The doctor's not in. The nurse practitioner would like to be. What's in the way?
N.L. health minister says public funding of private nurse practitioner-led clinics is on his radar
At a time when thousands of people in Newfoundland and Labrador don't have a doctor, a group of medical professionals stepping up to help is calling on government to make some changes.
Nurse practitioners are specially trained and are licensed to provide primary care, but a private nurse practitioner clinic in Corner Brook ran into roadblocks in getting established this past winter.
Their provincial association calls the situation "ludicrous."
"You've got three fantastic nurse practitioners who are ready and waiting and champing at the bit to provide this absolutely vital, necessary care, and are just running into obstacles day and night," said Margot Antle, president of the Newfoundland and Labrador Nurse Practitioner Association.
"We've got great providers who want to provide care. We've got a desperate need. We should be knocking down those barriers," said Antle.
Ready to serve
The nurse practitioner clinic in Corner Brook opened Feb. 21, and has since treated more than 400 patients, all of whom paid a fee for the care they received, since nurse practitioners in private practice in N.L. can't bill directly to government or through the provincial Medical Care Plan, as doctors do.
Lawrence McCarthy is one of three nurse practitioners at the clinic, which operates during late afternoons and evenings.
"We are certainly helping to keep people well in the community providing primary-care services. We have diagnosed individuals with various co-morbid medical conditions, mental health conditions. We are keeping people out of the emergency department and reducing the strain on the local emergency department," said McCarthy.
More than a few hiccups
While McCarthy and his colleagues are busy now with patients, it's taking a while to overcome certain challenges.
For example, the clinic was told it would be charged twice as much as doctors pay to get access to the provincial electronic medical records system.
McCarthy said the nurse practitioner clinic instead purchased a separate record keeping system at a much lower cost, but it has limitations for referral and follow-up since it's not integrated with the province-wide system.
It has been very disheartening and it undermines the profession.- Lawrence McCarthy
McCarthy said the clinic has also been unable to access diagnostic test supplies from the provincial public health lab, which so far does not recognize the nurse practitioner clinic as approved for such purposes.
"It has been very disheartening and it undermines the profession. And it just leads us to believe that maybe government is not recognizing what we are doing and don't see the importance and the value of what we are doing here on the west coast," said McCarthy.
McCarthy said the biggest obstacle has been the difficult matter of nurse practitioners having to charge patients directly for the care they provide.
"We've heard comments that they pay taxes in the province just like anybody else does.… And because they do not have a primary-care practitioner, they are availing of our services. But they say that they should not have to pay for it," said McCarthy.
McCarthy said the private clinic is willing to look at some sort of public/private partnership with government.
"Public/private partnerships are not a new idea in health care, and certainly we have some ideas of how we would like to do that," said McCarthy.
Two-tiered system
Health Minister John Haggie told CBC News that the nurse practitioners who've gone into private practice are to be commended and that nurse practitioner-led clinics are on the provincial government's radar.
But the clinic in Corner Brook has moved ahead faster than government has been able to accommodate.
"Creating the nurse practitioner-led clinic in this way has led to a two-tiered system, in the sense that those people who can pay have chosen to do so. The challenge here is that this group has come up with another innovative model that we have no direct experience of here and no framework within which to bring them," said Haggie.
Delayed by COVID
Before the pandemic, Haggie said, the provincial government had engaged in discussions with the Registered Nurses' Union Newfoundland and Labrador on a framework or model for publicly funding nurse practitioners but talks were stalled by the pandemic.
He said matters related to the use of the electronic medical records system would be sorted out in any framework involving nurse practitioners.
"It's important that when we set this up, we get it right. They're obviously filling a gap," said Haggie.
As for getting supplies from the public health lab, Haggie said he wasn't aware of the issue but will look into it.
They're obviously filling a gap.- John Haggie
Haggie said he was also encouraged to hear about the clinic's interest in a partnership or some sort of compensation model besides fee-for-service.
"I hadn't heard nurse practitioners talk about funding other than fee-for-service, so that is a sea change, and it's very welcome in terms of what that model might look like," said Haggie.
In a statement to CBC, the nurses' union said it's lobbied for many years for nurse practitioner-led clinics and a public funding model for nurse practitioner services.
"The improvements nurse practitioners could make in the delivery of primary health care are monumental," said the statement from the RNUNL.
Jonathan Carpenter, spokesperson for the Newfoundland and Labrador Medical Association, told CBC News the association supports all health-care providers working to the full scope of their practice but said it would be inappropriate for the NLMA to comment on how or how much nurse-practitioners are paid.
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