In the absence of definitive evidence about what mix of health professionals
works best in many different situations,27,28 a wide variety of approaches have
been taken. At the international level, there are large variations among
industrialized countries.29 The mix of health professionals differs significantly, so
do their range of skills and activities.
Even within Canada, there are significant variations among provinces and territories. Toronto, Montreal, Vancouver, and other large urban centres are at one extreme. They have a wide range of specialists, sub-specialists, and dozens of different types of health professionals. At the other end are very isolated remote communities. In some cases, indigenous health care workers may be the
only health care providers resident in these communities.17
Across the country there were about the same number of general/family physicians (GP/FP) and medical specialists in 2000. The national GP/FP to specialist ratio was 1.0. Among the jurisdictions, the ratio ranged between 0.9 for Ontario and 6.0 for Nunavut.
Large differences also exist for other professions. For example, different combinations of patient care staff work in health care institutions in different parts of the country. Even within the same jurisdiction, specific types of patient care staff are more likely to
work in particular areas. New research is exploring how patient outcomes vary when the mix of staff differs. For example, University of Toronto researchers studied patient, nurse, and system outcomes in 19 Ontario teaching hospitals. They found that patients on units with a higher proportion of
regulated nursing staff (RNs and LPNs) tended to have better outcomes when they left hospital. Specifically, they had higher functional independence, less pain, better social functioning, and were more satisfied with obstetrical care. This was true even after
controlling for the types of patients cared for on the unit, as well as their health status on admission, age,
gender, and complexity of illness. These units also tended to have fewer
medication errors and wound infections. The relationship between hospital staff mix and patient outcomes was not, however, seen when researchers followed up
six weeks after patients were discharged from hospital.30
The Mix of Patient Care Staff
In 1999, researchers from the University of British Columbia asked a sample of hospitals, long-term care centres, regional health boards, public health units, and other health care employers about the numbers and mix of unregulated aides, licensed practical nurses (LPNs), registered nurses (RNs), registered psychiatric nurses (RPNs), and other providers they employed in the previous year. A summary of their responses is shown below.* Note: Regional distributions include only responses from "single facilities" — those that reported staff from only one facility/agency.
Source: Kazanjian A, Rahim-Jamal S, MacDonald A, Wood L, Cole C. (2000). Nursing Workforce Study Volume IV ~ Nursing Workforce
Deployment: A Survey of Employers. University of British Columbia: Centre for Health Services and Policy Research.
0% 20% 40% 60% 80% 100% Aides LPNs RNs RPNs Other Atlantic Quebec Ontario Prairies B.C./Territories All Regions
% Patient Care Staff
Different Skills for Different Jobs
Patient care providers in different parts of a hospital tend to have different backgrounds. For example, the chart below shows the two most common types of patient care providers in different work assignments, as reported by tertiary/teaching hospitals across the country in 1999. In some cases, more than two groups are indicated because several types of qualifications were equally common.
Source: Kazanjian A, Rahim-Jamal S, MacDonald A, Wood L, Cole C. (2000). Nursing Workforce Study Volume IV ~ Nursing Workforce
Deployment: A Survey of Employers. University of British Columbia: Centre for Health Services and Policy Research.
Note: Registered Psychiatric Nurses are only licensed in the four western provinces so are not shown here.
Administration 3 3
Emergency Room 3 3
Extended Care/Long-Term Care 3 3 3
Critical Care 3 3 Maternity/Newborn 3 3 3 Medical Care 3 3 Operating Room 3 3 Pediatrics 3 3 Mental Health 3 3 Surgical Care 3 3 3 Community/Public Health 3 3 Home Care 3 3 Other 3 3 3 3
Aide LPN RN - Diploma RN - Diploma & Specialty RN - Diploma & P
ost-Basic Degree
RN - Basic Degree RN - Basic Degree & Specialty RN - Masters
What about Patients and Families?
In Canada and elsewhere, patients and their families and friends play important roles in health care. The World Health Organization has affirmed that:
The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.31
Patients and their families may be involved in a variety of ways.32For example, they may provide
important information to support care decisions, perhaps by describing their symptoms. They may also participate in or make decisions about their care, such as whether or not to have surgery. In addition, many Canadians care for themselves or their families or are involved in other ways (see the Who's Who in
Health Carechapter for more information).
A number of studies have examined the effectiveness of self-care and informal care. A review by researchers at Laurentian University and the University of Alberta found that, with the appropriate training and supports and in the context of the patient's or caregiver's abilities, these types of care can be effective.17