There always seems to be great attention paid to how to improve the healthcare system in this country. First, I think we have a pretty darn good system--thanks to Tommy Douglas and the legacy of our system of universal healthcare. But that being the pat on the back, we need to now take a long look at how this system needs updating. and I'm not just talking about a new hair-do, or repainting the front door to something more trendy... we need a big time overhaul.
To start with, the pyramid of care, with the physician at the peak, has got to go. From what I've seen from my MD friends and colleagues, they don't wanna be at the top--they want some quality of life, some down-time and the opportunity to really do the best they can without feeling like they are dancing on the head of a pin all the time.
I had to have eye surgery--nothing major, just a little laser weld-job on a retinal tear ("just" I say...), and it happened at the Ivey Eye Institute in London about a month ago-- my optometrist found the tear and sent me over to the Institute right away--she called them & they said, "C'mon over...we're waiting for you!!" In 3 hours, I'd seen a Clinical Clerk, a Year 2 Resident, a Year 4 Resident, and finally the surgeon, who was refreshingly knowledgeable, professional and quick: fixed me up in a matter of minutes.
But when I went back for the check-up, before heading up to the cottage, I arrived for my 9:30 appointment and he finally saw me for the requisite 10 minutes (if it was even that long) at 11:00am. In the intervening time, I'd seen the poor man dashing around, trying not to look superhuman or like a clone of himself, seeing a vast array of patients for a variety of things. All by himself. I asked him where his minions were, and he said, "Oh, they're all off learning things elsewhere"...and I thought, this is really the place for a Nurse Practitioner. or two. You could easily have 2 NPs seeing these patients and confirming "yup, that tear is healing" or "nope... there's a problem... now you need to see the surgeon". Then, the surgeon is used for his/her skills and the NP can see the garden variety patients. Believe it or not, the NP can be taught these skills--and best, know how to provide education, follow-up info and recognize when there is a problem when the surgeon really does need to be consulted.
Wow, if we had a system like that, imagine how many patients could be seen? Imagine how useful the surgeon's time would be--and how many actual surgeries he/she could perform? and, bonus, what about putting the surgeon on a salary, instead of fee-for-service? That way, he/she would have benefits, a pension, sick days...all the things "normal" professionals have.
I would bet that the majority of MDs would love a system where they could actually do what they have been highly trained to do--if they had colleagues (e.g., NPs) whom they could trust to do the other, less complex stuff. And, bonus, they could be paid a salary that would give them a reasonable wage. Gee, we could get rid of the bureaucracy of OHIP (does anyone actually know how much OHIP costs us??). Old doctors could retire, young doctors could have kids and families and time off, and other healthcare providers (like NPs) could work to their scope of practice and provide the excellent care, based on knowledge, research and (that over-used term) best practice. Patients would get the very best, and it would be faster, more appropriate and less expensive.
What's wrong with that picture, then? Why isn't this the way we are doing things? Well, old habits die hard, and those people who are entrenched in power can't understand how this "new way" could possibly be better, safer, more effective and efficient. If the MD is no longer top of the healthcare foodchain, how could that possibly work?
One way is to start looking at using the right people for the right job. Value engineering (a theory I particularly like) seems to fit this--choose the person who is the best fit for the job--get out of the old assumptions that only one "type" can do a job. So, why not have a clinic where the surgeon sees the complex patients, and the NPs (or RNs working to their full scope of practice) who are trained by the surgeon, see those patients who are likely to be "normal" or "routine".
why not? We need to start changing the way we do the "business" of healthcare.
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