For many years as a NP, I was advocating for NP's to be able to bill direct to the province (Manitoba Health) for our services which would allow us to have an independent clinic without all the red tape and bureaucracy that gets in the way of our job satisfaction and the quality of care for our patients!! Well, through experience, talking to family doctors, and looking critically at the politics and the true definition of patient-centered care, I discovered I was advocating for the WRONG thing!!!
Billing fee-for-service sounded like something that would work...why not? We could have our own practices and just bill direct for our services....but we are forgetting that this would create a situation where we would have to have our own or at least contribute to reception staff, software, clinic supplies and all of the overhead that is there in your own practice. All of a sudden, there is a perspective change! You then realize that you would have to see many patients per hour just to pay the bills and you would still have much unpaid hours of work to do in between. Hmmm, a fee for service practice funded by the health system suddenly doesn't feel so good. This system would still contain the pressures to see high numbers of patients every hour and would seriously limit the quality and true ability to provide patient-centered care as you would want to in order to have job satisfaction! Oh, and if you are working in a clinic that would be billing your work fee-for-service, there would also be productivity expectations to pay their bills as well!!
Another consideration is...the moment we are funded by the Province (thus becoming part of Canada Health Act), we will have limitations, restrictions for what will be paid for, and it will then be illegal to offer medical services outside what 'they' authorize. So what about those patients who want half hour or an hour appointment to sort out some major issues or multiple concerns? Will we have to put up a sign that says "ONLY ONE ISSUE PER APPOINTMENT" like we often see in physicians offices? The reason those signs are there is a billing system issue. The health system pays for ONE issue per appointment and the amount they pay only really covers about 10 minutes of professional time. Hmmmm....more things to think about!
Time to re-consider whether you would want to work fee-for-service through our provincial health system? ...I know I wouldn't want it! NO THANKS! Currently in Canada, Nurse Practitioners are considered an uninsured service. AHA!!! :) This is both good for us and for patients because they (the patients) can pay for the service that THEY want. They can get the client-centered care they want this way and not have some regulator putting a stop to the quality medical care they prefer to pay for!!
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Nurse Practitioner, Entrepreneur in Manitoba, Canada
Irrationally Passionate about NP role, outstanding care for patients, supporting and promoting NP’s and with Fitness and Nutrition / disease prevention and de-prescribing!
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Diane Gudmundson has been an NP for over 14 years. She has a passion for the value and uniqueness of the NP role in our health care system.