New payment model will see Alberta's nurse practitioners make 80% what family doctors make
The Alberta government has launched a new pay‐ ment model it says will al‐ low nurse practitioners to set up their own practices, or work within pre-existing clinics, and get paid di‐ rectly by the government.
Until now, Alberta's nurse practitioners (NPs) have not been able to work au‐ tonomously, through the publicly funded system, be‐ cause there was no direct funding model in place.
The new, $15-million pro‐ gram will see NPs make ap‐ proximately 80 per cent of what family doctors earn, providing they meet a num‐ ber of requirements includ‐ ing caring for a minimum of 900 patients.
"It will add more health capacity in communities across the province," said Health Minister Adriana La‐ Grange, touting it as one tool her government is using to address the family doctor shortage.
"It will give Albertans more access to a regular health-care provider who they can develop a long-term relationship with ... and it will help take pressure off the rest of the health-care sys‐ tem."
According to the provinci‐ al government, an estimated 700,000 Albertans are with‐ out a family physcian.
LaGrange estimates up to 50 nurse practitioners will sign on to the program this year.
"Once the program is fully implemented they will be able to serve approximately 45,000 patients which ... will go a long way to address cur‐ rent access issues," she said.
The NPs will be paid a salary based on patient num‐ bers and they'll be required to have panels of 900 patien‐ ts each within two years.
According to LaGrange, NPs must commit to provid‐ ing medically necessary ser‐ vices and after-hours care on evenings, weekends and holi‐ days.
There are also minimum work-hour requirements and NPs must provide walk-in ap‐ pointments while they build up their patient rosters, she said.
"We want this program to be successful," said La‐ Grange, noting the program will run for a minimum of five years and will be subject to regular reviews.
'Long time coming' According to the province, there are more than 900 nurse practitioners working in Alberta. NPs, registered nurses with extra training, can order tests, prescribe medication, manage chronic
diseases and make referrals to specialists.
"This has been a longtime coming for nurse practi‐ tioners," Jennifer Mador, president of the Nurse Practi‐ tioner Association of Alberta, said in an interview with CBC News.
"It's the right next step forward in a long-term rela‐ tionship with Alberta Health."
The association has been calling for a funding model, allowing for direct reimburse‐ ment, for years.
"The current supply of physicians in family medicine cannot [address] the demand alone," said Mador during Thursday's news conference.
"We are working towards a team-based model of care and we look forward to work‐ ing with our physician col‐ leagues in addressing the health-care deficits."
The funding will allow NPs to open their own clinics or join existing ones, she said.
When asked about the sustainability of the funding model, given some family physicians are closing their doors for financial reasons, Mador said it's unclear how many will set up independent practices.
"They do not need to do this independently outside of other multi-disciplinary clin‐ ics. They can certainly join clinics or collaborate with others in order to sustain the overhead, as we know it is challenging," said Mador.
AMA president raises concerns
The president of the Al‐ berta Medical Association, Dr. Paul Parks, said there is no question more access to primary care is needed in Al‐ berta.
Parks welcomes the idea of adding more nurse practi‐ tioners to clinic teams along with family physicians. But he's opposed to the idea of independently run NP clinics.
"Nurse practitioners ab‐ solutely have value," he said. "Are they the same as family physicians and is their train‐ ing the same? They are not."
Parks believes indepen‐ dent nurse practitioner clin‐ ics could lead to more siloed care.
"If the goal is to do this out on their own - totally dis‐ connected - independent, then there's many, many con‐ cerns," he said.
"There's many jurisdic‐ tions across the world that have tried this and it's shown that when they're not inte‐ grated into a medical home with a family medicine physi‐ cian, they do more tests, they take longer to see patients and they consult more. There's more cost to the sys‐ tem."
For her part, Mador said nurse practitioners have proven their ability to work independently.
"Nurse practitioners have been doing this work for a long time and they've been independent for a long time. This funding model doesn't change that," she said.
"We have lots of family physicians who've reached out so they can either retire and hand over their panels or to work collaboratively. So we're encouraged to work with those physicians that are supportive."
Money set aside
Fifteen million dollars has been set aside for the pro‐ gram for the 2024-25 budget year and LaGrange said it will be assessed for the first time in 18 months to see how well it's working.
According to the province, the 80-per-cent funding mod‐ el was based on an assess‐ ment of NPs' scope of prac‐ tice, training and education.
NPs will be eligible for fi‐ nancial supports, including incentives for working in rur‐ al and remote areas.
Also included in the pro‐ gram's budget is a $2-million panel management fund, of‐ fering a one-time payment of $75 per patient if NPs take on more than 900 people this year.
At least three spots will be set aside for nurse practition‐ ers working on First Nations communities or Metis Settle‐ ments.
In addition, clinics, pri‐ mary care networks and communities are eligible for $10,000, in federal funding, if they partner with a new nurse practitioner through a one-time mentorship funding program.