The Alberta government has launched a new payment model it says will allow nurse practitioners to set up their own practices, or work within pre-existing clinics, and get paid directly by the government.
Until now, Alberta’s nurse practitioners (NPs) have not been able to work autonomously, through the publicly funded system, because there was no direct funding model in place.
The new, $15-million program will see NPs make approximately 80 per cent of what family doctors earn, providing they meet a number of requirements including caring for a minimum of 900 patients.
“It will add more health capacity in communities across the province,” said Health Minister Adriana LaGrange, 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 system.”
According to the provincial government, an estimated 700,000 Albertans are without 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 current access issues,” she said.
The NPs will be paid a salary based on patient numbers and they’ll be required to have panels of 900 patients each within two years.
According to LaGrange, NPs must commit to providing medically necessary services and after-hours care on evenings, weekends and holidays.
There are also minimum work-hour requirements and NPs must provide walk-in appointments while they build up their patient rosters, she said.
“We want this program to be successful,” said LaGrange, 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 long-time coming for nurse practitioners,” Jennifer Mador, president of the Nurse Practitioner Association of Alberta, said in an interview with CBC News.
“It’s the right next step forward in a long-term relationship with Alberta Health.”
The association has been calling for a funding model, allowing for direct reimbursement, 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 working with our physician colleagues 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 clinics. 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 Alberta Medical Association, Dr. Paul Parks, said there is no question more access to primary care is needed in Alberta.
Parks welcomes the idea of adding more nurse practitioners to clinic teams along with family physicians. But he’s opposed to the idea of independently run NP clinics.
“Nurse practitioners absolutely have value,” he said. “Are they the same as family physicians and is their training the same? They are not.”
Parks believes independent nurse practitioner clinics could lead to more siloed care.
“If the goal is to do this out on their own — totally disconnected — independent, then there’s many, many concerns,” he said.
“There’s many jurisdictions across the world that have tried this and it’s shown that when they’re not integrated into a medical home with a family medicine physician, they do more tests, they take longer to see patients and they consult more. There’s more cost to the system.”
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 program 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 model was based on an assessment of NPs’ scope of practice, training and education.
NPs will be eligible for financial supports, including incentives for working in rural and remote areas.
Also included in the program’s budget is a $2-million panel management fund, offering 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 practitioners working on First Nations communities or Metis Settlements.
In addition, clinics, primary 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.
