What if the City of Calgary, in the face of a dire shortage of civil engineers, turned to Certified Engineering Technologists with a few months of extra training and handed oversight of bridge projects to them?
I wouldn’t be keen to zoom across those bridges.
That’s not an attack on the competence of engineering technologists, who are superbly skilled and vital to turning designs into reality. Without them, bridges don’t get built.
But the complex calculations that underpin bridge design are beyond their scope. A bit of “supplemental training” doesn’t — can’t — magically transform technologists into engineers.
The same principle applies to health care. Two of the key players, obviously, are doctors and nurses. Doctors train for years to be the “quarterbacks” of patient care; nurses train for years to ensure that care is delivered as planned.
Both are essential to the provision of excellent patient care; the one complements the other — but that doesn’t mean that one is the other.
That’s a distinction that the Alberta government seems determined to ignore. Last week Premier Danielle Smith announced an initiative to license nurse practitioners (NPs) for independent practice free of supervision from medical doctors.
Given the critical shortage of family doctors in Alberta this might seem like a fine idea to “enhance access to care.” It’s not.
One oft-stated claim is that “nurse practitioners can do 80 per cent of what family doctors do.” That’s debatable, but let’s just say it’s true: Will patients enter these new NP offices with a confirmatory label, “My problem is one of the 80 per cent?”
Of course not. Complex diagnoses are mixed in with the rest, and it can be incredibly challenging to pick them out.
Doctors spend years training to master critical clinical thinking skills built upon a vast foundation of knowledge, so they can reliably detect the hallmarks of complicated diseases and manage those patients accordingly.
Nurses are trained differently, and “supplemental training” doesn’t — can’t — magically transform nurses into doctors.
Last week on Alberta At Noon, Susan Prendergast, president of the Nurse Practitioners Association of Alberta, seemed flabbergasted that family doctors are upset by the premier’s attempt to replace them: “I think we’re fighting over — or arguing over — a word. No one likes to be ‘replaced.’ We’re not trying to undermine or make someone feel less valued. The point is that there’s hundreds of thousands of people that don’t have a care provider and we can do the same work. Our work can replace a family physician.”
Family doctors have every reason to feel upset, devalued and disrespected. But the main reason they’re bothered is because patients are at risk of receiving substandard care.
A bridge built by competent engineering technologists might handle traffic perfectly well 80 per cent of the time. But that’s not good enough. Civil engineers design bridges to withstand traffic as close to 100 per cent of the time as possible, regardless of the circumstances — including when the traffic is heavier than normal, or when high winds threaten to blow the structure sideways, or when rising and rapidly flowing waters stress the tall piers upon which it rests.
That’s the robustness of care that patients deserve from their health-care providers. They deserve a team that can handle their needs in all circumstances, a team that absolutely can (and increasingly should) include NPs — but a team that cannot operate safely without physician oversight.
The solution to the crisis in primary care isn’t simple. But any serious solution must begin with concerted efforts to make family practice attractive again, to restore it to the financially viable and professionally rewarding profession it used to be — so that doctors can get back to delivering the expert cradle-to-grave care they’ve been trained to deliver.
For years NPs have proven their incredible worth as key members of medical teams in Alberta. The tragedy here is that Smith’s initiative is breaking apart those teams, driving a wedge between professionals who have always collaborated successfully, and who should be allowed to continue working closely together for the benefit of patients.
J. Edward Les, MD, is an emergency physician at Alberta Children’s Hospital.