Stop the nurses before it's too late

[Guest success100]

This leads to a fairly common debate, however. If you increased med school enrollment you'd need to increase residency spots and hospital staffing and funding for when those residents finished.

 

Australia is facing a crisis of sorts right now with hundreds more medical graduates than spots available.

 

Uhm,interesting,instead of burning our tax money with tim horton tickets,they should invest that money to increase the number of spots in residencies,that's my point of view ...lol

[live101]

OR

 

Increase number of seats in Medical Schools,with bigger amounts of interviews given,i don't think there is a difference between someone who has 3.6 of GPA and the other guy with a 4.0...

 

or promote more students to go into nursing, and increase the scope of training that they receive so that they can have an increased scope of practise without people complaining?

[Guest success100]

or promote more students to go into nursing, and increase the scope of training that they receive so that they can have an increased scope of practise without people complaining?

 

Good idea...it's sad that the government is full of greedy people that would sell their mother for 5 bucks...they will never do that.

[Madz25]

Uhm,interesting,instead of burning our tax money with tim horton tickets,they should invest that money to increase the number of spots in residencies,that's my point of view ...lol

 

then you'd have to create more hospitals where the new residents can work and have adequate patient volume. ...and to get that you would need more physicians to oversee the residents and manage the patients at the new hospital.....

 

not as easy as simply 'increasing spots'

[sharpee]

medical education in canada is HIGHLY subsidized. why not take on IMG's and reduce the cost of putting more kids through med school, and save some money by only increasing residency spots vs both. just a thought.

[Madz25]

Most residents are overworked. Thirty-hour call shifts are a retarded concept. Adding more residents would negate the need for this unsafe practice.

 

some schools have moved over to the "night float" system. where one resident is 'on call' 2 weeks in a row. its basically shift work. all they do is call for 2 weeks - no day time stuff. avoids doing the 'retarded' 30-hour call shifts.

 

they made new regulations (in the maritimes, anyway) that residents must leave at 9am post-call. many residents i spoke to were actually upset by this (mostly surgical) because they used their post-call days to be in the OR. they all felt that residency would have to be even longer to ensure residents had adequate OR time and had experience with enough cases.

 

yes, call is horrible BUT what about the day time stuff? for example, on a 'pretend' rotation: there are 4 residents in total (1 in 4 call) - which means that during the day, 3 residents are present. doubling the number of residents so that call is reduced to 1 in 8 means that during the day, there are 7 residents around. you have to make sure that all of those 7 residents have an equal quality of education.

 

more residents = fewer patients per resident = less experience per given time frame = longer training

[cheech10]

I have an idea: all of these midlevels that pipe up about being equivalent to doctors could do all of the floor scut so the residents could actually practice medicine/surgery.

 

We don't even need midlevels for scutwork. A few ward clerks or secretaries would save tons of time in scheduling inpatient and outpatient tests, scheduling appointments, filling out the patient demographic areas of various forms, and getting other doctors on the phone, etc. This would have easily doubled my productivity as an internal medicine resident. Of course, as a fellow I now have residents to do those tasks for me

 

I have to disagree with the earlier poster's opinion that "30 hour call shifts are retarded". I learned and continue to learn infinitely more on call than during daytime hours. The interesting and acute cases tend to come in outside of working hours, and the independence you're granted is extremely valuable. The feeling of being overworked also helps you get faster/more efficient, which is a key difference between residents and community staff physicians. Night float's not a bad idea for keeping the hours more humane with a semi-consistent schedule, but adding more residents is definitely the wrong step to take for most programs. I've experienced rotations where there is no work to do during the day because each of the 6 residents has only 2 patients. Even with ICU patients, this is far too little work to learn from.

