Nurse Practitioners

[densa44]

Now that the province is funding these people for 80% of what Family Doctors are paid, we can all look forward to way better family medicine, or maybe not.

I do hope that the province will step up and insure these people against the unlimited liability law suits that will soon follow.

Maybe some of our lawyers and judges will describe what sort of settlements a patient can expect if a diagnosis is missed and the patient suffers irreversible, preventable harm.

Too bad we only have 2 medical schools, who are turning away qualified students because of funding cuts.

[Dewey Cox]

It's public Healthcare.
Keeping you alive hurts the bottom line.

[dmcbride]

BC already does this, why the fear mongering?

[CBintheNorth]

Originally Posted by dmcbride

BC already does this, why the fear mongering?

Because that's what he does here. It's kind of his 'thing'.

[Scott h]

Originally Posted by densa44

Now that the province is funding these people for 80% of what Family Doctors are paid, we can all look forward to way better family medicine, or maybe not.

I do hope that the province will step up and insure these people against the unlimited liability law suits that will soon follow.

Maybe some of our lawyers and judges will describe what sort of settlements a patient can expect if a diagnosis is missed and the patient suffers irreversible, preventable harm.

Too bad we only have 2 medical schools, who are turning away qualified students because of funding cuts.

It does seem odd that this new funding system seems designed to pit NP's against physicians. When you look at the education required to be a NP vs that required for a MD. it's not even close. The initial idea behind NP's was to offload much of the common repetitive workload off onto specialty RN's with increased training, that would compliment the healthcare team. The current "plan" has them replacing doctors. At 80% (plus vacation, sick time, pensions, insurance, etc.) the province will be paying the same, or more, for a vastly lower quality product. When someone goes to a NP with a problem outside their scope of practice, I would really have doubts if any physician would now take their referral. Why would they???

[jstubbs]

An NP can probably handle 75% of all doctor's office visits: all the worried parents hauling their kids in for a stuff nose, people getting vaccines for travel, prescribing antibiotics for minor infections, writing bloodwork requisitions, etc. A good implementation plan would have family medicine clinics with NPs working in conjunction with MDs at the same clinic, allowing the MDs to focus more time on the medically complex and out-of-NP-scope procedures.

However, like Scott h notes, it seems this plan pits NPs and MDs against each other rather than have them work together.

[walking buffalo]

Originally Posted by jstubbs

An NP can probably handle 75% of all doctor's office visits: all the worried parents hauling their kids in for a stuff nose, people getting vaccines for travel, prescribing antibiotics for minor infections, writing bloodwork requisitions, etc. A good implementation plan would have family medicine clinics with NPs working in conjunction with MDs at the same clinic, allowing the MDs to focus more time on the medically complex and out-of-NP-scope procedures.

However, like Scott h notes, it seems this plan pits NPs and MDs against each other rather than have them work together.

However....

Many very serious conditions first present themselves as "minor" symptoms.

Having lesser educated people handling "minor" infections and runny noses will lead to delayed or completely missed proper diagnoses, and we know where that leads.

[Scott h]

Originally Posted by walking buffalo

However....

Many very serious conditions first present themselves as "minor" symptoms.

Having lesser educated people handling "minor" infections and runny noses will lead to delayed or completely missed proper diagnoses, and we know where that leads.

That's why NP's work best in conjunction with, not instead of, physicians.

[jstubbs]

Originally Posted by walking buffalo

However....

Many very serious conditions first present themselves as "minor" symptoms.

Having lesser educated people handling "minor" infections and runny noses will lead to delayed or completely missed proper diagnoses, and we know where that leads.

Yes, I know all about that. My mom had a nagging cough, despite not being a smoker and healthy otherwise, she saw her family doctor about it (and he’s a great doc as well), he said well come back if it gets worse or other symptoms show. It never did get worse, but a month or two later she had to go to the ER for kidney stones. Further scans revealed she had stage 4 lung cancer. Nothing anyone could have done, short of tying up resources getting scans every time someone has a cough that lingers. Christ, after COVID it’d be a 10 year waitlist for a damn X-Ray if that were that case.

See, there is a process to medicine and only a finite number of resources. NP or MD, minor symptoms present without any other concerns are all going to be treated the same way. Vast majority of the time, the medical professional will tell you to let them know if it gets worse or other symptoms show, and try this prescription. At best, they might order bloodwork or an ultrasound type test. Basic Dynalife stuff—but they can’t and won’t order tests for every little thing.

