The Clark government has made its first move to wrestle down growth in health-care costs, clearing the way for nurse practitioners to take on tasks that currently only doctors can perform.
Health Minister Mike de Jong announced the changes on Monday, just as contract talks with the BC Medical Association were heating up. Two weeks ago, BCMA president Nasir Jetha told his members talks had failed and warned doctors to be prepared to withdraw services when the contract expires next year.
British Columbia began training nurse practitioners to provide primary care to patients five years ago, but, with a tepid response from the powerful association representing doctors, the job opportunities haven't materialized in sufficient numbers. About one third of the province's 218 nurse practitioners are not working as NPs.
But Mr. de Jong, who took over the health portfolio in the spring, is trying to change that. His task is to keep his budget's rate of growth to just three per cent this year – half the average rate of increase since 2004. Boosting the role of NPs is his first initiative to tackle that challenge.
Under the proposed legal changes introduced on Monday, NPs will be able to approve maternity leave, provide health exams for prisoners and do other tasks that currently fall to more highly paid physicians.
"These professionals are now a permanent fixture on the health landscape and their role will continue to evolve," Mr. de Jong said in an interview. He said some doctors are starting to work in partnership with NPs, although there is still resistance. "Are there still instances where professionals are suspicious around the changes? Sure," he said. He added that competitive edge isn't likely to disappear.
Nurse practitioners are more highly trained than registered nurses but less so than physicians. They can diagnose common illnesses, order investigations and prescribe medications. When the province first gave them a place in the medical system, they were touted as a new care option for patients, particularly those who don't have a family doctor.
An NP's salary works out to half of the average income collected by a general physician under the current fee for service system.
The BCMA has been negotiating a new physician master agreement that determines those fees, but on Oct. 18, Dr. Jetha told his members those talks had failed. He said arbitration is the next stage to set compensation, benefits and on-call payments, but he said the province has been so difficult, even that might not settle the dispute.
"Even then, the government may walk away from the [arbitration] award which will relieve the BCMA from the contractual restrictions on organizing or supporting withdrawals of services. Hopefully, it will not come to that, but, in light of the government's approach over the last six months, all doctors should be preparing for that eventuality."
Despite the dire warnings, talks have resumed. However, the tone is far less conciliatory than it has been in recent years.
Dr. Jetha said in an interview on Monday he still has concerns about the role of NPs in the province's health- care system, but would not say what effect the proposed changes will have at the bargaining table.
"Our first priority at the BCMA is to provide patient safety," he said. "Where is the accountability, what are the liabilities of nurse practitioners? We still need those clarifications."
He added that the BCMA was not consulted on the changes outlined on Monday.
"Our main focus is on negotiations. And our negotiations have failed and we are moving on to the next steps."
Health care consumes the largest share of the provincial budget. Since 2004, health-care spending has climbed by an average of 6.2 per cent every year, but the current B.C. budget provides for increases of only 3 per cent a year until 2013. In internal documents released through freedom of information, finance officials have warned those targets are ambitious – in part because of wage demands from health-care professionals.