Encroachment by NPs/PAs?

[applestooranges]

This is a sensitive topic so I want to preface it by saying that I am not making this thread to start a flame war. I really just want to hear sincere well-informed opinions on this topic.

 

I am a second year medical student in Ontario and I am very interested in pursuing family medicine. However, I am a bit concerned about the long-term job prospects in the field... specifically, the role of NPs and PAs. I am admittedly not very well-informed on this topic and would like to hear from people who are.

 

I have read things along the lines of: "Interprofessional models reduce reliance on physicians, slow job growth. These new roles complement and in some cases substitute physician services, making it possible to increase the amount of specialty medical care that physicians and surgeons provide without necessarily increasing the number of medical jobs."

 

and...

 

"“… we have advanced practice nurses in virtually every specialty now who can run a clinic, who can do a lot under the direction of a consultant. We have hospitalists, … physician assistants,... and physiotherapists picking up what orthopedic surgeons used to do. … You can’t look at a profession that hasn’t increased its credentials and increased its training and has spread out.

… Our hospital is paying for 16 anesthesia assistants. …and anesthesia specialists want more [anesthesia assistants]. … So even if I just put one anesthesiologist with two anesthesia assistants, I now need half as many anesthesiologists. That’s huge! ”"

 

I understand that these quotations are referring to both primary care and specialist roles but I am guessing that family medicine likely has more roles for which NPs/PAs can substitute physicians? What does this mean for long-term job prospects in family medicine vs. another specialty? Would it be "safer" (in terms of job prospects) for me to choose a different specialty in the long-run?

 

*Both quotations are from: "What is really behind Canada's unemployed specialists? - Findings from the Royal College's employment study -2013

[A-Stark]

Few points:

1) Hospitalists are physicians, usually family docs who have admission patients and cover inpatients in most community hospitals around the country where IM plays a consultant role primarily.

2) Anesthesia assistants can't start or end cases and don't exist in all centres. Staff can't cover more than one list/OR.

[shangrila]

Encroachment by mid-levels is a serious concern in the US and the issue may concern Canada as well in the future. There currently aren't nearly as many PAs, NPs, and CRNAs in Canada as the US, where you might easily see a mid-level instead of a family doctor at walk-in clinics. Many US hospitals and clinics argue that mid-levels increase the number of providers and cut costs, so the mid-levels will triage and direct patients to various specialists directly. Some private clinics are hiring PAs to do all the grunt work and some surgical clinics are hiring exclusively CRNAs rather than anesthesiologists. One MD-turned successful businessperson I recently talked to said that the family doctor specialty should be entirely replaced by mid-levels...