What is Primary Care?
November 23, 2023
Dear Members,
Yesterday we cut through the fog created by government about who provides primary care in Alberta. Our colleagues across the health care spectrum deserve respect and support. So do family physicians, who cannot be replaced by nurse practitioners. Integrated teams have been demonstrated to be the best model for primary care — evidence supports the model. It is misleading to suggest otherwise.
I made that point on Global News, CBC and AMA's X account. The Section of Family Medicine spoke out in a communication to section members. And I have submitted and hope to see a similar op-ed in tomorrow’s Edmonton Journal.
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I want to say thank you to the members who are working so hard with the AMA to develop a new model for longitudinal family practice. Government has invited this work and promised to address the crisis. You can read about that work on the AMA website (member login required), and I urge you to stay informed and share your input.
Regards,
Paul Parks
1 comment
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Daniel
1:13 PM on November 23, 2023
Thank you for your advocacy on this issue, Dr. Parks.
I understand the argument for introducing nurse practitioners into primary care; they can assist with routine care (runny noses, diabetes counselling, etc.) so the physician's skillset is better utilized on more complex visits. This is how team-based care should work. This benefit is entirely lost if nurse practitioners work in their own clinics.
If NPs work separately and have a completely different patient panel, that doesn’t lighten a physician’s load. The physician’s skillset will still be under-utilized seeing the same number of runny noses and prescription refills as before. And for the patients who are served by an NP with no collaborating physician, what happens when their problem is outside their NP’s scope? They’ll get unnecessary referrals to specialists, further worsening our waitlist problems and delaying the care a family doc could’ve just provided them on the spot. As an alternative, maybe the NP would send their patient to a walk-in clinic or ED to see a doctor-- what could have been one primary care visit with a family doctor who knows the patient's history has been turned into two subpar visits with 1) a NP not able to care for the patient and 2) a doctor who has to navigate a complex problem with no background on the patient's history. This adds unnecessary burden to patients, delays care, and defeats the purpose of having longitudinal primary care.
There are already family medicine clinics in every community across the province. It is beyond wasteful to duplicate this infrastructure with NP clinics rather than providing our existing clinics the support they need to continue operating (which could include funding to hire NPs under a team-based model). We already have a recruitment problem in family medicine and struggle to fill our residency positions. I don't believe the government wasting millions of dollars trying to outsource the work of family physicians to a group with significantly less medical training will improve recruitment efforts.
The Nurse Practitioners Association of Alberta has stated the fair market value of a nurse practitioner seeing a 900 patient panel is $300k plus overhead support [1]. It sounds like family doctors are an excellent deal for Albertans.
[1] https://albertanps.com/september-2023-npaa-executive-update/?utm_source=western%20wheel&utm_campaign=western%20wheel%3A%20outbound&utm_medium=referral