She's not a doctor, but this nurse practitioner thinks she's part of the future of rural health

It's not news to nurse-practitioner Sarah Kennedy that there's a doctor shortage in Newfoundland and Labrador, particularly for family doctors in rural areas.

But she says what she's doing in her hometown of Labrador City is a solution that the provincial government should be considering.

Kennedy, who says she worked as a nurse at the local hospital for eight years, just opened a private health clinic where she provides many of the same functions a family doctor offers at a clinic — the only catch is clients pay her.

"It's just opening more doors for access to patients, and I guess that's the other option for them now — if you can't get a family doctor then hopefully you could be seen by a nurse practitioner in a clinic," she said. 

While doctors are doing their part, there just aren't enough to go around, said Kennedy. Patients would have better access to health care if there were more nurse practitioner clinics, said Kennedy, who added they could work alongside doctors' clinics.

We can sort of fit in there somewhere to help alleviate that burden so people can have access - Sarah Kennedy

"Whether or not it's the absolute answer, I'm not sure — but it would definitely be a help, a step in the right direction to sort of alleviate the shortage," she said.

Freeing up doctors for non-emergency appointments with nurse practitioners could also take the stress off physicians, she said. 

"We can sort of fit in there somewhere to help alleviate that burden so people can have access — if people don't have a family doctor at the time — just to alleviate that stress and make people feel like they're not completely alone," she said.

The catch is that unlike in a family doctor's office, her clients pay her. The average cost of an appointment at the clinic is $60, with followups averaging around $30. 

"One of the setbacks is that it's a fee-for-service clinic, and our province doesn't have a public funding model," Kennedy said.

Alyson Samson/CBC

"That sort of restricts us a little bit there.… Lots of insurance companies do cover it so patients can apply through their own personal medical insurance to cover it."

But as an option to avoid a potentially long wait in an emergency room, Kennedy calls it the price of convenience and said she's gotten great feedback so far.

"That seems to be the theme, really. I've been able to get patients in day of, or next day," she said.

Kennedy says other provinces with doctor shortages offer services from nurse practitioners, leaving her wondering why Newfoundland and Labrador does not."We're hoping that Newfoundland will follow suit and get on board with that as well," she said.

"Everyone should have access to the same services."

Health Minister John Haggie says the era of a physician practitioner working on their own should be over. The only mechanisms the province has to easily pay doctors are by salary or fee-for-service, he said.

A problem with fee-for-service, he said, is that it provides an incentive for health-care providers to increase the volume of patients seen at the expense of the quality of individual care.

"I don't want to replicate the problems of fee-for-service … by just cloning that mechanism and making them nurse practitioners," he said. "It hasn't worked for general practitioners. We've heard this very clearly — I see no reason to expect that mechanism to work with nurse practitioners."

He said he's open to suggestions from the nurse practitioners' association and their bargaining unit, the Registered Nurses' Union, might have.

The challenge is how to integrate nurse practitioners into the system, he said.

"We need to support our practitioners and they need to then be able to deliver the best of care to the patients, the individuals that they serve. They can't do that on their own," Haggie said. 

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