Composition and Importance of the Sector

The health care and social assistance sector encompasses virtually all aspects of the health care system, as well as long-term care and predominantly private health establishments such as dentists' offices and healthcare practitioners. The social assistance sub-sector is comprised of organizations such as those providing community food and housing services, individual and family services, as well as child care establishments. The provincial governments provide funding for many subsets of this sector, while most hospitals in the region are run directly by provincial health authorities.

This sector employed the largest share (16.4%) of the region's workforce in 2023, totaling 198,600 individuals. The two largest sub-industries - hospitals and ambulatory health care services - accounted for over 60% of the sectoral employment, while social assistance and nursing and residential care facilities comprised the remainder.

In 2023, the sector contributed almost $12 billion to Atlantic Canada's real Gross Domestic Product (GDP), representing 10.4% of the region's total output.

Geographical Distribution of Employment

Employment-wise, the sector was the largest in every Atlantic province except Nova Scotia in 2023. Newfoundland and Labrador had the highest concentration of employment in this sector, at 19.2% of its entire workforce. Conversely, Nova Scotia had the lowest share of employment, at 15.5%, despite accounting for nearly two-fifths (77,000) of the sectoral workforce in the region.

The Halifax area in Nova Scotia, the Avalon Peninsula in Newfoundland and Labrador, and the Moncton-Richibucto area in New Brunswick had the largest concentration of workers in this sector within their respective provinces. Together, these three regions accounted for nearly 40% (78,700) of the sector's employment and had almost an equal share of the region's population in 2023.

TABLE 1. Employment by Province or Economic Region

Workforce Characteristics

Workers in the health care and social assistance sector are often highly educated, as several years of post-secondary education and professional licensing are required for occupations such as physicians, dentists, nurses, and other health or social work practitioners. In 2023, only a small percentage of workers had less than a high school diploma (3.3%), while the vast majority had at least a post-secondary certificate (83.3%) - much higher than the average share (68.8%) for all workers in Atlantic Canada. Additionally, 12% of health care and social assistance workers held a degree beyond the bachelor's level, largely due to the presence of specialized workers in hospitals and ambulatory health care services.

Female workers outnumber male workers by a ratio of 4.5 to 1 in this sector, partly due to the large size of historically female-dominated nursing professions. The workforce is also predominantly in the core working-age range, with 68.6% of workers between the ages of 25 and 54 - similar to the overall age distribution of the Atlantic workforce.

The share of workers in this industry employed in the public sector was 48.9% in 2023, compared to just 26.6% for all industries. The elevated share of public employment reflects the large role of provincially funded organizations in certain subsets of the sector. Most jobs in this sector are full-time (83.6%) and permanent (79.5%), both of which are close to the respective all-industry averages for the region.

Main Occupations

Occupations in health care and social assistance are diverse. In addition to positions related directly to patient diagnosis and treatment or community and social services, there are also supporting occupations such as custodians, receptionists, and food workers.

 In 2023, the two largest occupations in this sector were related to nursing: nurse aides, orderlies and patient service associates (26,250) and registered nurses and registered psychiatric nurses (26,100). Together, these two occupations accounted for more than a quarter of the sectoral employment. Additionally, the third largest occupation was early childhood educators (ECEs), accounting for 12,200 workers (6.1%).

TABLE 2. Top Five Occupations

Employment in health care and social assistance went up by 5,100 (+2.6%) in 2023, reaching 198,600. Provincially, the fastest growth rate occurred in Prince Edward Island, at 17.5% (+2,100), followed by New Brunswick, where the number of workers expanded by 8.2% (+4,700). In contrast, Newfoundland and Labrador posted a more moderate growth rate of 2% (+900), while sectoral employment in Nova Scotia shrank by 3.3% (-2,600).

Despite employment having expanded in most provinces, the sector faces a limited supply of workers and significant recruitment and retention challenges. Throughout 2023, quarterly job vacancy counts in the sector ranged from 9,870 to 11,035, exceeding the number of unemployed workers in the sector (4,600) by more than two-to-one. The situation is further exacerbated by retention and recruitment issues, as burnout and stress contribute to early retirements and erosion of the existing workforce. Concerns expressed among industry associations include physicians retiring without having found replacements to take over practices, as well as significant challenges in recruiting and retaining nurses and early childhood educators (ECEs) exist across the region.

