THEY NEVER PROMISED YOU A ROSE GARDEN
From Canada:
“The Alberta government is rolling out a new compensation model for nurse practitioners, one that it says will give Albertans greater access to a regular primary care provider when they need it. Nurse Practitioners (NPs) are registered nurses (RNs) with at least 4,500 hours of clinical RN practice and a graduate degree — at least a Master’s degree in nursing, although Alberta Health Services says some also hold a doctorate — and advanced knowledge and skills. They can diagnose and treat common health conditions and minor injuries, as well as order and interpret laboratory tests, prescribe drugs and make referrals to specialists. The province is still working out the details of the payment model but said it would include allowing nurse practitioners to open their own clinics and take on patients, beginning as early as next year.”
“Nurse practitioners can provide about 80 percent of the medical services a family physician can”, the province said.”
Can we say déjà vu? Yep, same scope creep s**t happening in the United States is also occurring in Canada, specifically Alberta. The provincial government is providing a $2 million dollar grant, over three years, to “implement the new program, recruit more NPs and set up clinics”, courtesy of the Health Minister of Alberta, Adriana LaGrange. No clarification whatsoever as to how “the province” concluded that nurse practitioners(NPs), aka registered nurses with master’s degrees, “can provide 80% of the medical services a family physician can”. Nor has it defined what “advanced knowledge and skills” these NPs possess that enable them to practice medicine. Allow me to clarify. Their “advanced knowledge and skills” is in nursing. Period. This modified dangling participle is intentionally left to the imagination of the public who will naturally presume it to imply “medicine”. If one repeats fiction often enough, it becomes fact. Using fabricated “facts” to promote scope creep is a oft-used marketing ploy that has been astoundingly successful for promoters of scope creep. Government leaders, legislators, health care entities, corporate medicine, etc. just don’t give a s**t about what’s actually true and what isn’t when there is an agenda to be met. If the Alberta government had $2 million dollars to throw around, why not use it to increase the number of physicians? Same reason as in the U.S. They simply don’t want to pay for expertise and/or they want to control the course of health care. Physicians, generally passive creatures, don’t tend to be so acquiescent when their patients are f**ked with, particularly for political reasons. Removing the power of physicians to fiercely advocate for their patients is tantamount, if one is to be successful at transitioning that power into the hands of non-medical officials so that they can easily control more pliable, non-physician minions, who are more likely to conform to the status quo that may or may not be in the best interest of their patients. Leaders can then tout that they increased access, they just didn’t promise you a rose garden. In other words, they did not guarantee that quality care could or would be provided. I would be remiss if I did not acknowledge the tremendous pressure placed on politicians to increase access to health care. However, leaders in both countries waited until the health care issue escalated to crisis levels, then sought a quick fix. For that, they deserve no empathy because they had plenty of notice s**t was going south. Consequently, because nurses are trusted health care professionals, the powers that be decided, in the interest of time and money, to manipulate the public’s trust by conflating two distinctly separate, unique professions and force-feed the public the bulls**t that nurses can fill a physician gap. These leaders erroneously surmised that they had no choice but to play catch up and resort to second-tier, fast-food, McDonald-esque “care”, except when it applied to them. Basically, it’s good for thee, just not for me.
Here’s the reality folks. At minimum, it takes 11 years to produce a fully trained Family Medicine physician in Canada, as well as in the U.S. As far as legislators are concerned, that’s too damn long to try and fix the physician shortage which never should have happened in the first place. All of the primary care specialties(Family Medicine, Internal Medicine, Pediatrics, Psychiatry) require extreme proficiency because they involve management of the entire human body and its systems. Have we physicians forgotten just how complex those systems are? FM docs are not glorified triage artists who use their skills to refer to specialists. One does not need to spend 11 years obtaining education and training in the art and science of medicine simply to refer. That only requires the brains of an amoeba. FM docs actually treat and manage patients as a whole, not parts of a whole as most specialists do. Their only mistake is that they are so f**king efficient at what they do that it appears easy. So much so that even their own colleagues believe that nurses can fill their positions. It’s not only ludicrous, it’s offensive and incredibly disrespectful to dismiss their professional and cognitive capabilities. What other specialties can competently manage and stabilize a post-COVID HIV patient with essential hypertension, diabetes, lupus and stage 3 kidney disease? The foundation of medical training is medicine, which also forms the basis of the licensing exams we must pass before going on to train and practice in our respective specialties. Every physician knows this s**t wasn’t simple, so how the f**k did we get to the place where we now minimize the value of our Family Medicine and other primary care physicians? It’s absurd. Listen, the practice of medicine is a wheel. Primary care specialists are the center of that wheel. Every other specialty is a spoke. Without that center, the wheel collapses, which is exactly what we are witnessing in medicine today. What else needs to be said? The f**king Primary Care specialists are absolutely essential to medicine. Without them, we are doomed.
Back to Canada…Enter the Alberta Medical Association(AMA), which “represents Alberta physicians, resident physicians and medical students”. They are not taking this scope creep s**t lying down.
“Yesterday we cut through the fog created by government about who provides primary care in Alberta. Our colleagues across the health care spectrum deserve respect and support. So do family physicians, who cannot be replaced by nurse practitioners. Integrated teams have been demonstrated to be the best model for primary care — evidence supports the model. It is misleading to suggest otherwise.”
Ironically, their acronym is faintly reminiscent of a medical organization in the U.S. that was not so vocal on this issue until fairly recently, but I digress….
For the life of me, I will never understand how legislators, or anyone else for that matter, can so easily draw conclusions about the ability of nurse practitioners to practice medicine independently, without exercising due diligence PRIOR TO passing laws that permit their constituents to become guinea pigs in an unproven model of practice. BASED ON PRESUMPTION. Let me tell you folks, presumption is a lousy litmus test. To her credit, the Health Minister has indicated that this experiment will be reviewed in five years to determine if it is working….or not. That is more than any state government in the 27 states in the U.S., which have sanctioned the unlicensed practice of medicine, has done. No follow up whatsoever. I hope for the sake of Albertans, that those findings in 5 years do not mimic what the Hattiesburg Clinic study in the U.S. found.
That was one clinic. Alberta is an entire province. Yeah, think about that. The provincial scope creep enablers can then say that they did their best. Again, they never promised you a rose garden. But damn, did they have to plant so many damn thorns?
“Every rose has its thorn, but that doesn’t mean you have to put up with a ton of pricks.”— Kelly Rossi
Patients should be scared. But I believe their malpractice system is different.
Though I value all of the writers on this blog, a week without Natalie is like a week without sunshine. Thank you Natalie!
I agree with all of the above. I know a few outstanding NP’s (usually worked as ER nurses for many years prior), but most are quite sub par and require a lot of supervision. We need a medical system that is cheap, timely, and high quality. Unfortunately you can only get 2 of the three.
The term is “quality harvest.” If a process effects a higher quality than allowed, then quality can be “harvested” by offering worse services. Imagine if the luxury brands lost their trademark an we all could drive a Ford “Jaguar” or Kia “Tesla” the gasoline version? You could pay much less for a Mercedes or BMW. Savings!
Very good analogy….saving.
Ironic, the system banned unsupervised residents, and medical students. Said they could make mistakes.
But allows unsupervised NP.
Yet the resident has far more training and knowledge than the NP. Even a 4th year medical student does.
The newest NP in our system, does not even know how to read an EKG. She hands it to the MD and says I’m still learning… at 130k a year.
Sadly, I am not surprised by this.