Nurse practitioners can relieve Canada’s doctor shortage
July 22, 2022
If Canada is serious about addressing the shortage of primary health-care providers, the federal and provincial governments must commit to a new funding model for nurse practitioners (NPs). And soon.
Health-care horror stories dominate Canadian news. In the past two months, four doctors in Charlottetown announced they were abandoning their practices, leaving more than 5,000 people without a family physician. They will join another 24,000 Islanders already on a waiting list for a family doctor. According to the Ontario Medical Association (OMA), there are a least one million Ontarians without regular access to primary care. The problem is more severe in rural areas, where the OMA says a shortage of 100 family doctors and 130 specialists threatens the sustainability of public health care.
Other ominous warnings come from Canadian Federation of Nurses, which warns the health-care system is “on the brink of disaster,” and from Doctors Manitoba, which notes that “the health-care system has slowly been crumbling … then COVID came along and just crushed us.”
Nurse practitioners can work alongside family doctors
I believe that nurse practitioners are key to relieving our overstrained health system. These advanced practice nurses have two extra years of schooling, allowing them to assess, diagnose, prescribe and manage patients in primary health-care settings. According to the Canadian Institute for Health Information, 6,661 NPs were licensed to practice in Canada in 2020. Even if they are all currently working with a physician in an office, many feel they can do more.
In Alberta, the Nurse Practitioner Association is asking that its members be allowed to set up publicly funded independent practices. According to a media report, the group states that 300 nurse practitioners “could open clinics tomorrow and service a full panel of patients, so that's anywhere from a thousand to 1,500 patients [for each nurse practitioner].”
Impressive numbers. But across Canada, the stumbling block is with how NPs are compensated. Unlike physicians who can bill their provincial health plans, nurse practitioners are paid by salary. Therefore, they can’t set up their own practices even though Canadians need their expertise.
Funding is the real issue
Keep in mind that NPs command a salary commensurate with their training. According to the Ontario Nurses’ Association, the minimum starting rate for NPs is $48.70 an hour. As with any professional position, that rate goes up with experience. Ontario’s 2021 Sunshine List of public sector employees making more than $100,000 includes 1,531 NPs.
I suspect all of these nurse practitioners are employed by hospitals, which pay their salaries from the global funding provided by the health ministry. The question then is: If the Ontario government can fund NPs in hospital, why not extend that same funding to primary care physicians?
Family doctors across Canada cannot afford to pay $100,000 annually to take on a NP, unless provincial governments offer some kind of incentive, perhaps a 50/50 funding split.
Just imagine if family physicians across the nation were financially encouraged to take on a nurse practitioner. Participating offices could then expand their hours of operation and even offer weekend visitations, along with more virtual telemedicine. That would cut down on demand at emergency departments, some of which are closing for intervals due to staffing issues.
MDs and NPs are gatekeepers of our health-care system
Primary care providers – MDs and NPs – are the gatekeepers of our health-care system. Patients need a referral from a primary care provider in order to see a specialist, for everything from a cancerous growth to an abdominal issue. After they consult with the specialist, the primary care provider will be sent a treatment plan, stating how the condition should be managed in the coming years. These providers know the patient and are in the best position to manage the condition and renew any needed prescriptions.
Another advantage of embracing NPs as valued components of the primary care system is that it would encourage medical school graduates to pursue careers as family doctors. They would be reassured that they can rely on the support of a NP, allowing them to better manage the needs of their patients.
An influx of more nursing practitioners is the shot in the arm our health-care system desperately needs. Yet that will only happen if provincial ministries of health recognize that the rules concerning the funding of this important aspect of the health-care model must change.