Primary care reform in Alberta: Costs for family physicians and expanded roles of independent nurse practitioners.

Objective: To analyze the economic effects of policies created by the Alberta government to address the shortage of family physician (FP) services following the COVID-19 pandemic.

Design: Starting with the government's statement of the shortage (between 600,000 and 700,000 persons with unmet primary care needs) and using current caseload measures, a measure of the number of FPs and nurse practitioners (NPs) needed to fill the gap was developed.

Setting: Alberta.

Participants: FPs and NPs.

Main outcome measures: The cost of meeting unmet needs based on provincial payment data.

Results: The government set 2 priorities to meet the shortage: to increase the number of FPs and to establish and implement a framework for NPs as independent primary care practitioners. Based on the defined shortage and excluding population growth, an estimated need was calculated: 715 additional FPs with 100% coverage, or 715 additional NPs covering 80% of the needed services (893 added NP-equivalents). The cost of each alternative was calculated as $245.9 million for FPs and $176.3 million for NPs. The time needed to achieve either of these alternatives is more than a decade.

Conclusion: The time to address the current doctor shortage is substantial and needs to be factored into government primary care policies.