Survey of Canadian Physician Use of Botulinum Toxin A (BoNT-A) for Paratonia: Real World Insights.

Paratonia is a form of hypertonia characterized by an inability to relax muscles in the setting of cognitive impairment. Paratonia results in pain, refusal of care, and caregiver burden. We sent surveys to 67 Canadian physiatrists and neurologists regarding their experience treating paratonia with botulinum toxin A (BoNT-A). Twenty-seven survey respondents were included in the analysis. Thirteen percent of survey respondents treating paratonia with BoNT-A reported a significant clinically relevant improvement; 74% endorsed a moderately clinically relevant improvement; 13% endorsed a slight clinically relevant improvement. Ninety percent of survey respondents endorsed significant barriers in treating paratonia with BoNT-A.

Emergency responses for a health workforce under pressure: Lessons learned from system responses to the first wave of the pandemic in Canada.

The global health workforce crisis, simmering for decades, was brought to a rolling boil by the COVID-19 pandemic in 2020. With scarce literature, evidence, or best practices to draw from, countries around the world moved to flex their workforces to meet acute challenges of the pandemic, facing demands related to patient volume, patient acuity, and worker vulnerability and absenteeism. One early hypothesis suggested that the acute, short-term pandemic phase would be followed by several waves of resource demands extending over the longer term. However, as the acute phase of the pandemic abated, temporary workforce policies expired and others were repealed with a view of returning to 'normal'. The workforce needs of subsequent phases of pandemic effects were largely ignored despite our new equilibrium resting nowhere near our pre-COVID baseline. In this paper, we describe Canada's early pandemic workforce response. We report the results of an environmental scan of the early workforce strategies adopted in Canada during the first wave of the COVID-19 pandemic. Within an expanded three-part conceptual framework for supporting a sustainable health workforce, we describe 470 strategies and policies that aimed to increase the numbers and flexibility of health workers in Canada, and to maximise their continued availability to work. These strategies targeted all types of health workers and roles, enabling changes to the places health work is done, the way in which care is delivered, and the mechanisms by which it is regulated. Telehealth strategies and virtual care were the most prevalent, followed by role expansion, licensure flexibility, mental health supports for workers, and return to practice of retirees. We explore the degree to which these short-term, acute response strategies might be adapted or extended to support the evolving workforce's long-term needs.

Anti-Black racism: Gaining insight into the experiences of Black nurses in Canada.

The call to address anti-Black racism in workplaces resonates across several organizations and institutions in Canada. But specifically, the coronavirus disease 2019 pandemic shed further light on how health inequities negatively impact the Black community. After conducting a literature review of the experiences of Black nurses in Canada, a deeper understanding of their plight was gained. In healthcare, the findings from the Black Nurses' Task Force report conclude that anti-Black racist practices are pervasive in nursing, and there remains a paucity of research in this area. This study builds off the report by exploring how Black nurses experience anti-Black racism while working in Canada's healthcare system. Inspired by critical race theory and Black feminist thought, an exploratory qualitative research study was conducted, using semistructured interviews to gather data. The study concludes that Black nurses experience anti-Black racism within the workplace, and it manifests itself through some of the attitudes of colleagues, patients, and nurses in leadership roles. Despite policies and statements that were in place to protect them, anti-Black racism continues to occur systematically. The findings point to the need for change in the overall workplace culture, which includes a fair representation of Black nurses in leadership roles, further research to identify best practices for tackling anti-Black racism within Canada's healthcare system, and mandatory training on anti-Black racism for healthcare leaders, educators, and service providers.

A national assessment of standards of care for inherited bleeding disorders in Canada.

