A Labour Market Study of Occupational Therapists in Saskatchewan

A Labour Market Study of Occupational Therapists in Saskatchewan Summary prepared for the: Saskatchewan Society of Occupational Therapists Annual General Meeting May 6, 2017 Doug Elliott Sask Trends Monitor 444 19th Avenue Regina, Saskatchewan S4N 1H1 306-522-5515 sasktrends@sasktel.net www.sasktrends.ca

Background The study, The Labour Market for Occupational Therapists in Saskatchewan, was commissioned by the Saskatchewan Ministry of Advanced Education in partnership with the Ministry of Health. The research was conducted by Doug Elliott, the principal of QED Information Systems, a Reginabased consulting firm. Mr. Elliott has previously conducted similar studies of the labour market for other health professions including nurses and lab technicians. The bulk of the work took place from July to September 2016 but the report was not released until April 2017. A copy is available on www.sasktrends.ca. This research was organized around three questions asked by the Ministry. How many occupational therapists are practising in Saskatchewan and how has the number changed over time? What factors are affecting this labour market supply? In particular, how many are graduates of the seats purchased from the University of Alberta? What is the labour market demand for occupational therapists in the province and how is it likely to change in the future? What are the educational options available to address any imbalance between supply and demand? In particular, should an entry-to-practise program for occupational therapists be established in Saskatchewan? May 6, 2017 2

Outline The research involved two undertakings that were mainly quantitative and two that were mainly qualitative. The quantitative ones were as follows. Statistical data from the Canadian Institute for Health Information (CIHI), Statistics Canada, and other reliable sources were obtained and analyzed. A survey of members of the SSOT was undertaken. The balance of the work had quantitative overtones but the majority of the research was qualitative. We conducted a series of face-to-face and telephone interviews with employers of occupational therapists, with organizations that use their services, and with individual occupational therapists. A separate set of interviews about establishing a School of Occupational Therapy was conducted with officials from Saskatchewan Polytechnic, the University of Regina, and the University of Saskatchewan. The opinions expressed in the report do not necessarily represent those of the SSOT or the government of Saskatchewan. This summary is organized in the same way as the report. Basic Counts Supply Indicators Demand Indicators Conclusions New CIHI data for 2015 became available after the report was released. May 6, 2017 3

Basic Counts Data from Statistics Canada and the Canadian Institute of Health Information (CIHI) are used to describe the number of occupational therapists in the province, how the number has changed over time, and how we compare with other provinces.

Numbers of Occupational Therapists in Saskatchewan Figure 2.7: Occupational Therapist Workforce in Saskatchewan, 2006 to 2014 400 CIHI uses information from the provincial regulatory agencies to calculate the number of occupational therapists that are practising in Canada. 350 300 250 200 To calculate the supply of OTs, CIHI includes occupational therapists who were registered and either employed as occupational therapists or on leave from an occupational therapist position. The profession has expanded rapidly in Saskatchewan, growing from 211 OTs in 2007 to 339 in 2014. 150 definitional change The number of other health professions (e.g. nurses, physiotherapists) was not growing as quickly. 100 2006 2008 2010 2012 2014 May 6, 2017 5

Occupational Therapists by Province in 2014 Canada Sask PEI Nfld Figure 2.6: Occupational Therapist Workforce per 100,000 Population, 2014 30 34 35 42 The OT workforce of 339 in 2014 works out to 30 occupational therapists per 100,000 population. The workforce is the smallest among the provinces. To reach the national average of 42 per 100,000, we would need 137 more OTs working in the province. Ont 37 B.C. NB 43 43 Alta NS 45 47 Man 49 Que 51 10 15 20 25 30 35 40 45 50 55 60 May 6, 2017 6

Changes over Time Figure 2.8: Interprovincial Comparison of Growth Rates, Occupational Therapist Workforce, 2010 to 2014 This rapid growth rate of nearly 4% per year was highlighted by provincial officials as evidence that the supply was increasing. Canada NB NS 0.3% 1.7% 2.7% In fact, the growth was probably a by-product of the general migration into the province during the economic boom. PEI Que Ont Nfld 2.1% 2.2% 2.6% 2.8% Data released since the report was released shows that the number of occupational therapists fell from 339 in 2014 to 330 in 2015 as the economy slowed. B.C. Man Sask Alta 3.1% 3.4% 3.9% 4.2% 0% 1% 2% 3% 4% 5% average annual increase from 2010 to 2014 Saskatchewan was one of only two provinces to show a decline in 2015 Nova Scotia was the other. On a per capita basis, there were 29 occupational therapists per 100,000 population in 2015. May 6, 2017 7

Supply Indicators This section describes some of the characteristics of occupational therapists working in the province.