Thus, as noted, if a case does turn from minor symptoms to more complex, it’s referred off to an MD. Same way that a family medicine MD refers off to complex specialist MDs when it goes beyond their knowledge base.

IMO, the overarching point here though is that family medicine doctors are woefully underpaid for the amount of BS they deal with, and it’s obvious you have to be some sort of Mother Teresa type (or maybe just an outright sadist) to work in family medicine. I don’t know why NPs would make 80% of an MDs average takehome, but that to me speaks more to an issue of MD pay than NP. But if we could reduce the amount of BS those doctors deal with but at least keep pay similar, maybe we’d get more bright people into the profession.

[npbra]

My last doctor had 2 NP in his office. I preferred to see them over the Doc. They took the time to listen and ask questions. Helped get to a proper diagnosis and treatment. Actually looking forward to the NP's setting up shop.

[walking buffalo]

Originally Posted by jstubbs

Yes, I know all about that. My mom had a nagging cough, despite not being a smoker and healthy otherwise, she saw her family doctor about it (and he’s a great doc as well), he said well come back if it gets worse or other symptoms show. It never did get worse, but a month or two later she had to go to the ER for kidney stones. Further scans revealed she had stage 4 lung cancer. Nothing anyone could have done, short of tying up resources getting scans every time someone has a cough that lingers. Christ, after COVID it’d be a 10 year waitlist for a damn X-Ray if that were that case.

See, there is a process to medicine and only a finite number of resources. NP or MD, minor symptoms present without any other concerns are all going to be treated the same way. Vast majority of the time, the medical professional will tell you to let them know if it gets worse or other symptoms show, and try this prescription. At best, they might order bloodwork or an ultrasound type test. Basic Dynalife stuff—but they can’t and won’t order tests for every little thing.

Thus, as noted, if a case does turn from minor symptoms to more complex, it’s referred off to an MD. Same way that a family medicine MD refers off to complex specialist MDs when it goes beyond their knowledge base.

IMO, the overarching point here though is that family medicine doctors are woefully underpaid for the amount of BS they deal with, and it’s obvious you have to be some sort of Mother Teresa type (or maybe just an outright sadist) to work in family medicine. I don’t know why NPs would make 80% of an MDs average takehome, but that to me speaks more to an issue of MD pay than NP. But if we could reduce the amount of BS those doctors deal with but at least keep pay similar, maybe we’d get more bright people into the profession.

There is nothing to be gained for Public health when lesser qualified personnel are overpaid.



Yet the main issues with our failing ( I personally feel that it is better described as failed) healthcare system is too rapid of population growth (99% due to Immigration rates) and an incredibly bloated bureaucracy.


If we dealt with these issues, we wouldn't be having this particular discussion about MDs and NPs....

[huntinstuff]

Originally Posted by jstubbs

An NP can probably handle 75% of all doctor's office visits: all the worried parents hauling their kids in for a stuff nose, people getting vaccines for travel, prescribing antibiotics for minor infections, writing bloodwork requisitions, etc. A good implementation plan would have family medicine clinics with NPs working in conjunction with MDs at the same clinic, allowing the MDs to focus more time on the medically complex and out-of-NP-scope procedures.

However, like Scott h notes, it seems this plan pits NPs and MDs against each other rather than have them work together.

The "plan" doesnt pit NP's and MD's against each other, culture and religion does. And we can't discuss that here as per the rules on AO.

NP "Kristy MacDonald" is best to open her own clinic.....

[Big Grey Wolf]

I could see this work if they were in a combined clinic with 1-2 doctors. Setting them free to operate their own clinic with half the training of real doctors, well we might pay the price.

[pikergolf]

Originally Posted by Scott h

It does seem odd that this new funding system seems designed to pit NP's against physicians. When you look at the education required to be a NP vs that required for a MD. it's not even close. The initial idea behind NP's was to offload much of the common repetitive workload off onto specialty RN's with increased training, that would compliment the healthcare team. The current "plan" has them replacing doctors. At 80% (plus vacation, sick time, pensions, insurance, etc.) the province will be paying the same, or more, for a vastly lower quality product. When someone goes to a NP with a problem outside their scope of practice, I would really have doubts if any physician would now take their referral. Why would they???