AIM: The Canadian Integrated and Comprehensive Care Standards for Inherited Bleeding Disorders were adopted in June 2020. In early 2023, a self-assessment of each of the 26 Canadian inherited bleeding disorder treatment centre's (IBDTCs) capacity to meet the Standards was conducted. The goal was to validate the standards by assessing appropriateness and adherence. As a result, centres can compare their own practices and capacity against those of all centres, identify barriers to adherence, identify opportunities for remedial actions and use the results locally as evidence for needed resources. METHODS: Healthcare providers (HCPs) in the 26 IBDTCs were provided with a checklist to assess adherence to each of the 66 standards of care. Centre participation was voluntary but strongly encouraged by the healthcare provider and patient associations. RESULTS: All 26 centres completed the self-assessments. Collectively, centres reported meeting 88.8% of the standards. Adherence to each standard ranged from 40% to 100%. Forty-one (41) of the standards were adhered to by 90% or more of the centres, 12 by 80%-89% of the centres and 13 by fewer than 80% of the centres. A report consolidating all the assessments was sent to the 26 centres. CONCLUSION: None of the comments received in the self-assessment reports indicated that a given standard was irrelevant, unrealistic or unnecessary. These data are strong indicators that the standards, as written, are appropriate. The self-assessments, however, reveal alarming deficiencies in staffing levels, notably in physiotherapy, psychosocial support and data entry and data management. These constitute a barrier to comprehensive care for many centres. The findings echo similar conclusions from a previous assessment conducted in 2015.

Nurse practitioner affecting systems change in the context of a LEADS leadership framework: Experience from the field.

AIM: This paper highlights a new role of Advanced Practice Nurse/Nurse Practitioner as the clinical planning lead in the development of a unique model of care and service delivery for children living with health complexity, in the context of a LEADS leadership framework and related capabilities. BACKGROUND: The LEADS in a Caring Environment Framework is an effective tool for leadership development and systems change. An experienced Advanced Practice Nurse/Nurse Practitioner hired into a leadership role contributes to system change for a complex population across a large geographic area. SOURCES OF EVIDENCE: World Health Organization, Canadian Nurses Association and other websites, academic databases (PubMed and CINAHL) and relevant books were explored, and the expertise and knowledge of the authors and the redevelopment project team were utilized. DISCUSSION: The Advanced Practice Nurse/Nurse Practitioner (first author) shares and reflects on her own lived experience as a leader in the planning for programmes and services at the new centre utilizing the five LEADS domains and related capabilities. CONCLUSION: The utilization of the LEADS in a Caring Environment Capabilities Framework showcases the strengths and skills of an Advanced Practice Nurse/Nurse Practitioner shifting from direct clinical care to successfully leading system-level change. By incorporating the LEADS framework into practice, in any setting or role, Advanced Practice Nurse/Nurse Practitioners can both evaluate and develop their leadership skills while positively effecting system transformation. IMPLICATIONS FOR NURSING PRACTICE: The LEADS framework fosters ongoing professional development and can be used to measure the added value of Advanced Practice Nurses within an organization. IMPLICATIONS FOR NURSING POLICY: Advanced Practice Nurses improve outcomes within the health care system. Leaders must consider this evidence in health workforce planning, ensuring that Advanced Practice Nursing roles become fully integrated and are supported in the context of national and regional health systems.

Relative remoteness and wage differentials in the Canadian allied health professional workforce.

INTRODUCTION: Health workforces around the world are characterized with geographic maldistribution, often leading to inequalities in rural health outcomes. Monetary incentives are frequently raised as a policy option to bolster recruitment of healthcare practitioners to rural and underserved communities; however, few rural health workforce studies focus on allied health professionals (AHPs), include urban comparators, integrate gender considerations, or measure rural diversity. This population-based observational study examines trends in the geographic and gender distribution and earnings of AHPs in Canada across the rural-urban continuum. METHODS: Nationally representative data from the 2006 and 2016 Canadian population censuses were pooled and linked with the geocoded Index of Remoteness for all inhabited communities. Five groups of university-educated AHPs providing prevention, diagnostic evaluation, therapy, and rehabilitation services were identified by occupation. Multiple linear regression models were used to estimate the associations between relative remoteness and annual earnings of AHPs aged 25-54 years, controlling for gender and other personal and professional characteristics. RESULTS: The density of AHPs was found to be 15 times higher in more urbanized and accessible parts of the country (23.6-25.6 per 10 000 population in 2016) compared to the most rural and remote areas (1.6 per 10 000 population), a pattern that changed little over the previous decade. A positive correlation was seen across occupations in terms of the degree of feminization and their geographic dispersion by relative remoteness. While pharmacists residing in more rural and remote communities earned 9% (95% confidence interval 4-15%) more than those in core urban centers, relative remoteness contributed little to wage differentials among dentists, physiotherapists and occupational therapists, or other AHPs in therapy and assessment (no significant difference at p<0.05). Women earned significantly less than men in dentistry, pharmacy, and physical or occupational therapy, after adjusting for remoteness and other characteristics. CONCLUSION: This study did not find consistent wage disparities by relative remoteness as characterizing allied health professions in Canada. The evidence base to support financial incentives to AHPs to reduce perceived opportunity costs associated with working and living in rural and underserved areas remains limited. More research is needed on the intersections of rurality, gender, and wage differentials among AHPs in different national contexts.

