The B.C. Liberals promised “a GP for me” in the last election, but as Times Colonist reporter Cindy Harnett wrote in the spring (“B.C. gives up on family doctor for everyone,” April 24), they are far from keeping that promise.
So I have a better idea for the next government, whichever party it may be: Don’t get so hung up on doctors, when there are other health professionals out there who can do much of the work just as well and at lower cost. Chief among them are nurse practitioners and midwives.
Forty years ago, I was a family physician practising in a community health centre in Toronto, and our team included a nurse practitioner, at that time a fairly new idea. But research on their effectiveness dating back as far as 1974 in Canada has shown that they produce “outcomes that are as good as and often better than the care provided by MDs in traditional primary clinical settings,” as a 2015 study put it.
Having been a family physician, I know that much of what brings people to the clinic does not need our highly developed and expensive skills. Many come for basic preventive care, minor illnesses, worries, social support, routine prenatal care or the ongoing management of chronic diseases.
These are all areas where nurse practitioners do a fine job. So why aren’t NPs much more widely used in the B.C. health-care system? The B.C. Nurse Practitioner Association notes there are more than 300 practising in B.C., but Harnett noted B.C. is only training 45 NPs per year. Meanwhile, Ontario, with about 2.5 times our population, has nearly 3,000 NPs, almost 10 times as many as B.C.
Ontario also has 27 nurse practitioner-led clinics, an important approach that B.C. should be vigorously exploring and that we, as patients, should be demanding. Ontario’s Health Ministry notes these clinics “improve the quality of care through enhanced health promotion, disease prevention, primary mental-health care and chronic-disease management” while “engaging patients as full partners in their care plan.”
The Association of Ontario Health Centres notes these NP-led clinics “provide comprehensive, accessible and co-ordinated family health-care services to people who formerly did not have access to a primary-care provider [i.e. unattached patients],” which is exactly what we need in B.C.
I am not suggesting that family physicians be replaced by NPs, but we need both, working collaboratively all across B.C. For the most part, I believe NPs and family physicians should be integrated in the same practice (which should be a community health centre, the topic for next week), or at least be co-located, rather than having freestanding NP practices. However, standalone NP clinics make a great deal of sense for small, rural or remote communities such as the Gulf Islands.
I would be more than happy with a nurse practitioner-led primary-care centre for my routine care. I would expect them to help me stay well, manage my health problems and keep me out of hospital. Of course, I would also expect them to know when it was time to refer me back to my family physician for management of complications or referral to specialty care.
This would free highly trained physicians to spend more time on diagnosis and on the treatment and management of complex conditions and unstable chronic disease. That way, we would need fewer doctors, with nurse practitioners making up the difference.
Of course, that is the problem, from the perspective of organized medicine, which in my experience has slowed progress in this area over these past decades. They have opposed the expansion of the role of nurses, just as they have opposed the expansion of midwifery, mainly to protect their own turf — although often dressing it up as protecting patients, which they are not.
Unfortunately, successive governments have gone along with this, protecting the interests of physicians rather than those of patients. But it is long past the time when governments should pay less attention to organized medicine and instead put more emphasis on the best interests of patients.
So how about pledging “a nurse practitioner for me” next time around? And how about creating nurse practitioner-led health centres across B.C., as a key part of the primary-care system?
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.