Several interview participants commented on how financial incentives for physicians interfered with PHCNP role integration. For example, incentives offered to physicians to hire PHCNPs position the PHCNPs as employees rather than colleagues. The unintended consequences of incentives to physicians for meeting preventive care target numbers were also problematic, because the work of PHCNPs was included in target achievement, yet sharing the incentive was at the discretion of the physician. Voicing their disapproval, the Nurse Practitioners' Association of Ontario stated that "in the spirit of team development, the notion that one provider is being paid an incentive for the work of others is incompatible and inconsistent with the interprofessional approach to care" (2008: 2); instead, they advocated for team-related bonuses. Some primary care practices have converted these physician-specific incentives into team-based incentives in recognition of team members' contributions to preventive care services. A government interview participant commented that remuneration mechanisms need refinement to ensure fair compensation of primary healthcare teams and suggested a team-based approach to remuneration negotiations.


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