Position Statement on Eckler Ltd.’s Ontario Community of Health Compensation Market Salary Review

A collaboration between 10 different provincial associations commissioned Eckler Ltd. to undertake a Health Compensation Market Salary Review that was finalized in November 2023. The study aimed to conduct a market assessment of benchmark positions universally applicable across various community healthcare organizations in Ontario. The analysis presented a provincial compensation grid that grouped jobs of similar scopes of practice while acknowledging market exceptions. The purpose was to update a previous salary grid that was co-commissioned by the Nurse Practitioners’ Association of Ontario (NPAO), Alliance of Healthier Communities, and The Association of Family Health Team of Ontario in 2009, 2012/2013, and 2017. A specific nurse practitioner (NP) Job Evaluation Opinion was also provided to address any concerns in evaluation.

The NPAO has carefully examined the revised 2023 report and the Job Evaluation Opinion. The NPAO has concerns regarding the representation of the NP role and practice in the report. A job description for NPs was used for the purposes of surveying that was highly simplified. The updating of the NP job description to accurately reflect the NP scope of practice was outside the mandate of this report. Although this may not have had an impact on the determination in role leveling, the previous and current job descriptions fail to clearly identify the expanded scope of practice of NPs in the community. Furthermore, the choice of language used in the job summary lacks specificity to NP practice and provides vague descriptors of NP roles, responsibilities, and qualifications. This is particularly concerning due to the comparative clarity of the language used to describe the responsibilities and capabilities of roles within the same level/band. The absence of clarity of NP practice exacerbates role confusion and detrimentally affects NPs, especially when stakeholders rely on such documents to shape compensation decisions, define role value, and assess the influence of NPs on patient care within an organization.

Stakeholders should note that Eckler recognizes the possibility of NPs with added responsibilities, employing the current survey description, “may need a different compensation arrangement”. While we endorse our psychologist colleagues’ pursuit of fair remuneration, the report draws compensation comparisons by placing NPs and psychologists roles within the same level/band. It is important to note that the legislative scope of practice of NPs includes seven (7) additional controlled acts when compared to psychologists that are outlined in the Regulated Health Professions Act (1991). There is a failure in recognizing the knowledge, risk, and responsibility these additional acts entail. Despite being a category within the nursing profession, NPs possess a distinctive capacity to address the substantial market demand for primary care providers. Other than physicians, NPs stand out as a significant market exception as the only other regulated health professionals equipped with the autonomy to fulfill this crucial role. Even though the scope of practice and the level of responsibility of NPs more closely aligns with those of physicians, there persists an inadequate recognition of this reality, particularly when it comes to compensation.

In conclusion, NPAO believes that caution is warranted in interpreting the findings of this report, particularly in relation to the NP job description, as it poorly describes the role and scope of practice of NPs. NPAO advises NPs to closely evaluate their current practice in relation to the 2023 Health Compensation Market Salary Review job description and to advocate for appropriate remuneration if their practice surpasses the outlined description and qualifications. The NPAO recommends that stakeholders exercise prudence when assessing NP compensation and recognize the perpetuation of historical biases and inadequate descriptors that continue to undervalue NPs. In the future, it is imperative that stakeholders and associations commissioning such meaningful reports accurately describe the roles and responsibilities of those professions being evaluated. The NPAO recommends distributing a copy of this position paper along with Eckler Ltd.’s report to ensure that the data is appropriately interpreted, and the undervaluation of NPs is acknowledged.

Nurse Practitioners’ Association of Ontario (NPAO) Board of Directors

December 2023

View the Eckler Health Compensation Market Salary Review

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