Olva Odlum BDS MSc LDS, the First Female Faculty Member in Manitoba and Dentist to the Indigenous Population.

Olva Odlum qualified as a dentist in England but went on to make a professional life in Canada. She became the first female member of the Manitoba dental faculty and provided care for many dentally-deprived groups, including disabled patients, those with cancer and members of the First Nation tribes.

Assessing the contribution of immigrants to Canada's nursing and health care support occupations: a multi-scalar analysis.

BACKGROUND: The World Health Organization adopted the Global Strategy on Human Resources for Health Workforce 2030 in May 2016. It sets specific milestones for improving health workforce planning in member countries, such as developing a health workforce registry by 2020 and ensuring workforce self-sufficiency by halving dependency on foreign-trained health professionals. Canada falls short in achieving these milestones due to the absence of such a registry and a poor understanding of immigrants in the health workforce, particularly nursing and healthcare support occupations. This paper provides a multiscale (Canada, Ontario, and Ontario's Local Health Integration Networks) overview of immigrant participation in nursing and health care support occupations, discusses associated enumeration challenges, and the implications for health workforce planning focusing on immigrants. METHODS: Descriptive data analysis was performed on Canadian Institute for Health Information dataset for 2010 to 2020, and 2016 Canadian Census and other relevant data sources. RESULTS: The distribution of nurses in Canada, Ontario, and Ontario's Local Health Integration Networks reveal a growth in Nurse Practitioners and Registered/Licensed Practical Nurses, and contraction in the share of Registered Nurses. Immigrant entry into the profession was primarily through the practical nurse cadre. Mid-sized communities registered the highest growth in the share of internationally educated nurses. Data also pointed towards the underutilization of immigrants in regulated nursing and health occupations. CONCLUSION: Immigrants comprise an important share of Canada's nursing and health care support workforce. Immigrant pathways for entering nursing occupations are complex and difficult to accurately enumerate. This paper recommends the creation of an integrated health workforce dataset, including information about immigrant health workers, for both effective national workforce planning and for assessing Canada's role in global health workforce distribution and utilization.

Accreditation as a driver of interprofessional education: the Canadian experience.

BACKGROUND: The purpose of this study was to (1) explore evidence provided by Canadian health and social care (HASC) academic programs in meeting their profession-specific interprofessional education (IPE)-relevant accreditation standards; (2) share successes, exemplars, and challenges experienced by HASC academic programs in meeting their IPE-relevant accreditation standards; and (3) articulate the impacts of IPE-relevant accreditation standards on enabling interprofessional learning to the global HASC academic community. METHODS: Profession-specific (bilingual, if requested) surveys were developed and emailed to the Deans/Academic Program Directors of eligible academic programs with a request to forward to the individual who oversees IPE accreditation. Responses were collated collectively and by profession. Open-ended responses associated with our first objective were deductively categorized to align with the five Accreditation of Interprofessional Health Education (AIPHE) standards domains. Responses to our additional questions associated with our second and third objectives were inductively categorized into themes. RESULTS/DISCUSSION: Of the 270 HASC academic programs surveyed, 30% (n = 24) partially or completely responded to our questions. Of the 106 IPE-relevant standards where evidence was provided, 62% (n = 66) focused on the Educational Program, 88% of which (n = 58) were either met or partially met, and 47% (n = 31) of which focused on practice-based IPE. Respondents cited various exemplars and challenges in meeting IPE-relevant standards. CONCLUSIONS: The overall sentiment was that IPE accreditation was a significant driver of the IPE curriculum and its continuous improvement. The array of exemplars described in this paper may be of relevance in advancing IPE implementation and accreditation across Canada and perhaps, more importantly, in countries where these processes are yet emerging.

A framework for nursing practice in rural and remote Canada.

