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Nurse practitioners to make 80% as much as family doctors for publicly-funded primary care

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The Alberta government says it will pay nurse practitioners 80 per cent of what family doctors are paid – if they want to practice comprehensive primary care.

A payment model for the new Nurse Practitioner Primary Care Program has been finalized.

The program, announced in November, will allow nurse practitioners (NPs) to operate their own publicly-funded practices, whether in stand-alone clinics or in existing primary care clinics.

"It will certainly expand access for individuals who want to find a primary-care provider, given the fact that we will now have nurse practitioners who can have their own panel of patients," Health Minister Adriana LaGrange said Wednesday.

LaGrange said NPs will have to apply and be accepted into the program.

To qualify, a practitioner must commit to caring for at least 900 patients and offer after-hours services on weekends, evenings and holidays.

Those accepted will receive 80 per cent of the funding received by family doctors.

"Nurse practitioners can do roughly about 80 per cent of the services that physicians can do," LaGrange explained. "They don't do surgery, they typically don't also provide services within hospitals as physicians do."

Panel size

Jennifer Wankiewicz, owner and president of River Stone Nurse Practitioner Clinic, said NPs are an underutilized health-care workforce in Canada.

She said they offer many of the services a family doctor does, like referrals, diagnostics and prescriptions – though certain drugs are restricted.

While she's excited about the new program, Wankiewicz said she's unsure how realistic the 900-patient panel minimum will be.

"Considering that nurse practitioners spend an awful lot more time with their patients than a general practitioner often does … that's a difficult number for them," Wankiewicz said. "It remains to be seen whether or not that number will actually pan out and provide them with the opportunity to provide the care that they want."

Depending on how services roll out, Wankiewicz said her clinic could employ eight full time NPs and care for between 6,000 and 9,000 clients.

Currently, NP clinics like River Stone charge for services or offer paid membership fees.

LaGrange said any NPs in the new program will no longer be able to charge for services covered by the province by the Canada Health Act.

Alberta Medical Association president Dr. Paul Parks said Thursday that adding more primary health care providers is a positive step.

However, he believes NPs will be more effective if they're supported in partnership with family doctors.

"If it's going to be siloed, and totally disintegrated and not connected, I think it's going to be a wasted opportunity," Parks said. "And I don't think that the government will find they'll get the value that they want." 

Funding model

Jennifer Mador, president of the Nurse Practitioner Association of Alberta (NPAA) said the program is a "great advancement" for the profession.

However, its ultimate success will depend on the long-term viability of the funding model, she said, pointing to financial difficulties faced by Alberta family doctors in recent years.

"We're not naive to the fact that our physician colleagues have been struggling with their funding model," she said. "That's not lost on us.

"So we need to ensure that over the long term that the funding model is sustainable and keeps these NP clinics viable."

Mador said she was hoping to see a higher level of compensation offered, and she will be looking to renegotiate in the future.

"Of course, we would like to see equal pay for equal work," she said. "Nurse practitioners won't be getting a 20 per cent discount on their overhead or any other expenses that they need to be able to run these clinics."

The province said overhead and practice-related costs have been factored into the 80 per cent compensation rate.

According to Lorian Hardcastle, a law professor at the University of Calgary, that funding model could see some pushback from Alberta's doctors, souring an already strained relationship.

In addition to spending more on training and having higher student-loan debt, Hardcastle said many family doctors have been struggling financially for years amid ongoing negotiations with the province.

"This nurse practitioner model compensates them based on their patient panel size and those sorts of factors," she added. "And physicians had to fight long and hard to get to a point to have those same compensation models available to them, as opposed to a fee for service type model."

Parks said he doesn't take issue with the pay rate, but he doesn't believe it will set NPs up for any more success than doctors have seen in recent years.

"Family physicians are saying that at 100 per cent of their pay, they can't make viable practices and pay all of their overhead," Parks said. "I don't think that nurse practitioners can do it at 80 per cent, it's just math."

The province said audits of the program will take place at 18 and 48 months.

LaGrange said there are currently around 600,000 Albertans without a family doctor. 

With files from CTV News Edmonton's Chelan Skulski

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