Having Second Thoughts about FM

[shikimate]

Well GP might just end up evolving into the mini version of royal college specialties. Maybe there will be one day when most FM end up doing R3 in ER, anesthesia, ob, surg assist, hospitalist or whatever, and the longitudinal FM becomes a thing of the past for most people (perhaps except very upscale "boutique" practices).

I mean at least NPs are better than "bare foot doctors" for the population right?

[Soon2BeMD]

2 hours ago, indefatigable said:

Yeah, but I think the concerns/issues for FM run much deeper.  

The Globe & Mail just ran a major pieces mentioning 10 ways how to fix health care .. and one of the Big Ideas is to stop creating/hiring FPs and create/hire NPs instead..  I mean that's pretty shocking and suggests the CFPC has a lot of work in order to justify its existence and importance..  It seems as if the writing is on the wall a little for FM..  

Nearly 15 per cent of Canadians don’t have a family doctor, but the solution isn’t hiring more

https://www.theglobeandmail.com/opinion/article-family-doctor-shortage-nurse-practitioners/

The Fix: Canada needs more primary-care nurse practitioners

"The authoritative Cochrane Library evaluated 18 randomized trials comparing nurse practitioner and physician outcomes and concluded that nurse practitioners “probably provide equal or possibly even better quality of care compared to primary care doctors.” And, according to a 2015 review of 11 scientific studies, the NP care model is 'potentially cost-saving'  [not sure how this could be concluded..] Currently, 25 nurse practitioner-led clinics are successfully operating in Ontario."

If we actually need more NPs and less FPs, should residency be increasingly only RC specialties?  Does FM need to be phased out long term?

That article is not talking about replacing FP with NPs, though. It's making an argument that NPs could be a great way to make primary care more accessible for everyone. In fact, I hope we get more NP-led clinics because it will significantly reduce the load on FPs and will give them the room to focus on some more complex care. I've seen clinics where FPs and NPs work together and it's WAY more efficient than an FP running the show alone. I literally cannot imagine a world where you would simply remove FPs and replace them for NPs. In the US, you have PAs, DOs, NPs and FPs all working and as far as I can tell, there is no sign that FPs are going "extinct" over there. 

Just because it "makes sense" for NPs to replace FPs, it doesn't mean it's actually feasible in practice. Demand for primary care will always be high and removing FPs from the work force will likely make the situation even worse. 

[1D7]

These are political articles that have little correlation with reality. These sort of sensationalized articles are pretty common. "AI Experts" thought we wouldn't need radiologists by 2021 because of AI, and that we should've stopped training rads... yet here we are.

The U.S. is much further along in terms of NP practice and it hasn't reduced the demand for family physicians.

[Redpill]

1 hour ago, Soon2BeMD said:

That article is not talking about replacing FP with NPs, though. It's making an argument that NPs could be a great way to make primary care more accessible for everyone. In fact, I hope we get more NP-led clinics because it will significantly reduce the load on FPs and will give them the room to focus on some more complex care. I've seen clinics where FPs and NPs work together and it's WAY more efficient than an FP running the show alone. I literally cannot imagine a world where you would simply remove FPs and replace them for NPs. In the US, you have PAs, DOs, NPs and FPs all working and as far as I can tell, there is no sign that FPs are going "extinct" over there. 

Just because it "makes sense" for NPs to replace FPs, it doesn't mean it's actually feasible in practice. Demand for primary care will always be high and removing FPs from the work force will likely make the situation even worse. 

You seem to be conflating "NP-led clnics" with "clinics where FPs and NPs work together", these are not the same thing. In BC we have the former, the government has decided that NP = FP and NPs see their own patients without any support from FP. I'm not convinced this is good for patients and would not want any of my family seen solely by an NP.

[GH0ST]

On 4/15/2022 at 10:54 AM, brackenferns said:

I'm not sure if you are a part of the "First Five Years of Family Medicine" Facebook group, but if you were, you'd realize my opinions (i.e. being pessimistic / frustrated at primary care) is the general sentiment held by practicing family physicians. Sure, there's a bias there in the sense that people with complaints are the most vocal. But the universal sentiment (even amongst happily practicing family doctors) is that things are getting more difficult. 

I have to laugh.... a facebook group as a representative sample for "general sentiment held by practicing family physicians"... 

There's also a substantial amount of GPs that don't use facebook (a trend that's becoming common). Of those that use any social media, there's even less people who acts like @carmsregrets telling everyone how awful the discipline is. At least @brackenferns had some points for discussion and is more respectful. 

- G 

 

 

[LoquaciousLoquat]

I'm jumping in, not to argue, but to add a few points for the impartial reader. Please feel free to take this information how you will.

First, a piece of news: pharmacists come January 2023 will be able to independently diagnose and treat 13 "minor" conditions, without any physician input.

On 5/16/2022 at 6:52 PM, GH0ST said:

I have to laugh.... a facebook group as a representative sample for "general sentiment held by practicing family physicians"... 

To clarify: the group has over 4000 members and is meant to be a platform for new Ontario family physicians in their first five years of independent practice. The total number of family physicians in Ontario is around 12500.

Yes, the platform will attract the more tech-savvy / younger crowd, but frankly speaking, that is the demographic I care about, because they are the future of family medicine. I don't really care about how some soon-to-be-retired boomer family doctor feels about our issues because they won't be the ones to experience it.

On 5/16/2022 at 3:44 PM, 1D7 said:

These are political articles that have little correlation with reality. These sort of sensationalized articles are pretty common. "AI Experts" thought we wouldn't need radiologists by 2021 because of AI, and that we should've stopped training rads... yet here we are.

 

Not quite the same comparison. As far as I know:

1 - AI does not have full independent and medicolegal scope to do the work of radiologists, in the way NPs now can vis-a-vis FPs.

2 - I don't believe there are any hospitals that have completely replaced their radiologists with AI, unlike how NPs can open NP-led clinics without any MDs being involved at all.

3 - High profile politicians have not come out to explicitly state that AI provides better care than radiologists, unlike how Adrian Dix (BC's health minister) has made the case for NPs. But maybe I missed this news, in which case I am happy to be corrected. 

4 - Radiologists are not denigrated to be referred to as "imaging interpreters" in the same way that family physicians are now "providers" in common and political parlance. We do not make a rhetorical equivalence between "human imaging interpreters" and "AI imaging interpreters" in the same way that we refer both FPs and NP now as "primary care providers".