Could nurse practitioners fill the primary care gap?
Could nurse practitioners fill the primary care gap?
More than 6.5 million Canadians are without a family doctor. Some would like to see nurse practitioners step in to ease the crisis in primary care
Nurse practitioners could help fill the void, advocates for the profession say, if more provinces would adopt policies to integrate them into primary care and pay them fairly for their work. Some physicians’ organizations have pushed back against that approach, arguing that NPs don’t have as much training or education as family doctors and therefore should only be funded publicly when they’re embedded in interdisciplinary teams with MDs.
Aren't these the same organizations that have been dragging their feet on recognizing foreign credentials?
I've been seeing a nurse practitioner for the last couple of years. So far, she's provided the same level of care I'm used to from family doctors: prescriptions, forwarding me to specialists when appropriate, providing the usual advice during checkups. It's fine.
Edit: took out my grumbly summary, since our healthcare spending seems to be middle of the pack, compared to peer countries.
Maybe we should, as a society, make the profession of physician suitably attractive so that we don't have a huge shortage of qualified people motivated to do this job instead of having this generation's clever people working out how to make people watch more ads.
Oh there's so many people who want to be doctors! No shortage of that.
What ends up is the extremely difficult admission process, poor mentorship/training structure, long work hours, and low salary; at the end you are rewarded with high salary and prestige, but very few makes it that far.
There are lots of people who want to get into healthcare. We don't have enough spots in post secondary education to train them all.
We refuse to hire some trained healthcare providers, like the nurse practitioners described in the article, and folks with credentials from elsewhere.
We have the people. We don't have the will to employ them properly.
The acceptance rate at Canadian med schools is about 1 in a 1000, and most of those 1000 applicants are qualified in the sense of having decent grades and passing the MCAT. There is no shortage of qualified applicants for med school. This issue is that there is a shortage of funded positions in med schools.
In addition, we admit many trained physicians via our immigration system. We have a system for training these physicians to work in the Canadian health care system, but it is woefully inadequate. I'm sure my numbers are out of date, but about a decade ago there were 5000 physician applicants to that training system with only 5 slots available. And, if you were not among the lucky 5 after 3 years on the list, you were no longer eligible. As a result, we have tens of thousands of trained physicians who gave up on medicine and now work in other fields.
So, the logical next question is, why? The answer is that there is a convergence of interests between the government and the physicians associations. Physicians don't want their profession flooded with additional members because it weakens their bargaining position with the government. And the government does not particularly want to license a whole bunch more physicians because each new physician they add represents a long-term expense to the health care system.
Health care consumer demand in a system like ours with no point-of-service fees is effectively bottomless. You could triple the number of physicians and they would all be busy. The only curb on consumer demand is rationing, which is done by limiting the number of licensed physicians.
Nurse practitioners could definitely fill the primary care gap independently, but that's not what physicians want. Physicians want nurse practitioners to work under them so that they can get a cut for every patient the NP sees.
All of that is to say that it is always about money. Always. It is no accident that there is a primary care shortage, and no mystery as to why either. Cost containment by the government and turf-protection by physician groups are the main reasons.
Fortunately, there has been some movement on alternatives. There are a few more NP-led clinics being approved. Midwifery was legalized in the 90s, and midwives and pharmacists in Ontario have had their scope expanded in recent years to include the ability to diagnose and treat a range of minor ailments. All of this helps, though hopefully it is only the thin edge of the wedge in terms of broadening the base of primary care.
Midwifery was legalized in the 90s, and midwives and pharmacists in Ontario have had their scope expanded in recent years to include the ability to diagnose and treat a range of minor ailments.
If only their pay weren't legally cut and then frozen by various legislation sponsored by physicians. It makes no sense to be a midwife here.
Exactly this. We have a handful of colleges dictating policy in Canada, with little or no evidence that the policy works.
I've had really disappointing experiences with doctors. I would like to be disappointed by NPs with smaller workloads, who spend more time with me (optional), better working conditions (required), and lower cost. Hell, if there's a possibility they'd do a better job, that'd be great too.
Broadening the pool of people in healthcare could solve many of the problems we're currently facing.
Woah, slow down there, commie. I can still kind of do stuff, like watch TV or games without being completely blocked by advertisements. There's still value to be wrung out for the shareholder. Why do you hate freedom?
Why not simply pay GPs a decent wage, thereby attracting more people into the industry?
The issue is they pay specialists grossly unreasonable wages, so thats where all the 2nd+ generation med students who have the best chamce at leaping over all of the arbitrary hurdles to med achool acceptance set their sights.
Wages are not a zero-sum issue. Raise the wages of GPs, and that gap narrows. With a narrower gap, fewer students will try to hop it, as the benefits are less. Or in other words, it becomes easier and more profitable to be a GP.
There is no reason why specialist wages need to be eviscerated. You can have high wages for both specialists and GPs. And in the end, we need plenty of people going into both.
They already are. My work benefits include a service where I can video chat with a NP any time and I don't have to wait as long for an appointment, which has been handy when I just need some quick advice or a prescription cream for my little ones. We have a family doctor and I love her but she typically books a few weeks out so I only make appointments with her for annual checkups and more serious talks that I can put off for a while.
My work benefits include a service where I can video chat with a NP any time and I don't have to wait as long for an appointment
Mine doesn't. I believe we need to try different models of care delivery, but I'm really leary of privately funded healthcare.
My publicly funded NP has done day-of calls, and usually books urgent appointments promptly.
Could nurse practitioners fill the primary care gap?
Not if we can't provide childcare for those nurses to be able to work.
Nurse Practitioner. I know "Nurse" is in the name, but they are completely separate jobs.
We're splitting hairs: "Nurse practitioners (NPs) are registered nurses who have additional education and nursing experience..." (SOURCE)
The same need for childcare still applies, no matter where on the spectrum of nursing someone decides to be on.
This is the best summary I could come up with:
Ms. Lamphier has a dozen years of experience as a nurse practitioner, a professional designation that allows her to perform many of the same tasks as a family doctor, including diagnosing illnesses, writing prescriptions, ordering tests, and making referrals to specialists.
When Ms. Lamphier finished covering a maternity leave at a Windsor practice last fall, she found there were no publicly funded job openings for primary-care NPs in her area.
Ms. Lamphier’s predicament puts her smack in the middle of a national debate about the role and remuneration of nurse practitioners at a time when as many as 6.5 million Canadians say they don’t have a family doctor or other primary-care provider.
Nurse practitioners could help fill the void, advocates for the profession say, if more provinces would adopt policies to integrate them into primary care and pay them fairly for their work.
Some physicians’ organizations have pushed back against that approach, arguing that NPs don’t have as much training or education as family doctors and therefore should only be funded publicly when they’re embedded in interdisciplinary teams with MDs.
After Premier Danielle Smith fleshed out the NP plan at a news conference on April 25, Paul Parks, the president of the association, said in an interview that it could work well if it bolsters team care with physicians.
The original article contains 1,470 words, the summary contains 219 words. Saved 85%. I'm a bot and I'm open source!
I'd settle for my provincial government not actively fucking over health care, ripping up contracts with doctors, and then wondering where all the doctors went…
Could nurse practitioners fill the primary care gap?
Oh look, another way to avoid funding the healthcare system!
I don't mean to demean NPs, but this is like saying "Can EAs fill the teaching gap?". Sure, they could, in theory, but they won't because the government doesn't see NPs as a solution per se; instead, they're a way to avoid spending money and create a two-tiered system where if you want to see a doctor you have to pay, but if you want to try and see an overworked, undercompensated NP you might be able to, if we actually had any.