 

As for midlevels, the few times I've worked with them have been great. They take care of a significant amount of scut, usually stick to the more mundane cases, and have been great team players. I wouldn't mind having more around, but their scope of practice needs to be narrowly defined and they should not be practicing independently without observation by an MD. The key reason for this is not an inability to diagnose; pattern recognition is easy and much of our management is algorithmic/protocol-driven. The issue is addressing a good differential diagnosis, which the NPs and APNs I've worked with have admitted is not covered as effectively in their training. The ability to see that something is not exactly right, and consider other possibilities rather than shoe-horning it into a pre-determined diagnosis and the ability to manage the unusual cases is what we as MDs really bring to the table and whot we should be really pushing, IMO.

[newresident]

I just don't understand why having nurse practitioners helps save the government any money (besides the training).

 

They are unionized, so they work less hours, probably < 40 hours / week (and of course this isn't referring to all the overtime hours they get paid like 1.5x or 2x etc).

 

So they work LESS, get paid well > $100k which isn't that far off from what a family doc makes, and how exactly is this saving the government money? They make slightly less than a family doc and work WAYY less....

!

 

I used to think this too, before I started med and had some very forthcoming preceptors.

 

Family docs in urban settings earn an average of 150-200K a year (after expenses)

 

Family docs in rural settings earn 250-500K a year. I was surprised too. I start my Emergency residency in a couple months, but If I didn't match to Emerg, my second choice was Family, and I would have set up shop in rural AB.

 

Docs that earn 100K a year, do so because they make that choice to only work 3 days a week so they can golf or cross-stitch . . . or maybe cross-stitch pictures of golf.

[da_birdie]

the NP I worked with earns $90+K/year. 90%-pay maternity leave. Full benefits and pension. 2-4 weeks paid vacation (not sure on the exact # of weeks)

 

Not a bad job at all with their level of responsibility

 

I used to think this too, before I started med and had some very forthcoming preceptors.

 

Family docs in urban settings earn an average of 150-200K a year (after expenses)

 

Family docs in rural settings earn 250-500K a year. I was surprised too. I start my Emergency residency in a couple months, but If I didn't match to Emerg, my second choice was Family, and I would have set up shop in rural AB.

 

Docs that earn 100K a year, do so because they make that choice to only work 3 days a week so they can golf or cross-stitch . . . or maybe cross-stitch pictures of golf.

[A-Stark]

I guess 2-4 weeks vacation might be better than other RNs (?), but even residents get 4 weeks.

[da_birdie]

as a non-salaried family doc, I wish I have even just 1 week of paid vacation

 

I guess 2-4 weeks vacation might be better than other RNs (?), but even residents get 4 weeks.

[)oooo>]

They Took Ar Jiiibs!!!!

[tiger15lily]

Isn't there a larger shortage of nurses than doctors?

What is our government going to do when skilled and experienced nurses become NP's, legislate the cleaning staff to be trained to do the lower level nursing functions?

[leviathan]

Isn't there a larger shortage of nurses than doctors?

What is our government going to do when skilled and experienced nurses become NP's, legislate the cleaning staff to be trained to do the lower level nursing functions?

There might be a shortage but the gov't doesn't care. I have friends graduating with their RNs right now who can't find anything besides casual work. I know an LPN who cannot find any work anywhere. Maybe it varies by region, but I don't see the shortage over here, or at least there might be a shortage but the gov't isn't providing the $$$ to hire nurses to fix it!

[mrnursing]

There might be a shortage but the gov't doesn't care. I have friends graduating with their RNs right now who can't find anything besides casual work. I know an LPN who cannot find any work anywhere. Maybe it varies by region, but I don't see the shortage over here, or at least there might be a shortage but the gov't isn't providing the $$$ to hire nurses to fix it!

 

This is correct. There aren't many jobs for RNs now. Hiring freeze and 2000 nurses have been laid off in past few months here in Ontario.

[Guest success100]

A big issue is that RNs have increased their training time, and their value, and now cost the system more money than before.

 

Pros: nurses make more money. Heck, I think a good nurse is valuable, and should be paid accordingly. I know that prior to their pay increase they were underpaid.

