informing this report has improved significantly in quality over the past two years. This, along with increased medical leader engagement results in a more robust report.
Forecasts continue to be focused on specific needs and are presented over a 10-year horizon. They are still simplified in this report and zone comparison will become more useful as collaboration and connections increase. As a result, it is difficult to formulate hard findings and targets in order to support physician-, Human Resource-, capital-, and service delivery planning in this round. Nevertheless, this report will support the zones in setting direction and goals for the near future and in developing their own physician workforce plans and forecasts.
3.1 Specialist Physicians ………………………………………………...
When a comparison is made between FTE counts this year and last year, one driver of significant differences in initial workforce FTE counts is greater accuracy in FTE counts. Another driver is for example: this physician workforce forecast for Public Health is done provincially.
In general, the following issues are recognized to increase the forecasted physician workforce need, which are not calculated by the sPWP application, for example:
New services and/or programs planned Immigration and arrival of refugees Opening of a new clinic, centre Opioid dependency crisis
In this report planning variables are used to adjust for these issues and to correct for restricted facility capacity and for under-capacity in their current workforce. Any planning variables entered apply only to AHS services and are not meant to apply to community work commitments and requirements.
When looking at the results of the physicians workforce forecasted need per zone, the following areas need attention from AHS:
Dr. Rollie Nichol Associate Chief Medical Officer, AHS ………………………………..
As AHS grows and refines its workforce planning and forecasting capacity, it is building a greater understanding of physician resource needs. Linking this work with the AHS People Strategy and AHS clinical and non-clinical staff workforce planning processes will provide a further dimension to this work and a greater understanding of healthcare workforce needs.
As work proceeds, there is a need, highlighted in provincial and zone discussions, for a data-driven family medicine forecasting mechanism either linked to or consistent with the specialist forecasting applications.
Finally, work is needed to understand physician FTEs and build connections with physician training programs regarding the type and mix of positions and programs.
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Current under capacity: in particular the following areas:
Pediatrics Mental Health and addictions (both psychiatry and family medicine with addictions
training/experience) Medicine Emergency Medicine Surgery Public Health
Services and programs provided to patient populations from outside Alberta, and services provided outside AHS facilities
Additional work is required to account for service responsibilities and services provided to patient populations from outside Alberta. Currently, the workforce requirements to meet this need are excluded from the analysis and projections developed using the Specialist Physician Workforce Planning Application.
Further work needs to be done to determine an estimated FTE for specialist physicians who only work in the community.
Diagnostic Imaging The impact of current negotiations with the Diagnostic Imaging group (i.e. radiology) for services within AHS facilities is currently unknown and will be included in next year’s forecast. The need for a provincial approach: regarding Lab Medicine & Pathology.
For more information, see chapter 2.1.1 and appendix H.
3.2 Family Medicine ………………………………………………...........................................There is currently no software application for family medicine, therefore forecasting is limited to
a three-year horizon. Data is collected from the AHS Appointment & Privileging database and
from the zones and presented in headcount.
Current workforce
The total AHS appointed family medicine physicians – including locums - has increased 1% for the province (table 2), compared with last year’s data in the AHS Appointment & Privileging database, as on June 29, 2016. The Calgary Zone (2.2%) and Central Zone (1.6%) show the highest increase in their workforce. The only decline in family medicine workforce is seen in the North Zone (-2.9%).
As on March 31, 2017:
North Zone had the highest proportion of vacancies (12%) regarding their number of AHS appointed family medicine physicians on March 31, 2017.
North Zone had the lowest proportion of their core workforce in the age group of 55-64.
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Central and Edmonton Zone had the highest proportion of their core workforce in the age group 65 and older.
Central Zone had the highest percentage of exits in fiscal year 2016-2017 (8%) regarding their number of AHS appointed family medicine physicians on March 31, 2017.
Calgary Zone had the highest proportion of female family medicine physicians. Recruitment Plan 2017-2020
Table 3 in the report, presents the data provided by the zones. Reality checks to adjust for changes, in for example service delivery models change in population health needs (demographics), and aging family physicians, are done by the zones based on their knowledge and experience of their workforce and their service delivery planning. As on March 31, 2017:
The Calgary and the North Zone have the highest number of planned recruitments (include: current vacancies, estimated exits in next 3 years and forecast most likely new positions created (net new) in 3 years). This is in line with their estimated exits in the coming 3 years. They also have higher forecasts than the other zones for anticipated creation of new positions.
