British Columbia's nurse practitioners and health minister agree: So far, the health-care professionals are not playing a large enough role in the health-care system.
Of the province's 190 nurse practitioners, only 100 are working in their field. Each day, 10 NPs from the Lower Mainland travel to Washington State to work, according to Lynn Guengerich, president of the B.C. Nurse Practitioner Association.
Meanwhile, an estimated 250,000 B.C. residents don't have a family doctor.
Health Minister Kevin Falcon intends to fix that. He is overseeing the launch of a $137-million program to provide integrated care and a family doctor for every B.C. resident who wants one.
Mr. Falcon says nurse practitioners have not been used as intended since the position was introduced in 2005. "To be honest, I don't think we did a very good job incorporating them into the health-care system," he said.
But he insists NPs will become an integral part of doctors' practices. "I want to make sure doctors embrace nurse practitioners," he said.
With six years of university training, NPs, still overwhelmingly female, can prescribe drugs, order tests, refer to specialists and handle primary care for about 80 per cent of patients, Ms. Guengerich said.
As people live longer, often with chronic conditions, the holistic, preventative care provided by NPs is well-suited to a more integrated model, she added.
Mr. Falcon admits the current health-care system is geared towards institutions, which do not always work in the patient's best interest.
Ms. Guengerich is "thrilled" a new way to deliver health care has been introduced to replace the antiquated system with doctors as gatekeepers.
She believes NPs will get a starring role in B.C. even though she says the B.C. Medical Association has resisted sharing centre stage.
"It's their job to keep physicians front and centre," Ms. Guengerich said.
BCMA spokeswoman Sharon Shore said the association, representing 8,500 practising doctors, is establishing a working group with the Ministry of Health to determine how NPs might work in concert with family practices.
Mr. Falcon acknowledged doctors have concerns, including that NPs cannot be in conflict with doctors or erode doctors' ability to earn.
NPs earn roughly $100,000 each year on a salary, not fee-for-service, basis. When benefits and office overhead are added, the government pays about $160,000 per NP, Ms. Guengerich said.
B.C. family doctors earn an average fee-for-service of about $250,000 gross annually, according to the Canadian Institute for Health Information.
The $137-million committed by the province over the next two years to fulfill its doctor-in-every-pot commitment has no money for doctors' fees increases, Mr. Falcon said.
But there will be new money to hire NPs, he added.
Special to The Globe and Mail