When There Isn’t Enough Meat To Go Around by Pat Conrad MD

Times are tough all over.  More and more patients need more care, for which the government takes more responsibility, and shells out more money, passing more laws, creating more shortages, and rationing more access.  As they have so often, the United Kingdom has led the way toward innovation and stretching limited resources.

Here in the U.S., we are learning to make do by having non-doctors do progressively more “doctor” things and are finding out that physicians are, really, a luxury we can really do without more often than not.  The Brits are humanity’s greatest masters of “muddling through”, and now they have one-upped us again:  welcome the next level of medical professional evolution, the surgical care practitioner (SCP).   No need to bother with a lot of expensive medical training and surgical residency:  “Becoming an SCP requires a background as a registered healthcare professional, such as a nurse, a love of clinical practice and academic aptitude… Now the recommended training is a two-year master’s programme at university – a much higher barrier to entry than training for general nursing roles.”  Well, there ya go!

Sara Dalby, the featured SCP in this story, is praised for “observing a hip replacement as a student nurse to training as one of the hospital’s first surgical first assistants, [and] tasked with camera holding for laparoscopic surgery when the service was introduced by a colorectal consultant.”  All things the average over-trained third-year med student might waste money doing over here.

Dalby was able to “push herself professionally, develop her clinical skills and still work directly with patients. She is now Aintree University hospital’s only SCP and works across two specialties – the maxillofacial unit and upper limb orthopaedics.”  Maxillofacial AND orthopedics?  And here we’ve been wasting our time on specialized care like suckers!  She says, “I feel a responsibility to ensure that I provide high standards of patient care in my capacity as an SCP and to evidence the role as a success, to prove non-medical practitioners are worth investment.  Being in advanced roles give nurses with experience an alternative career path to management. It keeps them on the frontline providing clinical care for patients.”  Wha-, huh?  So she wants an alternative path to management so she can be on the clinical frontline?  Or is it the other way ’round?

“The Association for Perioperative Practice, a professional organization for those working in surgical theatres, says that most large hospitals now use them, and estimate that are at least 400 people in the roles.”  These roles “could involve examining patients, requesting investigative tests, carrying out routine surgery and discharging patients.”

Why?  Maybe because “laws which limit the amount of time that junior doctors can work and the cost saving potential during the difficult economic climate have helped push forward the development of the job.”  Or maybe because SCP’s cost less than one-third those expensive surgeons.

Mr. David Ward, a council member of the Royal College of Surgeons (RCS) of England, observes:  “The role is an excellent idea and SCPs can be a valuable part of the multi-professional surgical team. The numbers are increasing significantly.  In some areas, SCPs are already a critical part of the care that the NHS can provide.  The driver is certainly partly financial in that it means that the NHS can deliver more care to patients at a cheaper cost.”

This is a brave new frontier of innovation.  Obviously, an ARNP over here should be able to put in a routine V-P shunt, and c’mon, aren’t they really all routine?  Since when do you need a rip-off vascular surgeon to put in a stent in anything smaller than an aorta?  And ophthalmologists?  Seen one cataract, you’ve seen ’em all, and the LASIK machines are fully automated anyway.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “When There Isn’t Enough Meat To Go Around by Pat Conrad MD

  1. Steve O'
    September 9, 2017 at 12:26 pm

    Quality. Once you can convince the average Joe that the only one who understands Quality is the proper authorities, you’ve got him in your pocket.
    “I feel a responsibility to ensure that I provide high standards of patient care in my capacity as an SCP “scutmonkey” and to evidence the role as a success, to prove non-medical practitioners are worth investment. Being in advanced roles give nurses with experience an alternative career path to management. It keeps them on the frontline providing clinical care for patients.”
    If something comes from an approved source (e.g. The Internet) then the properly trained consumer dutifully memorizes and parrots it, in lieu of an actual thought-out opinion.
    Can’t be getting common sense in the way.
    The fellow who commented has done “1100 major cases during this time and several hundred more minor ones.” I doubt that he’s done any cases on something new and interesting for quite a while now. Is that what you want, or someone thrilled by the novelty of discovering where the appendix is? It’s over THERE? The internet said it’s always in the right lower quadrant. How exciting!
    If people don’t have enough common sense left to tell sh_t from Shinola, they deserve what they get.

  2. Sir Lance-a-lot
    September 9, 2017 at 8:59 am

    And this, from the same article’s comments section:

    “jessinboots86 to aweofunderstanding on 31 Aug 2017 22:49

    Spoken like someone who has literally no clue what medical education and surgical training is like. No “newly qualified doctor” ever does a procedure alone – in fact they typically do them with highly seasoned senior surgeons who ensure that the patient receives a high quality of care. The new doctor has gone through years of schooling and rigorous exams for the privilege of even standing in the room to watch. I recently finished my surgical training – five years at over 80 working hours a week (not including my preparations and studying outside of work, nor additional time dedicated solely to additional academic research pursuits and publishing original work in peer reviewed journals), and logged over 1100 major cases during this time and several hundred more minor ones. There is no substitute for this kind of training. None. Holding the laparoscope in a few cases and doing a part-time master’s degree while working as a nurse does not qualify you to operate independently. This is a dangerous precedent and the unsuspecting general public will be the victims. In the US, nurse practitioners who are currently clamoring for practice rights independent of physician supervision can obtain a “doctorate” level degree entirely online without patient contact. They can obtain their NP certification with just 500 hours of patient contact, spread across any specialties that they want. That is the working equivalent of 6.25 weeks of my five year residency which focussed on just one specialty. And you want one of them to operate on your face instead of a doctor?

    Patients can and should demand a fully qualified surgeon for their operations. And in fact, if you have a surgical trainee taking care of you, then you are lucky. For we are taught first and foremost to ask for help when necessary, ego be damned and to always appreciate our limitations. You don’t know what you don’t know. These so-called “advanced practice” nurses are being sold a lie which they are then telling the general public and our politicians – that they are just as good as physicians, that their training is equal or even superior to ours, or even better(!) unlike us, they are “holistic” and care for their patients. What a load of garbage. It is insulting to those of us that have sacrificed a decade of our lives to the pursuit of excellence on behalf of our patients to insinuate that we don’t care for them. My medical school education left me with $319,000 in debt, and I am not unique among my peers in this regard. I shoulder that burden willingly because I choose to pursue excellence so that I can care for people like you. Show me one of these nurses whose training and sacrifice encompasses a decade of their lives or the financial stability of their family, or their ability to provide for their children. You won’t find one.”

  3. Sir Lance-a-lot
    September 9, 2017 at 8:46 am

    “Sometimes I know what the nurses are going through on the ward or what the theatre staff will be thinking.”

    Awwww. Isn’t that sweet.

  4. Perry
    September 9, 2017 at 7:53 am

    I’d like to comment more, but I have an appointment with my Super Advanced Nurse’s Aid for my yearly physical.

Comments are closed.