Alberta’s Primary Care Debate: Nurse Practitioners’ Independent Practices Stir Controversy

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A nurse practitioner meets with her patient at the Axis Primary Care Clinic in Surrey, B.C., in 2021. Alberta is putting a compensation model in place that will allow NP-led clinics as soon as January.

A recent announcement by Alberta’s government, allowing nurse practitioners (NPs) to set up independent, publicly funded practices, has ignited a contentious debate within the province’s healthcare community. This decision is seen as a critical step towards addressing the acute shortage of family physicians in Alberta, where an estimated 600,000 or more residents lack adequate healthcare access.

Premier Danielle Smith, during a news conference, emphasized the significance of this initiative. “Help is on the way,” she assured, underlining the government’s commitment to ensuring Albertans receive the care they need, as reported by CBC News.

Nurse practitioners, who possess advanced nursing training, are authorized to perform tasks such as ordering tests, prescribing medication, managing chronic diseases, and referring patients to specialists. The province is also developing a compensation model to facilitate direct payments to NPs, a system not currently in place.

Premier Danielle Smith, centre, stands with Health Minister Adriana LaGrange, at left, Susan Prendergast, at right, and parliamentary secretary Martin Long during a news conference in Edmonton on Nov. 22, 2023, on plans to strengthen the role of nurse practitioners in primary health care. They believe nurse practitioners can provide about 80% of the medical services a family physician provides. (Chris Schwarz/Government of Alberta)

Additionally, the government has committed to a $2-million grant over three years to assist with setup and recruitment, complemented by a previously announced $57 million fund to support patient caseloads for both NPs and family doctors.

However, this policy shift has not been universally welcomed. Dr. Sarah Bates, acting president of the family medicine section of the Alberta Medical Association, criticized the move. “It’s a false equivalency to think that a nurse practitioner is a family physician,” she stated, expressing concerns over family physicians feeling devalued and disrespected.

This friction stems partly from longstanding tensions between family doctors and the provincial government, exacerbated by the pandemic and changes in healthcare policies.

Susan Prendergast, president of the Nurse Practitioner Association of Alberta, responded to the criticisms, highlighting the urgent need for care providers for hundreds of thousands of Albertans. She pointed out that nurse practitioners successfully operate independent clinics in other provinces and that Alberta is simply catching up with this practice.

Training requirements for NPs and family doctors are a key point of difference. While NPs undergo a minimum of six years of education, family physicians require between eight and 11 years of training, according to standards set by respective professional bodies.

Myles Leslie, from the University of Calgary’s school of public policy, supports the idea of NP-led clinics to improve healthcare access. However, he also calls for a detailed plan, particularly for rural areas where the shortage of family doctors is most acute.

Critics, such as Calgary physician Dr. Terrence McDonald, argue that the complexity of patient care demands a team-based approach, rather than independent NP practices. He advocates for NPs to be integrated into existing healthcare teams.

Contrasting this view, Ivy Bourgeault of the Canadian Health Workforce Network suggests that while collaboration is essential, it does not necessarily require all primary care providers to be under one roof.

The Alberta government now faces the challenge of navigating these differing perspectives and finding a path forward that includes all primary care providers in the solution and implementation process, as emphasized by Bourgeault.