Ontario gives nurse practicioners power to admit, discharge patients.

[A-Stark]

I'd say the rumours of the demise of family medicine are greatly exaggerated. In academic centres where NPs are often the only real permanent housestaff around on a daily basis, they do a significant proportion of the discharge summaries and paperwork. I'm not exactly sure when they would ever independently do an admission or discharge - emerg is not about to "consult the NP from general surgery", and in community hospitals where family docs have admitting privileges it's the emerg docs that do the initial admission.

 

The bottom line is that NPs cannot bill and require direct salaried funding from hospitals and health authorities and clinics for their employment. A hospital giving admitting privileges to FFS family physicians - who bill provincial insurance directly - is not about to take on salaried employees as an alternative.

[bloh]

Do you believe that they will never have the ability to bill independently? Why?

[A-Stark]

Because governments are not about to introduce another class of professionals who can bill a provincial insurance plan. Perhaps in the longer team as practice models evolve this may happen, but governments' enthusiasm for expanding scopes of practice will end as soon as it starts imposing costs. NPs are already getting close to pricing themselves out of the market as it stands.

[seeking1]

The only problem is that med student won't see it that way as GPs in such an environment would get paid less.

 

Preliminary evidence from the journal articles and reports being produced on family health teams actually suggest that GP salaries are increasing.

 

I think people are coming to the realization that having armies of specialists is useless for population health if you don't have strong primary care. Everyone whines about GP's being the gatekeepers, but few have a plan to get around this issue. NP's are an interesting lot, I know little about them, but I am interested to see what kind of hell they will get into down the road regarding education and practice scope.

[seeking1]

I also question the long-term validity and stability of NP's given the increasing phasing in of PA's.

[thehockeykid]

If there is a shortage of doctors I would rather have more IMGs coming to Canada.

[apache]

we have 1000's, but when there is only one spot for img neuro at u of a forget about bringing them here, they are here, they just work as security quards, taxi drivers, etc. the real problem is there are no residency positions, i know an img who applied and matched to family medicine on their eleventh application cycle, this person also had a phd.

 

If there is a shortage of doctors I would rather have more IMGs coming to Canada.

[obi]

we have 1000's, but when there is only one spot for img neuro at u of a forget about bringing them here, they are here, they just work as security quards, taxi drivers, etc. the real problem is there are no residency positions, i know an img who applied and matched to family medicine on their eleventh application cycle, this person also had a phd.

 

vouch, i know quite a few.

[bloh]

Because governments are not about to introduce another class of professionals who can bill a provincial insurance plan. Perhaps in the longer team as practice models evolve this may happen, but governments' enthusiasm for expanding scopes of practice will end as soon as it starts imposing costs. NPs are already getting close to pricing themselves out of the market as it stands.

 

What is the difference between "Ontario gives NPs power to admit, discharge patients" and "Ontario gives NPs power to bill for procedures they work for like physicians"? In fact, the latter is less of a stretch then the former because why should they not get paid for things they do, like physicians? A higher workload/more responsibility deserves higher pay, doesn't it?

[ubcMDhopeful]

we have 1000's, but when there is only one spot for img neuro at u of a forget about bringing them here, they are here, they just work as security quards, taxi drivers, etc. the real problem is there are no residency positions, i know an img who applied and matched to family medicine on their eleventh application cycle, this person also had a phd.

 

No joke my dad knows a person who used to be pediatrician in iraq's top hospital and now they are working as a security guard at the vancouver airport.

[moo]

A little late to the discussion but more and more poorly trained folks are getting to do things that people that were highly trained used to do. The nursing home where I do some work at now employs only LPNs with 1 or 2 RNs per shift. The LPNs graduate from some private for profit college, with a 1-2 year diploma and a 3 month practicum, but yet can give medications, receive lab orders, etc. These LPNs I think are more of a threat and more of a danger to health care than having nurses renew Rx'es or NPs discharge patients. Their assessment skills are extremely poor and they really cannot think for themselves. I've gotten so frustrated giving phone orders (ordering labs and medications--because they've never heard of the lab or medication before) that I've complained to the nursing manager numerous times but because of cost-cutting measures this is what they have decided to do. It's gotten so ridiculous that to transfer a patient to emergency (literally right next door) I have to now call an ambulance because the LPNs are not trained to walk the patient down to emergency.