Sex and Age Group Figure 3.2: Age Distribution of Occupational Therapists, 2014 As in other provinces, the vast majority of OTs (88% in 2014) are women. Canada Alta 18% 20% 62% 61% 20% 18% Occupational therapists in Saskatchewan tend to be younger than those in other provinces. In 2014, 26% were under thirty years of age compared with the national average of 18%. Sask 26% 56% 18% The loss of OTs to retirement is not a major issue in the province; inter-provincial migration is. Four out of ten occupational therapists are living alone or with a spouse and no children and so will be quite mobile. Man 19% 58% 23% Temporary exits for maternity leave are also common. 0% 20% 40% 60% 80% 100% Under 30 30 to 49 50 & older May 6, 2017 9

Educational Capacity Figure 3.17: Capacity of Occupational Therapy Programs and Training Programs, Canada, 2013 Nova Scotia (Dalhousie) Quebec (5 programs) Ontario (5 programs) In 2013, the universities in Canada had a training capacity for occupational therapists of 968 seats. The University of Alberta, where Saskatchewan currently purchases fifteen seats, has a capacity of 112 per year. In recent years, the enrolment has been at the maximum of thirty students (15 in each of two years) and all have graduated. Manitoba U of M) Alberta (U of A) Staff from the Ministry of Advanced Education used a list of graduate names from the program with registration at SSOT to estimate that about one-half of these graduates come to practise in Saskatchewan. B.C. (UBC) 0 60 120 180 240 300 360 number of seats May 6, 2017 10

Location of Graduation Figure 3.11: Location of Graduation (Highest Level in OT), Those Employed in Occupational Therapy The majority of occupational therapists working in Saskatchewan graduated from the University of Alberta. Other Canadian University 13% Foreign 6% In the survey of occupational therapists, we found that the most common training path (among OTs working in Saskatchewan) was directly from a Saskatchewan high school to the U of A program. University of Manitoba 25% University of Alberta 56% May 6, 2017 11

Flows Into and Out of Occupational Therapy Figure 3.18: New Registrations as a Percentage of Supply, Five Year Average (2010-2014) 15% 12% Figure 3.19: Exits as a Percentage of Supply, Five Year Average (2010-2014) 12% 10.7% 10.5% 12.8% 10.7% 10% 8.9% 8.5% 9% 8.9% 8% 6% 7.0% 6.3% 6.1% 6% 4% 3% 2% 0% B.C. Alta Sask Man Ont 0% B.C. Alta Sask Man Ont Compared with other provinces, Saskatchewan has a relatively high turnover rate among occupational therapists. This is consistent with the fact that OTs in Saskatchewan tend to be young this may be their first position as an OT. May 6, 2017 12

Other Factors Affecting Supply Figure 3.23: What Factors Would Make you Leave the Profession Permanently? Workload prevents quality care/burnout Pay and benefits Scope of practice Nothing/Retirement only Family/personal reasons Advancement opportunities In the survey of occupational therapists conducted for the report, workload issues were mentioned by more than onehalf of respondents as a factor that could make them leave the profession. Pay and benefits were also an issue and were mentioned even more often as a possible reason for moving to another province. Respondents were also asked about the best and worst parts of working in the province as an occupational therapist. The results are shown on the next two pages. Other 0% 10% 20% 30% 40% 50% 60% percent of respondents (multiple responses permitted) May 6, 2017 13

Best Part Figure 3.25: Best Thing about Working as an Occupational Therapist in Saskatchewan Helping clients (general) Variety of work/scope of practice/being a generalist Colleagues (general) Sense of community among occupational therapists Opportunities/can specialize Work schedules, pay, or benefits Good employer or work environment Available equipment Can work near family, nice place to live Helping children (specifically) Travel Negative comments Other 0% 5% 10% 15% 20% 25% 30% 35% 40% percent of respondents (multiple responses allowed) May 6, 2017 14

Worst Part Figure 3.26: Worst Thing about Working as an Occupational Therapist in Saskatchewan Workload/caseload/staff shortage/funding shortage Being underappreciated or undervalued (general) Being underappreciated by colleagues or employer Pay or benefits or working conditions Poor educational or other opportunities for advancement No school/teaching opportunities Not enough occupational therapists in mental health Poor service to certain client groups Limited scope of practice Being underappreciated by the public or clients Weather, travel, driving Other 0% 10% 20% 30% 40% 50% 60% 70% percent of respondents (multiple responses allowed) May 6, 2017 15

Demand Indicators This section looks at the kinds of positions that occupational therapists hold and the kind of work that they do.

