Alberta
Healthcare Overhaul – Services to be provided by nurses in their own clinics
Strengthening primary care with nurse practitioners
Alberta’s government is expanding opportunities for nurse practitioners to give Albertans greater access to a regular primary care provider when and where they need one.
Too many Albertans cannot find a regular family doctor or have trouble getting an appointment with the one they have. Alberta’s government continues to support and stabilize primary health care across the province by enabling nurse practitioners to open their own clinics, take on patients and offer services based on their scope of practice, training and expertise. Typically nurse practitioners can provide about 80 per cent of the medical services a family physician provides, and this will be reflected in the compensation model when it’s finalized.
Nurse practitioners have completed graduate studies and are regulated by the College of Registered Nurses of Alberta. Like other regulated professions, all nurse practitioners must meet minimum requirements to practise and follow standards set by their regulatory college.
“Nurse practitioners are highly trained and valued medical professionals. By enabling them to open their own clinics, we are ensuring Albertans can more easily access the care they need. This is a significant improvement in our primary health care system that will benefit patients and help improve the overall health and health outcomes of Alberta families.”
As the province enables nurse practitioners to do more of the work they are trained to do, a new compensation model will be created to encourage them to operate independently, adding much-needed capacity to Alberta’s primary care system. Nurse practitioners are extensively trained in their graduate studies to assess, diagnose, treat, order and interpret diagnostic tests, prescribe medications, make referrals to a specialist and manage a person’s overall care.
In addition, through a $2-million grant over the next three years, the Nurse Practitioner Association of Alberta will help to implement a compensation model, recruit other nurse practitioners to participate and provide supports as they work to set up their own clinics.
“There is no doubt about it, we need more health professionals providing primary health care to Albertans. Nurse practitioners are skilled health care professionals who play vital roles in modern health care. This model has the potential to add capacity in communities across the province and help so many Albertans gain access to a regular primary care provider.”
The new compensation model will be phased in and is expected to launch in early 2024 when nurse practitioners who want to go into independent practice will be asked to submit expressions of interest. The model is expected to include payment for a specified number of clinical hours and other commitments, such as caring for a certain number of patients.
“The Nurse Practitioner Association of Alberta is thrilled for the opportunity to support Albertans across the province in accessing a care provider in all health care environments, not just primary care. With this announcement and this grant, the association will be perfectly positioned to ensure that our members will be fully prepared to meet the needs of Albertans in both urban and rural communities. Until now, accessing a nurse practitioner has been challenging. This announcement ends those challenges. The NPAA looks forward to working with Alberta Health to get clinics open and to support NPs in being able to do the work that they are trained to do.”
Nurse practitioners who opt into the compensation model will also qualify for caseload supports once their patient caseloads are established, as announced on Oct. 18. The three-year $57-million support program will help primary health care providers manage an increasing number of patients. Each provider has the potential to receive up to $10,000 annually.
“The shortage of health care professionals in rural communities has always been a challenge that required innovative solutions. The new nurse practitioner model actively addresses this need by enhancing and expanding rural health care deliveries. This new initiative will enable rural Albertans to have better access to primary health care close to home.”
Alberta’s government will continue working with the Nurse Practitioner Association of Alberta and the College of Registered Nurses of Alberta as the compensation model is implemented.
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Alberta
MAiD In Alberta: Province surveying Albertans about assisted suicide policies
Alberta’s government is launching a public engagement to gather input about legislation and policies around assisted suicide, also referred to as medical assistance in dying (MAID).
Medical assistance in dying is a process that allows an eligible person to receive assistance from a medical practitioner in ending their life. To be found eligible, a person must be suffering from a serious and permanent medical condition.
Alberta’s government is reviewing how MAID is regulated to ensure there is a consistent process as well as oversight that protects vulnerable Albertans, specifically those living with disabilities or suffering from mental health challenges. An online survey is now open for Albertans to share their views and experiences with MAID until Dec. 20.
“We recognize that medical assistance in dying is a very complex and often personal issue and is an important, sensitive and emotional matter for patients and their families. It is important to ensure this process has the necessary supports to protect the most vulnerable. I encourage Albertans who have experience with and opinions on MAID to take this survey.”
In addition to the online survey, Alberta’s government will also be engaging directly with academics, medical associations, public bodies, religious organizations, regulatory bodies, advocacy groups and others that have an interest in and/or working relationship to the MAID process, health care, disabilities and mental health care.
Feedback gathered through this process will help inform the Alberta government’s planning and policy decision making, including potential legislative changes regarding MAID in Alberta.
“Our government has been clear that we do not support the provision of medically assisted suicide for vulnerable Albertans facing mental illness as their primary purpose for seeking their own death. Instead, our goal is to build a continuum of care where vulnerable Albertans can live in long-term health and fulfilment. We look forward to the feedback of Albertans as we proceed with this important issue.”
