New 2 year PA (physician assistant) program at mcmaster

[abcwxyz]

Why is it troubling? A gastroenterologist will continue to move around the scope while a dedicated nurse assists. Same with surgery - surgeon, scrub nurse, circulating nurse, and possibly a resident or student. Worries among physicians regarding supposed encrochment by other HCPs are kinda beside the point.

 

There is no credible empiricism behind instuting further non-physician practitioners in the current healthcare system. Comparative analysis with the US is nonsense.

 

That is why it is troubling. If there is empirical data suggesting that Canadian physicians will move on to more specialized cases in every situation, I don't think there would be any opposition to non-physician practitioners.

[A-Stark]

I should clarify that I do NOT support expansions in the scope of practice - my comment was merely to report on the status quo where, of course, nurses are involved extensively. Nurse practitioner-led clinics are a bit of grey area for the moment - I don't think much evidence exists to support their establishment, and they strike me as a move away from team-based models which are much more supported by the literature.

 

However, it's simply not the case that governments are not making the investment to train more doctors - the proliferation of satellite campuses in Ontario, BC, and now the Maritimes should be evidence enough of that. The results of such investments cannot come fast enough, though, and they may still be insufficient to alleviate problems of access to primary care (though, of course, "not having a family doctor" is entirely distinct from not having access to walk-in clinics, community health centres, and, inevitably, the local ED).

[a41]

GPA

http://www.aamc.org/data/facts/2008/2008mcatgpa.htm

 

Matriculation

http://www.aamc.org/data/facts/2008/2008school.htm

Go to 4th footnote and do calculations off there. 44% was 2006

 

Interesting to see that there were actually more applicants in 1997 than 2008.

 

I'm not sure how you can say you're "safe" with a 3.5 GPA when the mean matriculant GPA is in the 3.6s. But I'm curious as to why the American acceptance rate and mean GPA bothers you. Are you implying that American medical students are not as competent as Canadian ones?

[Octavius]

Mean 3.66 STDEV 0.26. I was exaggerating but it still falls within 1 STD (although it can be a negative skew). I'm not bothered by a disparity in competence, just pretty downcast that our requirements are that much higher and that we have a much lower matriculation rate. I'm in Ontario.

[mrhumble]

From what I've heard about the new PA program in Ontario, all the students in the pilot program are IMG medical doctors???

[Halcyon]

No, that's not true for the PA degree program or the PA pilot project. There may be some, but not all. You can verify that on the Mac website.

[mrhumble]

No, that's not true for the PA degree program or the PA pilot project. There may be some, but not all. You can verify that on the Mac website.

 

You're right.

From http://www.healthforceontario.ca/upload/en/work/ontario%20pa%20initiative%20overview%20-september%202008.pdf

 

Here's the breakdown of the 20 people accepted into the PA pilot program in Ontario

 

1. Retired graduates of Canadian Forces physician assistant education program

2. PAs educated and certified in USA

3. IMG medical doctors

[ToHellInAHandbasket]

A nurse endoscopist will be supervised by a physician while performing endoscopy procedure her/himself rather than assisting a physician move around the scope.

There's also a limitation on what a nurse endoscopist can do.

 

http://www.oma.org/Health/IPC/NurseendoscopistsOMApaperFINAL.pdf

 

Perhaps I'm not seeing it. Could you please explain to me how this is beneficial if the nurse still requires immediate supervision from an MD while doing the job, AND has limitations on their scope (rightfully so)?

 

I'm all for advanced scopes of practice, but the fact remains that the nursing model of care, and the technical nature of nursing education simply does not translate well in this case. Nurses may be able to learn technical scope skills, but they (I would assume) lack the expertise and knowledge that an MD would have if that patient went bad during the scope, for example. Hence, the supervision of the MD.

 

I know the government is trying to figure out how to cut costs, but using NPs in place of MDs is not productive from what I can see, unless I am misunderstanding. It's fine to place nurses in positions of promoting health and wellness, but the issue needs to be examined further before we assume they can handle a wider spectrum.

 

The reality is, this is your typical nursing education:

 

-1 year of basic sciences, a stats course, perhaps a watered down microbiology course.

