Clinic under scrutiny for charging fee to see nurse practitioners
'We are doing our job legally,' clinical director says
Ontario's Ministry of Health says it is reviewing a walk-in clinic in Ottawa set to offer patients access to nurse practitioners for $400 a year.
The clinic, which is expected to open Oct. 10 out of the South Keys Health Center, has drawn criticism that its pay-for-care model will undermine the province's health-care system.
The head of the clinic, meanwhile, said they're responding to demands the province can't meet.
"We are just a Band-Aid to a broken system," said the centre's clinical director, Osman Nur, in a statement.
So far, more than 2,000 patients have registered and thousands more are on a waitlist.
The clinic would operate under the murky rules governing nurse practitioners, who are not covered by the Ontario Health Insurance Plan (OHIP) when they're not part of provincially funded clinics.
Nurse practitioners are able to examine patients, prescribe medication, order blood tests, refer patients to specialists and open their own clinics.
"We are doing our job legally, as the law permits nurse practitioners to charge patients directly," Nur said. Family physicians also work in the centre, but their patients are covered by OHIP and won't be charged.
"The initial $400 will cover the first consultation, and the rest will cover the patient's health administration for a year," Nur said. The fee will cover medication refills, referrals and interpretation of laboratory tests for the whole year, he added.
A spokesperson for Minister of Health Sylvia Jones said the office is looking into it.
"We will not tolerate any clinic charging for services," Hannah Jensen said.
"[W]e are taking steps to review this and shut down bad actors taking advantage of patients."
Clinics like this are legal, but 'fundamentally unfair'
It's unfortunate that clinics like these are popping up, said Melanie Bechard, chair of Canadian Doctors for Medicare and a pediatric emergency doctor in Ottawa.
Bechard said the clinic is legal since health-care providers such as nurse practitioners aren't explicitly covered by provincial legislation.
It's an unavoidable situation, she said. She sees these types of clinics as the "canaries in the coal mine" highlighting the gaps in Canada's health-care system.
"I think it's a sign that our health-care system has been so underfunded and underresourced for so long, especially in primary care, that people are turning to these other options," she said.
"Unfortunately, clinics like this are fundamentally unfair because those who can afford the fee will get preferential access," she added.
Bechard hopes this clinic will be a wake-up call for politicians on the importance of appropriately funding primary care.
"We have to keep in mind that although these services can seem like a great option for those who can afford it, that we are leaving people behind and there's a lot of people who would not be able to afford that fee of $400 a year," she said.
Can help alleviate demand
Dr. Georges Nicolas Mobayed, a family physician at the South Keys Health Center, sees first-hand the intense demand for family physicians across the city.
"Unfortunately it's a big problem in the country," he said. "Somebody has to do something about it. This has been going on for years and it's not going to get any better."
It's estimated that about 2.2 million people don't have access to a family doctor in Ontario, according to the Ontario College of Family Physicians.
Mobayed currently sees patients out of the South Keys centre, but operates entirely separately from the walk-in clinic and doesn't work with any of its nurse practitioners.
"[Nurse practitioners] do the same thing, exactly like family doctors. My question is, why shouldn't they be paid like family doctors are paid?" he said.
WATCH | This doctor sees benefits to the model:
Paying to see nurse practitioners might not be ideal, Mobayed said, but it can be a start to address the huge backlog of people in need of care.
"This will solve the problem of the shortage of family doctors today, which is going to become worse in the future. It can alleviate a little bit the congestion in the emergency rooms," he said.
Doris Grinspun, CEO of the Registered Nurses Association of Ontario (RNAO), disagrees. She said clinics like this compromise the quality of the health-care system.
"The detriment is that you will get faster access for those that can pay and slower access for others," she said.
"The answer is not to proliferate these clinics because of the demand."
WATCH | How Grinspun says the model hurts residents:
Instead, Grinspun said part of the solution is improving access to non-profit community health centres and nurse practitioner-led clinics across the province.
"In a world that is well developed like Canada, where you have universal access to health care, what you need is [24/7] access to primary care, and numerous countries are doing that," she said.
"That is a hallmark of a high-performing health system, not walk-in clinics and certainly not paying a fee."
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