The North Zone (38%) and Central Zone (16%) have the highest proportion of planned recruitments (include: current vacancies, estimated exits in next 3 years and forecast most likely new positions created (net new) in 3 years) regarding their AHS appointed core workforce on March 31, 2017.
Only the Calgary and North Zone show an estimated recruitment deficiency.
Calgary Zone: The crisis regarding opioid dependency for the most part requires family doctors with experience in addiction medicine rather than psychiatrists, specifically those who are able to initiate and maintain opiate substitution treatment. Initiatives to provide opiate substitution at specific AHS sites, in addition to the opening of private opiate dependency clinics are expected to narrow the service gap.
3.3 Provincial Trends Affecting the Physician Workforce ………………………………………………...........................................
Despite the slower annual growth rate of the Alberta’s population due to the economic downturn, the Alberta population is still growing. Alberta also has an aging and increasingly diverse population, with large rural and some remote populations.
Although Alberta’s population is becoming increasingly urban, physicians are still required in the rural areas to maintain appropriate service levels. Distribution of physicians remains a challenge as is recruitment and retention in some rural and remote areas.
The work of the newly-created Physician Resource Planning Advisory Committee (PRPAC) will have an impact on physician workforce deliberations and physician resource planning.
While urban populations
are growing in Alberta,
physicians are still
required in rural areas to
maintain appropriate
service levels.
“
“
33
CPSA licensed physicians versus AHS appointed In comparison with last year’s figures, both total CPSA licensed physicians (specialist and family medicine) and total AHS primary appointed physicians – including locums – have shown similar, though small, proportional increases (0.5%). The proportional difference between CPSA licensed physicians and AHS appointed physicians is greater for family medicine versus specialist physicians, reflecting:
Greater dependency between specialist physicians and AHS in which AHS provides facilities and infrastructure in which specialists provide patient care
Smaller number of urban family medicine physicians who hold AHS appointments and privileges as they do not work in AHS facilities. This is different from the close relationship between rural family physicians and AHS
Locum physicians The proportion of medical staff appointees who are locum physicians is the highest in the North Zone, followed by Central and South Zone. This reflects the dependence these zones have on locum physicians to maintain services in communities or departments with small numbers of physicians where a departure or planned absence such as vacation can significantly impact ability to maintain services. Locum physicians are mostly younger than 45 reflecting the stated desire of some younger physicians to have experience in a variety of work environments before making a decision regarding practice location. Gender distribution Zones with a higher female proportion will need to take into account the fact that female physicians work fewer hours a week on average during parts of their career than their male colleagues. Overall, the core workforce shows a higher proportion male versus female physicians in as well as the specialist physician as in the family medicine physician group. An exception is the Calgary Zone which has moderately higher proportion female family physicians. In comparing the gender distribution between the specialist physician and the family medicine core workforce, there is a higher proportion of female physicians in family medicine than in the specialist physician core workforce. Although the proportion of female physicians is lower than male in the physician core workforce across the province, female physicians account for more than 50% of those younger than 45. Age Overall, the province needs to plan that around 22% of its current physician workforce (those in the 55-64 age group) will start to reduce practice or leave practice over the next 10 years. Zones that have a large proportion of their physicians in the age group 55-64 and over 65, will need to plan for a higher number of exits of physicians leaving the workforce than zones that have a lower proportion of their physicians in the older age groups. Understanding this and the specific groups impacted will be key to planning physician recruitment strategies over that term. Zones with the greatest anticipated impact of age-related retirements or practice commitment decreases are:
South and Central Zones with the oldest core specialist physician workforce
34
Edmonton and Central Zones with the oldest core family physician population
In contrast, North Zone has the youngest overall physician population and South Zone has the youngest family physician population. This is largely indicative in North Zone of their ongoing recruitment efforts, and in South Zone of a significant recruitment initiative over the last few years to address anticipated retirements. Location of Postgraduate training: Alberta, Canada (excluding Alberta), international Looking at all AHS appointed physicians (excluding locums), 48% of the total number did their postgraduate training in Alberta and 25% of the total number did this in Canada (excluding Alberta). The proportion of physicians who did their postgraduate training outside Canada (internationally) is the highest in the North Zone, followed by Central and South Zone. This reflects challenges in recruiting Alberta and Canadian graduates to these areas, particularly to rural and remote locations. Ongoing efforts such as the rural medicine training programs offered in collaboration with the University of Alberta and University of Calgary Faculties of Medicine are underway, and have improved the situation to some extent. The Physician Resource Planning Advisory Committee’s work is anticipated to consider these issues of physician distribution and provide some direction and recommendations for action.