Type of Employers Figure 4.1: Kind of Employer, Saskatchewan, 2014 In 2014, more than one-half of the occupational therapists worked in a hospital setting. Professional Practice 10% Other 10% Compared with other provinces, Saskatchewan occupational therapists are: less likely to be working in the community; and less likely to be in a professional practice. Hospital 53% Community 27% May 6, 2017 17

Area of Practice Figure 4.5: Area of Practice, Saskatchewan Occupational Therapists, 2014 CIHI captures the area of practice from the registration forms. Other/ Unknown 26% Mental Health 3% In 2014, more than one-half of occupational therapists worked in physical health. Compared with other provinces, Saskatchewan OTs are much less likely to be working in mental health 3% compared with the national average of 11%. Additional direct service areas 15% Physical Health 56% May 6, 2017 18

Hours of Work 300 250 200 number of OTs Figure 4.8: Hours of Work full-time All of the growth since 2009 has been among occupational therapists working in full-time positions. Saskatchewan occupational therapists are more likely to be working full-time than occupational therapists in other provinces - 73% do so compared with the national average of 64%. 150 100 part-time This explains some of the difference in per capita counts of occupational therapists. Those in Saskatchewan tend to work longer hours than those in other provinces. 50 0 2009 2010 2011 2012 2013 2014 May 6, 2017 19

Earnings and Pay Rates $50 $45 $40 Figure 4.12: Wage Rates in Collective Bargaining Agreements Covering Occupational Therapists max Occupational therapists in Saskatchewan have wage rates that are: above those in Manitoba; below those in Alberta; and near the rates in B.C. The 3.5% reduction proposed by the provincial government will increase the economic incentive for Saskatchewan occupational therapists to move to other provinces. $35 midpoint $30 min $25 B.C. (Apr 2014) Alta (Apr 2014) Sask (Apr 2012) Man (Apr 2013) May 6, 2017 20

Vacancy Rates Figure 4.13: Vacancy Rates, Occupational Therapists, Full and Part Time Positions, 2015 Vacancy rates are the normal measure of unmet demand in the labour market. Regina Saskatoon SAHO conducted a survey of vacancy rates in the health professions as part of the review of the market supplement committee. According to that survey, there were no vacancies in Regina but a 20% vacancy rate in rural Saskatchewan. Other Total 0% 5% 10% 15% 20% 25% Vacancy rates are not a particularly useful measure of demand because: employers may choose not to advertise for an occupational therapist if they feel there are none available; and more importantly, they may not even feel that they need occupational therapy services. May 6, 2017 21

Other Factors Affecting Demand The population of the province is growing more slowly than it has in recent years but even with the current growth rate of 1.0% per year, the number of occupational therapists would have to increase by three to four persons per year to maintain our per capita number of occupational therapists. The provincial government s recently released Disability Strategy, if implemented, will undoubtedly lead to an increased demand for occupational therapists. The same is true for the Mental Health and Addictions Plan. Many SSOT members mentioned mental health as an area that is currently under-served by occupational therapists. The provincial population is aging. With more seniors, there will be an increase in the demand for many kinds of health care services including occupational therapy. Some examples include fall prevention, recovery from hip replacements, and increased home care services. The number of school-aged children will increase in the coming years because the echo generation and the Aboriginal population are in the family formation age group and the number of births is increasing. Even maintaining the current per-student level of therapy services in the education system will require more occupational therapists. The provincial government is committed to reduced waiting times for surgery and emergency services. The services of occupational therapists are known to help patients return home after a stay in the hospital. May 6, 2017 22

Conclusions Things We Know We know that the number of occupational therapists in the province is well below the national average. We know that the number of graduates from the purchased seats at the University of Alberta is only enough to maintain the current number of OTs in the province. We know that the wage rates for occupational therapists are near the national average but well below those in Alberta. We know that the turnover rates for occupational therapists are relatively high compared with other provinces they frequently move from one position to another in the province. Things We Don t Know We do not know why the demand for the kind of services provided for occupational therapists is high in some sectors and probably increasing but that the need for these services has not translated into a demand for occupational therapists. We do not know why some employers (e.g. school boards and mental health) do not hire more occupational therapists. We do not know what the impact of the economic downturn in the province will have on the number of occupational therapists coming to Saskatchewan from other provinces. We do not know why the demand for occupational therapy services has not translated into more occupational therapists setting up a private practise. We do not know to what extent a school of occupational therapy in the province would increase the supply of and demand for occupational therapists. May 6, 2017 23