February 21, 2013

Is there a solution to address the shortage of physicians? It seems there is, and a recent articlepublished in L’Actualité correctly reminds us that this solution is within reach. That wouldconsist of first having the health-care system benefit from the expertise and experience of thenurses, by letting them fully carry out the role given them by the law, and by promoting thedeployment of the specialty nurse practitioners (SNP). The one small problem: the QuébecMinistry of Health will probably not find this solution very appealing.

For now, Québec only has 167 nurse practitioners and none of them have the flexibility forwhich they were trained. At the same time, our neighbours in Ontario are experiencing realsuccess with the deployment of nearly 2,000 nurse practitioners, who have received the sametraining as those in Québec, and are able to prescribe almost all medications, follow patients,consult medical specialists and treat chronic diseases. The Ontario health-care system can evencount on a growing number of clinics run by nurse practitioners.

It has been nearly ten years since Bill 90 was passed in Québec. How, despite all the underlyingvolition to recognize the expertise and autonomy of the healthcare professionals, can we stillbe in the same situation? The problem is that our government has to deal with a Fédérationdes médecins omnipraticiens that shouts about heresy regarding this new model of health care.Add to that, the Collège des médecins, who negotiates the powers that it wants to grant to thenurse practitioners on a case by case basis. With all of that, we can even ask if only the medicalspecialists will agree to have patients referred by the nurse practitioners.

And as if those obstacles weren’t enough, each one of the competencies extracted from theCollège des médecins can only be performed under the supervision of another physician.That generates “supervisory” costs for every nurse practitioner hired in a clinic, and tells thegovernment that it lacks the money to go ahead with hiring these professionals for the timebeing.

When we see how Québec is trying right now to fill the shortage of physicians, I cannotunderstand at all why the government still tolerates such childishness. Is that the result of a lackof long-term vision? Or is it a perception of the nursing profession that is still too chauvinist?

For the time being, I prefer to believe that the Minister of Health is in the process of seriouslystudying the issue, and that he will soon surprise us with a worthwhile announcement fromsomeone who truly wants to attack the problem of the physician shortage.