Labour Market Trends: Summary

The purpose of chapter 2 has been to sensitize those providing career services to the kinds of issues that have an impact on occupational growth and decline. In particular, the following have been considered:

By way of example, the remainder of the chapter summarizes and illustrates in detail how these labour market trends combine to influence employment opportunities in the health care industry. The health care industry provides a good example because nearly all the trends discussed here are affecting this industry. It provides an excellent example of how government policies can affect employment in a sector.

Illustration of the Impact of Labour Market Trends on the Health Care Industry

As pointed out in section C of this chapter, economist Nuala Beck lists the health sector as one of the areas of industrial growth for North America. However, despite the growing demand for health care products and services, deficit-ridden provincial governments have curtailed medical expenditures so cost containment and improved productivity are going to be the themes in hospitals and the health care industry throughout the 1990s.

Part of the result of reducing costs has been a move to shift care from the hospital to the community. Health care workers have lost their jobs during this transition and restructuring of health care, and more losses are expected in the next few years. However, in the long term, health care that can be provided to an aging population - chronic care, rehabilitation, gerontology - in a cost-effective way will offer many opportunities.

To cut costs, the ways in which medical services are delivered must be changed. Since doctors' services represent the largest expense in delivering medical services, attempts are being made to decrease the need for doctors in the health care system. Many health economists are looking to the use of nurse practitioners as a major instrument in the struggle to provide more cost-effective health care in Canada.

Nurse practitioners are registered nurses who have received advanced education enabling them to handle many aspects of primary health care such as annual checkups and counselling. They are likely to practice in community health centres and public-health clinics.

Nurse Practitioners: Growing Field

Inside the neo-natal unit at Toronto's Women's College Hospital, nurse practitioner Tricia Scott diagnoses premature infants, studies X-rays and directs registered nurses. When resident doctors were scaled back more nurse practitioners were hired at a reduced cost.

More are on the way. Ontario has announced it is setting up special courses to teach nurses to do some of the things doctors have traditionally done, including diagnosis and treatment of common disease and injuries.

Other provinces, such as British Columbia, use practitioners who take some extra courses, but no official programs are available as there are in Ontario. In the Comox Valley on Vancouver Island, a centre run by five nurses started seven months ago. They mostly manage patients' diets and lifestyles. If the two-year pilot project is a success, more responsibility could follow.

In Alberta, proposed amendments to the Public Health Act would allow nurses to prescribe medicine and perform some of the functions of doctors in areas where no doctor is readily available. Health department officials say the concept could be expanded to inner-city facilities to speed up delivery of primary care.

SOURCE: Vancouver Sun, Dec. 14, 1994 and February 16, 1995.

Ontario is making the first move in Canada to introduce nurse practitioners as a major part of the health-care system. Those interested in the nursing field would be well advised to obtain university degrees as part of their training. It is expected that nurses who specialize, become nurse practitioners and obtain a master's degree will have very little trouble finding employment. On the other hand, one job forecaster predicts that community college nursing programs will be eliminated and the number of nurses graduating is expected to decline as a result. Instead, colleges will focus on courses for registered nursing assistants (RNAs) and health care aides as demand increases for these medical workers (Campbell, 1994, p. 86).

It appears that nursing is heading in the same direction as the clerical field. That is, a declining demand for middle level skilled workers, such as general duty nurses who don't have a university degree and an increased demand for highly skilled nurse practitioners and lower skilled registered nursing assistants (RNAs) and health care aides.

Many fields such as printing, clerical, auto parts and broadcasting are reducing the number of workers because of technology. However, in the health care sector, technology is generally seen as increasing the staffing requirements because many of the technologies are complementary to existing ones as opposed to replacing them. Emerging fields include laser and lithotripsy technicians, and molecular genetic technologists.

Although technology is a major shaping force in the health care field, reduced government spending will control the entry of high-tech developments into the public realm. Information technologies in health care include computerized patient records, scheduling, accounting, pharmacy as well as health care literature, decision support systems, health devices data bases, public health information and government information systems.

