Health care workers may be immune to unemployment

Aging population means jobs in nursing, medicine and more

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Tom Gannam/AP

Tom Gannam/AP

From the Future of Jobs report

As an ecological field researcher with British Columbia’s Ministry of Forests, Sonya Powell had a dependable, though segmented, career. Seasonal contracts put her in the woods each summer, surveying tree life for $20 to $25 an hour; in the winters, she taught geography classes at the University of British Columbia (UBC). Gaps between jobs were her vacation time, she chuckles.

That was before the global economic downturn led to the collapse of the forestry sector. In the summer of 2009, Powell couldn’t find her usual contracts. Remembering the health problems of the isolated communities she had passed through in the summers, she enrolled in an accelerated 20-month nursing program at UBC designed for students in their second careers. It paid off: She landed not one, but two nursing jobs when she graduated.

“I started almost the next day,” says the 36-year-old, who now works full-time at one of them, the safe-injection centre Insite, in Vancouver’s Downtown Eastside. There, she does immunizations, screens patients and is mentoring a nursing student. “I really love my job,” she says. It also happens to pay around $31 an hour—far more than she earned in forestry.

As Canada’s resource jobs recover from the slowdown, health care appears to be one of the rare recession-proof industries where employment is virtually guaranteed for new grads.

Over the past two years, health care has been among the biggest drivers of job growth. Jobs in the health care and social assistance sectors were up seven per cent (representing 93,000 new positions). That pace will only quicken as Canada’s population ages. Nurses, support staff and therapists are all expected to be in demand.

More doctors were licensed in Ontario in 2012 than ever before—4,149 new registrations, four per cent more than in 2011, according to the College of Physicians and Surgeons of Ontario. In the U.S., since the start of the recession, the story is much the same: The health sector has added 1.4 million jobs, while overall employment has fallen by 5.6 million jobs.

Greying demographics are leading the surge. “Our population is getting older, living longer,” says Monica Parry, director of nurse practitioner programs at the University of Toronto’s faculty of nursing. “Someone might have diabetes, but now that they’re getting older, they also have lung disease or kidney disease. So the average patient is much more complicated to care for than they used to be 10 to 15 years ago.”

At the same time, the health care industry’s own workforce is aging fast, putting pressure on the labour supply. It is estimated that one in five active physicians in Ontario is over the age of 60, according to numbers released in December 2012 by Working in Canada, a job portal run by the federal government. By 2020, nearly 9,000 nurses with a median salary of $72,000 will be retiring every year.

For these reasons, health care and supportive care are excellent choices for those entering the job market. What kind of health jobs are on the rise? Nearly all of them, according to Working in Canada, which shows that everything from family physician to personal care assistant has above-average growth projections across all regions.

A major trend driving health care job creation in 2013 is the continuing push to care for patients in the home, rather than in the hospital. “The whole shuffle is toward providing services in the community,” says Parry. “We used to keep patients in the hospital longer. Now we send them out sooner, so you need the support through resources to manage when people go home.” The roster of health care workers needed to support this shift is huge. It encompasses personal care assistants, who might help a patient with limited mobility bathe or buy groceries, as well as diabetic educators, who work in communities to help diabetics manage their conditions.

The need for these supportive roles for a less institutionalized population of patients has meant a multiplication of routes into the health care sector. A diabetic educator is a registered nurse who has earned another certificate, while a personal care assistant merely needs a college diploma or certificate to provide what is often life-changing care for elderly patients or those with chronic conditions that keep them homebound.

Demand is especially high in under-serviced remote and rural communities, according to Employment and Social Development Canada. To meet the need, in April 2013, the federal government designated more than 4,200 rural communities across the country in which family doctors, nurses, nurse practitioners and family medicine residents could apply for Canada Student Loan forgiveness of up to $20,000 for nurses and $40,000 for doctors.

A position that continues to become more prominent is the nurse practitioner, an advanced class of nurse that has been filling in the widening cracks in Canada’s stressed health care system. Nurse practitioners work on the borders of nursing, in roles that more traditionally belong to physicians. Although they can’t provide all the medical care doctors can, they can perform much of what patients seek doctors for. A couple of years ago, the rules changed to broaden their scope further, allowing them to prescribe most medications except controlled substances (such as narcotics) and to order many diagnostic tests, says Parry, who works as a nurse practitioner at Kingston General Hospital and teaches a new generation of nurse practitioners at U of T.

In Ontario, nurse practitioners are registered nurses with two years of experience in the field who return to school for master’s nursing degrees in the nurse practitioner stream. In exchange for those extra years of schooling, nurse practitioners benefit from more career autonomy—and more money. In their starting year in Ontario, they can expect salaries of roughly $80,000, which is what many regular registered nurses can earn toward the end of their careers.

Schools such as U of T have shifted to accommodate demand. Of the 130-odd nursing master’s students admitted to the school each year, 20 per cent might have been in the nurse practitioner stream years ago, says Ann Tourangeau, associate dean of academic programs for the university’s nursing faculty. Now, nearly half the school’s nursing graduate students are hoping to become nurse practitioners.

Even as the ranks of newly minted medical professionals grow, some barriers are holding them back. Students wishing to become family doctors face long years in school, limited postgraduate training positions and the reality of hundreds of thousands of dollars of student-loan debt.

Many health care education programs face their own hurdles to growth, putting more downward pressure on the labour supply. “One of our challenges that we’re facing right now is faculty shortages,” says Tourangeau. Nursing faculty at U of T must be Ph.D.s with both clinical experience and outstanding research publications. As a result, the faculty has added only about 25 new slots for undergraduates over the past seven years, although it had roughly 900 applicants vying for 170 spots last year.

The much-publicized problem of immigrants who struggle to have their foreign credentials in medicine recognized in Canada has been a focus of government initiatives. The 2009 federal budget funded the development of a national framework to smooth foreign-credential recognition for key health care jobs, such as medical radiation technologists, pharmacists, physiotherapists, registered and licensed practical nurses, dentists and physicians.

The existence of newcomers with foreign medical training may be leading to the growth of a different kind of medical stream, however: the physician assistant, sometimes called the “physician extender.” Originating in the United States, the as-yet-unregulated profession pairs one supervising doctor with an assistant, who takes on a number of tasks, such as getting patient histories and doing select diagnostic jobs. According to national advocacy group the Canadian Association of Physician Assistants, Canada has approximately 300 physician assistants, mainly in Ontario and Manitoba, a number that’s set to grow. Roughly 160 students are now enrolled in physician assistant programs, such as McMaster University’s bachelor of health sciences (physician assistant) program—preferred by many foreign medical professionals over studying for a whole new medical degree.

For Powell, her second career as an Insite nurse is exciting. “There are no typical days there,” she says. Another bonus: It includes real, grown-up vacations—the paid kind. “As a consultant, I never had that before. It’s great to be supported that way, because nurses work really hard.”