I am writing in response to two items in the December 14 issue of To the Editor ... "Looking for solutions to the physician shortage" and "Outpatients nightmare." It would appear that these are both symptomatic of the same issue. Several people have since provided comments, and I would like to add my thoughts as well.

 The issue of doctor shortage is a phenomenon that is occurring not just on the South Shore, but throughout the western world. We look to the less industrialized world to help reduce our problem by hiring their doctors. In doing so we are decreasing their ability to look after their own populations.

 In recent years we have begun to use nurse practitioners (NPs) to help overcome the lack of medical coverage. The main question with respect to the use of these practitioners is, "Why is it taking so long?" These practitioners are trained to assess, diagnose and provide resolution, including prescriptions where appropriate, for many cases that they could see.

 Much of the usage of emergency rooms is as a result of families not having a family doctor or knowing that the emergency room can be accessed 24 hours a day. I would contend that some, if not most, of this problem could be alleviated by more use of NPs.

 There would be a number of additional benefits to such an approach. There is a much greater pool of nurses available from which to draw; it would provide an enhanced career ladder for those who chose to partake; it would be less expensive to educate to the NP level than to the MD level.

 In discussing this with a GP it was suggested that the general population is not ready to be seen by an NP rather than a GP. I would contend that in the past, not only did doctors smoke, but they prescribed smoking as a stress reliever for patients.

 It was the subsequent efforts of the medical community that has resulted in the dramatic decline in the number of smokers. Given the will of the College of Physicians and Surgeons such a shift could be made with the NP usage as well.

 Where could these NPs be employed? There are several important areas:

 - More use could be made in the emergency room in triage and complete patient management. Such streamlining could reduce the number of patients seeing the doctors, thus reducing some of the stress on the doctors. The NPs could undertake the follow-up to inpatients, again reducing the time being spent by the doctors.

 - Today, many doctors have adjacent offices. Shared usage of NPs could make it possible for patients to come in for minor ailments, again reducing the need to be seen by a doctor. There is at least one local situation in which a similar approach is being used.

 - In some provinces, NPs are able to establish their own offices without the need to be overseen by doctors. Adopting such an approach would again reduce the workload of doctors and have the potential of having NP offices in more convenient places, such as malls.

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 - Upgrading the staff of the VON would allow for an increase in the number of procedures that could be done at home, thereby reducing the need of patients to leave their home for service. This would reduce the stress on the patient and negate the need to have an extra person accompany the ill person to a medical facility.

 There are many situations where a similar plan is currently being employed. They include:

 - In Canada's North, the fly-in MD is being replaced by the fly-in NP;

 - Militaries in three western countries with which I am familiar use specially trained non-MD personnel for both triage and a specified level of medical procedures. This is not only for battlefield procedures but to help alleviate the chronic medical officer shortage in peacetime.

 - In places where NPs are being utilized they are able to spend more time with the patient rather than the 10 to 15 minutes being allotted by the MD's schedule. A greater chance of determining an underlying cause rather than just the presenting issue is made possible. This could help in the long-term wellness of the patient with the resulting reduction in the pressure on the system.

 I would never suggest that the above would cure all of the ailments of the medical system, but they could be a step in the right direction for both cost containment and person power shortages.

 Additionally, it is a system that could be put in place much more quickly and at a lesser cost than increasing the number of positions in our medical schools.

 It might allow the system to be taken off life support.

 BOB SALZMAN
 Northfield

posted on 01/11/12