As a recent medical school graduate, I feel the need to weigh in on recent comments by Health Minister Dr. John Haggie.
In a CBC news article dated Jan. 2nd, the minister commented: “The whole big discussion point in health care is around scopes of practice. We have significant resources that could take a big part of the health care delivery away from a physician-centered model. Eighty per cent of a general, normal day’s work for a family practitioner can be managed perfectly well and in some respects with a better outcome by nurse practitioners, for example.”
Unfortunately, whether known to the minister or not, he has started rumblings across the country that may bode poorly for the already large challenge of recruitment and retention of physicians in this province.
The reality is, in Newfoundland and Labrador, we do need to move towards a collaborative care model. We need to ensure that every patient is receiving primary care that is top quality. Given the higher rates of diabetes, obesity and heart disease in this province, access to quality primary care is a must. It keeps people out of hospital, it ensures treatment in the community, and as M.J. Hollander et al. (2009) have shown, it saves considerable money in the health system.
Instead of using a collaborative approach between family physicians, specialists, nurses and all allied health professionals, the minister has chosen to pit professionals against each other, threatening replacement of one health-care profession by another. I think where the minister will fall short here is the fact that health-care professionals see the needs of patients in our communities, and are willing to work together to achieve the goal of better primary care. Just last year, the Newfoundland and Labrador Medical Association, in collaboration with the Department of Health, started this process with its family practice network initiative — ultimately a project that will lead to better shared, collaborative care. To hear the minister talk about replacement over partnership in primary care is troubling, to say the least.
Unfortunately, whether known to the minister or not, he has started rumblings across the country that may bode poorly for the already large challenge of recruitment and retention of physicians in this province. On Jan. 3rd a CBC article from Nova Scotia quoted a vascular surgeon who states that their specialist services are overwhelmed because of the lack of primary care physicians. In our province, I’ve heard personal stories of specialists who are dealing with as many primary care issues as that of their chosen specialty. Will a specialist in training look to N.L. as their destination knowing that the government is not working to build healthy primary care, but an ill and divided system? The chances are much lower, that’s for sure.
As a resident physician, I am actively thinking about where I will set up shop. I know my colleagues, from coast to coast to coast, are doing the same. With looming cuts to nursing as referenced by the deputy minister of health, and now what seems to be a push-out of family physicians in communities, I could hardly blame my colleagues if they chose a place other than N.L. to practice family medicine. Because the reality for them is, they chose family medicine to do collaborative, consistent, community-centred care, and the minister’s recent comments do not support that. Maybe unknowingly, he has created a “poison well” for the recruitment of GPs to this province.
I want every nurse, nurse practitioner, specialist, and any health-care professional who reads this to know: we are all in this together. Please stay above the minister’s comments to pit us against each other. Medicine is a team effort and caring for our patients involves us all pulling in the same direction. At the end of the day, every health professional is a human caring for a human. We have the same feelings, physiology, and determination to make a better system — health-care workers and patients alike. And while the minister’s comments sting, they won’t keep primary care in the province from advancing forward, because the truth is, there is no better place to care for people than right here at home.
Maybe he didn’t mean what he said; I would hope that’s the case. If so, I think a lesson in communication is as needed as his lesson in primary care.
Dr. Desmond Whalen
MUN resident physician
Vice-chair elect, College of Family Physicians of Canada Section of Residents