Many an anxious mother with a wailing baby has shown up late at night in the Emergency Department and received two things.First, something to settle down the child.Second, reassurance that everything will be alright, the little one is not about to die. Certainly, physicians say much of what we call healthcare is actually managing ‘patient anxiety.’ And usually, that comes from a doctor.But it doesn’t need to. Any nurse who’s been around for a while knows enough to either deal with ailing infants, or to recognize that there is something else going on that she can’t deal with, and that the child needs to be seen by a doctor urgently.So goes the argument and in that simple scenario, repeated dozens of times in real life daily across Alberta no doubt, lies the common-sense argument for making more use of nurse practitioners, as Premier Smith has announced that her government intends to do. Not everything requires the physician’s touch: according to the Government of Alberta “nurse practitioners can provide 80% of the services a family physician provides.” And on Wednesday, Smith announced nurse practitioners will be authorized to open their own clinics, take on patients and “offer services based on their scope of practice, training and expertise.”Nurse practitioners are registered nurses who have additional education and nursing experience. According to the Canadian Nurses Association, this enables them to “autonomously diagnose and treat illnesses, order and interpret tests, prescribe medications and perform medical procedures.” Interestingly, the CNA further defines nurse practitioners as “health-care professionals who treat the whole person.”It also speaks enthusiastically of how nurse practitioners address “needs relating to a person’s physical and mental health, gather medical history, focussing on how an illness affects a person’s life and family, offering ways for a person to lead a healthy life and teaching persons how to manage chronic illness,” as though fully qualified general practitioners were above such touchy-feely trivialities.So, is this a good idea?To some degree it depends upon the options.Obviously, the gold standard is a GP who has known you for 20 years and your family before you for another 20 years, and who has also found time to stay current on the latest medical developments. However, given that a quarter of Alberta’s population didn’t live here 20 years ago, that is hoping for too much, by definition. Meanwhile, Smith expects the Alberta population to grow a further 25% by 2050.So, if the choice becomes to talk to a nurse practitioner or talk to nobody, then of course let’s have more nurse practitioners.Indeed, for some Albertans that is already the choice. As a specialty, family medicine — what we used to call general practice — has lost its lustre for recent medical grads. Bottom line: who therefore does not have access to a GP, will take what they can get.The government also expects to save money. But will it?It depends somewhat on what the incentives are. The announcement linked the 80% of a full doctor’s services that a nurse practitioner provides to a yet-to-be negotiated “compensation model.”If nurse practitioners see as many patients as doctors do for 80 cents on the dollar, perhaps. But that assumes they bill for service. If on the other hand the compensation deal sees them paid by the hour and they retain their union membership, that can’t be taken for granted. And if the salary model is what’s chosen, tack on the cost of benefits and pensions — something for which physicians are typically obliged to make their own provision at no extra charge to the Government of Alberta.Finally, general practitioners — doctors — see everything and are trained ‘generally.’ (Hence the name ‘general practice,’ rather than the slightly diminutive ‘family medicine.’) However, there are some subtle conditions that aren’t ‘generally’ encountered and this whole scheme stands or falls on whether nurse practitioners, whose training according to the CNA emphasizes some hard-to-measure specialties, will recognize and refer on those unusual conditions that may be presented to a fully qualified physician.Apparently, they do. Mindful of the consequences for their profession of too many adverse outcomes, nurse practitioners have been shown to refer on more frequently than general practitioners. This adds the further cost of specialist consultations, to an already costly healthcare system.Health-system users will not find that offensive, of course…Yet, people who have no GP may also still be wondering, ‘would I actually register with an 80% nurse practitioner the way I would with a 100% doctor?’ Perhaps. Half a loaf is better than no bread. Nurse practitioners certainly have much to offer, working as they already do in cooperation with other medical professionals.But, they are an asset, not an answer. Albertans must hope the Government of Alberta will use whatever time it buys for 80 cents on the dollar, to start training up more doctors right here in Alberta. And then, doing whatever it takes to make general practice more attractive.
