An empty waiting room! No, we’re not in a medical clinic, and we’re certainly not in an emergency room. We’re in a private super nurse clinic in St-Hippolyte, in the Laurentians. There’s not a soul in the waiting room, but the appointment book is packed. Patients follow one another in 15-minute intervals. And 95 per cent of the time, the clinic’s specialized nurse practitioners are able to deal with their problems.
Even though they’re sick, patients are all smiles when they leave, satisfied with the care they’ve received. “I don’t need to wait 20 hours in an emergency room for a prescription for antibiotics for an ear infection,” one mother told me.
“My ear was blocked for three weeks, but the CLSC was making me wait three months for an ear-cleaning,” confided another patient.
Here is a solution for alleviating the lack of access to health care. But Health Minister Gaétan Barrette disagrees. Instead of getting behind super nurse clinics, it seems he would rather preserve the rigid, centralized, bureaucratic model that has prevailed for decades and is plagued with problems.
Like his predecessors, the minister is tweaking the recipe, not making major changes. On April 25, for instance, Barrette announced the creation of 50 super clinics, open 12 hours a day, seven days a week, to allow Quebecers to finally have quick access to health-care services. He wants the super clinics to be open by 2018.
Yet, super nurse clinics are a solution that already exists. We just have to look to our neighbours in Ontario, who adopted this practice to help ease congestion in their emergency rooms and provide patients with better access. The result: Ontario has 2,134 specialized nurse practitioners compared with 294 in Quebec.
Doctorless clinics respond to the needs of people who do not have access to a family doctor or clinic, and for whom emergency rooms are their only point of access to the system. Indeed, Quebec’s Health and Welfare Commissioner recently reported that less-urgent cases represent 60 per cent of emergency-room visits.
A specialized nurse practitioner can prescribe antibiotics, treat minor injuries, change a dressing or drain an abscess. For cases that are more complicated and are beyond the skill set of specialized nurse practitioners, a referral can be made to the clinic’s partner doctor.
It’s effective, and it’s less expensive. Indeed, a specialized nurse practitioner costs the health-care system around one-third of what a general practitioner costs. But our health minister categorically refuses to support this model. “My goal is for family medicine to take place exclusively in (Family Medicine Group clinics),” Barrette told me. “A parallel structure represents an extra cost,” he said, “not a saving.”
In recent months, a lot of ink has been spilled over the case of a doctorless clinic in Quebec City.
The clinic, known by its acronym, SABSA, for Service à bas seuil d’accessibilité, was part of a pilot project funded by Quebec’s federation of nurses, and was seeking permanent funding. Barrette rejected the clinic’s request for that funding, leaving the clinic’s future in doubt.
I don’t know how the minister does his calculations. Not only is a nurse practitioner less expensive than a doctor, but chronic illnesses that are better cared for and followed more closely reduce the number of hospitalizations, and therefore reduce costs down the road.
The public sector is missing the boat. Fortunately, entrepreneurs are offering this service in the private sector. Private clinics have emerged over the past year and are responding to an obvious need. Thanks to them, thousands of patients have been able to be seen and treated quickly.
Patients will end up having the last word — with or without the backing of the health minister.
Pascale Déry, Senior Advisor, Communications and Development at the MEI and content producer of the short documentary Doctorless Clinics: Why Not Let Patients Decide? The views reflected in this op-ed are her own.