A truly comprehensive patient care system could replace all manual systems of patient care documentation, all methods of assignment of health care personnel, workload measurement technologies, and report writing for clinical research and auditing of medical records for legal/professional requirements.

The health care sector is likely to make greater use of these information technologies to improve productivity and contain costs. It will likely lead to less clerical and middle management staff and more opportunities for technical workers such as chief information officers, computer application specialists, computer programmers and data base managers.

Samples of Technologies in the Health Care System

A. Diagnostic Technologies such as 3-D imaging techniques that will replace some X-rays; nucleic acid probes tagged with a tracer substance used to locate or identify.

B. Emergency Care Technologies such as new trauma management techniques.

C. Therapeutic Technologies such as artificial intelligence in ventilation which would adjust oxygenation, adjust ventilation, and detect deterioration of the patient; non-invasive shock waves that destroy kidney and gall stones; recombinant DN which is the ability to insert altering genetic information into the cell; pain management techniques.

D. Rehabilitation Technologies such as new and better assistive devices including environmental control systems which permit disabled people to operate appliances; Smart houses.

E. Computer Technologies such as computerized mannequins that allow anaesthetists-in-training to practice their techniques with simulated patient problems and equipment malfunctioning programmed to occur.

The aging of the baby boom generation will mean increased demand for both highly skilled workers (geriatricians, long-term care administrators, physiotherapists, social workers) and for workers with little or no post-secondary training (nurses aides, home care workers, kitchen staff, laundry and housekeeping aides, maintenance workers, office co-ordinators and admissions receptionists). However, as aging Boomers use health services in ever increasing numbers, cost containment and improved productivity will remain a priority.

In a strange paradox, the high cost of technological advancements in medicine and the need to reduce health care spending are serving to advance the consumer preference to have holistic, complementary forms of medicine available alongside traditional medicine.

In Ontario, public pressure for mother-controlled and family-centred birthing is leading to the development of three low-tech birthing centres. Economic pressure to save money by using midwives instead of specialists is supporting this move. British Columbia has also made midwifery a regulated health care profession. And Quebec and Alberta are following.

In addition to midwives, public acceptance of nurse practitioners should also be high. These health care professionals will likely be salaried, so it is more likely that nurse practitioners will spend a bit more time with a patient because they're not involved in revolving-door fee-for-service medicine. They also emphasize keeping people well, rather than just treating illness.

Patient-focused care is a new management strategy being adopted by some hospitals in which staff members learn skills from other health-care disciplines. For example, housekeepers used to just clean hallways, lounges and patients' rooms. But under this strategy, they are retrained to do certain bedside tasks. The housekeepers are renamed patient-care associates and are paid at a higher rate. These upgraded housekeepers are helping patients with their hygiene, assisting with feeding and transferring patients from bed to chair to bathroom.

Patient-focused care originated in the United States in the late 1980s to reduce costs. It has since spread to Great Britain, Australia and some Canadian provinces. In California, Ontario and Manitoba hospitals where patient-focused care has been introduced, there has been job loss particularly for nurses.

This chapter has provided an introduction to several major trends that affect the Canadian labour market. They include:

The intention of this chapter is to introduce practitioners to the kinds of issues that have an impact on occupational growth and decline as illustrated in the example of the health care industry.

In almost all cases, the trends demand higher skill levels of workers. For this reason, one of the most useful things practitioners can do to help prepare clients and students for the future is to advise them of the skills and attitudes needed to operate successfully, no matter what jobs remain and what new jobs will emerge. Chapter 4 is devoted to this subject.

Please note that this chapter on major labour market trends is only the first step. There are many more kinds of labour market information that need to be used and understood in the career development process.

The next chapter provides more specific information on occupations. The National Occupational Classification system is introduced, followed by an examination of occupational forecasting and occupational mobility.