Fear-mongering about nurse practitioners

Over the past decade, the Ontario Medical Association has targeted nurse practitioners as it fights to protect what it sees as doctors’ turf.

Indeed, the leadership of the powerful doctors’ group has at times gone so far as using fear-mongering in opposing proposals to expand the role of these critical, but underpaid and undervalued, health-care professionals.

That attitude, still on display today, is a major roadblock in efforts to address doctor shortages in parts of Ontario and to ease pressures on the province’s healthcare spending. In the past three weeks alone, communities from Belleville to Sundridge, near North Bay, have been crying out for more nurse practitioners.

Nurse practitioners are specially trained registered nurses authorized to treat common illness and injuries, set bone fractures, order diagnostic tests and prescribe medications. In fact, the 3,300 NPs in Ontario provide about 80 per cent of similar care to that of doctors.

Their role is important for three key reasons. They provide top-quality health care for tens of thousands of people without a family doctor; they free up doctors to focus on serious illnesses; and they stretch the province’s health care dollars.

Despite all these positives and urgings by vast numbers of its members, the OMA leadership has done little to encourage the expansion of nurse practitioners.

Back in 2009, the OMA fought the government’s move to open 25 NP-led clinics. Its then-president, Dr. Ken Arnold, said the move was the wrong way to go. “It strikes me as a different, backward direction in an unproven way of delivering care, “he said.

It also launched an aggressive ad campaign warning that patient safety would be risked unless physicians reviewed the diagnosis and treatment decisions of nurse practitioners, suggesting that “having these roles filled by non-medical personnel is like having a member of a flight crew fly an airplane.”

And today the OMA leadership is using nurse practitioners as unfair targets as the OMA struggles to deal with the publicity surrounding the Star’s investigation into top-billing physicians, some of whom bill OHIP well over $1 million a year.

Dr. Sohail Gandhi, the current OMA president, has argued Ontario is getting great value for the money OHIP pays doctors. “The average general family practitioner makes about $380,000 and pays about $120,000 in overhead costs” and another $60,000 in other expenses, Gandhi wrote recently in the Star. “All things considered, the average family physician makes about $200,000 for caring for about 1,200 patients.”

But he then goes on to claim that “nurse practitioners, for example, do not pay overhead, which would typically average about $100,000 for their services. If overhead were factored in, their total compensation would be closer to $200,000 for 800 patients.”

In reality, the average NP makes much less than the $100,000 cited by Gandhi, often must work three part-time jobs to reach that level, and serves up to 1,000 patients, not 800.

Despite Gandhi’s cheery words about the OMA working with other health care providers “to fix” the system, the reality is the OMA has had virtually no relationship with nurse and NP organizations. They rarely, if ever, meet or talk.

All of which frustrates Dawn Tymianski, CEO of the Nurse Practitioners’ Association of Ontario, who told me recently that “some doctors do see us as a major threat. We’d like NPs to be recognized as the primary care providers that we are, to be respected for what we do and for doctors to see us not as a competitor.”

Clearly, Ontario needs more nurse practitioners if we are to improve the quality and sustainability of our health-care system. It’s time the OMA started to actively support nurse practitioners — and ended its self-serving “turf wars.”

Bob Hepburn is a politics columnist based in Toronto. Follow him on Twitter: @BobHepburn