C.D. Howe report calls for more nurse practitioners in primary care, says doctors’ groups have too much influence

A new report from the C.D. Howe Institute is calling for an “aggressive increase” in the number of nurse practitioners working in primary care and the promotion of more multi-discipline clinics, rather than trying to increase the supply of physicians.In a health policy brief set to be released Thursday morning, economist John Richards notes that in the 2021 OECD survey on healthcare, only 56% percent of Canadians said they were satisfied with the availability of quality healthcare—down 22% from 2019 and well below the OECD average.Richards says solving the dysfunction in the healthcare system requires major institutional reforms, but argues that provinces have not been able to do so due to “fear of provoking interest groups—particularly physicians’ organizations.”Physicians’ associations across Canada have long called for more remuneration, but Richards notes pay for family physicians in Canada is higher than 69% of OECD member countries, while pay for specialists is at the 79th percentile rank. In addition, Richards says physicians’ productivity is going down, citing a 2021 study that found weekly working hours for physicians in Canada declined from 52.8 hours per week in between 1987 and 1995 to 45.9 hours in 2017-2021, while remuneration remained consistent. “The combination over the last three decades of reduced weekly hours and an increase in inflation-adjusted remuneration is further evidence of the influence exercised by physicians’ associations,” Richards writes.Many physicians’ groups have also long opposed expanding roles for nurse practitioners, but Richards cites several studies that found that nurse practitioners “provide services as good as those provided by physicians.”In particular, he highlights a 2015 British Medical Journal study that compared physician-provided care to nurse practitioner-provided care. That study concluded that nurse practitioners in alternative provider ambulatory primary care roles “have equivalent or better patient outcomes than comparators and are potentially cost-saving.”“Studies have repeatedly shown that nurse practitioners can deliver equally good care as family physicians in most situations, while costing the healthcare system less,” Richards says in the report.He also argues this would be more cost effective, given that the cost of training and remuneration for a nurse practitioner is “probably half that of a family physician,” especially given that a registered nurse does not need to attend medical school to become a nurse practitioner. On top of that, Richards argues provinces should do more to promote multi-discipline primary care clinics that incorporate nurse practitioners and other professionals with a funding model based on capitation rather than fee-for-service (FFS).“The direct cost of multi-discipline primary care is on average higher than in FFS clinics. Including specialist referrals and hospitalization, however, the total cost per patient in most of Ontario’s alternatives is below traditional FFS clinics, due to fewer referrals and hospitalization,” Richards wrote.

C.D. Howe report calls for more nurse practitioners in primary care, says doctors’ groups have too much influence

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