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For-profit medical centre set to open

Charleswood facility will use nurse practitioners

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Charleswood is set to become a new front in the battle for private for-profit medical care.

The Four Rivers Medical Clinic will open a new centre at 5905 Roblin Blvd. this spring that will charge patients who are treated by nurse practitioners, registered nurses who have advanced medical training.

Internet pharmacy pioneer, downtown property developer and medical clinic operator Daren Jorgenson said he believes the time is right to charge patients a nominal fee for basic health care in place of them not being able to find a family physician.

"I think everyone understands our current health-care system is broke," Jorgenson said. "Is there any family medicine physician in Charleswood accepting new patients? No. Can I recruit 10 doctors for Charleswood? No, I can't. But what I can do is recruit some nurse practitioners and, partnered with some doctors, deliver a mixed model of fee-for-service."

The clinic is already renovated to begin operation and all Jorgenson is waiting to do is recruit some nurse practitioners. Still, it hasn't been an easy sell.

"There's some that believe that anytime you charge a patient money that somehow you're against Tommy Douglas and our universal health-care system," he said. "But then you remind them that dental care is health care and you pay for that and a pharmacist is health care and you pay for that."

Nurse practitioner Laura Johnson, co-chair of the Nurse Practitioner Association of Manitoba and instructor at the University of Manitoba, said Jorgenson's plan is a mixed blessing.

While it has the potential to create jobs for nurse practitioners, it's not the best solution for those who want the power to set up their own practices, but have been so far stymied by rules and legislation.

"The reality is, he is creating positions in the city where there is not a lot of employment for nurse practitioners," Johnson said. "But he is pushing the envelope."

The province brought in legislation for nurse practitioners in 2005, allowing those with the necessary training to take on some of the jobs traditionally reserved for doctors, including ordering diagnostic tests, prescribing medication and performing minor surgical procedures. Manitoba was one of the last provinces in Canada to register nurse practitioners as a way to address a shortage of physicians.

There are now 76 publicly funded nurse practitioner positions in the province, but about 10 vacancies mostly in rural and northern Manitoba. Those positions are difficult to fill as most nurse practitioners, or NPs, prefer to work in Winnipeg.

Johnson said 14 NPs graduate this year and will be looking for work. Three who graduated last year are still looking for work.

Johnson said NPs are lobbying government to look at other ways to fund them and to eliminate restrictions so they can set up their own practices and in some instances bill the province for their services, much in the same way doctors do. Health Minister Theresa Oswald was unavailable to comment.

A spokesman said the province is examining how NPs should be paid, but at this point believes a nurse practitioner fee-for-service model is not necessarily the best for patient care. "We are always open to innovative ideas and partnerships as we work to better integrate nurse practitioners into the primary care system and optimize their unique role," the spokesman said.

Progressive Conservative health critic Myrna Driedger said the issue demonstrates the province is too wishy-washy over how to use nurse practitioners.

"I think they've dragged their heels instead of embrace nurse practitioners," she said, adding with nurse practitioners, people who do not have a family doctors get the care they need rather than end up in hospital.

Jorgenson also said he's opening a clinic this fall in Kenora near the town's Wal-Mart under a deal signed with Rat Portage First Nation. Four Rivers also has space in the old downtown Greyhound bus depot to begin operating a clinic this summer. The U of W is currently renovating 42,000 square feet on the main floor of the building under an ambitious expansion plan. Jorgensen opened the Four Rivers clinic on Main Street in 2004 and a second one on Broadway a year later.


Nursing the facts

What is it about? A soon-to-be-open privately run medical clinic in Charleswood plans to charge patients, who are seen by a nurse practitioner (NP) on staff for a nominal fee.

Why? It's one way the clinic will stay open and pay staff. Under current rules, nurse practitioners in Manitoba can't bill for their services like doctors can. That cost instead will be passed on to the patient. The Manitoba government is currently examining new funding models so NPs can earn a living. One example is nurse practitioner-led clinics, which are opening in Ontario to relieve waiting times caused by a shortage of doctors.

Will the clinic cause the father of universal medicare Tommy Douglas spin in his grave? No, but maybe a hiccup. The upfront cost paid by a patient will be reimbursed at tax time as it's a claimable expense.

Why Charleswood? It's seen an exodus of family physicians. The clinic's operator believes the time is right to give people a new option in how they access family health care.

"The Manitoba government could try to stop us from opening. They might feel I'm delivering insured services, which is family care, but I'm circumventing it by using nurse practitioners. I've told them they have no legal grounds to stop me, but that doesn't stop government from doing things that if they feel in principle I'm doing something wrong. Maybe they'll take it on. We'll see."

-- Four Rivers Medical Clinic founder Daren Jorgenson


Republished from the Winnipeg Free Press print edition February 27, 2010 A5

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