Her clinic fills urgent rural health needs; now this nurse practitioner fears she is being shut out

Cara Sabourin is a nurse practitioner who runs a pay-for-service nurse practitioner clinic called Cara Health in Moose Creek. Sabourin is calling for a more flexible approach to supporting the work of nurse practitioners. Photo by Jean Levac /Postmedia

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When Cara Sabourin was studying to become a nurse practitioner, people in her small Eastern Ontario community of Moose Creek began asking her to set up a clinic there.

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“We literally had a lineup of people saying, ‘As soon as you are done school, please take care of me,’ ” she said. “We are rural and there is lots of need.”

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In 2021, she opened Cara Health in a medical building in the village — one that, in previous years, residents had raised money to have built. Today, she offers primary care to more than 700 people, along with other health services. Because nurse practitioners have no way to independently bill the Ontario Health Insurance Plan, as physicians do, her clinic charges patients a one-time intake fee of $150 and $350 a year after that.

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When she opened, Sabourin believed those fees would be temporary. She knew the federal government was working on a directive to provinces and territories about nurse practitioners and other health professionals who provide medically necessary care.

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When that so-called interpretation letter came in January 2025, it ordered provinces and territories to publicly fund nurse practitioners and end out-of-pocket billing for medically necessary services they provide to patients. The federal government set a deadline of April 1, 2026, but said it would not begin penalizing them for another year.

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That deadline passed earlier this month without a clear plan from the Ontario government. When Health Minister Sylvia Jones began to articulate the province’s approach to the federal directive — with a focus on team-based, salaried positions for nurse practitioners, rather than independent practice — Sabourin felt there was no place in the plan for the thriving clinic she had built to serve a desperate local need for health care.

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Cara Sabourin is seen outside her clinic, Cara Health, in Moose Creek. It opened in 2021. Photo by Jean Levac /Postmedia

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She has looked at various options but fears the lack of flexibility in the province’s approach to funding nurse practitioners could force her to abandon her patients — something she does not want to do.

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“There are job postings now. I could close and leave here, but I feel like I have made a commitment to the people who have signed up with me. I have a lease. I have employees. I can’t just leave. I am not sure what the provincial government wants us to do.”

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Sabourin is not alone in calling for a more flexible approach to supporting the work of nurse practitioners, especially in rural Ontario where other medical services may be far away. Ontario has the most nurse practitioners in Canada. They are registered nurses with advanced university training who can independently diagnose, treat and manage illnesses, order tests, prescribe medications and perform some procedures. They are widely seen as a key to solving the critical primary care shortage in Ontario and elsewhere.

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In order to do that, both the organization that represents nurse practitioners, the Nurse Practitioners Association of Ontario, and individual NPs like Sabourin say there can’t be a one-size-fits-all model for paying nurse practitioners.

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In a letter to provincial Health Minister Jones, Sabourin said she looked for positions within the publicly funded model at local team-based clinics when she graduated as a nurse practitioner, but there were no jobs available. “My goal was to work within a publicly funded model, but the system had no place for me and, faced with that reality and recognizing the needs of the community, I built my own clinic.”