The solution to the ‘doctor shortage?’ Actually, it's nurses

$153 million a year.That's how much it would cost to bring family medicine services to many, or most, of the 1.5 million Quebecers who have no family doctor now. But the $153 million solution involves hiring more nurses, not doctors. Is this a lot of money? By comparison, in 2023 the Quebec government paid $240 million, without batting an eyelash, to buy land for the Northvolt battery factory. (It was never built because the company went bankrupt.) The $153 million, per year, would pay for 1,500 new nurse practitioners. They are also called "super-nurses." This would go a long way toward filling the need for the 1,500 family doctors that are said to be lacking.Nurse practitioners are not substitutes for doctors. However, they are authorized to do many "family doctor" activities. If we had more nurse practitioners, family doctors could free up time to take on many more of the Quebecers who have no family doctor. Perhaps all of them. Nurse practitioners work in group settings such as family medicine clinics (GMFs). The doctors in the clinics can delegate a lot of their work to the nurses. Here are some things that nurse practitioners are allowed to do:Give antibiotics for otitis and other infections, such as UTIs and sore throats.Stitch up big cuts and do other minor surgery.Order X-rays and CT scans.Treat common injuries, for example sprained ankles.Give ongoing treatment for some chronic conditions, including diabetes and high blood pressure. They can adjust medications.Provide women's health services, including contraception, Pap tests, breast exams, mammograms, and monitoring normal pregnancies.Give ongoing compassionate care for people dying of cancer and other illnesses.Fill in most forms for salary insurance. These forms take up hours of our time!Some nurse practitioners specialize in mental health. They are allowed to treat depression and severe illnesses including addictions, bipolar disorder, and schizophrenia. Some nurse practitioners have special training to help treat children, including newborns.Nurse practitioner training involves a two-year master's degree programme with intensive on-the-job experience.About the $153 million cost, we would need about 1,500 new nurse practitioners to expand family healthcare to serve a lot more of the 1.5 million Quebecers who now have no family doctor.Nurse practitioners earn typically $120,000 per year. Quebec gets back about $18,000 in Quebec income tax. The net expense for Quebec is $102,000 per nurse practitioner per year. For 1,500 new nurse practitioners, the total yearly expense for the Quebec government is about 1,500 x $102,000 = $153 million.By contrast, 1,500 new family doctors would cost $576 million per year. Family doctors cost an average of $384,000 to the government, but typically take home $227,000 after office expenses and before taxes.Other provinces and countries endorse the nurse-practitioner piece of the puzzle. In Quebec, there are 17 nurse practitioners per 100 family doctors—not enough. In Ontario, there are 24. In the U.S., there are about 100 nurse practitioners per 100 family doctors. This suggests that the huge U.S. private health insurance companies see the logic and the savings.There are now 1,890 nurse practitioners in Quebec. We need at least 1,500 more.The existing training programmes produce only 200 new nurse practitioners per year. These programmes could easily be expanded to produce double that number, possibly more.However, right now, some graduates are panicking because they can't find jobs. This is because the Quebec government has cut new funding for nurse practitioners. This is a result of the $1.5 billion health budget cuts announced in November 2024. The $1.5 billion squeeze on healthcare is about the same amount that Quebec has wasted in the past year on "corporate welfare"—big handouts—to companies that went bankrupt or lost money heavily. The wasted money includes the Northvolt battery disaster, with losses to the taxpayer of $510 million.These handouts to companies increased by 67% under Legault since 2018. Every year, "corporate welfare" losses make up a big part of the government budget deficit.This is the same deficit for which the Quebec government was bashing doctors, and refusing to increase nurse practitioners. The ordinary person gets less health service, while some big companies walk away with a lot of cash from our pockets.Many economists, even small-c conservative ones, say that corporate welfare doesn't really do any good, and should be stopped.Big handouts to companies have led to net losses for Quebec of $848 million per year, on average, since Legault came to power in 2018.Quebec routinely justifies "corporate welfare" by saying that it creates new jobs.Let's directly create 1,500 new jobs for nurse practitioners instead. This will go a long way towards solving the health system crisis.Dr James Farquhar is a retired Montreal psychiatrist with a keen interest in the health system, its strengths and challenges.

The solution to the ‘doctor shortage?’ Actually, it's nurses

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