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What does it take to improve Quebec Health care like other provinces

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Improve Quebec Health care – Last week I was on about the need for health care changes in Quebec. Every time I look for information on health care in Quebec I find that we don’t do very well compared to other provinces. What does it take to improve Quebec Health care like other provinces?

Other provinces are allowing nurse practitioners to do what they should doing. All nurses for that matter can be providing front line access to care. This would certainly start to improve Quebec Health care. The number of nurse practitioners in Quebec is shockingly lower than in Ontario.

The creation of the CLSC’s was motivated by the desire to provide front line services outside of the hospitals in the 1970’s. To improve on shortcomings of the CLSC’s the government decided in the early 2000s to create Family Medicine groups… Doctors in charge and working closely with Nurses.

Despite the greater resources allocated to these changes for over 20 years we still struggle with difficulty in accessing front-line care. So many Quebecers do not have a family doctor. The proportion of the population without a regular family doctor (2015, Stats Canada) was 24.6% in Quebec, 8.3% in Ontario and 15% in Canada. We are the worst performers in all provinces. It is no wonder that our emergency rooms are full and wait times are so horrible. What a waste!

This lack of access to front line services has direct and indirect consequences on the health of our population in Quebec. Thousands of hospitalizations could have been avoided in Quebec with better access to care. (21,000 annually based on stats from 2013) The numbers are only increasing.

Where are those Nurse clinics? There are none on the West Island and only a few private care Nurse Clinics in the East End of Montreal. The presence of nurse practitioners has the potential to greatly improve access to front line care. The existence of Nurse Practitioners began in 2007 in Quebec following an agreement with the Order of Nurses of Quebec and the College of Doctors of Quebec. The agreement allowed Nurses to prescribe under collective orders for common health problems and minor emergencies. Why are we not using this to alleviate the bogged down system?

The Ontario Government encourages the opening of nurse clinics. They announced the establishment of 25 of them in 2007 with the capacity to serve 40,000 patients. Nurse practitioners direct the activities of different health professionals without a doctor on site. A doctor working in collaboration with the clinics is available for more complicated cases.

Quebec insists on maintaining the Family Medicine Model at much greater cost and worse outcomes. A nurse practitioner costs the health care system 1/3 of what a general practitioner costs. While a GP can count on an income of $264,000.00 and the most experienced Nurse practitioner gets $93,700.00. Studies show that anywhere from 25%-70% of the work of non- specialist doctors providing front line care could be carried out by nurses, with referrals to doctors when necessary. Clinics led by nurse’s report that in less than 5% of the cases they need doctor supervision and consultation.

Because our Government does not support and encourage the development of these Nurse Clinics, private clinics are opening. They are more flexible and make greater use of all of the capabilities delegated to nurses.

Resistance to change also deserves to be mentioned. According to Dr. Louis Godin, President of the Fédération des médecins omnipraticiens du Québec, the proper role of nurses is limited to helping and supporting doctors. Innovations like nurse-led clinics have “no place in the health care system” according to him, even though patients are flocking to them. (La Press 2016).

When will we ever learn?

By Donna Byrne – info@mtltimes.ca
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