The professional order representing Quebec physicians has voted to allow the roughly 500 nurse practitioners in the province to begin diagnosing patients in an effort to reduce wait times in the health system and increase access to health care.
Following years of debate and pressure from nurses and provincial politicians, Quebec’s college of physicians decided at a general assembly Friday to give nurse practitioners some of the same autonomy enjoyed by their colleagues in other parts of the country, such as Ontario.
Nurse practitioners – also known as registered nurses – will soon have the authority to diagnose common health problems in patients as well as six chronic health conditions, including hypertension, diabetes and asthma, according to a news release issued by the college Saturday.
Spokeswoman Caroline Langis said the new rules should come into effect in the coming months, after the college’s board of directors adopts a bylaw giving nurses the extra autonomy they’ve been seeking for years.
Quebec Health Minister Danielle McCann made a surprising announcement this week when she stated doctors were ready to cede more ground to nurses in medical clinics. By the end of the year, the minister said, Quebec’s registered nurses could be diagnosing patients.
Gaetan Barrette, the health minister under the previous Liberal government, told The Canadian Press in an interview earlier in the week that McCann would likely have to use the threat of legislation in order to get the doctors to change. When he wanted to give more authority to nurses during his mandate, he said he had to personally intervene in the file and threaten the college of physicians.
“Behind closed doors I said: ‘Either you move or I will legislate’ – and they moved,” Barrette said. As a result of his efforts, nurse practitioners in the province gained the authority last March to initiate treatment for six chronic illnesses and to prescribe more medications than had previously been the case. But an official diagnosis still had to come from a doctor; patients were required by law to be seen by a doctor within 30 days of being treated by a nurse practitioner.
Less than a year later, all that has changed. The college decided Friday that patients will no longer have to see a doctor after being treated and diagnosed by a nurse practitioner for common health issues or for the six chronic illnesses, Langis confirmed.
Quebec’s college of physicians had always been opposed to giving nurses more authority. Barrette, a radiologist who was president of the federation of Quebec’s medical specialists from 2006-14, said there is a culture among Quebec doctors that makes it difficult for them to accept change.
“It’s their profession, it’s their fibre – their essence,” he said. “A doctor in Canada, on average, sees 30-35 patients a day,” Barrette said. “In Quebec, it’s 14. I did everything to change that, and it is changing. But there is more work to be done.”
Barrette says the nursing profession is also partly to blame. “We are facing two organizations who are corporatist,” he said. Each side wants to protect its own territory. Nurses want to have a parallel system alongside doctors, Barrette explained, while most doctors don’t want change.
Prof. Yannick Melancon Laitre, nurse director at McGill University’s primary care nurse practitioner program, said Quebec has been debating the authority of registered nurses since 2012. He said in an interview before Saturday’s decision by the college, that he is “always a bit skeptical” about whether nurses and doctors can agree to co-operate.
“I’m excited for us to just come to a decision – to stop talking about it and arrive at a result that is similar to our colleagues in Ontario,” he said in an interview.
Registered nurses in Ontario currently have significantly more authority than in Quebec. They can diagnose, order and interpret diagnostic tests, and as of 2017, can even prescribe controlled substances such as opioids if they receive additional training.
Laitre says the differences between Quebec and Ontario nurses “seem trivial” but they are not, especially when it comes to insurance claims. If nurses can’t use the word “diagnosis,” that means the medical care they offer isn’t covered by private insurance policies. Their work must be overseen by a doctor, which increases bureaucracy in the system, he said.
“We’re doubling up on the services instead of working in collaboration with doctors,” Laitre said.
Barrette said research has shown how to reduce waiting times and increase access to medical care. Doctors need to take on more patients, he said, and nurses and doctors should work together each with their own, clear authority. Unfortunately, he said, less than 20 per cent of doctors in Quebec work this way, he explained.
A 2015 government proposal that was eventually dropped because of a backlash from doctors would have required young doctors to be responsible for a minimum of 1,500 patients. Barrette argues that if clinics were properly organized, one doctor could be responsible for 3,000 patients.
“But in order to do that you need nurse technicians, auxiliary nurses, and nurse practitioners,” he said. “You need all three. And it exists. But it needs to happen more.”