INTRODUCTION: Despite the increased understanding of Canadian rural and remote nursing practice in the past two decades, a synthesis of nursing frameworks to guide practice has been missing from the literature. In this article, the process undertaken to develop a nursing practice framework is described. The purpose of the project was to integrate existing rural and remote nursing evidence into a framework to guide rural nursing practice; inform the actions of rural communities, other health professionals, educators, policymakers and regulators; and support the health of Canadian residents who live in rural and remote areas. METHODS: Two consultants (DE, JK) worked with the Canadian Association for Rural & Remote Nursing (CARRN) Executive to plan and implement a process to develop a rural and remote nursing framework. An external advisory group, representing regulated nurses, and six expert rural nursing researchers were invited to critique project outcomes. A focused international review of the literature was conducted to determine which rural nursing frameworks existed. Electronic database platforms (ProQuest and the Cumulative Index of Allied Health Literature and Medline) were searched, with literature limited to English-only articles. Each article was analyzed to determine relevant key components and elements. RESULTS: The literature review generated 22 full-text articles that were analyzed and synthesized into five main categories: larger society/determinants of health, role of place/the rural or remote context, rural and remote peoples/communities, rural and remote nursing, and health outcomes. A draft document describing the creation of the framework and two different graphic designs of the framework were developed, then sent to the advisory group for critique. All critiques were reviewed and the document was revised as appropriate. The framework design, which used concentric circles to depict relationships between the five identified categories, was selected by a majority of the advisory group reviewers as being representative of their practice and experience. CONCLUSION: It is envisioned that, by using the framework, practicing nurses can identify the tightly woven interconnections within the rural context affecting the health of their clients. Nursing assessments and practice can then be strengthened from consideration of the framework. Nursing programs with dedicated rural nursing content potentially could incorporate the rural and remote nursing practice framework document into classroom and clinical discussions. Due to resource and time restrictions, Indigenous and Francophone nurses were not part of the framework discussions, nor were community members living in rural or remote Canada. Ongoing critique from relevant rural groups will be beneficial for future input and revisions. CARRN is developing a knowledge mobilization strategy to begin this process.

Diversifying the health workforce: a mixed methods analysis of an employment integration strategy.

BACKGROUND: Historically, immigration has been a significant population driver in Canada. In October 2020, immigration targets were raised to an unprecedented level to support economic recovery in response to COVID-19. In addition to the economic impact on Canada, the pandemic has created extraordinary challenges for the health sector and heightened the demand for healthcare professionals. It is therefore imperative to accelerate commensurate employment of internationally educated nurses (IENs) to strengthen and sustain the health workforce and provide care for an increasingly diverse population. This study aimed to determine the effectiveness of a project to help job-ready IENs in Ontario, Canada, overcome the hurdle of employment by matching them with healthcare employers that had available nursing positions. METHODS: A mixed methods design was used. Interviews were held with IENs seeking employment in the health sector. Secondary analysis was conducted of a job bank database between September 1 and November 30, 2019 to identify healthcare employers with the highest number of postings. Data obtained from the 2016 Canadian Census were used to create demographic profiles mapping the number and proportion of immigrants living in the communities served by these employers. The project team met with senior executives responsible for hiring and managing nurses for these employers. The executives were given the appropriate community immigrant demographic profile, a manual of strategic practices for hiring and integrating IENs, and the résumés and bios of IENs whose skills and experience matched the jobs posted. RESULTS: In total, 112 IENs were assessed for eligibility and 95 met the inclusion criteria. Twenty-one healthcare employers were identified, and the project team met with 54 senior executives representing these employers. Ninety-five IENs were subsequently matched with an employer. CONCLUSIONS: The project was successful in matching job-ready IENs with healthcare employers and increasing employer awareness of IENs' abilities and competencies, changing demographics, and the benefits of workforce diversity. The targeted activities implemented to support the project goal are applicable to sectors beyond healthcare. Future research should explore the long-term impact of accelerated employment integration of internationally educated professionals and approaches used by other countries.

Regulating health professional scopes of practice: comparing institutional arrangements and approaches in the US, Canada, Australia and the UK.