Migration
According to the Canadian Institute of Health Information (CIHI, 2015), in 2015, Alberta had a net gain of 10 physicians from interprovincial migration (0 specialist and 10 family physicians). Primary provincial sources of physicians moving to Alberta were Ontario and Saskatchewan for specialist physicians and Ontario and BC for family medicine physician. Primary destinations for those leaving the province were BC and Ontario for both specialist and family physicians.
35
Chapter 4 – Next Steps
4.1 2018 - 2019 ………………………………………………...........................................
1. Strengthen linkages between the work by the provincial Physician Resource Planning Advisory Committee (PRPAC)-created under the Albert Health (AH)/Alberta Medical Association (AMA) agreement-, AHS physician workforce planning and forecasting, and AHS recruitment planning.
2. As described in AHS People Strategy, build linkages with other AHS clinical and non-clinical workforce plans.
3. For Family Medicine, continue to work with AH regarding support for a robust, data-driven, family physician workforce planning application. This will include the various special skills areas, such as anesthesia and basic surgery.
4. Continue to evolve to a provincial report which will guide and give direction to zone medical
leaders and other key stakeholders: a. To support them in thinking about trends and developments in physician workforce and b. How they will influence and be influenced by AHS business and service planning and
forecasting and trends in other professions.
5. Link AHS -, zone Physician Workforce Plan and Forecast Reports (zones’ long range planning) and the zone recruitment plans in 2018-2019.
6. Work to determine an appropriate FTE estimation for community-based specialists and understand the impact of community-provided services.
7. Greater data sharing and comparison related to RCPSC specialties between zones to
prevent double counting. 8. Develop a provincial approach regarding services and programs provided to patient
populations outside AHS facilities, Diagnostic Imaging, and Lab Medicine & Pathology. In addition a closer look is needed to the forecast methodologies regarding some RCPSC related specialties for Pediatrics in order to develop a provincial approach.
Future 9. Greater connection with physician training programs and consideration and discussion of
workforce needs in planning for the type and mix of residency programs available.
10. Consider what data might be collected that would provide context and information regarding physician productivity.
11. Consider the impact of wait times on future forecasts and explore how they might be
incorporated into future workforce planning.
36
Ongoing Quality Improvement 12. Continue to build capacity zone capacity in:
a. Workforce planning principles and concepts b. The difference between workforce planning and forecasting and recruitment
planning 13. Continue refining uniform data governance and principles. 14. Improve access to forecast data by specialty and zone.
37
Acronyms AH Alberta Health AHS Alberta Health Services AMA Alberta Medical Association AMHSP Academic Medicine and Health Services Program, formerly
Academic Alternate Funding Plan (AARP) A&P database/application Appointment & Privileging database/application CCA Cancer Control Alberta CCMHBI Centennial Centre for Mental Health and Brain Injury CIHI Canadian Institute of Health Information CMA Canadian Medical Association CMO Chief Medical Officer CPSA College of Physicians & Surgeons of Alberta CRG Clinical Risk Group EM Emergency FFS Fee-for-Service FTE Fulltime-Equivalent IHDA Interactive Health Data Application LGC Local Geographic Code LOA Leave of Absence MA Medical Affairs NIPM Net Inter-Provincial Migration OR Operating Room PARA Professional Association of Resident Physicians of Alberta PCN Primary Care Network PPEC Provincial Practitioner Executive Committee PPEC WFP Subcommittee Provincial Practitioner Executive Committee Workforce Planning
Subcommittee PRPAC Physician Resource Planning Advisory Committee PWP Physician Workforce Plan(ning) RACI Chart Responsible, Accountable, Consulted, and Informed Chart RCPSC Royal College of Physicians and Surgeons of Canada RDRHC Red Deer Regional Hospital Centre RFA Return From Abroad sPWP Specialist Physician Workforce Planning software application U of A University of Alberta U of C University of Calgary ZMA Zone Medical Affairs
38
Key Terminology/Definitions Active medical staff category: Physician who has satisfied the requirements of the probationary
period and have received an appointment in the active staff category, or have been appointed directly to this category.
