Clinic offering access to nurse practitioner for $400 annual fee facing criticism

Ontario’s Ministry of Health says it is reviewing a walk-in clinic in Ottawa south set to offer patients access to nurse practitioners for $400 a year.

The clinic, which is expected to open Oct. 10 out of the South Keys Health Center, has drawn criticism that its pay-for-care model will undermine the province’s health-care system.

But the head of the clinic says they are responding to demands the province can’t meet.

“We are just a Band-Aid to a broken system,” said the centre’s clinical director Osman Nur, in a statement.

So far, the clinic says more than 2,000 patients have registered, and thousands more are on a wait list.

A spokesperson for Ontario Health Minister Sylvia Jones says they will not ‘tolerate any clinic charging for services,’ and will look into all possible violations. (Frank Gunn/The Canadian Press)

The clinic takes advantage of the murky rules governing nurse practitioners, who are not covered by the Ontario Health Insurance Plan when not part of provincially-funded clinics.

Nurse practitioners are able to examine patients, prescribe medication, order blood tests, refer patients to specialists and can open their own clinics.

“We are doing our job legally, as the law permits nurse practitioners to charge patients directly,” Nur said. Family physicians also work in the centre, but their patients are covered by OHIP and won’t be charged.

“The initial $400 will cover the first consultation, and the rest will cover the patient’s health administration for a year,” Nur said, adding that fee will cover medication refills, referrals, and interpretation of laboratory tests for the whole year.

But a spokesperson for Minister of Health Sylvia Jones says the office is looking into it.

“We will not tolerate any clinic charging for services,” said Hannah Jensen. 

“[W]e are taking steps to review this and shut down bad actors taking advantage of patients.” 

Clinics like this are legal, but ‘fundamentally unfair’

It’s unfortunate that clinics like these are popping up, said Melanie Bechard, chair of Canadian Doctors for Medicare and a pediatric emergency doctor in Ottawa. 

Bechard said by the letter of the law, the clinic is legal, since health-care providers like nurse practitioners aren’t explicitly covered by the Canada Health Act. 

“I think it’s a sign that our health-care system has been so underfunded and under-resourced for so long, especially in primary care, that people are turning to these other options,” she said. 

It’s an unavoidable situation, she said, adding she sees these types of clinics as “canaries in the coal mine,” highlighting the existing gaps in the Canadian health-care system. 

Dr. Melanie Bechard is a pediatrician at CHEO in Ottawa and president of Canadian Doctors for Medicare.
Dr. Melanie Bechard, a pediatrician at CHEO and chair of Canadian Doctors for Medicare, says clinics like this are unavoidable but ‘fundamentally unfair.’ (Christian Fleury)

“Unfortunately, clinics like this are fundamentally unfair because those who can afford the fee will get preferential access, even if it is within the letter of the law based on the Canada Health Act,” she said. 

Bechard said she hopes this clinic can be a wake-up call for political leaders on the importance of appropriately funding primary care. 

“We have to keep in mind that although these services can seem like a great option for those who can afford it, that we are leaving people behind and there’s a lot of people who would not be able to afford that fee of $400 a year.”

Can help alleviate demand on family physicians

Dr. Georges Nicolas Mobayed, a family physician at the South Keys Health Center, sees first hand the intense demand for family physicians across the city. 

“Unfortunately it’s a big problem in the country,” he said. “Somebody has to do something about it, this has been going on for years and it’s not going to get any better.” 

It’s estimated that around 2.2 million people don’t have access to a family doctor in Ontario, according to the Ontario College of Family Physicians. 

Mobayed currently sees his patients out of the South Keys clinic, but operates entirely separately from the walk-in clinic and doesn’t work with any of its nurse practitioners. 

A doctor standing in his office beside dozens of letters on an examination table.
Dr. Georges Nicolas Mobayed stands beside some of the recent letters he’s received from people looking for a family doctor. He can’t take on any new patients, and says demand will only increase. (Safiyah Marhnouj/CBC)

“They do the same thing, exactly like family doctors. My question is, why shouldn’t they be paid like family doctors are paid?” he said.

Paying to see nurse practitioners might not be ideal, Mobayed said, but it can be a start in addressing the huge backlog of people in need of care.

“This will solve the problem of the shortage of family doctors today, which is going to become worse in the future. It can alleviate a little bit the congestion in the emergency rooms.” 

Doris Grinspun, CEO of the Registered Nurses Association of Ontario (RNAO), disagrees, and said clinics like this compromise the quality of the health-care system. 

A woman standing in front of a podium with a microphone.
Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario, says despite the high demand for primary care physicians, paying for faster access to nurse practitioners isn’t the answer. (Registered Nurses’ Association of Ontario)

“The detriment is that you will get faster access for those that can pay and slower access for others,” she said. 

“The answer is not to proliferate these clinics because of the demand.”

Instead, Grinspun said part of the solution is improving access to non-profit community health centres and nurse practitioner-led clinics across the province. 

“In a world that is well developed like Canada where you have universal access to health care, what you need is [24/7] access to primary care and numerous countries are doing that,” she said. 

“That is a hallmark of a high performing health system, not walk-in clinics and certainly not paying a fee.”

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