Province adds $18.6M for some family physicians to expand their practice
New billing options introduced for family doctors to work with nurses, maintain patient registry
The province is spending $18.6 million on billing changes to encourage solo-practice physicians to work with nurses and take on more patients.
The money will result in an update to the way physicians working under the fee-for-service model in private practice are compensated, Health Minister Bruce Fitch said at a news conference Thursday.
Fitch said more than half of the province's family doctors now operate their own practices.
"[That] number that is much higher than in other provinces, when we do the inter-jurisdictional scan," Fitch said.
"We're working with various stakeholders, like the regional health authorities and the medical society, to encourage a shift to the collaborative-care clinics."
To that end, Fitch said physicians will see "expanded codes" to bill for nursing services starting on Sept. 16.
The province will also introduce a patient and provider registry that physicians will be compensated for maintaining, with payments to begin this fiscal year.
Fitch said the pay scale attached to the registry will give doctors an incentive to add more patients to their rosters.
Dr. Paula Keating, president of the New Brunswick Medical Society, said the funding will help bridge the gap until negotiations with the province begin on a new physician-services master agreement, expected in 2025.
"Many physicians are small-business owners," she said. "With extraordinary inflation affecting rent, staff, salaries, equipment, supplies, not to mention mounting administrative burdens, the pressures on family physicians have become unsustainable."
While Keating said the funding is a step in the right direction, she added that it will not be enough to establish the required number of collaborative-care clinics.
The medical society and the New Brunswick Nurses Union said in a budget submission this year that a $70-million commitment would be necessary to establish 50 of those clinics, much more than what the province announced on Thursday.
If the Progressive Conservatives are re-elected, the 2025-26 fiscal year would see a $20-million spend, Fitch said, with potential increases in years after based on uptake.
The
New Brunswick Nurses Union president Paula Doucet believes government
should have spent the funds on multidisciplinary clinics managed by
the regional health authorities. (CBC)
Paula Doucet, president of the New Brunswick Nurses Union, is not convinced the updated compensation model will help fill the province's primary care gaps.
"This government's choice to incentivize physicians to expand their private practices is not the solution ... It will weaken the public health-care system by drawing more health-care resources out of the public system," she said in an email.
It also promotes "structural inequity" among health care professionals, Doucet said, and won't be effective "considering the magnitude of New Brunswick's nurse shortage."
Doucet said the government should focus on "multidisciplinary, nurse-practitioner led, primary care clinics," managed by the regional health authorities.
The provincial government defines a collaborative-care clinic as a practice with family physicians and "allied health-care professionals," spokesperson Bruce Macfarlane said in an email.
"There are a total of 54 collaborative health-care clinics across New Brunswick," he said.
That total includes community health centres operated by the regional health authorities, nurse-practitioner clinics, family-medicine practices, N.B. Health Link clinics, Vitalité family-health teams, Macfarlane said.
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Jack Bell
When my original doctor (who could aways see you the same day) retired, it took multiple doctors to take on his patient load.
Now it can take weeks to see my family doctor.
Laura Smith
Progress!
Judge erred in denying class-action lawsuit against Horizon Health Network, lawyer argues
A number of women have come forward so far with affidavits alleging traumatic experiences at Moncton Hospital
A lawyer representing women who believe they were improperly given a labour-inducing drug at the Moncton Hospital has argued that a judge erred by not allowing a class-action lawsuit to proceed.
John McKiggan told a panel of three judges on the Court of Appeal of New Brunswick on Thursday that there is an identifiable class of women who have a claim against former nurse Nicole Ruest, and the Horizon Health Network, and that it would be "impractical" to require them to pursue damages by filing their own individual lawsuits.
"We've been contacted by over 200 women who believe they have been part of this class," said McKiggan.
"So the solution is to file hundreds of malpractice claims and hundreds of expert statements? That is impractical. That makes no sense."
McKiggan's comments were made during a hearing for an appeal of an earlier decision by Court of King's Bench Chief Justice Tracey DeWare to not certify a lawsuit against Ruest and Horizon as a class action.
Jayde Scott is the representative plaintiff of the proposed class action and filed the lawsuit in 2019, alleging Ruest improperly gave her oxytocin while she was admitted to the Moncton Hospital's labour and delivery unit.
