Adam: How nurse practitioners are starting to fill big gaps in Ontario health care

With a family doctor shortage, nurse practitioners are gradually gaining a foothold in primary health care and demanding an even greater role.

Published Sep 12, 2024  •  3 minute read

Nurse practitioner Aisha Mbilitem sees patients at the South-East Ottawa Community Health Centre in Ottawa. Photo by Tony Caldwell /Postmedia

One day in June, as I watched my grandkids play in a city park, I struck up a conversation with another parent who was there. He mentioned, as I recall, that he was from Mauritius in East Africa, and on learning that I originally came from Ghana, revealed that his “doctor,” named Aisha, was also a Ghanaian by origin.  She is a good doctor, he said.

I chuckled, because I know Aisha Mbilitem. But she is not a physician, and doesn’t claim to be. Mbilitem is a nurse practitioner at the South-East Ottawa Community Health Centre (SEOCHC). But the fact that one of her patients saw her as a doctor, left me thinking that nurse practitioners may in fact be filling an important role most of us don’t appreciate.

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Indeed, Mbilitem has been treating patients at an SEOCHC clinic for more than 10 years. She sees about a dozen patients a day, and has a roster of about 700. She says her work as a “primary care provider,” is fundamentally no different from what a family doctor does. Her routine is no different. She listens to what ails patients, notes their history, asks questions, makes a physical examination as needed and, following diagnosis, offers a course of treatment. She can prescribe medication, including controlled substances; order diagnostic tests such as X-ray, MRI, CT scan and ultrasound; analyze the results; and offer treatment. She can make a referral to a specialist.

“I take care of patients from uterum to death (cradle to grave). I diagnose, prescribe medication and offer a course of treatment. If I require imaging I order it, and can make referrals,” she says. “I work independently and I am not supervised by a physician. We don’t see ourselves as doctors and we are not a replacement for family doctors.”

Even though she works independently, that doesn’t stop her from consulting a physician or NP colleagues if something stumps her. For instance, she has no experience in hormone therapy and would refer such patients to physicians who do. She says many NPs had some of their training under family physicians, and holds them in high esteem. But the demand for primary care today is so high, NPs have a big role to play.

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But can an NP really do the work of a doctor, and do you get the same quality of service? Certainly, says Mbilitem. “(In primary care,) one is not better than another. We have a crisis and we need everybody onboard.” She points out that many of her patients are low-income, including refugees and new immigrants who have not had proper care for years. Yet, they all receive the very best care, and are grateful. “We have a health care crisis now and we need all hands-on-deck. We need each other,” adds Barbara Bailey, president of the Nurse Practitioners Association of Ontario. She says the profession is “a bit of an untapped market” with room to grow.

Mbilitem is part of a growing cadre of nurse practitioners in Ontario and across Canada who are gradually gaining a foothold in health care and demanding a greater role. NPs work in hospitals, community health centres (CHCs), family practices, family health teams, and in nurse-practitioner-led clinics. Mbilitem works in a community health centre (CHC), where she is part of an inter-professional team that includes family physicians, NPs, nurses, dieticians, social workers, respiratory therapists, and others, delivering comprehensive care under one roof. Gurjit Kaur Toor, director of health at SEOCHC, says even though NPs there don’t operate under the supervision of family doctors, the CHC model lets them work as a team and treat many more patients. The centre provides primary care for 4,600 patients, and across the six CHCs in Ottawa, the figure is more than 30,000.

Mbilitem says NPs are all about extending the reach of primary care. “Right now, a lot of family doctors are leaving and the need for primary care is high,” she says. “It is a very big pie and we are sharing that pie.”

Mohammed Adam is an Ottawa journalist and commentator. You can reach him at [email protected]

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