Accessing nurse practitioners – a double standard?
My friend Ron is an energetic seventy-year-old who is diabetic. We live in northwestern Ontario, in a town called Kenora, two hundred kilometers east of Winnipeg, Manitoba. Ron's life has just been complicated by the fact that his family doctor moved away recently. Why is this a particular complication for him? Because the lab in Kenora has refused to do his blood tests now that he doesn't have a family doctor. To get his bloodwork done, Ron has to make the two hundred kilometer trip west to Winnipeg.
His other problem? He may qualify for a Northern Health Travel Grant but has no one to sign the "from" portion of the form. So in addition to the inconvenience, and sometimes the danger of travel in bad weather, he now has to personally bear the cost of a two and half hour trip from Kenora to Winnipeg and back.
What about a nurse practitioner? We do have a nurse practitioner in Kenora, who works with a family doctor who isn't taking on any new patients. Ministry of Health “rules” prohibit Ron from being seen by this NP. The explanation that I received from the Ontario Ministry of Health and Long-Term Care was, and I quote, "In settings where a NP works in a practice with family physicians, a person must be a patient of a physician within the practice to see the NP. The physician is the lead provider of primary health care in these settings.”
It's amazing to me that less than five hundred kilometers to the east, in Thunder Bay, the Lakehead Nurse Practitioner-Led Clinic has four nurse practitioners seeing a total of 3,200 patients. These NPs work in a stand-alone facility as independent primary care providers and are not under the supervision of family doctors. I assume that their training has been identical to that of the nurse practitioner in Kenora, but residents here are penalized because in Kenora, the nurse practitioner and doctors work in the same building.
Kenora is a community of 15,000 people. We have no community health centre, no walk-in clinic, no urgent care clinic, no nurse practitioner-led clinic, and ER wait times average five to six hours. We have one clinic in Kenora and a smaller one in nearby Keewatin, so it seems that, even with our critical doctor shortage, there is no way around this arbitrary edict of the Ministry of Health.
I have explored the Ministry’s websites and spoken to several service representatives at the Ministry of Health and Long-Term Care as well as Service Ontario about this double standard, and have not been able to get an explanation. Apparently, nurse practitioners can provide primary care in Thunder Bay, on remote reserves and out in communities, but they are not allowed to provide primary care in this area of northwestern Ontario where they are so sorely needed.