Nurse practitioner behind pay-for-care clinic in Brant explains reasons behind opening private practice

Crystal Troup recently got a call from someone wanting an IUD.

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The patient’s family doctor told her she would need a referral to a gynecologist — with a six- to nine-month wait — to have the birth control device inserted, and she wondered if it was something the nurse practitioner (NP) could do.

Two days later, at her practice on Grand River Street North, Troup completed the procedure.

Paris, with a population of around 15,000 as of the 2021 census, is where Troup and her business partner — registered nurse Cailynn Bateson — opened MESH aesthetics and medical wellness clinic in March.

Opening an NP-led clinic was “a risk” personally and financially, Troup told The Spectator.

Right now, Ontario has 25 publicly funded NP-led clinics, and recently announced six new and expanded ones.

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NP-led clinics outside of that don’t receive funding from the Ministry of Health and are unable to bill OHIP for assessments, meaning practitioners bill patients directly.

Troup admits the transactional component feels “weird,” because in her 15 years of nursing, it has never been part of the equation.

But she said NPs aren’t doing it because it’s “lucrative.”

They “genuinely want better care for people in our communities,” Troup said.

Still, the payment factor has inspired controversy over whether such clinics have a place in Ontario’s health-care system.

The Ontario Health Coalition has spoken out against such NP-led clinics, arguing that the Canada Health Act protects residents from paying for medically necessary hospital and physician services out of pocket.

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But, because NPs aren’t specifically mentioned in the act, and can’t bill OHIP, they argue the payments are legal.

In October, Health Minister Sylvia Jones announced the province was investigating an Ottawa walk-in clinic charging for NP services.

However, when The Spectator asked the ministry if the province is investigating other NP-led clinics, a spokesperson said the ministry “cannot comment on any ongoing investigations.”

Troup said she thinks if people experienced the care NPs are providing, “or were even willing to have conversations with us independently,” they might have a better idea as to what it actually looks like.

What does care look like?

Troup performs minor procedures such as skin tag, wart and cyst removals, biopsies and joint injections — things some primary physicians refer out, Troup said.

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She also offers services like addictions counseling and ADHD assessments.

While some patients come for a one-off issue, like ear pain, others have an ongoing, primary care relationship with Troup.

Thomas Jankowski, CEO of Medimap, an app that connects people with local health-care practitioners, told The Spectator care from a NP isn’t that different from having a family doctor, and there are communities within the US, Asia, and Europe that rely heavily on NP clinics.

With a high demand for doctors, Jankowski said there’s a “massive supply of nurses that could be upskilled to become nurse practitioners quite quickly,” by taking a two-year masters program.

As for privatization, Jankowski said medical private pay services already exist in Canada, such as chiropractors and massage therapy.

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“Except usually it’s our insurance that covers it,” he said.

But not everyone has private insurance.

“The argument (that) somebody with money shouldn’t have better access to anything — tell me something that doesn’t apply to,” Troup said, giving the example of public vs. private education.

While the province announced in June they’re “starting consultations with the College of Nurses of Ontario and other health care partners on expanding the scope of practice for nurse practitioners,” OHIP coverage was not among the considerations mentioned.

The Spectator asked the ministry if they are considering adding NP services to OHIP, and a spokesperson said the ministry is “working with our partners to determine which scope of practice changes will be made, and will make it easier for Ontarians to connect to care. ”

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Is it sustainable?

Ancaster-based Holistic Solutions NP, a clinic led by five NPs, had 3,000 web hits per month, but that didn’t translate into visits, lead NP Christopher Savard told The Spectator in an email in June, the week before the clinic shuttered.

“If we had OHIP funding it would have been successful. It is very sad. Our NPs tried our best to help the community and improve access to care but it is just not financially viable to continue,” he said, around half a year after they opened.

While Troup said being able to bill OHIP would bring more patients, it’s something she’s conflicted over.

“Part of me would love to say, ‘yes, that is a model that I would prefer,’ because I want to be able to have a positive effect on as many people in our community as possible,” she said.

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But, knowing what she knows about billing codes and “the inadequate amount of funding given to a clinician for each visit,” Troup said she’s skeptical she would be able to deliver “the level of care that I want to provide, and that I refuse to compromise on,” if covered by OHIP and restricted to short, single-issue visits.

“I don’t want to become a walk-in clinic. I want to… provide preventive health care.”

Troup told The Spectator she and Bateson identified “a growing need” for primary health care and procedural services in Paris “because of their lack of access right now.”

And with residential development happening in Paris, “the need for access to care is only going to get greater,” she said.

Local supply and demand

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The county has budgeted $100,000 annually to meet the need for ongoing physician recruitment, Coun. John Bell, who is chair of the PrimaCare Community Family Health Team board of directors, told The Spectator in an email.

The family health team, based in the Cowan Community Health Hub, primarily has county residents, although a “significant number of residents” from Brantford and North Dumfries also access service, Bell said.

Paris also has a walk-in clinic, independent physician practices, and the Willett urgent care facility — which often has a wait of several hours, Troup pointed out.

But, as many as 30 per cent of Brant residents may be without a family physician, Bell said.

And, Brant’s population is growing at two per hundred each year, he added.

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Still, Bell said he personally doesn’t see a need for “out of the box” solutions such as pay-per-service clinics.

“The much simpler solution is for the provincial government to increase the resources to support a model that, when fully resourced, works well,” he said.

Bell said he believes the provincial government “understands the imbalance between supply and demand,” pointing to recent increases in the number of services pharmacists and nurse practitioners can provide, and increasing the number of medical school places.

‘We just hope that our assets are recognized’

Troup said patient growth over the past few months has been “steady” with a “warm welcome” from the community.

While she knows not everyone will choose to use her clinic, she hopes “no NP clinics are ever looked at to be a negative impact on our health-care system, or the communities we serve.”

“We just hope that our assets are recognized,” she said.

“Everybody who is choosing to participate in trail-blazing this… they’re taking risks and it is because of a passion and because of changes that they want to see implemented. For people just to be better, to feel better.”

Celeste Percy-Beauregard is a Local Journalism Initiative Reporter based at the Hamilton Spectator. The initiative is funded by the Government of Canada.

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