So many of us have experienced difficulties while trying to get an appointment on short notice. If you have a child running a fever and you can't access your provider, the last thing you want to hear is that your regular provider is not available. But, what if there was a highly qualified private nurse practitioner (NP) was available to examine your child the same day?
Nurse Practitioner are nurses with advanced education and training that allows them to have a broad scope of practice including diagnosing and treating many common conditions, ordering diagnostic tests, and prescribing medications. Just like a family doctor, if the patients needs are beyond their scope, they will consult with another doctor or specialist. Nurse practitioners are independent practitioners regulated by their provincial and federal bodies and have the opportunity to offer valuable and thorough medical services to patients across Canada.
Of note, there are a number of independent practices by Nurse Practitioners that have opened across Canada. These represent a new type of business model that can allow patients to have a transformational way of receiving health services. There is a 'perceived' concern with billing because nurse practitioners (NP) are not allowed to bill the province for their services. This means that these high-quality healthcare services will require patients to pay out-of-pocket for their care.
So what's the answer?
Some people seem to feel that NP services being billable to the province is the answer… That may or may not be the case though! Is important to note, that as soon as a service becomes billable to the province, it also becomes over-regulated and too many rules applied which then affect patient choice. For example, if the patient wants to see their nurse practitioner every week to help with diabetes control or perhaps mental health concerns… The province would not pay for a weekly visit and certainly no longer than 15 minutes each… So where's the patient control if they want to have their NP there for 30 minutes to an hour to address all of their concerns? ...And then, guess what else?… As soon as the Nurse Practitioner services become billable to the province, it then becomes illegal for Nurse Practitioners to offer medical services privately for an additional cost. Some may say that's OK… But for those patients that want to have control and to pay for what they want… All of a sudden there are unreasonable limitations imposed and the NP services become severely limited to the public. Doesn't this sound something like the crappy system we already have right now? Short visits, no control, lack of time spent for your concerns and often poor care? OK...so who wants that? When you have a private service that provides medical care, but give the patients control… Now THIS is completely transformational and the patients I know and care for would not want to lose this!!
Now, for a hiatus in the conversation...to bring your attention to another issue you may or may not be aware of!
A huge issue that many people are not aware of is the fact that the walk in clinic model is very costly to the system and takes valuable family practitioners out of their primary care positions.… At a recent visit, while seeing a patient regarding back pain, difficulty peeing and depression, she asked me about whether there was new family doctors available at the local clinic.
I told her, that it appears that many family doctors are leaving family practice to go work in walk-in clinics. The walk-in clinic medicine is much preferred by young practitioners because those doctors can generate the same income and less than half the time with no requirement them to provide after hours coverage or ongoing hospital care for patients.
I then pointed out that I had seen her today and dealt with three separate issues and despite the fact that that took almost an hour, a family doctor doing this service would get the same fee as a walk-in clinic would get for a short two minute appointment for "one complaint only" with no ongoing responsibility required beyond the initial visit. The patient was shocked with disbelief!! She had assumed that family practitioners are paid significantly higher fees then a walk-in clinic physician would get. 'Nooo, thats not the case', I said. That's why many family practitioners opt for walk-in jobs. Its far more lucrative, you work your shift and go home and far less issues with paperwork, forms, on call and all of the after hours responsibility and far HIGHER pay in less time! We all know about the quality of care we get in a 2-minute walk-in appointment, right?
In my years of practice, especially in the last few years, I have seen many family doctors leave family practice for the higher pay and less paperwork and commitment of walk-ins and emergency rooms. Family practitioners in general are overworked, underpaid and have significant jobs of dissatisfaction and burn out… It is not good!
If you think about it, family doctors providing high-quality care are not compensated adequately relevant to the walk-in Doctor, who in most cases is not providing the same level of care given the limited time available for the patient visit and the lack of continuity. If this kind of practice is allowed to continue, family practice will continue to die a slow death. It is very sad, but is the current reality!
So, back to Nurse Practitioners....
After that little hiatus from the nurse practitioner conversation, back to another look at what policies may be a good idea. Nurse practitioners in private practice will allow the patients to have 100% control over the type of service they want, the duration of time they want to have that service, and the frequency with which they want to have service. The moment you place nurse practitioners within the 'public' system, the control that the patient has over their medical care is completely gone. There would be restrictions regarding time, number of visits allowed per year, and services provided within the 'public pay' system. And... then, once the nurse practitioner billing is placed in the public system, it eliminates the possibility of offering private services outside of that because then it will be officially become illegal. Hmmm, definitely something to think about and to be careful what you ask for!!!
Nurse practitioners are a viable option for health care, currently have the option of paying for what services YOU want as a patient and has been linked to high quality patient outcomes and satisfaction...both in research and in day-to-day feedback I get from patients. I say lets keep it the way it is and expand the private services available to completely TRANSFORM the health care options for our Canadian population!!
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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.