[apache]

lol, there's so many bad stories of people who are more qualified than most canadian grads (don't get me wrong, lots of them suck too) and are still here for 10-15 years before they get a spot, the lady i was talking about is now 48. the guy i live with who has usmle scores through the roof and passed the toefl, osce, ee, qe1, qe2 with extremely high scores and only got 1 interview, the spot he applied for only interviewed 5 applicants, so if they were canadian they would have all had spots since this position had way more than 5 cmg spots. he's also very high up in the img association if anyone's wondering why it's a real big pet peeve issue of mine (i meet a ton of them, and there's a lot of "personal bias" in a system that still might only let in 1 candidate, when normally they would take every person they interviewed)

 

No joke my dad knows a person who used to be pediatrician in iraq's top hospital and now they are working as a security guard at the vancouver airport.

[Mandibular]

This is shameful. Even your institution does not trust LPNs enough to transfer patients. You should report this to the local media - the so-called underfunding of the health care system may be better described as embarrassing inefficiency.

 

Health care costs money. The body politic gets what it pays for. If cost-savings are desired over quality health care, then we'll see more and more underqualified individuals taking on roles beyond their abilities, and patients will suffer.

 

I agree. People should know how dangerous this is/can become

[A-Stark]

Sign up for "life"? There's a point at which an ROS contract becomes pure exploitation and it occurs well before 25 years. Or are you not being serious?

 

There are lots of people who enjoy rural medicine, but there's a difference between smaller centres which still have decent-sized regional hospitals and call groups and very remote areas where you'd be lucky to have any significant complement. There is a shortage in certain specialties in certain areas but it's not so dramatic that we need to massively increase the number of physicians. Where are they all going to work after all?

 

As for the billing issues, nurses do not and cannot bill fee-for-service under most circumstances.

[PhoenixFlare500]

IMGs ARE the solution to Canada's rural problem. Gov'ts should be looking to them to fill the void. Obviously we have the whole ~5 year agreement thingy but even beyond that, they need to commit to rural practice for life or something. I am sure most IMG would sign without thinking. Can you imagine if the provinces opened up ~25 rural family medicine positions for IMGs (who then have to sign up for life or like 25 years or so)?

 

I'm pretty sure recruiting med students from rural communities who are more likely to return to work in those communities is the solution to Canada's rural problem. But you know what, if Canada ever has a surplus of cotton that needs to be picked (hey that could be considered rural practice too right?), then you should totally push for your idea there.

[apache]

a near perfect score on the toefl, a great score on the evaluating exam (which canadian grads don't even have to write), qe1, qe2, osce, and have 3 stellar recomendation letters from physicians who are hard to shaddow, also, many of them have experience as clinical assistants as well and have graduate degrees, I'd say that that's enough info to guage whether an img will be as proficient as the average 4th year medical student as they're only expected to perform at the residents level and many of them have already practiced for years in their countries.

 

i agree with you on lifetime contracts, but many img's i talk with would jump at the oppurtunity to practice fm in the yukon for 5 years, whereas i know i wouldn't be so inclined to do so. i know i'm not really comming up with drastic solutions to these problems but i think a better understanding of the process imgs go through to ensure they're proficient (lots get weeded out) would make cmgs less weary the quality of their skills.

 

Oh the IMG CMG debate.

 

The unfortunate fact is that there exists no consistent standard on which to gauge the competency of IMG physicians. At least with CMGs there is an assumption (or in some cases, illusion) of competence.

 

Lifetime ROS contracts would be completely illegal and amount to nothing more than indentured servitude. By your logic we might as well just have IMG doctor camps where they learn how to be rural country docs (against their will) and are shipped out to the middles of nowheres for slave wages.

 

The physician maldistribution problem is not easily fixed. The truth is that type A upper middle class students, who tend to comprise most med school spots, want to be somewhere that has amenities and culture, which rules out rural nowhere. IMGs could presumably have an even tougher time accepting that kind of life.

[PhoenixFlare500]

First, I don't understand why you are communicating in that form with me, I don't see how my post was at all offensive; its just a policy proposal. Get over yourself and your fake anger. Well, I didn't mean rural as in just rural but anywhere there is a need for doctors (North? rural? suburbs? lol). Otherwise, we have plenty of doctors and these IMGs shouldn't be pushing on CMGs' turf. Canadian tax payers pay for the medical education of these CMGs and therefore, should get the area of their choice, whether it be urban or rural, and actually have a job at the end of the day.

 

I understand that some IMGs might be offended by this but the reality is that we have more than enough doctors in certain places but not others. If we don't selectively place these IMGs in places that need them, then there is no reason to even have IMGs as they'll just contribute to the current pile-up in cities.