Let me ask you this, for those without a family doc, if you have a really bad cold and are coughing up blood do you want to go sit in emerg for 10 hrs and be treated like a criminal because they don't think it's an emergency or do you want to see a NP? Everything that looks serious a family doc sends you to a specialist same as a NP would. I would much rather have a NP that knows me than keep going to emerg or walk in to see a strange doc every time. The plan is not to replace Doctors like your union tell you, it is to fill a need that a world wide DR shortage is causing. They would be running the practice as a private practice not unionized according to the government so stuff your fear mongering. As for your doubt that a specialist would not see them if referred well that is more fear mongering.

[densa44]

Well you have already been told what will happen sooner or later, what I can add is that this will drive out some of the Doctors that you have trained to more welcoming locals.

Just BTW would you encourage your gifted child to peruse career in medicine? When all this "socialized" medicine got started the Doctors warned that the government would sooner or later begin to interfere with the practice of medicine. They (the doctors) had a strike in Sask. It is now "later"

[MK2750]

Originally Posted by pikergolf

Let me ask you this, for those without a family doc, if you have a really bad cold and are coughing up blood do you want to go sit in emerg for 10 hrs and be treated like a criminal because they don't think it's an emergency or do you want to see a NP? Everything that looks serious a family doc sends you to a specialist same as a NP would. I would much rather have a NP that knows me than keep going to emerg or walk in to see a strange doc every time. The plan is not to replace Doctors like your union tell you, it is to fill a need that a world wide DR shortage is causing. They would be running the practice as a private practice not unionized according to the government so stuff your fear mongering. As for your doubt that a specialist would not see them if referred well that is more fear mongering.

Here is the right answer and the same thing applies to Pharmacists prescribing drugs. They are more compassionate and know more about drugs but stand in line at the doctor's office so they can further bankrupt the system.

The only people truly fearful should be those double dipping in the tax payer's pocket.....again.

[pittman]

Originally Posted by MK2750

Here is the right answer and the same thing applies to Pharmacists prescribing drugs. They are more compassionate and know more about drugs but stand in line at the doctor's office so they can further bankrupt the system.

The only people truly fearful should be those double dipping in the tax payer's pocket.....again.

It doesn't seem like you understand the system.

In your example, the only person who could be accused of double dipping would be the pharmacist (paid for their assessment/prescription, then sells the drug they just prescribed).

The physician only gets paid for their assessment. Not for writing the prescription. Not for the drugs getting dispensed.

[pittman]

I've seen plenty of well-run family medicine clinics where NPs play a part. Lots they can do to help for sure.

Running their own clinics? I have my doubts. The training to be a nurse is drastically different than training to be a physician. That's just the reality of it. On top of that, they'll have to deal with the reality of running a business. At 80% their margins will even be tighter, unless the government thinks they'll pay their overhead too. Also, their goal is to have each NP carry 900 patients. A full patient load for many GPs is 2000. Hard to see the value there.

The real problem is that primary care has been destroyed by years of underfunding and increasing business costs. Ultimately, the most affordable care a person can get is what they get in the community. Without good primary care, people get sick enough to have to go to the hospital. As soon as a person has to come in to hospital the costs go through the roof.

[Sporty]

Originally Posted by walking buffalo

However....

Many very serious conditions first present themselves as "minor" symptoms.

Having lesser educated people handling "minor" infections and runny noses will lead to delayed or completely missed proper diagnoses, and we know where that leads.

Not having access to a doctor at all also presents an issue as well. Many minor health issues that aren't treated early on leads to bigger health issues. Far too many people without access to a family doctor. NPs are pretty educated and many actually specialize in areas where they would be able to diagnose and treat their specialties or refer patients to a specialist the same way a GP would.

Originally Posted by dmcbride

According to this article Alberta has added 500 new doctors and a new deal is coming for doctors.


https://edmontonjournal.com/news/pol...”%20she%20said.


On a side note, the whole country has a doctor shortage because of reckless immigration, effecting everything from healthcare to housing. Alberta just seems to be Trudeau’s paid media punching bag.

Add in the expensive, bloated bureaucrat and admin who sucks up health dollars for their big salaries, benefits, pensions and bonuses to continue screwing up our HC.

[Sundancefisher]

Nurse practitioners are registered nurses who have advanced training in health assessment, health promotion and illness prevention. They diagnose and treat health problems, order and interpret tests, and prescribe drugs.

