In 2023, Quebec lost more family doctors than it welcomed. According to the Federation of General Practitioners of Quebec, the arrival of new workers has not compensated for the departures. And this, even though the Ministry of Health and Social Services (MSSS) has modified the designations of medical residencies so that 55% of places are reserved for family medicine and 45% for other specialties. The number of family doctors practicing in the public network has seen a significant decline, among other things because the proportion of them retiring at a younger age or moving to the private sector has been increasing sharply in recent years.
To plan the workforce, the MSSS uses a regional medical workforce plan (PREM). The PREM suggests opening a number of doctor places based on the gaps observed between the existing workforce and the needs to be filled in each region. However, it is difficult to plan the workforce because several elements can come into play. With the aging of the population, more patients suffering from chronic diseases require care and support. In addition, neighborhoods experiencing strong population growth have a greater need for professionals who will offer basic care and carry out prevention.
Which means that voices are being raised to denounce this system of distribution of family doctors. Some allege that some regions are disadvantaged compared to others.
Embrace the chaos
However, no country adequately manages its health workforce. For the World Health Organization (WHO), the workforce is the weak link in many networks around the world because the health sector is poor at predicting and training the right number of workers.
Therefore, the WHO emphasizes the importance of having a labor market analysis that is based on data and information. Many countries have policies and strategies to control variations and fluctuations in the workforce. And the failure of the system can lead to a shortage of employees which will have harmful consequences on the provision of care to the population.
Measure, measure, measure
Countries such as Belgium and the Netherlands have developed models that integrate projections into workforce planning strategies. These assess needs by analyzing worker migrations, socio-cultural developments, changes in hours worked, evolving clinical practices and tasks allocated to other professionals. The models are based on a balance of projections, assumptions, scenarios, heuristics and statistics. We want to know what the optimal number of medical students will be in the next 15 years.
However, even in these countries, we observe shortages in certain specialties and uneven distribution across the territory. Workforce planning will never be an exact science because it requires making assumptions about the evolution of supply and demand for services and estimates about the number of employees needed in the long term. Also, the models are developed separately from policies that concern wages, working conditions, education, migration and retirement.
Dreaming better for the health workforce
Of course, workforce planning cannot only be focused on recruitment, network managers must also improve productivity and review the organization of work so that employees feel good in their work environment and want to stay.
In a study of Journal of the American Medical Association which analyzed responses from more than 20,000 doctors and clinicians, researchers found that burnout and the desire to leave were correlated with things like lack of control over workload, a chaotic environment, problems at team level and not feeling valued within the organization. In addition, when employees work in environments where empathy is encouraged, they are more satisfied in their work, more likely to take risks, more inclined to help their colleagues. Physicians want to be in an organization that uses their expertise well and where they feel included.
Hence the importance of understanding and managing the work environment and adjusting the workload so that clinicians have greater control over their schedule. Benefits, salaries, working conditions are important, but having a good organizational culture is essential to retain employees.
The health care workforce is aging and not being replaced quickly enough. It would be good to reexamine the assessment made of future human resource needs and to review how doctors, nurses and managers are deployed. The challenge of the coming years will be to think, work and collaborate differently.