Alberta Takes A Bold First Step To Improve Access To Primary Care And Alberta Doctors Believe It’s Foolhardy

On November 22, 2023, the Alberta Health Minister announced that nurse practitioners would soon be allowed to open independent clinics in the province. This announcement comes in response to the fact that approximately 18% or roughly 540,000 Albertans are without a family doctor.

Every Albertan should welcome this initiative with open arms, especially family physicians, emergency room physicians, and hospital administrators around the province, who are all overworked, over-stressed, and overdue for help. As a former resident of BC without a family doctor for two years, I would have been delighted. 

But sadly, the Alberta Medical Association has taken a very different approach despite calling for reforms from the government to alleviate the strains on hospitals and family medicine physicians. Allowing nurse practitioners to operate independent clinics is a step in the right direction, and Alberta’s doctors must appreciate this. There are no simple solutions, but allowing nurse practitioners to provide desperately needed primary care will accomplish the following:

• Increase access to primary care for ALL Albertans;

• Reduce the strain on emergency rooms around the province; 

• Reduce the stress on family physicians around the province.

By allowing more access to primary care to more Albertans sooner, they will be less ill if they ultimately need to be hospitalized - a good thing; they will be treated sooner, resulting in less pain and suffering - a good thing; less ill patients have shorter hospital stays - a good thing; shorter hospital stays mean less pain and suffering, less work lost and less cost to the province - all good things.

The new president of the AMA, Dr. Paul Parks, has raised several issues since his election: the ongoing crisis in family medicine and strains on hospitals, particularly ERs, due to the family physician shortage. While allowing nurse practitioners to set up independent clinics does not solve all of Alberta’s access to primary care problems, let’s let the facts determine how much of a difference this change could make to Albertans without a family doctor.

There are nearly 800 nurse practitioners in Alberta, so let’s make a few assumptions and see how many Albertans could be served by this change, and let’s be conservative:

• Let’s assume 400 nurse practitioners work in independent clinics; 

• Let’s assume each NP works 45 weeks per year;

• Let’s assume they work four days a week;

• Let’s assume each NP works a full 8 hours per day;

• Each NP sees two patients per hour or 16 patients a day.

45 x 4 x 8 x 2 = 2,880 patient visits per NP annually; if 400 NPs offer primary care services, they could provide 1,152,000 patient visits annually!!! Or put another way, that would allow each Albertan (540,000) without a family physician to be seen twice yearly by a nurse practitioner - a good thing.

If Alberta recruited another 100 nurse practitioners to the province or 100 more nurse practitioners decided to join an independent clinic, the number of annual patient visits would jump to 1,440,000 or almost three visits annually for every Albertan without a family doctor. - another good thing! This could occur for two reasons: 1. these nurse practitioners are already working in Alberta, and 2. the independent clinic model could attract nurses from other provinces.

So, what are physicians saying in Alberta? One Calgary-based doctor has tried the age-old scare tactic of comparing doctors to engineers and nurse practitioners to engineering technicians. The analog he is using is an old one: would you let Certified Engineering Technologists build our bridges? Hell no, he says, but this analogy is completely wrong.

Engineering technologists routinely inspect bridges and bring their findings to the Civil Engineer responsible for bridge maintenance. If anomalies are discovered, the engineer is called in to check and make the final decision. And at last count, I can’t recall too many bridges collapsing in Canada lately. 

By allowing nurse practitioners to operate independently, the Government of Alberta is not allowing them to perform brain surgery or “replace doctors”; they are allowing them to provide routine exams, and if anomalies are discovered, those patients are referred to a family physician or specialist. That’s precisely what happened with my wife. She suffered a hard fall and hit her head on some ice, and the nurse practitioner told her to go to the ER for an exam and X-ray immediately.

Doctors are worried that nurse practitioners will miss something, and I bet nurse practitioners are worried as well. Initially, potentially complex cases will be referred. But let’s be honest: Most of the time, most of what they see is routine. And let’s be honest: doctors miss things too, especially when rushed, stressed, and overworked, all conditions that exist today.

Change is difficult; stakeholders, like doctors, hate yielding any turf when changes are imposed, but with Canada’s crisis in primary care access, something has to be done, and this is a very good first step. It’s not perfect; nothing is, but let’s not let perfection get in the way of an excellent first step.

In my next blog post, I’ll explain why allowing nurse practitioners to practice independently is a good idea and should be adopted nationwide. I’ll also examine the pluses and minuses of broadening the scope of practice for nurse practitioners and ways to ensure proper care is being provided, monitored, and improved upon using electronic medical records.