NP/PA

[GeriGIM]

How’s the mid-level (NP/PA/CRNA) workforce shaping up in Canada, particularly for FM, GIM and ED medicine? 

Here, in America, mid-levels are increasingly a very desirable (ie cost-effective) alternative to physicians. In fact, nearly all hospitalists/GIM docs supervise at least one mid-level; it’s a requirement of the job. Several smaller hospitals now operate ORs without any physician anesthesiologists. 

You’d think Canada would want to invest in mid-levels (to minimize health care costs). 

[unmatch]

They're around, mostly in the community settings but not plentiful. In my experience it's mostly administration that is into hiring them but multiple physicians have called into question their clinical acumen especially in generalist settings. I've personally seen NPs completely miss the point of the visit in FM and in the emerg and require staff physician intervention for the patient to be properly cared for. I don't see us ending up like the US, especially not in the near future.

[insomnias]

A few reasons NPs may not take off in Canada like they have in the US:

1) No such thing as direct-entry programs (i.e. you cannot apply for a BScN+NP program), and US NPs are not granted equivalence

2) Health authorities are given a lump sum budget at the beginning of the year. Staff (including NPs) come out of this budget. Physicians do not.

2a) Consequently, there's no real incentive to shorten LoS

3) NPs cost more than MDs after factoring in utilization

4) Urban areas tend to be saturated with family doctors (at least in Alberta), whereas rural areas have a shortage. It's therefore hard for NPs to get a foothold in urban areas, which disincentivizes people from pursuing that path as opposed to going RN->MD

Reasons CRNAs may not take off in Canada like they have in the US:

1) Currently, no province allows them to work here, although I've heard BC may do so soon

2) We already have anesthesiology assistants, but these are also utilized sparingly

3) Family doctors can undergo a year of training in anesthesiology and work with ASA1/2 cases, primarily in rural hospitals. If CRNAs were to come, they'd have to compete against these family doctors, and it's very clear who would win that competition

[medigeek]

11 hours ago, GeriGIM said:

How’s the mid-level (NP/PA/CRNA) workforce shaping up in Canada, particularly for FM, GIM and ED medicine? 

Here, in America, mid-levels are increasingly a very desirable (ie cost-effective) alternative to physicians. In fact, nearly all hospitalists/GIM docs supervise at least one mid-level; it’s a requirement of the job. Several smaller hospitals now operate ORs without any physician anesthesiologists. 

You’d think Canada would want to invest in mid-levels (to minimize health care costs). 

So we can destroy medicine? Midlevels are literally the worst part of American healthcare. Just go read some of the American dominant forums and see the daily ranting from doctors. 

Doctors in Canada need to become more aware of how much of an issue it is and not train midlevels to prevent the same issue from spreading up north.