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Rebuttal: Do nurse practitioners pose a threat to family physicians?: YES

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  Canadian Family PhysicianLe Médecin de famille canadien  Vol 55:  january • janVier 2009

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dmittedly, the concept of nurse practitioners is not new. As my colleague states, these professionals were originally created in an attempt to address the shortage of physicians, a shortage that in my view persists. Nurse practitioners have not been a panacea for this problem, which is undermining our profession. She also notes that their numbers have increased by 20% in 7 years. And to think that they were supposed to lend us a helping hand!

My fears are confirmed when I hear about clin- ics managed by nurse practitioners in big-box stores.

Nurses who break free and work independently in dis- count stores, without a physician: a prime example of marked-down medicine!

My colleague also points out the obstacles to their training, including important limitations on their oppor- tunities to do practical rotations at a time when faculties of medicine are experiencing an increase in enrolment.

Physicians need a minimum level of exposure in order to be adequately trained. If this training were to be diluted, that would indeed pose a threat to our profession.

I smiled as I read the argument regarding “male- female issues” and the dysfunctional health care family.

With admission rates of female students reaching 75%

in some faculties, I think that the medical model itself is being redefined. I don’t think that female physicians fear female nurses simply because they are women!

When I am told that medical support staff are not adversely affected by nurse practitioners, I tend to believe it because my understanding is that they perform differ- ent duties. But I remain sceptical about the claim that the duties performed by nurse practitioners and family physicians complement each other because I believe that many of these duties duplicate one another and overlap.

Perhaps my reaction is partly based on fear, but since I have become interested in this issue, no one has been able to answer my questions regarding these half-doctors. I truly believe that cooperation is the key to success, but only when we make the best use of each individual’s talent, not when we infringe on each other’s knowledge and skills.

Dr Laguë was Chair of the Quebec College of Family Physicians’ Continuing Professional Development Committee.

Competing interests None declared

These rebuttals are responses from the authors of the debates in the December issue (Can Fam Physician 2008;54:1668-71). See www.cfp.ca

YES

Guylaine Laguë

MD

Rebuttal: Do nurse practitioners pose a threat to family physicians?

NO

Gisèle Bourgeois-Law

MD FRCSC MEd

Cet article se trouve aussi en français à la page 23.

W

hat makes physicians unique is not their ability to diagnose. Physiotherapists and chiropractors diagnose, as do nurses in remote settings. What dis- tinguishes family physicians is the breadth and depth of knowledge and skills that allows them to diagnose uncommon problems or common problems with uncom- mon presentations, and to oversee the management of patients with multiple complex problems. That is what those extra years of training provide. Nurse practitioners will become a threat only if too many family physicians practise in a way that is indistinguishable from that of nurse practitioners.

I am not suggesting that all family physicians need to go back to the old model of full-service family practice.

Family medicine does need to reaffirm its unique role in the health care system, however, to ensure that it does not lose precisely what makes it unique. For example, family medicine residents do need to spend time on acute care wards in tertiary care hospitals even if they might never practise in such settings: they need the exposure to develop the understanding and experience that will differentiate them from nurse practitioners, and they need to be visible in the system. Family physicians have focused on their unique relationship with patients;

they need to add an equally strong focus on preserv- ing the breadth and depth of their training and lifelong learning.

Finally, physicians are disadvantaged politically in relation to nurses because there are comparatively few of them in administration. Even though administration is much less remunerative than clinical practice, a suffi- cient number of family physicians need to be involved in medical, educational, and government administration to ensure that family medicine continues to have a strong voice in its future.

Dr Bourgeois-Law is Associate Dean of Continuing Professional Development at the University of British Columbia in Vancouver.

Competing interests None declared

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