 

Cons: They become more expensive, and other cheaper but less well-trained alternatives are used instead, like LPNs. Once LPNs gain legislation(not more training..that would be expensive) to perform duties that were once exclusively those of RNs, RNs will have no more bargaining power. Quality of care be damned!

 

It's kind of similar with what we are seeing with GPs and midlevels.

 

I say remove the CCFP and family medicine residency. General practice should be general practice. Shortage gone!

 

You do realize that Family Physicians are almost 50% of the Physicians.

If we remove FM,it means there will be demands on other specialties,making them over populated due to the lack of spots and lots of graduates will end up with no possibilities to find a residency spot.

[Guest success100]

My opinions have not entirely changed. I think serious premeds should have cGPAs of 3.90+, with grad students given maybe a slight allowance. I think 33+ MCATs should be standard cutoffs, with nothing below a 10. And I think too many people think that somehow they are special and deserve to be doctors because they are "special", play a sport, were born poor, or started some charity.

 

That does not mean I think lesser of other professions or people. That is the difference infomeddude. Your attack on nurses, perhaps the largest macroprofession held by females in Canada, was disgusting. I also don't think nurses should be given doctor responsibilities - but attacking nurses wholesale, in the savage disgusting manner you did, is pretty shocking. Much like how I outed ahmed (the york pre-med), I have enough info on you to probably out you too (need to confirm a few things before I know for sure). It's a small world out there. I can assure you, you can never truly hide behind the internet.

 

Pfft,good grades don't make good doctors.

Someone who gets a 4.0 cGPA vs a 3.7 doesn't make any difference.

You can get good grades but obviously suck at the job.

What should be strict and brutal is the interview,that should be a phase where the interviewer spots the motivated applicants by asking psychological questions.

 

Yet,i can guarantee that if we boosted nurses salaries and cut MD salaries,70% of people here would act like their mind changed and would IMMEDIATLY drop out Med and join a nursing school...don't come up with a random excuse,both you and i know it's true.

 

We should even introduce a personality test just like Sherbrooke University did,they will see if you're REALLY motivated for the job and the wrong minded people will simply GTFO the Med admissions.

[Mandibular]

dumb question, but arent generalists and FMs the same thing?

[Guest success100]

dumb question, but arent generalists and FMs the same thing?

 

Yes.

Even FM docs + 1 year of EM or other qualifications are considered Generalists.

[Guest success100]

Sounds like you're bitter because you've tried, and failed, to get into medical school numerous times. Might be a blessing, consider that.

 

I said not to get rid of generalists, but FAMILY DOCTORS. By making it a DEAD-END residency back in 93, we DESTROYED the number of students interested in it. Why would they be? If you have one shot to pick a specialty, most people pick the high paying ones. Can you blame them?

 

And sorry to burst your bubble, but money is a HUGE motivating factor for physicians. It's hard training and its a TON of responsibility. We deserve to get paid even more than what is presently the average. If you want to work for free, or even on par with nurses, then you're a bloody fool. Go be a nurse.

 

Such a sanctimonious fool, judging by the above posts and your other posts, shouldn't get into medical school. You need humility.

 

Lol all that nerd-rage about money,how sad.

 

I never said Physicians deserved to get 50k year so i don't even know why you pull out all that trash talk.It's just that 70% of people who join med are doing it for the MONEY ONLY and nothing else,they don't even give a dirty **** about others.Maybe you're one of them,maybe not,maybe you should just cut that "MD>All cuz i studied 10 years" attitude out.

 

Also,i never applied to med,maybe in the future,still studying right now,but i know lots of friends already in med and my dad is a Gen.Surgeon,i know a lot about the field.

[NLengr]

It's just that 70% of people who join med are doing it for the MONEY ONLY and nothing else,they don't even give a dirty **** about others.

