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.