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The following column by Murray Campbell appeared in the September 17, 2002 issue of the Globe and Mail…

Susan Boudreau is a walking metaphor for the halting, perhaps imperceptible, progress the Ontario government is making in reforming the way health-care services are delivered.

Four years ago, the Callander, Ont., nurse upgraded her qualifications and became one of the first to be designated a nurse practitioner.

This further training was supposed to allow her to fit in smoothly in the new era in which doctors, nurses and other health practitioners would work as a team and wouldn't rely on the old fee-for-service model.

The trouble is, she never got a chance to do this. She found only spotty work that used her new training, even though she lives in Northern Ontario, a region that has a severe shortage of doctors.

Last week, the 34-year-old resigned her half-day-a-week nurse-practitioner post to concentrate on her job as an emergency-room nurse at a North Bay hospital.

"I've had enough of my skills being wasted," she said.

Ms. Boudreau is one of about 260 nurse practitioners in Ontario who were ready for the big job, but now find themselves unemployed or, as in Ms. Boudreau's case, underemployed. Considering there are just 467 people with the qualifications, 260 is a staggering figure, and it will only get worse as this fall's 89-member graduating class enters the work world.

The villain behind this underuse of the highly trained nurses is, in the eyes of many, the failure of the government to get its vaunted Family Health Network program off the ground.

The network, launched in March, 2001, is intended to bring family doctors together with other health-care professionals to provide co-ordinated, 24-hour service to patients.

It is intended to be the engine for reforming primary care delivered by family doctors. The theory is that more doctors could be persuaded to practise family medicine if they were given a predictable income and enabled to provide better care for their patients.

At the same time, network proponents believe the after-hours care the clinics could provide would take the pressure off beleaguered hospital emergency wards.

The nurse practitioners may be ready but the doctors aren't buying it.

Health Minister Tony Clement announced last week the creation of four new Family Health Network sites, involving about 38 doctors and 60,000 patients -- but no nurse practitioners. But this means there are now just five new network sites and 19 pilot sites, involving less than 4 per cent of Ontario's family doctors.

It's not an auspicious start. Mr. Clement is discovering what every health minister has found -- the road to reform is rocky and unpredictable. The government may be the paymaster in the $25-billion system, but getting doctors onside is something like herding cats.

The Health Minister is hanging tough, however, on his prediction that 80 per cent of family doctors will sign on to the networks by 2004. He says nearly 800 doctors are doing a financial analysis of the basic network template contract.

And he says momentum is building to a "tipping point" that will bring the majority of physicians onside. For the sake of his political ambitions, he had better be right.

Liberal health critic Sandra Pupatello predicts Mr. Clement will need divine intervention to reach the goal. What lifts this out of the usual political rhetoric is the fact that the Coalition of Family Physicians remains opposed to the networks.

Coalition president Douglas Mark says the base pay rate in the network contract is "dismally low" and that his members "do not want to sign contracts giving government more control over their lives and incomes."

Ruth Wilson, chairwoman of the Ontario Family Health Network, may have the toughest job in Ontario in trying to persuade her fellow family physicians to sign up.

At this point, she says it's like a high-school dance where no one wants to be the first to grab a partner and hit the floor. "The bulk of doctors are interested, waiting to see what their peers and colleagues will do."

It's safe to say that nurse practitioners and other health professionals are waiting, too.

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