Looks like a great program to help rural areas get improved care.

https://alis.alberta.ca/occinfo/cert...-practitioner/

Need 4500 hours of nursing experience or 562 days at an 8 hour shift.

Nurse practitioners can’t do all the same stuff doctors can however they can also phone doctors to consult as needed in remote treatment.

People still have the option to go see a doctor if they want.

It would appear the time and effort needed to become a nurse practitioner is difficult and maybe more will do it if the pay is better. I suspect most don’t want the added stress of this new level of care.

https://www.ualberta.ca/nursing/abou...ctitioner.html

[pikergolf]

Originally Posted by Sundancefisher

Looks like a great program to help rural areas get improved care.

https://alis.alberta.ca/occinfo/cert...-practitioner/

Need 4500 hours of nursing experience or 562 days at an 8 hour shift.

Nurse practitioners can’t do all the same stuff doctors can however they can also phone doctors to consult as needed in remote treatment.

People still have the option to go see a doctor if they want.

It would appear the time and effort needed to become a nurse practitioner is difficult and maybe more will do it if the pay is better. I suspect most don’t want the added stress of this new level of care.

https://www.ualberta.ca/nursing/abou...ctitioner.html

Ideally a NP would work in a Dr's office, the first step so to speak, more difficult stuff would be passed on to the family doc and if done right could be the same day. Reduce wait times and have the little stuff done by the NP.

[Sundancefisher]

Originally Posted by pikergolf

Ideally a NP would work in a Dr's office, the first step so to speak, more difficult stuff would be passed on to the family doc and if done right could be the same day. Reduce wait times and have the little stuff done by the NP.

Agreed

There is already that set up in some offices in Alberta and it’s more common in Ontario.

Small rural towns and reserves desperately need a NP as it is not sustainable for a doctor.

[Ariu]

Originally Posted by densa44

...Too bad we only have 2 medical schools, who are turning away qualified students because of funding cuts.

I do not understand why the med schools here in Canada, do not adapt the European system? The med schools here require a degree (four years) as prerequisite followed by four other years of med school. (not to mention volunteering hours required, the interview, diversity hiring and so on....)
In Europe you can start medicine school from day 1 and finish it in six years.
EU system has a two years advantage, plus the premed courses can be much better adapted for the following med courses.

[huntinstuff]

Originally Posted by Ariu

I do not understand why the med schools here in Canada, do not adapt the European system? The med schools here require a degree (four years) as prerequisite followed by four other years of med school. (not to mention volunteering hours required, the interview, diversity hiring and so on....)
In Europe you can start medicine school from day 1 and finish it in six years.
EU system has a two years advantage, plus the premed courses can be much better adapted for the following med courses.

I believe it's because post secondary is a business first, not an educational institution first.

[Jtenkink]

I’ve got a NP in the family, she works in Sask which is slightly different than Alberta but mainly the difference is that they are paid a lot less there.
Yes, a NP is technically not as educated as a doctor but they are way more trained than the average nurse. It was at least a couple years of full time education after 20+ years of being a Registered Nurse for the one I know.

Also the NP is often better suited to the more complex cases as they aren’t paid by the patient. Drs get paid per patient so they allot the patient 5-10 min of a 15 min appointment, NPs are salaried (at least in sask) so they often take way more time getting to know the patient and really work through the details do the more complex cases. Yes, if something beyond their expertise comes up they refer to a specialist. Exactly like a general practitioner (dr) would. I’ve heard lots of stories where the NP caught stuff like interacting medications or really weird stuff that fell through the cracks just because they aren’t financially incentivized to rush patients out the door.

I’m all for more NPs in Alberta, I’d prefer a good NP for my family than most of the Drs offices I’ve tried to get into around here the last 15 years.

[Grizzly Adams1]

Originally Posted by Ariu

I do not understand why the med schools here in Canada, do not adapt the European system? The med schools here require a degree (four years) as prerequisite followed by four other years of med school. (not to mention volunteering hours required, the interview, diversity hiring and so on....)
In Europe you can start medicine school from day 1 and finish it in six years.
EU system has a two years advantage, plus the premed courses can be much better adapted for the following med courses.

I believe in Europe most doctors are essentially civil servants when it comes down to it, you just get a salary which isn't that great either.