The Association of Family Health Teams (AFHTO), the Association of Ontario Health Centres (AOHC) and the Nurse Practitioners’ Association of Ontario (NPAO) are pleased to share our joint report with our members.
It has been a challenge for primary care organizations to recruit and retain the skilled and compassionate staff needed to deliver accessible, high quality, patient-centred primary care. Our three associations – representing all of Ontario’s interprofessional primary care organizations – teamed up in September to gather the facts and create the solid case to address the issues. About half of the 295 organizations – 10 aboriginal health access centres (AHACs), 73 community health centres (CHCs), 186 family health teams (FHTs) and 26 nurse practitioner led clinics (NPLCs) – responded to our survey. This information, together with data from salary studies by the Hay Group, has been combined to make the compelling case. Our joint report was finalized this week and sent to the ADMs of Negotiations and Accountability Management Division and Health Human Resources Strategy Division in advance of our meeting on Feb.22. The meeting had been scheduled for Feb.9 but was postponed due to personal circumstances. The report makes the case that:
- The full compensation package – salaries, pensions and benefits –must be addressed to make working in primary care sufficiently attractive to recruit and retain competent staff in this sector. Recognizing current economic constraints, it is well understood that reaching a competitive compensation level will need to be phased in over a few years.
- As an immediate first step, the barrier to labour mobility must be removed to enable all primary care organizations to offer the HOOPP pension plan and reasonable benefit package. This entails a 2.5% increase in compensation funding, for a total of $10.36M.
- Since staff are required to contribute a minimum of 6.9% of gross earnings toward the pension, a matching increase of 2.5% should be added for all staff to defray their reduction in take-home earnings. This would bring the total investment across all of primary care to $19.48M.
The investigation found:
- The biggest vacancy rates appear among the largest staff groups, e.g. 19% for Nurse Practitioners, 14% for dietitians, 10% for RNs, and 5-12% for administrative managers. Add to this an 18% vacancy rate for pharmacists, and the result is a serious gap in skills to provide the full scope of primary care, particularly chronic disease prevention and management.
- Factoring in turnover rates and the time needed to fill each type of position, roughly 6-7% of overall staff service capacity is lost each year due to turnover.
- The most troubling finding is that the majority of staff who leave are then lost to the primary care sector – only 1/3 move to other primary care settings, but about 1/2 go to work in hospitals and other health care settings.
- While Ontario’s Action Plan for Health Care calls for placing “Family Health Care at the Centre of the System,” there are barriers to attracting health providers to primary care and keeping them in this part of the health system.
- There is overwhelming evidence that compensation packages are the root cause. Independent review found salaries to be 5 – 30% below market. Lack of the HOOPP plan makes it hard to compete with the other health sectors that do offer it.
- Growing inequity in compensation is creating conditions for rapid expansion of unionization in this sector, beyond the 10% of PCOs who currently have staff under collective agreements.
Please click here to read about the outcome of the joint meeting. 
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