Low wages and benefits makes interprofessional primary care a hard sell

Stock photo of a nurse with a tablet used to illustrate a shortage of nurse practitioners and other professionals in the pimary care sector.

Family Health Teams and other interprofessional primary care providers are having difficulty retaining and recruiting health professionals due to poor compensation. One in five nurse practitioner positions are vacant according to a report issued last year. (Canstock Photo)

The Ontario government would like every dollar of funding increase to be used to increase the volume of care. In their world, nothing would go to the increased cost of wages, benefits, drugs, energy, equipment, or any other cost pressure that health providers regularly experience.

We are told there is money for volumes, but nothing for base budgets.

While simplistically laudable, it’s not realistic and may be doing harm to the sectors the Wynne government wants to transition more of the health system.

Last year three organizations representing all of Ontario’s interprofessional primary care organizations quietly submitted a report to the Ministry of Health highlighting how the compensation structure for their sector is driving away the professionals they need.

It’s the same low wage strategy that personal support workers have been trapped in, creating high levels of turnover and undermining continuity of care. The big difference is there isn’t a large pool of professionals to continually draw from, leaving significant vacancies.

The Association of Family Health Teams of Ontario (AFHTO), the Association of Ontario Health Centres (AOHC) and the Nurse Practitioners Association of Ontario (NPAC) say there are three reasons why recruitment and retention is so difficult in their sector – low wages, lack of pensions and too few full-time opportunities.

Instead of being able to resolve these issues, they watch their professionals depart for other employers in the health system as the heavy hand of restraint weighs them down.

The three organizations point out that they have the second lowest starting salary in Canada for Nurse Practitioners at $74,038. A typical registered nurse with eight years’ experience would earn more than that in Ontario. NPs typically work for 16 years as an RN before returning to school to qualify as an NP.

When the Community Care Access Centres began recruiting NPs at a posted salary of $115,000, the exodus began, leaving many Ontarians with no primary care provider. The report anticipated that 70 NPs will leave interprofessional primary care to take up these positions at the CCAC. The CCACs are by no means paying top of market wages – Alberta was recruiting NPs at $124,000 per annum.

At the time of the June report, nearly one in five positions for NPs went vacant in Community Health Centres, Family Health Teams, Aboriginal Health Access Centres and Nurse Practitioner-led clinics. NPs in this sector have experienced a wage freeze for more than six years and are continually told by their employers there is no more money for them.

It’s not just NPs the sector is struggling to recruit and retain. The report references a survey indicating 26 per cent of dietitians in this sector plan to leave their current position within a year and another 23 per cent within two to five years. When 50 per cent of the overall Canadian dietetic workforce is expected to retire by 2018, the report notes that this will cause a “potential mass exodus of dietitians from primary care as more lucrative positions open up.”

By contrast the government did open the vault for doctors to be recruited into this sector. The Auditor General of Ontario notes in his 2011 report that “total funding to all family physicians increased by 32% — from $2.8 billion to $3.7 billion — between the 2006/07 and 2009/10 fiscal years. Of the $3.7 billion in total payments made to the province’s family physicians in the 2009/10 fiscal year, more than $2.8 billion was paid to physicians participating in alternate funding arrangements.” On average, doctors participating in these arrangements earned 25 per cent more than their more traditional fee-for-service counterparts.

The interprofessional primary care organizations say they are capped at 20 per cent of salary for pension and benefits, which often means they have to choose between HOOPP and other benefits. Many professionals do not want to leave a pensioned workplace for one that offers nothing in retirement.

According to a Hay Group study commissioned in 2009, salary rates for interprofessional primary care were five to 30 per cent below market. In a follow-up study done three years later, that gap had grown by another 5 per cent.

The province recognized that they needed to do more around compensation for the province’s personal support workers. More than a year after this report was submitted to the Ministry, professionals in the sector are still being told there is no money.

The province may soon discover that with no money, there may also soon be no professionals.

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