(August 5, 2024) By: Celeste Percy-Beauregard, The Brantford Expositor<\/p>\n
Crystal Troup recently got a call from someone wanting an IUD.<\/p>\n
The patient\u2019s family doctor told her she would need a referral to a gynecologist \u2014 with a six- to nine-month wait \u2014 to have the birth control device inserted, and she wondered if it was something the nurse practitioner (NP) could do.<\/p>\n
Two days later, at her practice on Grand River Street North, Troup completed the procedure.<\/p>\n
Paris, with a population of around 15,000 as of the 2021 census, is where Troup and her business partner \u2014 registered nurse Cailynn Bateson \u2014 opened MESH aesthetics and medical wellness clinic in March.<\/p>\n
Opening a NP-led clinic was \u201ca risk\u201d both personally and financially, Troup told The Spectator.<\/p>\n
Right now, Ontario has 25 publicly funded NP-led clinics, and recently announced six new and expanded ones.<\/p>\n
NP-led clinics outside of that don\u2019t receive funding from the Ministry of Health and are unable to bill OHIP for assessments, meaning practitioners bill patients directly.<\/p>\n
Troup admits the transactional component feels \u201cweird,\u201d because in her 15 years of nursing, it has never been part of the equation.<\/p>\n
But she said NPs aren\u2019t doing it because it\u2019s \u201clucrative.\u201d<\/p>\n
They \u201cgenuinely want better care for people in our communities,\u201d Troup said.<\/p>\n
Still, the payment factor has inspired controversy over whether such clinics have a place in Ontario\u2019s health-care system.<\/p>\n
The Ontario Health Coalition has spoken out against such NP-led clinics, arguing that the Canada Health Act protects residents from paying for medically necessary hospital and physician services out of pocket.<\/p>\n
But, because NPs aren\u2019t specifically mentioned in the act, and can\u2019t bill OHIP, they argue the payments are legal.<\/p>\n
In October, Health Minister Sylvia Jones announced the province was investigating an Ottawa walk-in clinic charging for NP services.<\/p>\n
However, when The Spectator asked the ministry if the province is investigating other NP-led clinics, a spokesperson said the ministry \u201ccannot comment on any ongoing investigations.\u201d<\/p>\n
Troup said she thinks if people experienced the care NPs are providing, \u201cor were even willing to have conversations with us independently,\u201d they might have a better idea as to what it actually looks like.<\/p>\n
What does care look like?<\/strong><\/p>\n Troup performs minor procedures such as skin tag, wart and cyst removals, biopsies and joint injections \u2014 things some primary physicians refer out, Troup said.<\/p>\n She also offers services like addictions counselling and ADHD assessments.<\/p>\n While some patients come for a one-off issue, like ear pain, others have an ongoing, primary care relationship with Troup.<\/p>\n Thomas Jankowski, CEO of Medimap, an app that connects people with local health-care practitioners, told The Spectator care from a NP isn\u2019t that different from having a family doctor, and there are communities within the U.S., Asia, and Europe that rely heavily on NP clinics.<\/p>\n With a high demand for doctors, Jankowski said there\u2019s a \u201cmassive supply of nurses that could be upskilled to become nurse practitioners quite quickly,\u201d by taking a two-year masters program.<\/p>\n As for privatization, Jankowski said medical private pay services already exist in Canada, such as chiropractors and massage therapy.<\/p>\n \u201cExcept usually it\u2019s our insurance that covers it,\u201d he said.<\/p>\n But not everyone has private insurance.<\/p>\n \u201cThe argument (that) somebody with money shouldn\u2019t have better access to anything \u2014 tell me something that doesn\u2019t apply to,\u201d Troup said, giving the example of public vs. private education.<\/p>\n While the province announced in June they\u2019re \u201cstarting consultations with the College of Nurses of Ontario and other health care partners on expanding the scope of practice for nurse practitioners,\u201d OHIP coverage was not among the considerations mentioned.<\/p>\n The Spectator asked the ministry if they are considering adding NP services to OHIP, and a spokesperson said the ministry is \u201cworking with our partners to determine which scope of practice changes will be made, and will make it easier for Ontarians to connect to care.\u201d<\/p>\n Is it sustainable?<\/strong><\/p>\n Ancaster-based Holistic Solutions NP, a clinic led by five NPs, had 3,000 web hits per month, but that didn\u2019t translate into visits, lead NP Christopher Savard told The Spectator in an email in June, the week before the clinic shuttered.<\/p>\n \u201cIf we had OHIP funding it would have been successful. It is very sad. Our NPs tried our best to help the community and improve access to care but it is just not financially viable to continue,\u201d he said, around half a year after they opened.<\/p>\n While Troup said being able to bill OHIP would bring more patients, it\u2019s something she\u2019s conflicted over.<\/p>\n \u201cPart of me would love to say, \u2018yes, that is a model that I would prefer,\u2019 because I want to be able to have a positive effect on as many people in our community as possible,\u201d she said.<\/p>\n But, knowing what she knows about billing codes and \u201cthe inadequate amount of funding given to a clinician for each visit,\u201d Troup said she\u2019s skeptical she would be able to deliver \u201cthe level of care that I want to provide, and that I refuse to compromise on,\u201d if covered by OHIP and restricted to short, single-issue visits.<\/p>\n \u201cI don\u2019t want to become a walk-in clinic. I want to \u2026 provide preventive health care.\u201d<\/p>\n Troup told The Spectator she and Bateson identified \u201ca growing need\u201d for primary health care and procedural services in Paris \u201cbecause of their lack of access right now.\u201d<\/p>\n And with residential development happening in Paris, \u201cthe need for access to care is only going to get greater,\u201d she said.<\/p>\n Local supply and demand<\/strong><\/p>\n The county has budgeted $100,000 annually to meet the need for ongoing physician recruitment, Coun. John Bell, who is chair of the PrimaCare Community Family Health Team board of directors, told The Spectator in an email.<\/p>\n The family health team, based in the Cowan Community Health Hub, primarily has county residents, although a \u201csignificant number of residents\u201d from Brantford and North Dumfries also access service, Bell said.<\/p>\n Paris also has a walk-in clinic, independent physician practices, and the Willett urgent care facility \u2014 which often has a wait of several hours, Troup pointed out.<\/p>\n But, as many as 30 per cent of Brant residents may be without a family physician, Bell said.<\/p>\n And, Brant\u2019s population is growing at two per cent each year, he added.<\/p>\n Still, Bell said he personally doesn\u2019t see a need for \u201cout of the box\u201d solutions such as pay-per-service clinics.<\/p>\n \u201cThe much simpler solution is for the provincial government to increase the resources to support a model that, when fully resourced, works well,\u201d he said.<\/p>\n Bell said he believes the provincial government \u201cunderstands the imbalance between supply and demand,\u201d pointing to recent increases in the number of services pharmacists and nurse practitioners can provide, and increasing the number of medical school places.<\/p>\n