“As MAID is a federally legislated and regulated program that touches the lives of many Albertans, our priority is to ensure we have robust safeguards to protect vulnerable individuals. Albertans’ insights will be essential in developing thoughtful policies on this complex issue.”
The federal Criminal Code sets out the MAID eligibility criteria, procedural safeguards and reporting obligations. The federal government has paused MAID eligibility for individuals with a mental illness as their sole underlying medical condition until March 2027 to ensure the provincial health care systems have processes and supports in place. Alberta’s government does not support expanding MAID eligibility to include those facing depression or mental illness and continues to call on the federal government to end this policy altogether.
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Alberta
On gender, Alberta is following the science
Despite falling into disrepute in recent years, “follow the science” remains our best shot at getting at the truth of the physical sciences.
But science, if we are to place our trust in it, must be properly defined and understood; it is at its essence an ever-changing process, a relentless pursuit of truth that is never “settled,” and one that is unafraid to discard old hypotheses in the face of new evidence.
And it is in this light—in the unforgiving glare of honest science—that Alberta Premier Danielle Smith’s three new legislative initiatives around gender policy are properly understood, notwithstanding the opprobrium they’ve attracted from critics.
Bill 26, the Health Statutes Amendment Act, proposes to prohibit the prescription of puberty blockers and cross-gender hormones for the treatment of gender dysphoria to youth aged 15 and under. It would allow minors aged 16 and 17 to begin puberty blockers and hormone therapies for gender “reassignment” and “affirmation” purposes only with parental, physician, and psychologist approval. The bill also prohibits health professionals from performing sex reassignment surgeries on minors.
Bill 27, the Education Amendment Act, seeks to enshrine parents’ rights to be notified if their kids change their names/pronouns at school, and it gives parents the right to “opt in” to what sort of gender and sex education their kids are exposed to in school.
And Bill 29, the Fairness and Safety in Sports Act, is designed to protect females in sports by ensuring that women and girls can compete in biological female-only divisions, while supporting the formation of co-ed opportunities to support transgender athletes.
Each of these initiatives is entirely reasonable, given what we know of the science underpinning “gender care,” and of the undeniable advantages that a male physique confers upon biological males competing in sports.
The notion that the trifecta of puberty blockers, cross-gender hormones, and revisionist surgery is a pathway to good health was a hypothesis initially devised by Dutch researchers, who were looking to ease the discomfort of transgender adults struggling with incongruence between their physical appearance and their gender identities. As a hypothesis, it was perhaps reasonable.
But as the UK’s Cass Review exposed in withering detail last spring, its premises were wholly unsupported by evidence, and its implementation has caused grievous harm for youth. As Finnish psychiatrist Riittakerttu Kaltiala, one of the architects of that country’s gender program, put it last year, “Gender affirming care is dangerous. I know, because I helped pioneer it.”
It’s no accident, then, that numerous European jurisdictions have pulled back from the “gender affirming care” pathway for youth, such as Sweden, Finland, Belgium, the Netherlands, and the United Kingdom.
It makes perfect sense that Canadians should be cautious as well, and that parents should be apprised if their children are being exposed to these theories at school and informed if their kids are caught up in their premises.
Yet the Canadian medical establishment has remained curiously intransigent on this issue, continuing to insist that the drug-and-surgery-based gender-affirming care model is rooted in evidence.
Premier Smith was asked by a reporter last month whether decisions on these matters aren’t best left to discussions between doctors and their patients; to which she replied:
“I would say doctors aren’t always right.”
Which is rather an understatement, as anyone familiar with the opioid drug crisis can attest, or as anyone acquainted with the darker corners of medical history knows: the frontal lobotomy saga, the thalidomide catastrophe, and the “recovered memories of sexual abuse” scandal are just a few examples of where doctors didn’t “get it right.”
As physicians, we advocate strongly for self-regulation and for the principle that medical decisions are private matters between physicians and patients. But self-regulation isn’t infallible, and when it fails it can be very much in the interests of the public—and especially of patients—for others to intervene, whether they be journalists, lawyers, or political leaders.
The trans discussion shouldn’t be a partisan issue, although it certainly has become one in Canada. It’s worth noting that Britain’s freshly elected Labour Party chose to carry on with the cautious approach adopted by the preceding administration in light of the Cass Review.
Premier Smith’s new polices are eminently sensible and in line with the stance taken by our European colleagues. None of her initiatives are “anti-trans.” Instead, they are pro-child, pro-women, and pro-athlete, and it’s difficult to see how anyone can quibble with that.
Dr. J. Edward Les, MD, is a pediatrician in Calgary, senior fellow at the Aristotle Foundation for Public Policy, and co-author of Teenagers, Children, and Gender Transition Policy: A Comparison of Transgender Medical Policy for Minors in Canada, the United States, and Europe.
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