First Nation health centre model now being used by Ontario government against the wishes of doctors
Medical risk for rural patients? OMA concerned about number of 'nurse-led' clinics with limited access to physicians in under-serviced areas
By CHRISTINA BLIZZARD - June 6, 2008
The province's doctors are raising the alarm that new "nurse-led" clinics being set up in rural and underserviced areas will not meet the health care needs of patients in those communities.
One clinic has already been set up in Sudbury and there are plans to add another 25 across the province, including Sault Ste. Marie, Belleville and Thunder Bay, staffed by nurse practitioners. Ontario Medical Association President Dr. Ken Arnold says the part-time support the Sudbury clinic is getting from a physician is inadequate.
"We are concerned perhaps about the level of contact that nurse practitioners will have with physicians in some of these proposed clinics," he said in an interview yesterday.
In an attempt to beef up health services in under-serviced areas, the government set aside $38 million in its March budget to set up the clinics. The Sudbury clinic opened last summer and serves 1,200 patients.
The OMA prefers family health teams, that include doctors, nurses, dieticians and physiotherapists, as the best way of delivering health care in those areas.
The OMA has written to Health Minister George Smitherman and to the mayors of the affected cities outlining their concerns.
Smitherman dismisses the docs' concerns.
"I feel that is actually territorialism," he said in an interview this week.
"There are many models of practice that can enhance access to family health care for Ontarians and as a government we are very committed to examining them and to implementing them," Smitherman said, adding that "billions" of dollars from the health budget go to pay for doctors.
He says the doctors can't have it both ways when they complain there is a doctor shortage.
"If you want to argue, as the physicians do, that there is a shortage of doctors, and we all agree that it takes quite a long time to make a new doctor, is their alternative to say, 'don't take advantage of the skills of these health care practitioners, let the patient wait?'" he asked.
While Smitherman says there is a doctor associated with the Sudbury clinic, Arnold says it is only on a limited basis.
"I think it is good that the physician with the team is there, but I think the contact is sketchy," Arnold said. "My understanding is it may involve a couple of half days a week. That really isn't providing enough support to the nurse practitioners when they run into questions that they are unable to handle," he said.
Arnold points out also there is a nurse shortage in the province and the nurse-only clinics are taking nurses away from the family health care teams and other vital medical services. The Thunder Bay family doctor says Sudbury's family health team can't find a nurse practitioner.
WORKING TOGETHER
"Doctors need to work with nurses. Nurses need to work with doctors, so working together is the best way to go. We are concerned about the level of contact that nurse practitioners will have with physicians in some of these proposed clinics," he said.
He wants Smitherman to monitor the Sudbury clinic carefully before expanding the model to the rest of the province.
It's a delicate balance: Sure, we want to increase access to health care, but not if it dilutes quality of care. Nurses play a vital part in health care -- as a team. You can't replace a doctor with a nurse.