The Royal College of Physicians and Surgeons of Canada recently released a report entitled What’s Really Behind Canada’s Unemployed Specialists. A subsequent Vancouver Sun article noted that the report doesn’t address whether there are too many specialists for the Canadian health care system, but does identify a number of possible reasons why newly certified specialists are having trouble finding work (i.e., competition for resources such as operating rooms, hospital beds and money to pay their fees). However, the report also references “relatively new categories of health professionals encroaching on doctors’ territory, such as advanced practice nurses, nurse practitioners and physician assistants.”
As a family nurse practitioner (NP) who has worked in B.C. for seven years, I initially chuckled at the idea that anyone could think an NP would do the work of a cardiac surgeon. But then I began to consider whether or not this decline in specialist positions might actually be, in part, because nurse practitioners and other primary health care providers are helping more British Columbians focus on prevention and health promotion solutions rather than waiting until they have a health crisis to see a physician.
Nurse Practitioners have expert communication skills - we partner with patients and families to promote health and prevent or manage disease; spend time listening to patients, identifying their health goals and priorities; provide expert information and advice on choices they can make to achieve their health goals and improve their chances of living a healthy, vital life. Nurse practitioners practice holistically - we understand that patients often have challenges in the socio-economic aspects of their lives that impact their ability to achieve their health goals, and we support patients to develop action plans that are practical, based on their individual situations. For those patients who are already struggling with chronic disease, we provide advice and support to help them understand and self-manage their health challenges to stay as healthy as possible, for as long as possible.
More and more British Columbians are seeking the services of nurse practitioners - in part, because we work closely with people to help them understand how to avoid preventable diseases and live a balanced, healthy lifestyle, that will help keep them out of the specialist’s office. We are essential health care professionals and that is at the heart of what British Columbians need to understand about NPs.
What would happen if every British Columbian was supported to avoid preventable diseases by eating right, exercising daily, and having access to timely checkups and prevention programs at all stages of life? Government has been warning that our health care costs are outpacing our tax revenue, and one solution is for each and every citizen to make choices that will help them avoid heavy use of the health care system. The nursing profession has advocated for greater attention to the determinants of health such as housing, food security, community support and social programs as fundamental conditions to improving people’s health. If we invested more in prevention and health promotion, could we spend less on curing or mitigating disease?
If all British Columbians had the opportunity to work with an NP on a regular and timely basis - for holistic primary health care that includes health promotion, and disease prevention and management - including the small things that can grow to become significant health challenges - maybe the end result would be less visits to specialists. In fact, perhaps what we are seeing right now is that nurse practitioners and other primary health providers have begun to shift the population into taking better care of themselves, thereby reducing the need for specialists.
Shouldn’t our priority be helping every single person achieve optimal health? Wouldn’t it be better if our B.C. population was so focused on wellness and health promotion that only a rare few ever required the services of a specialist?
Perhaps we need to worry less that new specialist graduates aren't getting jobs, and start celebrating that the need for specialists is being reduced!
ABOUT CARRIE MURPHY
Carrie Murphy is a Family Nurse Practitioner and member of an interdisciplinary team in a full service family practice in Langley, B.C. Her clinical focus is seniors’ health including frail seniors living in residential care facilities. She has 20 years of experience in older adult health in various clinical and management roles but finds the NP role the most rewarding. Carrie sits on the Executive Committee of the BC Nurse Practitioners’ Association (BCNPA) as the Regional Representative for Fraser Health Region. Visit www.bcnpa.org for more information.