 The Atlantic Region has a higher share of residents aged 65 years and older, at 22.8% in 2023, compared to the national average of 18.9%. This aging population, coupled with increasingly complex comorbidities among patients, has contributed to the growing demand for service in this sector. Additionally, Atlantic Canada's population has increased by more than 125,000 in the last two years, including a gain of nearly 72,000 in 2023 alone. This demographic shift has put pressure on public services, increasing demand for primary care, nursing and residential care services, child care spaces, diagnostic and medical services in hospitals, and many others. For example, in Nova Scotia, more than 160,000 residents (over 16%) were on the provincial waitlist for a family doctor as of June 1, 2024, while in New Brunswick, patients awaiting long-term care placements occupy a third of the hospital beds (33.6%), according to the latest report (June 2024) by Horizon Health Network.

Provincial governments across Atlantic Canada responded to these pressures by increasing health care expenditures in their 2024-2025 budgets with the goal being to hire additional health care workers, create and expand collaborative care teams, and support workforce development strategies.  

Provincial health organizations are increasingly turning to international recruitment, as well as providing various forms of financial incentives and benefits to recruit and retain physicians, nurses, continuing care assistants (CCA), and ECEs. Efforts are also being made to increase the domestic supply of health care workers through the establishment of two new medical schools (UPEI and CBU - to train 20 and 30 new doctors per year, respectively), the expansion of health-related programs in universities and colleges, and the introduction or expansion of roles such as emergency medical responders, physician assistants, and midwives. 

Notable recent capital investments in this sector include two new nursing homes in Shediac ($70 million; 190 beds) and Oromocto ($50 million; 60 beds) in New Brunswick, and a new adult mental health and addiction facility ($250 million) in Newfoundland and Labrador. Meanwhile, in Nova Scotia, the QEII Infirmary expansion (estimated cost: $2 billion+) and Cape Breton Regional Hospital redevelopment (estimated cost: $700 million) are underway to support the growing population in the province. Prince Edward Island also plans to invest $215 million over five years to improve healthcare facilities and purchase new equipment.  

Employment growth in health care and social assistance is forecasted to average 2.3% over 2024 to 2026, surpassing the region's overall projected employment growth by 0.6 percentage points.

 All four Atlantic provinces are expected to see job growth in this sector. Prince Edward Island is projected to lead with a 3.0% growth rate, while Newfoundland and Labrador is expected to grow at a slower pace of 1.7%, over the projection period. In New Brunswick and Nova Scotia, the industry is forecasted to grow at moderate rates of 2.5% and 2.4%, respectively, exceeding their overall employment growth projections.

This projected job growth is largely driven by increased demand for services resulting from the recent rapid population growth and an aging population. Although the region's population growth is anticipated to slow down due to recent immigration policy changes, demand for health care and social assistance services is expected to remain elevated. 

All Atlantic provinces have agreements with the federal government through Canada-Wide Early Learning and Child Care Agreements, which aim to provide funding for affordable childcare spaces and include support for workforce development. So far, Prince Edward Island and Newfoundland Labrador have reached $10-a-day childcare fees, while Nova Scotia and New Brunswick are on track and have achieved a 50% reduction in fees. However, lower childcare fees, along with growing population, have increased demand for childcare spaces and there are widespread reports of long waitlists for childcare spaces across the region. As more spaces are added, more ECEs and support staff will be needed to support the expanding number of childcare spaces in the region.

Additionally, all Atlantic provinces have signed health transfer agreements with the federal government through the Working Together to Improve Health Care for Canadians Plan (NS - $5.07B, NB - $3.94B, NL - $2.28B, and PEI - $1.08B over 10 years). These investments aim to improve health care access and strengthen the health care workforce. These investments, along with the recently announced new Youth Mental Health Fund and the Canadian Dental Care Plan, are expected to support employment growth for this sector. 

Though challenges with recruitment and retention are expected to continue for the foreseeable future, employment is anticipated to grow at a moderate pace through 2026, as provincial governments and other organizations respond to increasing demand from a growing and aging population.