 

Do you have any data to back that up or are you just making stuff up? EVERY pre-med kid talks about this and how all the others are only interested in money but they themselves really deserve to get into medicine because their motives are pure. Every single one says the same thing. It's far beyond a cliche now.

 

I'm in agreement with whoever stated the govt. shot family med in the foot in the 90's. People used to finish internship, take a few years, work as a GP while starting a family and paying down loans. Then after a few years they would go back and retrain for a specialty. Now that is no longer an option, so people now go straight into the specialty fearing if they don't get it right out of med school, they will never get it (a legitimate concern). In essence a large pool of GP's who could fill they gap is gone from what existed prior to the change.

[Guest success100]

Do you have any data to back that up or are you just making stuff up? EVERY pre-med kid talks about this and how all the others are only interested in money but they themselves really deserve to get into medicine because their motives are pure. Every single one says the same thing. It's far beyond a cliche now.

 

I'm in agreement with whoever stated the govt. shot family med in the foot in the 90's. People used to finish internship, take a few years, work as a GP while starting a family and paying down loans. Then after a few years they would go back and retrain for a specialty. Now that is no longer an option, so people now go straight into the specialty fearing if they don't get it right out of med school, they will never get it (a legitimate concern). In essence a large pool of GP's who could fill they gap is gone from what existed prior to the change.

 

That's psychological,just look at all the threads about it,tell them it pays lower than what they expected and they soon change subject.

Also,the BS fact that "only premed kids talk about others attracted to money" is also a cliche.I'm not saying that every people making threads about salaries are money hungry jack asses,but yes,70% of them is a reasonable equation.

[UTPEOPLE]

Pfft,good grades don't make good doctors.

Someone who gets a 4.0 cGPA vs a 3.7 doesn't make any difference.

You can get good grades but obviously suck at the job.

What should be strict and brutal is the interview,that should be a phase where the interviewer spots the motivated applicants by asking psychological questions.

 

Yet,i can guarantee that if we boosted nurses salaries and cut MD salaries,70% of people here would act like their mind changed and would IMMEDIATLY drop out Med and join a nursing school...don't come up with a random excuse,both you and i know it's true.

 

We should even introduce a personality test just like Sherbrooke University did,they will see if you're REALLY motivated for the job and the wrong minded people will simply GTFO the Med admissions.

 

While good grades might not be the master indicator of a med student, high grades certainly dont hurt and is not the "cause" of those people who get good grades but would suck at being a doctor. There is a logical fallacy here. It is true that some people get good grades but would suck in med. However, that is only a very specific subset. Plenty of people get 3.7 or less GPAs AND would suck as a family doctor. Having a better grade (and by inference logic/memory skills, especially for information heavy specialties such as rads or derm or even FM) will make a better doctor, if all else is kept constant.

 

Greater emphasis on the interview would risk a greater variability of doctor quality because you would be basing admission based on a single 1-2 hour window into the applicant (with an N of 1, interviews hardly help conclusively establish one applicant over another, not possible to even draw a 95% CI). GPA at least is something that reflects more of a trend and can be compared statistically.

 

As per physician pay, there is nothing wrong with wanting a high salary. It is merely equivalent exchange for a job well done. If I have to pay (through the government) 1 million dollar salary for a capable surgeon who will save my life or the lives of my loved ones, I will pay it gladly, and send chocolates. There is nothing inherently wrong with a CAPABLE physician being in it only for the money (why did you almost use it as an insult?), because the work that they do more than pays for itself. Fine, some premeds want to be the highest paid physician, but once again, there is nothing wrong with that. Greed can be thought of as having desires beyond your abilities. The greedy folk are the ones who know that they dont have the qualifications to be in med and yet lust after the high wages. For those who do get in med school, the high wages are merely a fair (as determined by the government) representation of their value to society. Therefore, almost by definition, people in med generally cannot be greedy, because all that they are expecting is what they are deserved. The greedy folk would be the ones who cant make it into med and yet want the high wages. Thus, greedy people do exist, but this has little bearing on the people inside med. Isn't there a fundemental principle in economy that states nothing sold is ever overpriced (because the seller of the service receives an amount that the buyer is willing to pay).

