Will Alberta’s experiment of paying NPs 80% of FPs pay off?

Alberta is experimenting with a new payment model that will allow select nurse practitioners (NP) to start clinics and be directly paid about 80% of what family docs make. Previously NPs would have to be paid by a clinic or hospital. This program will also allow a select number of NPs to set up their own practice or join a pre-existing one.What’s motivating this? Well, 700,000 folks in Alberta lack a family doctor. Each NP will be required to roster at least 900 patients within two years.Now it’s not a big bang rollout—NPs have to apply and be accepted to what seems like a pilot program. If 50 NPs sign up this year (as planned), this would get more than 45,000 patients a primary care provider within two years. Alberta NPs have a fairly full scope of practice: diagnose, order tests, manage chronic disease and make referrals.Read: ‘Loophole’: Should NP-led clinics that charge patients fees for care be allowed to continue?What compensation are we talking about exactly?NPs will be able to bill $246,000 to $361,000 per year (based on patient roster size, ranging from 900 to 1,500). Like with family doctors, these are billings and do not include cost of overhead, etc.So $15 million has been allocated for this initiative, and results will be evaluated after 18 months.My thoughts?ONE: If some family doctors are closing their practices because they can’t make the economics work . . . and if NPs are making about 80% of a family doctor’s billings (but having substantially similar overhead costs), why would we expect NP-opened practices to be economically more viable?TWO: Some (most?) doctors are going to argue that the evidence shows independent NP clinics can lead to higher costs to the system. But even if we assume it’s true that family doctor-led primary care has better outcomes, while that may be true in a vacuum, the alternative isn’t only a choice between family doctor-led or NP-led clinics. Right now, there’s actually a third reality: no primary care for some patients. And at some point, one could argue any primary care is better than no primary care (for 700,000 patients). This is probably the logic the government is using.THREE: Some (most?) doctors are going to view this as a slight from the government. Why not use that funding to pay family doctors more to make that specialty sustainable? The government is spending “only” $15 million on this experiment—it’s not a fully funded long-term initiative yet. If you divided up the $15 million among the 5,000 family doctors in Alberta, that’s just $3,000 per family doctor. Won’t do anything for tackling the primary care shortage.In some ways, the government would rather invest $15 million in this experiment to see if tackling the primary care shortage with NP-led clinics is viable or not.What do you think?Dr. Joshua Liu is a Toronto physician and the co-founder/CEO of SeamlessMD.

Will Alberta’s experiment of paying NPs 80% of FPs pay off?

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