With doctor shortages, nurse practitioners filling in New West's gaps

As more people in BC struggle to find family doctors, nurse practitioners are filling in the gaps in primary care coverage, including in New Westminster.

Currently, there are four nurse practitioner-led clinics, and throughout the province, the number of nurse practitioners (NPs) has ballooned from 650 in 2021 to more than 800.

About half of those NPs work in family practice, according to Karen Sims, president of the NP council at Nurse and Nurse Practitioners of BC. (NNPBC)

Nurse practitioners are registered nurses “who are educated at a masters level and have advanced training,” according to NNPBC.

NPs first began family practice in BC in 2005, Sims said, and since then, the numbers have kept growing to the point they’re at today.

The shortage of primary care providers is well-documented in BC, and anyone who has tried to get a family doctor recently has likely faced the brunt of it. A recent sign-up with the waitlist at the Fraser Northwest Division of Family Practice, which includes New West, indicated the wait of over a year before a primary care provider could be assigned.

A shortage of doctors or clinics?

Dr. Carllin Man, a family doctor with a private practice on 10th Avenue, on the Burnaby-New West border, points to Statistics Canada data showing that BC has the second-lowest percentage of people with a regular primary care provider. At 80.9%, BC only beats Quebec, where 80.6% of residents have a regular healthcare provider.

Meanwhile, the rate in Canada at large is 85.8%, while Ontario and New Brunswick reach as high as 90.6%.

Man challenged the notion that there is a shortage of family doctors in BC, instead saying that there’s a shortage of family doctors who practice family medicine.

While StatCan data show BC having one of the lowest rates of access to primary care providers, Man said BC also has one of the highest rates of doctors trained in family medicine in the country.

Throughout Canada, there are 123 family doctors per 100,000 people, compared to 134 in BC. Only New Brunswick (137) and Nova Scotia (139) have more, while Ontario has 115, Prince Edward Island has 109, and Manitoba has just 108.

And the number of family doctors per 100,000 in BC has only climbed over the years, from 127 in 2016.

Instead, Man said, many of those family doctors go into different areas of medicine.

A long search for a family doctor

New West residents Nadine Nakagawa and Kevin Smith had largely different experiences with finding primary care providers, but both wound up with nurse practitioners.

Nakagawa, an incumbent city councillor who is running for re-election, said she searched for years. Smith, on the other hand, said he was able to get on with a nurse practitioner after only a few months of searching.

“I started looking for a family doctor when I first moved to Metro Vancouver, and the only doctors that were accepting patients were only accepting people if they were pregnant, which was very surprising to me,” said Nakagawa, who moved to the region in 2008.

Over the course of years, she said the level of engagement in seeking a primary care provider had ebbed and flowed, having been “very, very active” when she first moved to the region and more passively looking for doctors at other times.

“People, I think, get discouraged and become more and more passive,” she said.

“It’s really demoralizing. And it also makes me very worried for other people in the community. Again, I don’t really have a lot of chronic health issues, so I’m really fortunate that I don’t desperately need them.”

Just before the pandemic started—more than a decade after she started looking—she said she came across a clinic that was accepting patients for a nurse practitioner.

“The nurse practitioner meets my basic needs, but I don’t think she would meet my extended needs if I had them,” Nakagawa said, citing things like chronic illness and more complex diagnoses.

“At least it fills the gap in the meantime.”

Landing with a nurse practitioner

Smith, on the other hand, said he’s more than happy with his nurse practitioner.

He moved to New West from Burnaby about two years ago, and he’d been seeing a family physician in Ladner. The move to New West spurred him to look around for a new primary care provider.

So after moving, he joined the FNW Division of Family Practice’s waitlist and was notified just a few months later that there was an opening with a nurse practitioner in Queensborough.

“I’m still crossing a bridge, but it’s still closer than Ladner,” he said.

He’s only had one in-person visit for a general checkup with his NP, but he said he didn’t see any difference between that and a family doctor visit.

All about pay models

Nurse practitioners in primary care and family doctors have largely the same scope of practice, but there are a few differences. One of the biggest differences is how they’re paid.

Family doctors in private practice bill health authorities on a per-client basis, at about $35 per patient, while NPs are paid a salary.

Man said family doctors often go into other areas of medicine besides primary care, and he believes the reason for that is the pay model.

“For a new doctor to start a family practice, it really makes no financial sense to do that at this point in time,” Man said.

On top of the outdated pay model, the flat rate of $35 per patient has not kept up with inflation, with the rate being more like $29 two decades ago. According to the Bank of Canada’s inflation calculator, $29 in 2002 would be nearly $44 today.

He’s hopeful for more positive change in the near future, as the province is expected to bring in a new pay model for family doctors this fall.

Family doctors working in urgent and primary care centres, which the province has set up around BC, do tend to receive salaried pay rather than per-client pay, and he said those doctors—and their patients—are better for it.

“The doctors that work at a UPCC … [are] probably earning close to double of what I’m earning in the clinic here, with a lot less responsibility in terms of hours worked,” he said.

And Man said the province should implement something in-between, improving pay-per-service by adding a time-based component to the pay model rather than replacing it entirely with a salary.

NPs filling a gap, not replacing doctors

Health Minister Adrian Dix came under fire from Doctors of BC earlier this year for his comments in a debate, in which he said: “I’m not saying they can provide better primary care, but for many people, they do.”

This, he said at the time, was largely because of the differences in pay models—where family doctors are incentivized to rush patients through, nurse practitioners are afforded more time with their patients.

“NPs cannot replace doctors, and they do not provide better care than doctors in ‘severe’ medical cases,” Doctors of BC said at the time.

Sims said NPs aren’t replacing doctors but filling a gap in primary care that has only widened over the years, and she balked against language that pits NPs against doctors.

“People can see either a family doctor or a family nurse practitioner as part of that primary care family practice system,” she said.

“I think that probably trying to compare the roles, it doesn’t really serve the public that well. It creates an impression of conflict or competition, and that’s not the case at all.”

Nurse practitioners have some limits, including delivering babies—though they can provide pre- and postnatal care—and major surgery, though they can do minor procedures like casting and IUD insertions.

And while some nurse practitioners work in emergency rooms, as some family doctors do, Sims said that typically requires extra training.

Sims and Man both pointed to the primary care networks (PCNs) in BC that seek to link primary care to a variety of services, including family doctors, nurse practitioners, registered nurses, and some specialists, to create a more holistic standard of care.

Nakagawa similarly spoke in favour of that kind of model of care, saying it would make the process easier for patients as well.

“I would personally love to actually have a community health centre model where I could have a doctor as an anchor and then have a nurse practitioner or a physiotherapist or whatever else it is to sort of look at issues more holistically,” she said.