 

If we have enough doctors, then IMGs shouldn't get spots as it takes spots and jobs away from a CMG but you and I both know that this isn't the case. This is unfortunate but that is the trade-off one has to accept to practice in Canada.

 

I responded in that fashion to make a point, because your post showed utter disrespect for immigrants and makes it sound like we should just be able to use them as we see fit, kinda like they did back in the south. You make it sound like we should manipulate IMGs (the part about them probably not even thinking about it when they sign, implying that if they did think about it you think they probably wouldn't like the deal, yet you're willing to offer it to them anyways because it just benefits you) into coming over here and then forcing them to work in places that they probably won't want to with no chance of leaving (where you stated that they should be forced to work in a rural area for life, twice, after having signed their life away without thinking about). I'm not saying docs that have been raised and educated here shouldn't be able to choose where they work, but your policy would mean that a lot of docs in rural communities wouldn't want to be there and would probably not work as hard, causing patient care to suffer. The other point of my post is that despite what you may think, some people actually plan to do rural medicine. We just have to find people like that and support them in their goals. Or maybe we should find all the new rural family medicine residents and make them sign something that says "they need to commit to rural practice for life or something". "I am sure most [of them] would sign without thinking".

[A-Stark]

Just going to throw this out there, but apart from some under-serviced area, it's debatable how much of a shortage of physicians there really is. On the other hand, there absolutely is a shortage of acute care beds (floor, stepdown, ICU alike) and OR time. Both of these come down to government funding - or lack thereof - and funding for RN positions in particular. We don't need that many NPs and we don't need them to take on tasks now done by physicians - what we need are more RNs in "traditional" nursing positions, because when it comes down to it, whether it's overcrowded EDs or elective surgery cancellations, it's a matter of a lack of funding for hospital (and long-term care/rehab) beds.

[thehockeykid]

^ I know in my undergrad school it is really pushing the nursing program, with classes expanding and such. So i am sure in time the RN problem would be fixed, in time.

 

For an IMG who has problems getting placed why dont they just look elsewhere rather than "be a security guard" or a "taxi driver"? If they are smart enough and know their material enough couldn't they write the USMLE and try and get placed in Americia?

 

As for domestic graduates not being able to find residency positions shouldn't the best person get the job regardless of where they went to school?

[ubcMDhopeful]

^ I know in my undergrad school it is really pushing the nursing program, with classes expanding and such. So i am sure in time the RN problem would be fixed, in time.

 

For an IMG who has problems getting placed why dont they just look elsewhere rather than "be a security guard" or a "taxi driver"? If they are smart enough and know their material enough couldn't they write the USMLE and try and get placed in Americia?

 

As for domestic graduates not being able to find residency positions shouldn't the best person get the job regardless of where they went to school?

 

Some of the IMGs dont have visas to the US as the citezenship process can be timely.

 

Also they cant really get good jobs as they are "over qualified" alot of them also work in pharmacies.

[taiga gal]

just as i finished my nursing degree a woman was just starting 1st year nursing, but she was a pediatrician in her home country. i think that would be extremely challenging to hold back in terms of scope of practice, but she seems very happy to be in Canada and is willing to do this for the sake of her family. the nursing students are lucky to have her, and so are her patients.

my dental hygienist was a Dentist in Mexico, but there is so much red tape to go through to practice in Canada, that she went and got her hygienist's license. she is awesome at her job and she always tells me so much about my teeth.

[apache]

perhaps there should be a program where qualified imgs have to pay for residency positions, just like the saudis (who don't have to write most of the exams i listed above as they usually go back to the kingdom) do, i'm sure banks would lend an img 200 g to do a family medicine residency, with knowledge that they would have the capital to repay the loan once they finished their residency, believe it or not i've had lots of imgs say that would be a great solution and that they would be willing to pay

 

But here's the thing: the roadblocks aren't just to ensure that IMGs are proficient. They are there because of a lack of funding and positions. Obviously, CMGs should get those positions as their education was funded by the taxpayers and these Canadian schools are in cahoots (in a good way).

[Slashsev01]

canada is a disgrace!!

we should start a public uprising to over throw the government!!

[cnb88]

canada is a disgrace!!

we should start a public uprising to over throw the government!!

 

What do we need a public uprising to overthrow the government for?.... There's an election in a few weeks

[seeking1]

If everyone here is so gung-ho at maintaining the strength of family med and GPs, then I suggest we start supporting more initiatives like the Mississauga Academy of Medicine and McMasters satellite campus in Waterloo. Just saying.