Alberta's nurse practitioners seek autonomy as family doctor shortage worsens

Alberta's nurse practitioners say they could be doing more to help the province's ailing health-care system — by caring for patients who don't have a family doctor— and they're renewing calls for the provincial government to put a system in place to allow for that.

Nurse practitioners (NPs) are registered nurses with extra training and, like family physicians, they can order tests, prescribe medication, manage chronic diseases and make referrals to specialists.

But they say they can't set up publicly funded independent practices because they have no mechanism to get paid directly by the Alberta government.

"There's roughly 300 nurse practitioners that could open clinics tomorrow and service a full panel of patients, so that's anywhere from a thousand to 1,500 patients [for each nurse practitioner]. But we have no way to get paid," said Susan Prendergast, the director of independent practice with the Nurse Practitioner Association of Alberta.

"The other barrier is that the current model of NP employment requires that we are employees of a primary care network that is basically run by physicians and so again our role is determined by someone else."

The Nurse Practitioner Association of Alberta submitted a proposal last year suggesting a salary model that would see them paid directly by the province and bring in roughly 25 per cent less than the average doctor who bills through the fee-for-service model.

Prendergast, who's an assistant professor in the University of Victoria's school of nursing, said Alberta lags behind other provinces such as B.C., Ontario and Nova Scotia, where NPs have more autonomy.

"Our work has been going on for more than 15 years to provide Albertans with access to independent nurse practitioners. There's never been a more critical time," said Karen Parker, vice-president of the Nurse Practitioner Association of Alberta.

"You're having more provider accessibility issues, less care being provided and more gaps in care typically from fallout from the pandemic." 

According to the Nurse Practitioner Association of Alberta, there are 749 NPs working in Alberta. Most of them practice in hospitals and some in primary care networks alongside physicians.

The Alberta government is not committing to the proposed changes but says it is considering them as it studies a range of different structures and funding models.

"Alberta's government continues to focus on providing greater choice to Albertans in their health-care practitioners by increasing the number and scope of NPs in Alberta," Alberta Health spokesperson Charity Wallace said in a statement emailed to CBC News.

"This work involves developing access guidelines, population health needs assessments and an exploration of opportunities to establish collaborative team-based clinics that are appropriately staffed to meet the needs of Albertans."

Health officials will continue to consult with NPs and other stakeholders, she said, adding the government intends to focus on areas where the need is greatest.