-2 years of nursing theory and technical nursing education.

-1 year of advanced 'nursing theory' which largely includes promoting health and wellness for specific populations.

 

Compare this to the typical MDs education and scope of training, and the girth just isn't there. Even with an 'advanced practice' certificate tacked on.

 

Nurses are not jr. doctors, nor should they function as such. The nursing model of care and role is completely different. I do not mean to sound ignorant with this last comment. My concern is that we should use nurses primarily in their intended role. If NPs provided primary care, prevention, and health and wellness promotion, it would free up healthcare resources and doctors to do *their* role, which is the diagnosing and treating of illness and disease. Having different cooks in the kitchen all stirring the same pot or watching the pot boil is not the road to efficient healthcare.

 

Perhaps I am simply misunderstanding.

[mrhumble]

You're right.

However, we're not talking about regular nurses.

 

These are specialist nurses who have taken extra years to learn the medical model and medical training on how to perform the specific medical procedures and tasks in the clinical area.

Physician assistants are supervised by the medical doctors. It usually doesn't mean that the doctors are right beside them.

 

Seriously guys. All these talk show huge ignorance...Come on... Doctors don't do a "God" works. PA can do a lot of the things that the physicians can do. How long is their training? 1 year of school and 1 year of clinical.

 

Bottomline is, public is benefiting from these health care workers.

They're doing their best to serve the public and provide efficient care and treatment for the patients.

 

Stop the hating.

[ToHellInAHandbasket]

You're right.

However, we're not talking about regular nurses.

 

These are specialist nurses who have taken extra years to learn the medical model and medical training on how to perform the specific medical procedures and tasks in the clinical area.

Physician assistants are supervised by the medical doctors. It usually doesn't mean that the doctors are right beside them.

 

Seriously guys. All these talk show huge ignorance...Come on... Doctors don't do a "God" works. PA can do a lot of the things that the physicians can do. How long is their training? 1 year of school and 1 year of clinical.

 

Bottomline is, public is benefiting from these health care workers.

They're doing their best to serve the public and provide efficient care and treatment for the patients.

 

Stop the hating.

 

 

I don't hate anyone...except student loan officers... Ouch! Those people act like they're giving away their *own* money.

 

Anyway, nobody here 'hates' NPs/PAs. I'm sure overworked MDs are happy for any help they can get. That is not the issue. The issue is, should we be training mid level HCPs to do more as a bandaid solution when the real issue is (I think) that we need *more MDs*?

 

Nobody is saying that medicine is rocket science. God knows it's not. But the fact is that you still have to have a certain level of skill and education when dealing with people's lives, as a safety blanket in case something *does* go wrong. That's all I meant. And you want that done as part of an efficient model.

 

P.S. One thing I find interesting is that if these nurses are becoming NPs (who go on to learn the medical model of care according to your post), why are they abandoning the nursing model? Why did they go into nursing in the first place instead of Medicine? The nursing model of care doesn't really translate well with very advanced nursing practice/procedures, so why not just go into Med?

 

MY major issue is that we need nurses, and nurses who function within their traditional setting. Our healthcare system is desperate for nurses. My concern is that some people are using nursing as a means to an end. These people are taking a spot from someone who really wanted to be a nurse, and work as a nurse. Each nurse that leaves is one more nurse that we needed. Others are concerned about the fact that NP clinics are yet to be proven as efficient and adequate.

 

If any NPs are using this as a 'back-door' route to have their own clinic as an NP because they *couldn't* be an MD, should we be concerned to have them performing similar skills and assessments as a GP would? Or do those in the medical community agree that they are properly trained? Should GPs be phased out entirely and replaced with NPs and PAs (PAs are trained in the medical model and usually must have a science and healthcare background)? To me, again, it doesn't make a lot of sense to have 2 cooks making the same dish.

 

It's one thing to hire a NP/PA as a Patient Educator to work in an Endocrinology and Metabolism clinic in a team role, it's another to have them see patients for primary care. The problem is that if they end up referring the majority of their patients to an MD or ER for primary care outside their scope, it is an inefficient model. I think the jury is out on NPs/PAs. I'm rather curious to see what happens.