BACKGROUND: Fundamentally, the goal of health professional regulatory regimes is to ensure the highest quality of care to the public. Part of that task is to control what health professionals do, or their scope of practice. Ideally, this involves the application of evidence-based professional standards of practice to the tasks for which health professional have received training. There are different jurisdictional approaches to achieving these goals. METHODS: Using a comparative case study approach and similar systems policy analysis design, we present and discuss four different regulatory approaches from the US, Canada, Australia and the UK. For each case, we highlight the jurisdictional differences in how these countries regulate health professional scopes of practice in the interest of the public. Our comparative Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis is based on archival research carried out by the authors wherein we describe the evolution of the institutional arrangements for form of regulatory approach, with specific reference to scope of practice. RESULTS/CONCLUSIONS: Our comparative examination finds that the different regulatory approaches in these countries have emerged in response to similar challenges. In some cases, 'tasks' or 'activities' are the basis of regulation, whereas in other contexts protected 'titles' are regulated, and in some cases both. From our results and the jurisdiction-specific SWOT analyses, we have conceptualized a synthesized table of leading practices related to regulating scopes of practice mapped to specific regulatory principles. We discuss the implications for how these different approaches achieve positive outcomes for the public, but also for health professionals and the system more broadly in terms of workforce optimization.

High turnover in clinical dietetics: a qualitative analysis.

BACKGROUND: Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care. It takes time for multidisciplinary team members to build collaborative, trusting relationships. For this reason, frequent dietitian turnover is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with high turnover have not been identified. We predicted that managers would identify disease prestige as having an impact. In this study, we aimed to explore: 1) characteristics of clinical dietetic jobs associated with the highest turnover, and 2) consequences of high turnover on patients and managers of clinical dietitians. METHODS: Research assistants conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public healthcare system. We employed a constant comparative approach to thematic analysis. We classified themes related to turnover as either avoidable or unavoidable. RESULTS: Sub-themes under avoidable turnover included lack of manager support, growth opportunities, burnout/workload, tension/conflict and hours of work. Sub-themes under unavoidable turnover included life-stage/life-events and geography. We also identified themes related to consequences of turnover, including: burnout/workload, client/patient impact, tension/conflict, cost and gap-specific. As predicted, prestige was perceived as playing a role in triggering dietitian turnover. Managers observed high turnover resulting in low provider continuity and limiting patient access to dietitians. CONCLUSIONS: Managers of publicly-employed dietitians identified many factors as contributing to high turnover. Future prospective research, incorporating the objective measure of turnover and multi-method analysis of work characteristics and work setting, would be of value in the identification of characteristics of clinical dietetic jobs associated with high turnover and the consequences of high turnover on patients and managers of these staff.

The meaning of nursing practice for nurses who are retired yet continue to work in a rural or remote community.

BACKGROUND: Although much research has focused on nurses' retirement intentions, little is known about nurses who formally retire yet continue to practice, particularly in rural and remote settings where mobilization of all nurses is needed to assure essential health services. To optimize practice and sustain the workforce stretched thin by the COVID-19 pandemic, it is necessary to understand what it means for retired registered nurses (RNs) and licensed practical nurses (LPNs) to work after retirement. This study explored what nursing practice means for RNs and LPNs who have formally retired but continue to practice in rural and remote communities. METHODS: A pan-Canadian cross-sectional survey conducted in 2014-2015 of nurses in rural and remote Canada provided data for analysis. Textual responses from 82 RNs and 19 LPNs who indicated they had retired but were occasionally employed in nursing were interpreted hermeneutically. RESULTS: Retired nurses who continued to practice took on new challenges as well as sought opportunities to continue to learn, grow, and give back. Worklife flexibility was important, including having control over working hours. Nurses' everyday practice was inextricably tied up with their lives in rural and remote communities, with RNs emphasizing serving their communities and LPNs appreciating community recognition and the family-like character of their work settings. CONCLUSIONS: Retired nurses who continue to work in nursing see retirement as the next phase in their profession and a vital way of engaging with their rural and remote communities. This study counters the conventional view of retaining retired nurses only to combat nursing shortages and alleviate a knowledge drain from the workplace. Rural and remote nurses who retire and continue working contribute to their workplaces and communities in important and innovative ways. They can be characterized as dedicated, independent, and resilient. Transitioning to retirement in rural and remote practice can be re-imagined in ways that involve both the community and the workplace. Supporting work flexibility for retired nurses while facilitating their practice, technological acumen, and professional development, can allow retired nurses to contribute their joy of being a nurse along with their extensive knowledge and in-depth experience of nursing and the community.

Quality of work life of paramedics practicing community paramedicine in northern Ontario, Canada: a mixed-methods sequential explanatory study.