Former
nurse Nicole Ruest was fired in March 2019 after women at the Moncton
Hospital were allegedly administered the labour-inducing drug, oxytocin,
without their consent. (Instagram)
The hormone is commonly used to induce contractions in pregnant women, however, Scott claims Ruest administered it without her knowledge, leading to fetal distress and ultimately requiring her to undergo an emergency caesarian section.
Several other women have since come forward and filed affidavits alleging similar experiences while giving birth at the Moncton Hospital over the period Ruest was working in the labour and delivery unit, between 2010 and 2019.
Horizon fired Ruest immediately after the complaint, yet both of them have filed statements of defence denying any wrong-doing.
Last December, DeWare denied an application for the lawsuit to proceed as a class action, however, the Court of Appeal of New Brunswick granted Scott leave to appeal that decision.
None of the allegations have yet been tested in court.
Definition of class too broad, respondents say
Also in court Thursday were lawyers for Horizon and Ruest. Both argued the lawsuit should not proceed as a class because the definition of who would fit into it is too broad.
"I think [the class action] would be capturing a whole lot of people who have no hope of a potential claim against the respondents," said Andrea Pierce, a lawyer for Horizon.
Jayde Scott is the representative plaintiff of the proposed class action against Horizon Health Network and Nicole Ruest. (CBC)
While McKiggan believes there could be hundreds of potential class members, eight women have so far come forward to provide affidavits alleging traumatic experiences at the Moncton Hospital's labour and delivery unit when they were required to undergo emergency C-sections.
However, Andrew Faith, lawyer for Ruest, pointed out discrepancies in the details described in some of the affidavits, notably that for three of them, Ruest wasn't working on the day they gave birth.
"On this class definition, their experience could be vastly different," Faith said.
Faith said Scott might very well have a valid claim on her own, but, he added that a lack in similarity between the potential class members' experiences make a class-action lawsuit an inappropriate avenue.
Court of Appeal Justice Ernest Drapeau told the parties the court would reserve its decision until a later date.
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N.B. nurses reject latest tentative agreement, pausing negotiations until after election
Part 3 nurses reject tentative agreement by margin of 59 per cent
The New Brunswick government and the union representing nurses will have to return to the negotiating table after the largest segment of nurses in the province voted against a new tentative collective agreement Thursday.
Part 3 nurses, who make up about 90 per cent of the New Brunswick Nurses Union membership, voted against the tentative agreement by a margin of 59 per cent, said union president Paula Doucet.
"Our negotiating team will be reconvening next week to reach out to our members in that particular unit to find out where we did not meet the needs for successful ratification for the tentative agreement," Doucet.
The vote of rejection means Part 3 nurses will remain with a collective agreement that expired at the end of last year.
And with a looming provincial election scheduled for Oct. 21, both parties have signalled they don't plan on recommencing negotiations until after a new government is formed.
The
New Brunswick Nurses Union will be consulting its members about what
was missing from the tentative agreement, said president Paula Doucet. (Daniel St Louis/New Brunswick Nurses Union)
"Obviously, it's disappointing that the broader nursing community did not vote in favour of the contract," said Health Minister Bruce Fitch, in an email statement Friday.
"The contract that was offered would have made New Brunswick nurses the highest paid in Atlantic Canada, and fourth highest paid in Canada."
In an interview Friday, Doucet sidestepped a question about whether the tentative agreement would elevate the salary of nurses by that much.
"What I can say is that nurses are recognizing that their working conditions needed serious attention that was not obviously meeting the needs for the members in Part 3," Doucet said.
Health
Minister Bruce Fitch said he was disappointed by the vote, adding that
the tentative agreement would have made New Brunswick nurses the highest
paid in Atlantic Canada. (Shane Fowler/CBC)
Fitch's statement also noted that he understands the concerns nurses had were related to issues outside of the "actual contract."
When asked about that, Doucet said those issues have to do with the long-term disability plan and benefits nurses must pay for entirely on their own.
"We will be regrouping with our Part 3 nurses and looking forward to bringing back a potential new tentative agreement as soon as we can," she said.
Agreement ratified for managers, supervisors
Part 3 nurses work in hospitals, clinics and extramural care, and make up about 7,800 of the union's 8,500 members, Doucet said.
While Part 3 nurses rejected their tentative agreement, about 225 nurse managers and supervisors voted in favour of their agreement by a margin of 56 per cent, Doucet said.
Doucet said the union represents about 500 other nurses who work in long-term care homes, and a tentative agreement has not yet been reached for those members.
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