 

So relax, I am not 'hating' anyone. Can we all just be friends now?

 

P.P.S. Mrhumble, I agree that it should be about what's best for patient care.

[rmorelan]

 

P.S. One thing I find interesting is that if these nurses are becoming NPs (who go on to learn the medical model of care according to your post), why are they abandoning the nursing model? Why did they go into nursing in the first place instead of Medicine? The nursing model of care doesn't really translate well with very advanced nursing practice/procedures, so why not just go into Med?

 

 

Not everyone fully knows what they want to do when they start out in a profession. I think it is pretty natural for some skilled nurses to reach a point and what to expand beyond their original role.

[ToHellInAHandbasket]

Not everyone fully knows what they want to do when they start out in a profession. I think it is pretty natural for some skilled nurses to reach a point and what to expand beyond their original role.

 

I understand that. I was thinking more along the lines of those nurses who fully know that they want to be an NP/advanced care practitioner when the enter the BSN/BScN program. If they *know* that they want to work in anesthesia, endoscopy, primary care, etc. why not go straight into Med, where you are prepared for these careers from day one? The nursing model of care doesn't really translate or apply when you get to these advanced levels of practice (aside from areas of primary heathcare...namely general health promotion).

 

Furthermore, it suggest that nurses seem themselves as 'less than' MDs or as 'para-MDs', which is not the case. They do operate under/alongside an MD, but they function under their own license in a different model of care. Nurses have a specific role and scope of care (or used to) that is required in order for the healthcare system to run smoothly. For them to think that they should/can 'upgrade' to become MDs is troubling. The focus of nursing is primarily to promote health and wellness, and have patients function at their highest level. If someone knows that they want to obtain very advanced clinical skills and diagnostic capabilities, I would think they should be choosing medicine, not nursing. It makes no sense for a nurse to want to learn the medical model if they truly like nursing. You would think they'd want to 'move ahead' by getting a PhD in nursing and focus on nursing research, health promotion, and nursing theory.

 

I think that one must decide if nursing has a limited scope of practice from a clinical sense (and many would say it does), or if APN nurses should function relatively equally alongside MDs providing similar care using a different model. A choice in either direction has implications for both the medical and nursing model. What really matters is what's best for patient care and efficiency within the Canadian healthcare system.

 

Again, a concern of mine is not just inadequate or inefficient care for patients, but rather that we are going to lose nurses, and the valuable traditional roles that we need them in. I think that Canada is already experiencing a huge shortage of nurses, and I think we should *primarily* focus on educating and retaining more MDs and RNs as opposed to trying to 're-designate' RNs as NPs to fill gaps. While I understand that nursing unions are very vocal about increasing wages, respect, scope of practice for RNs, etc. the bottom line is always what's *actually* best for patient care in reality and not nursing theory based ideology. The 2 don't *necessarily* run parallel.

 

Anyway, while I definitely am supportive of people who truly feel that they made a mistake with their first career choice or are following a new calling, I am concerned with those who use nursing (due to the shortage) as a stepping stone/means to an end to get out of being a nurse (in the traditional sense).

 

To each his own.

[mrhumble]

Not every nurse want to become a NP, get masters, teach, or do research (PHD). However, there are those from the beginning that want to become a NP. In US, there are universities with direct entry NP programs. You don't have to get your RN first. We're a bit slow here in Canada. However, US had NP and PA for many years. Result? Introducing NP and PA (also cost effective) contributed positively to the health care system.

 

If there were more PA programs here and not as competitive to get into one like in US, I would've applied for that program instead of nursing.

 

I want to be able to do medical diagnosis and treatment. That's why I'm aiming for medical school. However, you and I both know that getting into medical school is no joke.

If I can't, my backup goal is to be an anesthesia assistant (trained under medical model - admission requirement: RN/RT), physician assistant or nurse practitioner. It's what I want to do.

