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.
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 I’m sure my numbers are out of date, but about a decade ago there were 5000 physician applicants to that training system with only 5 slots available.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.
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Yeah, midwifery is a very tough job and should be better compensated. The call schedule is nuts!
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.