 

The fact is that more capable people deserve to be paid more and have higher societal status. To deny that is to invite communism. Currently, the most capable people are attracted to med because of both the importance of health to society. The fact is, greater training and greater responsibility does deserve better compensation, so I dont see anything wrong with brooksbane's reasoning that doctors deserve more because of their greater training. To say that the majority of people who go into med are in it only for the money IS kind of the sort of things a person with sour grapes would say. What about the extra long work hours that medical doctors put in? There is always a tradeoff. What if people started to put down firefighters by saying that 70% of then are only in it for the respect and the chance of getting recognized as a hero?

[Hushwawa]

This is serious! I encourage EVERYONE: medical students, residents, attendings, pre-meds, and the lay public to send letters of concern to the CMA, the FRCP, FRCS, and CCFP, your provincial health ministry, and the prime minister. It's bad in the US. We have to SQUASH this before it has the chance to come to fruition here in Canada.

 

Having nurses and physician assistants expand their practice breadth through legislation, and not by training and instruction, is DANGEROUS for patients, and speaks POORLY for our profession. Not only will patients be exposed to harmful intervention(or lack thereof) but it will partially be OUR OWN FAULT for not stopping this before it gets out of hand.

 

The NATUROPATHS have already secured independent practice rights in BC! They can essentially be family doctors, except they can't prescribe narcs. Yes. Four years of medical school and two of residency so you can prescribe narcs! HOW DID WE LET THIS HAPPEN?

 

The NATUROPATHS are trying to push forth legislation in Ontario, called BILL 179, granting them the same rights. The ministry of health and long term care supports it(!!WTF!!!?). It just has to be signed by the legislature. WE MUST STOP THEM!

 

It's sad that the government's solution to the primary care shortage is to lower the standards of who can provide such care. This is horrible.

 

 

This is such nonsense, and it's clear that you have little to no knowlege on Naturopathic school curriculum. Just so you know before you go off like this, Naturopaths do have a considerable amount of training. They do 4 years AFTER an undergrad degree, and to get in they need the same pre req requirements as the Med students in Canada. They do Human physiology, anatomy AND pharmacology in their 4 years. These arn't some bootleggin idiots, and I think you need to learn to respect other professions. If you do not agree with naturopathy that's your right, but it isn't your right to belittle it. I don't believe many naturopathic claims, and don't do naturopathic treatments, but it doesn't mean that if I don't believe in it, I need to punish everyone else. I have two friends in Naturopathy in Canada who are working their butts off doing something they believe in. It's time you stepped down from your self-rightous pedestal... the only people we need to stop is people like you.

[Hushwawa]

While I do believe that Medical School takes a lot of work and sacrifice both to get into and to complete medicine, I don't know why those (not all) trying to get into Med and those already in Med think that they have the right to look down their noses at other health care professions.

 

As part of the Pimary Care network, NPs are very important. If we are really interested on increasing the quality of health for patients, I think we ought to empower NPs and encourage patients to respect their knowledge. We have a shortage of both doctors and nurses and since patients go on 4 year waitlists to have a family doctor,more help is welcomed. Of course I'm not saying NPs should do open heart surgery of prescribe anti-psychotics, but they play part in the primary care network and should be empowered. I think doctors should advocate for increasing a patient's quality of care. At the end of the day, a doctor is a doctor, there is a difference in training and patients will always trust their doctor more (at least I will).

 

Also, what this does is it forces doctors to up their game. If you look at it in a business perspective, doctors are like individual contractors. If they are losing patients to NP's and Naturopaths, maybe it's because the patients don't trust them and don't feel listned to. I think this will push doctors to spend a few more minutes with their patients and could improve the doctor-patient relationship.