2024-11-12 10:00:00
Pierre Martin relied for four years on a specialized nurse practitioner (NPP) to treat his “sores” and health problems. “I was absolutely delighted with the service I got,” says the 70-year-old. Until this IPS left the medical clinic he attended and moved to the private sector.
Published at 5:00 a.m.
“It’s quite discouraging,” comments the resident of Hemmingford, in Montérégie.
Pierre Martin had “a lot of hope” on the arrival of IPS in the public health network. His family doctor will retire shortly. “I thought they would bring a life-saving second wind to the front line with the creation of IPS clinics. »
However, many of them are abandoning the public network to join the ranks of private clinics. They offer front-line and “family nurse” services where they specialize, for example, in family psychiatry and food allergies.
“It’s certain that we see a movement, like almost everywhere else,” recognizes the president of the Association of Specialized Nurse Practitioners of Quebec, Maude Raymond.
We really see that there is a little more exodus towards the private sector.
The president of the Association of Specialized Nurse Practitioners of Quebec, Maude Raymond
The phenomenon remains difficult to quantify. The Ministry of Health and Social Services (MSSS) does not have any data on the number of nurses and NPs in the private sector. Neither does the Order of Nurses of Quebec (OIIQ).
The OIIQ, however, lists 1,689 “active” IPS holding a regular practice permit. As of October 5, 1,424 worked in the public network, according to the MSSS. Some 265 IPS therefore practice elsewhere, some of which – but which one? – in the private sector.
The Interprofessional Health Federation of Quebec (FIQ) says it is “concerned”. “The health network cannot afford to lose a single IPS to the private sector, especially in the context where Minister Dubé has just promised that all Quebecers will have a health professional in 2026,” says the vice-president of the executive committee, Jérôme Rousseau.
Too much work and no part-time
In January 2022, Stéfany Larocque co-founded the nursing clinic Au Center D’elle, in Prévost, in the Laurentians. The team will soon have four IPS.
“What they are looking for, when they come to the private sector, is often a reduction in their workload,” says Stéfany Larocque, a nurse who worked for seven years at the CISSS des Laurentides.
The working week of full-time NPs often stretches beyond 40 hours, due to the administrative tasks they have to accomplish, she explains.
They want to have a better work-life balance, working three or four days a week, for example.
The co-founder of the nursing clinic Au Center D’elle Stéfany Larocque
Which is rarely possible, if not impossible, in the public network. Caroline (fictitious first name) will soon make the jump to the private sector for this reason. The IPS specialist in mental health remains anonymous because she has not yet resigned to her employer.
“I’m not asking for charity: I’m asking to work part-time and only be paid for the hours I work, and that’s refused to me,” explains the mother of two young children, whose partner has an atypical schedule.
In addition to determining her schedule, she will have better remuneration in the private sector. “About double the salary,” she points out. Caroline will not, however, benefit from a pension fund or group insurance like the public.
She says she is “reluctantly” leaving her “very vulnerable” clientele. “The majority will not be able to come see me privately. »
No vacation during the summer
Nearly two years ago, Kim Blais-Provencher left the public network to improve her quality of life. “I didn’t have a vacation during the summer with my children,” says the IPS.
PHOTO PROVIDED BY KIM BLAIS-PROVENCHER
Kim Blais-Provencher, founder of Clinique Harmonie
After working for many years in Montreal, the mother of two returned to her native region, Trois-Rivières, during the COVID-19 pandemic. His seniority was not recognized at the CIUSSS de la Mauricie-et-du-Centre-du-Québec. The counter started “from zero”.
The IPS, who has an entrepreneurial spirit, decided to found the Harmonie Clinic. The president works more than before, but she can organize her schedule and spend more time with her patients rather than “putting out fires.” She would not go back, even if she says she had “good managers” in the public.
Scholarships to retain IPS
Quebec offers a $60,000 scholarship to clinical nurses who wish to become NPs. However, they must commit to working a minimum of 6,000 hours, or approximately three and a half years of service, in a health establishment in the public network, specifies the MSSS.
Caroline says she knows IPS who are “waiting for that moment” to go to the private sector. At the Center D’elle, an IPS preferred to reimburse her scholarship, underlines Stéfany Larocque.
Family doctor Geneviève Gauthier deplores this exodus towards the private sector – just like that of family doctors, she specifies. Since 2020, three NPs from its family medicine group (GMF) in Sainte-Adèle have left to work in the private sector.
It’s hard to convince my doctors to continue working with IPS. When they leave, the doctor is left with an overload of tasks.
Dr. Geneviève Gauthier
According to Dr. Gauthier, who is co-head of her GMF, it would be necessary to “adapt the schedule” of IPS to retain them in the network.
Jérôme Rousseau says he is aware of the “work overload” of IPS. “Many managements,” he explains, ask NPs “to see patients for 40 hours.” They must therefore carry out their administrative tasks after their working hours. “We often refuse to pay them overtime,” he adds.
The FIQ says it has agreed with the management party to review the organization of IPS work, once the collective agreement has been signed.
A victory for the IPS
In a decision rendered on November 4, the Administrative Labor Tribunal indicated to the Quebec government that it must recognize the master’s degree and the diploma of specialized higher studies (DESS) of IPS for the evaluation of their training. A victory for the IPS, the DESS not being recognized. The FIQ filed a pay equity complaint on this subject in 2010. “We think it will have an impact from a salary point of view, but we are still analyzing this aspect,” comments Jérôme Rousseau. The Treasury Board Secretariat did not respond to questions from The Press at the time these lines were written.
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The article discusses the challenges faced by Independent Practice Nurses (IPNs) in the public healthcare system in Quebec, with personal accounts illustrating the struggle to balance work and family life, job satisfaction, and compensation versus private sector opportunities.
One mother of two highlights her difficulties in securing part-time work that accommodates her family needs, despite being willing to be paid only for the hours she works. She emphasizes the disparity in remuneration, noting that she could earn about double her current salary in the private sector, although this would come at the cost of benefits like a pension or group insurance available in public employment. She expresses concern about having to leave behind her vulnerable clientele, who may not be able to afford private care.
Kim Blais-Provencher, another nurse who moved to the private sector for better work-life balance, shares her experience of not having summer vacations with her children while working in the public network. After relocating back to Trois-Rivières during the COVID-19 pandemic, she faced a setback as her seniority was not recognized, forcing her to start over. She eventually founded her own clinic, allowing her to have more control over her schedule and patient interactions, despite the increased workload.
The article also touches on financial incentives, such as a $60,000 scholarship offered by Quebec to encourage clinical nurses to become Nurse Practitioners (NPs), with the condition of serving a minimum of three and a half years in the public system. However, many nurses, like Caroline, are aware of others who are eager to leave for the private sector, which leads to dismissals of such offers, as seen in the case of an IP who opted to repay her scholarship.
Family doctor Geneviève Gauthier expresses her concern regarding the trend of nurses leaving for the private sector, noting that her medical team has lost three NPs since 2020. The departure of these nurses creates additional workload for the remaining doctors, hindering collaborative care efforts. the narrative reveals a concerning trend in the healthcare workforce, where dissatisfaction with public sector conditions drives trained professionals to consider private practice despite potential long-term repercussions for the public system.