Clinical Risk Groups (CRG): Clinical Risk Groups. A diagnostic code-based classification
system for risk adjustment that assigns each individual to a single mutually exclusive risk group based on historical clinical and demographic characteristics to predict future use of healthcare resources5. For more information about CRGs, see appendices J1 and J2.
Community medical staff Category: Physician who does not provide specified clinical services for
patients in facilities, and who does not require access to AHS services and programs, may apply for a medical staff appointment in the community staff category in order to benefit from participating in the activities of AHS and membership in the relevant zone clinical department.
Current or Base Year (F0): Is fiscal year 2016/2017. Forecast Period: Is the ten years period - Forecast Year 1 (F1) to Forecast Year 10
(F10) -beginning 2016-17 and ending 2026-27. Locum Tenens: In this report: a physician temporarily placed into an existing
practice and/or facility in order to facilitate the short term absence of another physician, or to address a temporary shortfall in physician workforce.
Long-term locum Physician who is working in the same role for 12 months and
longer.
People Strategy: To ensure we are building an engaged, empowered and high-performing workforce.
Physician: A person licensed in independent practice as a physician pursuant
to the Health Professions Act (Alberta). In this report, we also use it when we are talking about family medicine and specialist physicians as one group.
Planning Variables: Planning Variables are used for making corrections in the
Forecast Report to get a more realist forecast. Examples are: correcting the workforce (clinical FTEs) for: Introducing a new policy, technology, service delivery Facility capacity.
5 John S. Hughes, R.F. (2004). Clinical Risk Groups (CRGs): A Classification System for Risk‐Adjusted Capitation‐Based and Health Care Management. Medical Care, Volume 42 (1), p.81‐90.
39
Probationary medical staff Category: All initial medical staff appointments shall be to the probationary
staff, other than those in the temporary and community staff category, or where, in the opinion of the CMO or designate, after consultation with the applicable Zone Clinical Department Head(s) and Zone Application Review Committee, a direct appointment to the active staff category is appropriate.
Quality: AHS has described six dimensions of quality: acceptability,
accessibility, appropriateness, effectiveness, efficiency and safety. For more information, see AHS Health Plan & Business Plan 2016-17.
Recruitment Plan: A recruitment plan looks at a shorter time horizon and known
changes in physician workforce to understand risk and plan for needed recruiting activities. Recruitment planning focuses on meeting known need for physician resources to either replace or increase the complement of physicians in a particular community or department.
Short-term locum Physician who is working in the same role for less than 12
months.
Workforce Planning and Forecasting:
A forward-looking projection based on assumptions regarding key determinants of population health need, patient service models and workforce supply. It shapes a forecast of workforce needs according to organizational strategy (e.g. patient-centred, economically sustainable, quality, meets policy and objectives).
Zone: A geographically defined organizational and operational sub-unit of AHS.
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Acknowledgments
We would like to thank the following Committees and individuals for their support and hard work in preparing this plan. Without their commitment to and ongoing support of physician workforce planning, this report would not have been produced:
Dr. Francois Belanger, Vice President Quality and Chief Medical Officer Zone Medical Directors
o Dr. Kevin Worry (North Zone) o Dr. David Zygun (Edmonton Zone) o Dr. Evan Lundall (Central Zone) o Dr. Sid Viner (Calgary Zone) o Dr. Jack Regehr (South Zone
The Provincial Practitioner Executive Committee (PPEC) and the PPEC Workforce Planning Subcommittee
Zone Clinical Department Heads and Zone Clinical Section Heads from across the province
Zone Medical Affairs team members from across the province
South Zone: Chelsey Hurt Les Saggars Calgary Zone Stephen Jefferson Catherine Keenan Central Zone: Ola Ajidahun Trina Heron Andrew McCorkill Tyler McKinnon Marlene Young
Edmonton Zone: Josephine Amelio Matthew Campbell Lise Caouette Corinne Cornell Tracy Schlodder North Zone: Grant Frame Susan Smith Deborah Whetstone
We hope this report will provide information to support physician resource-, human resource-, capital-, and service delivery planning on a provincial and zone level to improve sustainability, delivery of care and services leading to better population health outcomes for Albertans. Dr. Rollie Nichol, Associate Chief Medical Officer Norma Shipley, Anne Van Der Aa, Provincial Medical Affairs December 2017
