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Dix under fire from doctors for comments praising nurse practitioners

B.C. Health Minister Adrian Dix attempted to fend off criticism from doctors Thursday that he was purposely pitting nurse practitioners against physicians at a time of crisis in the health-care system.
The Doctors of B.C. issued a rare statement Wednesday criticizing Health Minister Adrian Dix over comments he made during a committee meeting Wednesday reviewing estimates on health spending that suggested nurse practitioners are better than doctors because they spend more time with patients. DARREN STONE, TIMES COLONIST

B.C. Health Minister Adrian Dix attempted to fend off criticism from doctors Thursday that he was purposely pitting nurse practitioners against physicians at a time of crisis in the health-care system.

The heightened tensions between the province’s doctors and the health minister come as negotiations for a new contract focused on new payment models continues.

“I celebrate the work of family-practice doctors every day. I celebrate the work of nurses every day … and I do celebrate the work of nurse practitioners,” said Dix during question period.

The Doctors of B.C., which represents 14,000 physicians in the province, including 6,800 family doctors, issued a rare statement Wednesday criticizing the minister over comments he made in a committee reviewing estimates on health spending.

During the debate, Dix said of nurse practitioners: “I’m not saying they can provide better primary care, but for many people, they do.”

Dix said based on analysis of a nurse practitioner-only clinic, they tend to see fewer patients, spend more time with patients and take patients with higher needs.

The doctors group says the comments suggest nurse practitioners — who, with a few exceptions, have a similar scope of practice to doctors — are better than family physicians because they can spend more time with patients.

Nurse practitioners, usually paid on salary or contract, are not confined to the same fee-for-service model many doctors work under, which limits visits to about 15 minutes if doctors in private practice are to make a reasonable amount before paying overhead.

The Doctors of B.C. said in a statement that physicians have the utmost respect for the important role that nurses and nurse practitioners play in the delivery of health care to patients: “However, NPs cannot replace doctors, and they do not provide better care than doctors in ‘severe’ medical cases.”

The B.C. Family Doctors Association called the minister’s comments disheartening and divisive: “B.C.’s primary-care crisis will not be solved by fostering an us-versus-them culture.”

In the legislature Thursday, Opposition House Leader Todd Stone called the minister’s comments disrespectful at a time when about 900,000 people in the province are without a family doctor.

“Again to the minister of health, will he stop with this divisive rhetoric and focus on the action required, so that British Columbians have a family doctor when and where they need one?” said Stone.

B.C. doctors primarily want team-based care, said Dix, and that’s what the government is working on providing.

One of the challenges, he said, is that the complexity of patients’ health-care needs is increasing, yet the current fee-for-service model, which pays doctors about $31.62 per patient visit, “depends on volume.”

Many young doctors have said they’re not interested in taking on a fee-for-service practice, Dix said. “And that’s why we’re working closely together with doctors in B.C. to address these issues.” Alternate payment plans for doctors have increased in number under the current provincial government.

Dix pointed to the former Liberal government’s so-called GP For Me program, which promised everyone in the province a family doctor but was later dropped as unattainable. The Liberals then began pursuing the same goal the NDP government is pursuing now, which is to link patients with primary-care providers who work as a team in a clinic.

Such teams could see physicians working alongside nurse practitioners, mental-health clinicians and registered nurses.

“Family-practice doctors are foundational in our health-care system,” Dix said in a media scrum outside the legislature. “It’s family-practice doctors who’ve made the recommendations and suggestions to hire team-based care in our communities.”