[medisforme]

No one has mentioned yet where NP's are incredibly useful. That is as part of an in-patient medical team on acute care medical wards. They contribute to much more efficient and continual care of patients. On an in-patient basis they don't have "their own" patients in the sense that physicians do. They remain on the ward and become familiar with all (or a certain number) patients charts, histories etc...When a staff nurse has a minor to moderate concern they can bring with up with the NP and get the issue resolved immediately as opposed to phoning a physician with a random question which may or may not get an immediate and/or attentitive response. If the NP judges the patient issue to be above their scope of practice they then phone the on-call doctor (btw all these patients are still seen by a physician on a daily basis). The fact of the matter is that patient problems often occur when there is not a physician around and having an NP present leads to more efficient patient care. Furthermore, in-patient NP's save RN's from wasting valuable time as a gopher in-between doctors (ie. there is an issue call the surgeon, he doesn't want to deal with it so he instructs you to call the hospitalist or anaesthesia or radiologist etc...).

I agree that NP's are probably not the best option in certain practice settings, but I think it is a good idea to train a certain number of them for jobs such as that listed above.

[gogirl]

What is wrong with a nurse's job?

 

 

If you graduate from the PA program in McMaster, you're employed in some rural area for 2 years. After that, there's no guarantee that you'll be employed anywhere in Ontario.

 

That is not accurate information. There is no stipulation about working in a rural area. Many PA's in the pilot project are working in urban areas and McMaster's first class has no restrictions on where they are going to accept a position once they graduate.

[elemenoepe]

tennisball80, upon closer inspection it appears your avtar is erroneous. It states a HR of 75 bpm when it is clearly 60.

 

Sorry, I have an upcoming cardio exam... looks like I've been studying too much haha

[nine99_9]

http://www.cbc.ca/canada/toronto/story/2009/05/11/ontario-health.html

 

I think this is kind of pertinent to this thread

[Hopeful Med]

http://www.cbc.ca/canada/toronto/story/2009/05/11/ontario-health.html

 

I think this is kind of pertinent to this thread

 

I was very pleased to see this.

[Halcyon]

http://www.cbc.ca/canada/toronto/story/2009/05/11/ontario-health.html

 

I think this is kind of pertinent to this thread

 

How do you think these changes will impact FM/GPs (in ON)?

 

In some ways, I imagine if everyone's role is clearly defined and designed to improve health care and overall patient care, then it's a good thing. That being said, if everyone's fighting for a bigger scope of practice and doing the things that FM/GPs do, then, it's going to get complicated.

 

Personally, I see that NPs/PAs can be a real asset, as can prescribing pharmacists. But, what about the future of FM/GPs? Any thoughts?

 

[NLengr]

As I've said in these type threads before NP's have an important role in rural areas of the country.

 

There are areas where we just can't afford to put a physician (Coastal Labrador for example). There are not enough patients to justify putting a family physician. On top of that, the typical family physician wouldn't get the case load to keep up their skills. NP's on the other hand, are better suited. They are less expensive and have a more practical, every day, type skill set. They're perfectly capable of providing basic health care in these communities on a day to day basis. You can then fly an MD (FM or specialist) in every few weeks to see the couple more complex patients. The MD can also meet with the NP and discuss concerns at this point. For more immediate contact, you just teleconference them together. NL has a fairly well established tele-oncology program at this point, so that patients can minimize their number of required trips into St. John's.

 

That's the big strength I see for NP's. Letting you provide good medical care in areas where we wouldn't be able to if we just used MD's.

[mrhumble]

That is not accurate information. There is no stipulation about working in a rural area. Many PA's in the pilot project are working in urban areas and McMaster's first class has no restrictions on where they are going to accept a position once they graduate.

 

It's good to hear that. I saw a document with map somewhere (I forget now), and it showed clinical areas where the pilot PAs would be practicing (mostly in rural areas).

If I ever become a PA or NP someday, I hope to work in the urban area and assist the physicians and diagnose & treat the patients.

 

http://www.cbc.ca/canada/toronto/story/2009/05/11/ontario-health.html

 

I think this is kind of pertinent to this thread

 

I wonder if NP or PA will ever be able to prescribe schedule IV drugs.

So far, in Ontario, PHC-NP can prescribe schedule II & III drugs.