By Senthujan Senkaiahliyan, Smith School of Business at Queen’s
with Christopher Cotton, Queen’s Economics Department and School of Medicine

As the government and society works to address the challenges of COVID-19 pandemic’s Omicron wave, there has been a lot of discussion around the capacity of the healthcare system to deal with the increased number of cases. Much of the public discussion around these issues have focused on well recognized contributing factors such as vaccine hesitancy and the emergence of increasingly-contagious variants. However, there are many other less-discussed factors that have reduced the capacity of the healthcare system to deal with COVID.

Some of Ontario’s policies have contributed to reduced healthcare capacity in this time of crisis. Bill 124 is one of the measures enacted by the Ontario Government to limit wage increases in the public sector. What was first introduced as a fiscally responsible management plan to protect the sustainability of public services has, however, impacted the ability of the health system to respond to staffing shortages and capacity needs during the COVID-19 pandemic.

Bill 124 applies to most organizations under the public sector, including most provincial healthcare institutions. It effectively limits salary and wages increases for public sector workers including healthcare workers. An excerpt from Bill 124 (Article 10 (I)):

“No collective agreement or arbitration award may provide for an increase in a salary rate applicable to a position or class of positions during the applicable moderation period that is greater than one per cent for each 12-month period of the moderation period, but they may provide for increases that are lower.”

This effectively caps annual pay increases to 1%, substantially below Ontario’s annual rate of inflation, which was estimated at 4.9% this past October. This cap is in place for the moderation period of three years starting in 2019.

This legislation means that real wages for healthcare professionals are falling even as the demands of the job and workload are increasing. It is little wonder why Ontario has seen a rising shortage of nurses and other healthcare workers, which some experts have predicted will be `beyond anything we have ever experienced‘ and which likely contributes to the inability of the system to keep up with need.

The labour market constraints have contributed to a mass exodus of nurses either leaving the profession or utilizing their clinical skills in non-bedside roles. The bill was introduced prior to the onset of the pandemic and claims to be investing in a sustainable Ontario however we can see through this graph, that Ontario is well on its way to a severe nursing crisis exacerbated by this bill.

Sustainable health care is the appropriate balance between the cultural, social, and economic environments designed to meet the health and health care needs of individuals and the population without compromising the outcomes and ability of future generations to meet their own health and health care needs. Under Bill 124, the marked increases for the next three years are highlighted for nurses.

Newly graduate nurses are the most inclined to take on bedside roles due to their willingness to get direct patient experience. However, with these wage forecasts for the next three years and no discrepancy in pay between patient facing and non-patient facing roles, new graduates will choose the less burdensome route, which is what we are witnessing in Ontario with new graduates being employed at vaccination centres and in care coordination roles. With every passing year, we will begin to witness a skills gap in which these nurses will not be equipped with the right clinical skills to take on bedside care. Without direct action, such as incentivizing bedside care, prioritizing nursing mental health, and providing adequate support, Ontario is heading towards a very unsustainable healthcare future. 

Senthujan Senkaiahliyan is an MBA and Masters in Artificial Intelligence candidate in the Smith School of Business at Queen’s. He has worked in the healthcare sector since 2017. Christopher Cotton is a Professor at Queen’s with appointments in the Department of Economics, the School of Policy Studies, and the School of Medicine. He has worked on COVID-19 policy since 2020.

Featured photo: Dr. Annalisa Silvestri during the Covid-19 pandemic, 2020. Creative common license, source https://commons.wikimedia.org/wiki/File:Covid-19_San_Salvatore_09.jpg