INTRODUCTION: This article aimed to evaluate pilot community paramedicine (CP) programs in northern Ontario from the perspectives of paramedics to gain program recommendations related to both rural and urban settings. METHODS: An online questionnaire was created and distributed to 879 paramedics with and without CP experience employed at eight emergency medical services providers in northern Ontario. An explanatory sequential design was used to analyze and synthesize the results from the quantitative survey items and the open-ended responses. RESULTS: Seventy-five (40.5%) respondents participated in a CP program, and the majority of 75 paramedics who indicated they participated in CP (n=41, 54.4%) were from rural areas. CP was generally well received by both paramedics currently practicing CP and those who were not practicing CP. The majority (86.3%) of paramedics stated paramedics should be practicing CP in the future. Paramedics identified developing professional relationships and improving health promotion as positive aspects of CP. Areas for CP program improvement included better organization and scheduling, improved training and a need for better patient tracking software. CONCLUSION: Engaging and consulting paramedics in the ongoing process of CP development and implementation is important to ensure they feel valued and are part of the change process.

The Proving Ground: Colombo Plan Fellowships and the Changing Landscape of Health Education in Canada, 1951-69.

This article examines the history of the Colombo Plan fellowship program in Canada during the 1950s and 1960s. It will argue that this program had a visible impact on Canadian institutions of learning and health care for three reasons. First, it brought an unprecedented number of students and health care professionals from South and Southeast Asia to Canada; second, it fostered a sense of mission within Canadian institutions about the role education should play in contributing to health and international development overseas; and third, it revealed the challenges and tensions inherent in fulfilling this mission in the context of differences between the objectives of Canadian officials and those of the fellows themselves. With its focus on South and Southeast Asia, the Colombo Plan fellowship program anticipated broader trends regarding the international migration of health workers from that region in later years.

Health professional regulation in historical context: Canada, the USA and the UK (19th century to present).

BACKGROUND: There is no widespread agreement over what form healthcare professional regulation should take, and the evidence base concerning the effectiveness and fairness of regulatory systems and practices is limited. Those urging policy change argue there is a need to modernize; however, there is much we can learn from reviewing the history of healthcare professional regulation. MAIN BODY: An overview of the history of regulation in Canada, with consideration of the United States of America and the United Kingdom, is provided. Self-regulating professions emerged in the nineteenth century, influenced by a variety of stakeholders responding to local concerns for healthcare quality, access and professional training. Regulatory practices changed over the course of the twentieth and twenty-first centuries in response to changing stakeholders and shifting interests. CONCLUSIONS: Reviewing the history of healthcare professional regulation reveals lessons to inform policy in a range of settings.

Pediatric Neurology Workforce in Canada: A 5-Year Update.

BACKGROUND: In 2013, a task force was developed to discuss the future of the Canadian pediatric neurology workforce. The consensus was that there was no indication to reduce the number of training positions, but that the issue required continued surveillance. The current study provides a 5-year update on Canadian pediatric neurology workforce data. METHODS: Names, practice types, number of weekly outpatient clinics, and dates of certification of all physicians currently practicing pediatric neurology in Canada were obtained. International data were used to compute comparisons between countries. National data sets were used to provide information about the number of residency positions available and the number of Canadian graduates per year. Models for future projections were developed based on published projected population data and trends from the past decade. RESULTS: The number of pediatric neurologists practicing in Canada has increased 165% since 1994. During this period, wait times have not significantly shortened. There are regional discrepancies in access to child neurologists. The Canadian pediatric neurology workforce available to see outpatient consultations is proportionally less than that of USA. After accounting for retirements and emigrations, the number of child neurologists being added to the workforce each year is 4.9. This will result in an expected 10-year increase in Canadian pediatric neurologists from 151 to 200. CONCLUSIONS: Despite an increase in the number of Canadian child neurologists over the last two decades, we do not predict that there will be problems with underemployment over the next decade.

