Canada’s Health Care Crisis Is in Large Part a Labor Crisis

In several Canadian provinces, burned-out health care workers are leaving in droves, a result of wage suppression and attacks on workers. The fight for labor rights is key to fixing Canada’s health care crisis.

Ontario's pediatric care crisis had the Sick Kids Critical Care Unit busy moving children between hospitals and making space for the most severe cases. Toronto, Canada, December 15, 2022. (Steve Russell / Toronto Star via Getty Images)

Over the Christmas holidays, emergency departments at several Canadian hospitals were forced to close temporarily due to lack of staff. Overwhelmed with patients, the Children’s Hospital of Eastern Ontario in Ottawa began postponing surgeries and airlifting children to other facilities. Across the country, a backlog of surgeries is proving life-threatening. These are simply the latest episodes in an ongoing health care crisis that is national in scope.

Canada’s system of Medicare — a point of national pride — was strained before the COVID-19 pandemic hit. It’s now teetering on the brink, with some Conservative provincial leaders salivating at the prospect of privatization.

For months, provincial premiers have been demanding that the federal government increase health transfer payments. Indeed, the cost-sharing model which sees the federal government currently kick in around 22 percent of health funding should be revised so that Ottawa pays more of the bill. Although a deal to boost federal funding appears to be in sight, Prime Minister Justin Trudeau and the Liberals are failing to ensure that protecting public health care delivery is a part of it.

Doug Ford’s Progressive Conservative government in Ontario has been as brazen in its plans to outsource surgeries that are not “serious” to private clinics, most of which are for-profit operations. This dangerous plan — an “innovation” according to Trudeau — is the latest thrust of health care privatization in Ontario, but it’s by no means the only threat. Contracting out hospital services and so-called public-private partnership investments also pose considerable challenges to unions and the public alike.

Labor and public health advocates have long been calling for greater health care funding to be tied to protecting public delivery and investment. But as frontline workers well know, Canada’s health care crisis is not simply a funding issue — it’s also about stagnant wages and unbearable working conditions.

Canada’s Health Care Labor Shortage

Canada’s health care crisis is in large part a labor crisis. In general, unceasing anguish over a generalized “labor shortage” in Canada has had only the most tenuous relationship to reality. In the health care sector, however, worker burnout and a consequent lack of staff are all too real. While the Canadian Federation of Independent Business, the mouthpiece of Canadian employers, bemoaned a purportedly economy-wide labor shortage that was crippling business, an actual dearth of nurses and other health care professionals snowballed as deteriorating pay and working conditions drove these workers out of their jobs.

Newly released Statistics Canada payroll data helps paint the picture. Overall payroll figures show year-over-year employment across the whole economy virtually unchanged in November 2022, despite the Bank of Canada’s aggressive series of interest rate hikes (how much longer stable employment numbers will persist is debatable). Job vacancies — the bugbear of employers in Canada for most of the past year — declined another 2.4 percent, down to 850,300 from 1,002,200 at their peak, and reached their lowest post-pandemic level since August 2021. Average weekly wage growth, while continuing to lag inflation, ticked upward slightly to 4.2 percent (5.3 percent in goods-production alone).

The figures for the health care and social assistance sector contrast sharply with this picture. Weekly earnings in this sector increased a measly 1.6 percent in November, amounting to a 5.2 percent cut to real weekly wages. The sector also saw a 3.7 percent drop in hours worked. Perhaps worst of all, despite declining by 12.8 percent, the job vacancy rate in health care and social assistance remained far higher than the economy on average — at 5.6 percent, third only to accommodation and food services and construction. Astonishingly, job vacancies remain 82.5 percent higher in health and social services than they were when the pandemic began.

Meanwhile, December’s Labour Force Survey — Canada’s monthly jobs report — puts year-over-year employment in health care and social services down by over five thousand employees, after shedding roughly 17,400 workers from November to December 2022 alone.

While most provinces saw employment gains in health care and social services by the end of 2022, there was an exodus of workers from the sector in Ontario and British Columbia. In Ontario, year-over-year employment in health care and social assistance fell by over nine thousand employees, while in British Columbia eighteen thousand workers left between December 2021 and December 2022. Quebec and Manitoba also posted marginal health care employment losses. Still, despite employment gains in six out of ten provinces, all continue to report shortages of health care professionals.

In the private sector, such a labor shortage would offer an opportunity to bargain up wages, but in a public sector service like health care — especially one subject to legislative wage suppression in some provinces — a worker shortage of this magnitude translates into a crisis in service provision.

