Nurse practitioners filling health-care gaps, despite lack of funding
Published Saturday, October 26, 2019 10:25PM EDT
Last Updated Friday, November 1, 2019 2:52PM EDT
TORONTO -- Amid doctor shortages across the country, nurse practitioners have been filling in the health-care gap in many communities, helping to diagnose and treat patients who don't have access to a family physician.
But despite growing demand, many clinics can't get adequate funding to employ enough nurse practitioners (NPs). The issue is evident in communities such as Ingersoll, a rural southwestern Ontario town where many residents often experience long waits for primary care.
Among the approximately 110,000 people who live in Oxford County, which includes Ingersoll, Elizabeth Wilson considers herself fortunate. Unlike many people in the region who don't have a family physician, she gets regular and timely care thanks to nurse practitioner Adrienne Bienot.
NPs are registered nurses with advanced education and training that allows them to diagnose and treat minor illnesses and injuries, screen for the presence of chronic disease and monitor patients with stable conditions.
"It's just like going to the doctor...it's the same to me," Wilson told CTV News. Even better, she said, is that the nurse practitioner has the time to listen and discuss her problems.
There are four nurse practitioners at the Ingersoll Nurse Practitioner-Led Clinic, handling more than 2,100 patients. The clinic, which also houses support services such as social workers and mental health counsellors, looks just like a doctor's office. On the desk in the front office, there are hundreds of applications from people who want to join the clinic as registered patients.
Like many rural communities across Canada, Ingersoll has seen a number of its doctors retire or die. And while some new ones have been recruited, there aren't enough physicians to meet the demand.
Almost a quarter of the doctors in Ingersoll are over the age of 60, and there is only one walk-in clinic. But while other provinces are expanding NP services, Ontario -- which has the largest number of nurse practitioner-led clinics in the country -- is not funding new NP positions.
The Nurse Practitioners Association of Ontario said it spoke with 10 NP-led clinics across the province, and found that funding for all of them has been reduced by between three and 10 per cent, with no new funding on the horizon. Only three of the clinics are accepting new patients and five clinics stated that their general practitioners are retiring, but they are not aware of any replacements.
"We are really hopeful that the ministry is going to see that we have a situation here, that we would like to provide services for these patients," Ingersoll nurse practitioner Sue Tobin told CTV News. "We have 3,000 that already don't have a primary care provider, and expect to have about another 3,000 or possibly more who will lose their primary care provider in the next few months."
"We could easily hire four to five nurse practitioners and help take care of the situation here," Tobin added.
About a quarter of the patients who walk through the ER doors at the Alexandra Hospital in Ingersoll -- just down the road form the Nurse Practitioner-Led Clinic -- are people who don't have access to a family doctor or an NP, often referred to as "orphaned" patients.
"They're coming in with a rash, an ingrown toenail, sore throat....We will see anyone, but I think if those people have a different avenue to pursue then maybe we will see less of those visits," said Dr. Max Rachinsky, a physician at the hospital who said that for such patients, ER visits are a last resort.
"Any solution that would help patients that are orphaned, or patients that don't have access to primary care, should inevitably reduce some of the volume and maybe some of the pressure and strain that we're facing in emergency," he said.
However, the growing role of nurse practitioners hasn't always been well-received in Ontario, with some physicians suggesting that NPs don't provide the same level of care.
"I don't think that opinion is well-founded, however, because the nurse practitioners do an excellent job," said Dr. Rob Hiemstra, a physician consultant at the NP-led clinic in Ingersoll.
Hiemstra is more than happy to work with NPs at the local hospital and he consults at the clinic once a week on more complex cases. His view is that NP-led clinics are a win for the patients.
"They get extra attention with longer visits and more spectrum of care, whereas many family doctors are tight for time," he said. "I think there is a role for more nurse practitioners in clinics such as this one."
The Ingersoll NP-led clinic also offers a wider range of hours and makes room for same-day or next-day appointments, ready to help more patients who don't have a family doctor.
The Nurse Practitioners Association of Ontario said research shows that NP-led care can be more cost effective, with the average annual cost per patient between $500 and $700. Doctor-led care costs can be as low as $200 or as high as $12,000 per patient, per year, the association said.
But the Ontario Medical Association President Dr. Sohail Gandhi disputes the suggestion patient care under a physician would be as much as $12,000, suggesting it is "grossly inaccurate."
"The Ontario government pays on average $300 per year per patient enrolled with a physician working in Family Health Organizations (under the capitation model, which is a payment system in which the doctor is paid a fixed amount per patient for a prescribed period of time)," he said in an emailed statement.
"Out of this $300 per patient, the physician must pay all the overhead costs required to provide patient care including rental of office space, staff salaries and benefits, electronic records systems, medical and office supplies, and other necessary expenses. On the surface this would seem to be far less than the $500 per patient nurse practitioners get paid."