Les effectifs en neurologie pédiatrique au Canada : une mise à jour tenant compte des cinq dernières années.Contexte:En 2013, un comité de réflexion a été mis sur pied afin de discuter de l'avenir des effectifs canadiens en neurologie pédiatrique. Un consensus s'est alors dessiné : bien que rien n'indique qu'il faille réduire le nombre de places disponibles dans ce domaine de formation, cette question nécessite toutefois un suivi continu. La présente étude vise ainsi à offrir une mise à jour des données qui concernent ces effectifs en tenant compte des cinq dernières années.Méthodes:Les données suivantes ont été obtenues : noms des praticiens, types de pratique, nombre de consultations hebdomadaires en clinique externe et dates de certification de tous les médecins pratiquant actuellement la neurologie pédiatrique au Canada. Des données internationales ont également été utilisées pour effectuer des comparaisons entre divers pays. Des données au niveau national ont été rassemblées pour établir le nombre de places disponibles en résidence et le nombre de diplômés canadiens par année. Des modèles de projection ont aussi été élaborés en se fondant sur des projections de population déjà publiées et sur les tendances ayant marqué la décennie précédente.Résultats:Le nombre de neurologues pédiatriques qui pratiquent au Canada a augmenté de 165 % depuis 1994. Fait à noter, les temps d'attente n'ont pas été notablement raccourcis durant cette période. Il existe aussi des disparités régionales en matière d'accès à cette spécialité de la neurologie. Les effectifs canadiens en neurologie pédiatrique disponibles pour des consultations en clinique externe demeurent proportionnellement moins importants qu'aux États-Unis. Après avoir tenu compte des départs à la retraite et des apports de l'extérieur, le nombre de neurologues pédiatriques ajoutés chaque année a été en moyenne de 4,9. Pendant une période de 10 ans, on anticipe donc qu'on devrait passer de 151 à 200 neurologues pédiatriques canadiens.Conclusions:En dépit d'une hausse du nombre de neurologues pédiatriques canadiens au cours des deux dernières décennies, nous ne prédisons pas de problèmes de sous-emploi au cours de la prochaine décennie.

The early retiree divests the health workforce: a quantitative analysis of early retirement among Canadian Registered Nurses and allied health professionals.

BACKGROUND: Early retirement (before age 65) is the norm among registered nurses (RNs) and allied health professionals (AHPs) employed in Canada's public system. As a country whose population is rapidly aging, it is in Canada's best interest to try and extend the work lives of RNs and AHPs. OBJECTIVES: (1) To test the predictive validity of our conceptual model of early retirement among publicly employed, Canadian RNs and AHPs and (2) to compare, across professions, model fit and factor significance METHODS: We conducted multivariable logistic regression in two data sets, one consisting of 483 retired RNs and the other of 177 retired AHPs. The number of AHP respondents limited our ability to comprehensively test the model. RESULTS: Eighty-five percent of RNs and 77% of AHPs had retired early. (1) Results indicate that 25% of variance in RN early retirement and 19% of variance in AHP early retirement was explained by included variables. (2) Organizational restructuring increased odds of early retirement by more than 100% among RNs and AHPs. Among RNs (but not AHPs), both financial possibility and caregiving responsibilities predicted early retirement at statistically significant levels, while a "desire to stop working" predicted retirement at or after 65 years of age. CONCLUSIONS: Clearly, there is much more to learn about RN and AHP pathways to early retirement. Further research, ideally research exploring the role of workplace characteristics, attitudes, and beliefs towards retirement and work-related factors, could deepen our understanding of the phenomenon of RN/AHP early retirement.

Availability of health workforce in urban and rural areas in relation to Canadian seniors.

Geographic imbalances in health human resources exist in a health care system when the composition, level, or use of health care providers does not lead to the same optimal health-system goals in all regions. This can lead to inequitable distribution of health care services, particularly for rural and remote populations. This study aims to determine to what extent the distribution of regulated health professionals and seniors in urban and rural areas of the Canadian jurisdictions is different from one another and from the national average. Data used in this study are for the 2016 calendar year. Information about physicians was obtained from the Canadian Institute for Health Information (CIHI) Scott's Medical Database. The data for nurses (nurse practitioners, registered nurses, and licensed practical nurses) were also sourced from CIHI, Health Workforce Database. Geographic information is based on the postal code of physicians' preferred mailing address, and the residence in the case of nurses and the population. Using the Statistical Area Classification from Statistics Canada, each physician and nurse was assigned to either an urban metropolitan, urban non-metropolitan, or rural/remote area. Findings indicate that there were twice as many nurses per 1000 seniors in urban Canada than in rural Canada. However, this gap was threefold in the case of physicians. Provinces with the largest and lowest gap and international comparisons are also provided. Three broad strategies are offered for policymakers in order to mitigate this health workforce imbalance and reduce the regional shortage of nurses and physicians.