Wage Suppression Manufactured the Crisis

The health care labor shortage is the entirely predictable result of pandemic burnout and provincial governments that have chosen wage restraint over fair compensation. Conservative governments in Ontario, Manitoba, Saskatchewan, and Alberta have driven the hardest bargains.

In 2019, the Ford government in Ontario passed Bill 124, the so-called Protecting a Sustainable Public Sector for Future Generations Act, a wage suppression law capping public employee compensation at one percent annually for three years. Unions heavily criticized the government and challenged the bill in court. Their legal strategy proved successful in late November when the Superior Court of Ontario found Bill 124 unconstitutional and declared it “void and of no effect.” Rather than accept the court’s decision and publicly acknowledge the bill’s role in driving the health care labor shortage, the Ontario Conservatives appealed the decision — leaving many public sector workers without their constitutional right to free collective bargaining.

As Ontario’s Financial Accountability Office (FAO) reported, Bill 124 did indeed “save” the province roughly $9.7 billion in wages, but at the cost of provoking labor crises across a range of public services, principally health care and education. The FAO’s September 2022 report found that job vacancies in health care had doubled since the bill was introduced in 2019.

In Manitoba and Alberta, less robust but still impactful public sector wage suppression has also contributed to the staffing crisis. Even in Ontario, before the direct attack represented by Bill 124, base salaries in public sector union settlements averaged only 1.2 percent annually between 2011 and 2019.

By all accounts, most provinces are in healthy fiscal shape. The Ontario government chose to attack public sector workers’ wages while simultaneously reducing program spending and amassing a budget surplus of over $2 billion in fiscal year 2021–22. In April of last year, the FAO reported that Ontario continued to have the lowest per-capita program spending in the country and the second lowest revenue, just ahead of Alberta.

Lackluster revenue generation and meager program spending are a direct result of provincial governments choosing austerity over properly funding health care systems and adequately paying workers.

The Best-Laid Plans

Instead of addressing the sources of the labor crisis, some provincial governments are now advancing plans to attract nurses and health care workers from other parts of Canada. Rather than repeal wage restraint legislation, bargain in good faith, and generally treat health care workers with decency, these governments are attempting to effectively poach workers from other provinces.

Earlier this month, Ford’s government announced that it will allow out-of-province nurses to start working “immediately” in Ontario. Legislation that the government plans to introduce in February would permit health care workers licensed in other provinces to practice upon arrival in Ontario, instead of first registering with one of the province’s professional regulatory colleges.

New Brunswick meanwhile has been offering “hefty” signing bonuses to out-of-province nurses and holding hiring fairs in Montreal, Ottawa, Toronto, and Edmonton. Ontario and New Brunswick aren’t the only provinces competing with one another to woo health care workers away.

The complete irrationality of provinces competing for health care workers during a national labor shortage in the sector is obvious. Observers in Manitoba, for example, are already expressing concern that Ontario’s plan could put further strain on “the keystone province’s” overstretched hospitals.

As well, provincial governments are ramping up their efforts to bring foreign nurses to Canada. In November, the government of Saskatchewan announced a “targeted health care recruitment mission” to Manila, Philippines, with the objective of hiring hundreds of nurses. The same month, Andrew Furey’s Liberal government in Newfoundland and Labrador made a similar announcement, launching a nurse recruitment effort in India. British Columbia and Quebec also have introduced new measures to tap nurses internationally.

Although these plans don’t carry the same risks and shortsightedness as the out-of-province recruitment schemes, Canada is notorious for the byzantine system new immigrants encounter when trying to have their foreign credentials recognized. It’s not uncommon for foreign-trained health care professionals to wait months or even years for approval to work in their fields. Without addressing this issue, international recruitment alone is no solution.

Provinces, including Ontario, are also working with health care licensing bodies to make regulatory changes that would supposedly allow greater numbers of nurses to enter or return to the sector. There are roughly 5,300 nonpracticing nurses in Ontario, but the College of Nurses of Ontario’s rules state that they must have worked within the past three years to be reinstated. This rule could be relaxed or eliminated. Regulatory colleges and unions have been supportive of easing interprovincial work rules, but as part of national labor-force planning, not as a faux solution to a health care labor shortage.

Common to all of the above strategies is a myopic focus on recruitment over retention. Health care workers, underpaid and mistreated by provincial governments, are burned out after a pandemic that seems to have ceased for nearly everyone but them. Government wage repression has allowed inflation to decimate workers’ pay, especially in Ontario. Now premiers across the country want to poach workers from each other’s provinces, as though the health care labor crisis isn’t national.

Nurses unions have sustainable plans to fix these problems at their root, which center on paying good wages and bargaining in good faith with health care unions. It’s up to Canadian labor to turn these proposals into reality.