# Shortage of Military Doctors Critical and getting worse



## old medic (19 Jan 2006)

Canadian Press Article
19 January 2006

Published under Various Headlines

Chronic Shortage of Army Docs
http://www.edmontonsun.com/News/Canada/2006/01/19/1401231-sun.html



> OTTAWA -- According to a Canadian military physician, critical shortages of doctors, nurses and other medical staff mean the Canadian army and its allies in Afghanistan are being forced to rely on each other in emergencies like Sunday's suicide bomb attack.
> 
> Canada's military has a 35% shortfall in deployable doctors and the problem is growing as it begins its most dangerous Afghan mission yet, the doctor in charge of recruiting the Forces' medical staff said yesterday.
> 
> ...



Military medical shortage worsens
http://lfpress.ca/newsstand/News/National/2006/01/19/1400893-sun.html



> There aren't enough MDs, nurses and other staff, so Canada and its allies in Afghanistan rely on each other in emergencies like Sunday's suicide blast.
> By STEPHEN THORNE, CP
> 
> OTTAWA -- Critical shortages of doctors, nurses and other medical staff mean the Canadian army and its allies in Afghanistan are being forced to rely on each other in emergencies like Sunday's suicide bomb attack, Forces doctors say.
> ...


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## Armymedic (20 Jan 2006)

I got two words on how the CFMG is working on resolving some of the strain because of doctor shortages:

Physician Assistants


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## Lima_Oscar (23 Jan 2006)

I got two other words:

Nurse Practitioner


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## Armymedic (23 Jan 2006)

Lima_Oscar said:
			
		

> I got two other words:
> 
> Nurse Practitioner



Nice try, but I got a one word response why NP's are not the answer:

Nondeployable.


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## Fraser.g (23 Jan 2006)

Please expand,

Why are you under the impresson that NPs are non-deployable?

GF


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## Armymedic (23 Jan 2006)

what is thier role in the CF?

where do they work? what army or naval unit do they work for?

what is thier scope of practice?


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## winchable (23 Jan 2006)

I've been reading about health-workers and the differences between them lately (IE; The roles of Doctors, RN's, NP's, LPN's etc.) and from there trying to see how they fit into the forces. 
I'm under the impression that an NP technically requires an RN or a Doctor around as they haven't got a mandate to do certain things themselves (even though they may be perfectly capable of doing said things) because they need to work on the RN or the MD's license...license might not be the right word, ah hell.
Am I in the ballpark here? The same city even?

Sorry to jump into the medical forum, I feel like an ass for doing it but I was looking for some clarification on this exact area.


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## Fraser.g (23 Jan 2006)

The developing role for NPs is to replace or augment the care provided starting at the Treatment facility. It is burgeoning now but we are well on our way. There were just three reg RNs who were authorized to take their NP Masters degree.

Now where do they work. Last one I personally met was at the MIR in Pet. She was tasked from 1 Fd Hosp. Last time I looked the third line facility being deployed to TFA was from that unit. I would also not be surprised if your clinical standards officers be NPs and or RNs.

Now Scope of practice: Unlike a PA an NP has their own licence and do not need to be countersigned by an authorizing MD. This autonomy will be essential with the declining numbers of MDs in the system. 

The simple fact is that an NP is a cheep alternative to an MD who can still act autonomously therefore they are a viable alternative. Just because the CF has used PAs in the past does not mean that they have the monopoly on advanced treatment in the field, clinic or in a hospital.


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## winchable (23 Jan 2006)

> Unlike a PA an NP has their own licence and do not need to be countersigned by an authorizing MD. This autonomy will be essential with the declining numbers of MDs in the system



Cheers for that, that's exactly what I was looking for.


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## Armymedic (23 Jan 2006)

RN PRN said:
			
		

> The developing role for NPs is to replace or augment the care provided starting at the Treatment facility. It is burgeoning now but we are well on our way. There were just three reg RNs who were authorized to take their NP Masters degree.
> 
> Now where do they work. Last one I personally met was at the MIR in Pet. She was tasked from 1 Fd Hosp. Last time I looked the third line facility being deployed to TFA was from that unit. I would also not be surprised if your clinical standards officers be NPs and or RNs.
> 
> ...



Now, Grant, lets not get into a big bun fight over this...
Not all your points above accurately portrait the current reality:
PA's are licenced and regulated by the CMA. PA's do not require countersign from a MO within thier formulary. NP as I understand, do not have a larger Rx list.
The following is the list that PAs can independantly Rx, without consult or countersign:
http://www.forces.gc.ca/health/policies/medServiceInstructions/engraph/msi_cf_3000-004_AnnexA_e.asp

There is a role for NP in CDU under PCRI. That would be 1 per CDU. But the vast majority those would be civilian, and hence non deployable. There is also 1 PA per CDU as well.

I have heard of more Reg F NO failing the NP program then passing. I have only seen 2 military NPs, and heard of one more. I have not yet heard of any NP being allowed to practice further then arms reach of the supervising MO. I qualify these statements by saying "I have heard"...none of this is first hand knowledge, but this discussion did come up during my course last week.

CFMSS is producing 16-20 PAs a yr. These are all Med Techs with 15-20 yrs of experience. Can't reproduce that corporate knowledge. The Navy loves PA's, and in the navy they do have the monopoly.

Reality is, as far as CFMG is concered, PAs are the answer to current shortage of MO's


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## medicineman (23 Jan 2006)

NP's and deployments - last I heard, they were non-deployable assets as such.  There was one in Haiti from Pet - she couldn't go down as "an NP", she had to fill a GDNO position in order to deploy.  We had one with 2 RCR when I was there, but alas, she was "non-deployable" with the unit, which in fact was a bit of a concern, since we didn't have a PA on our establishment and we were a High Readiness Unit.  As it stands, from the TO&E's I've seen thus far, NP's aren't on any as NP's (subject to change without notice of course).

I can think of a few possible reasons.  First, alot of physicians still haven't come on board with them; I see and have seen it frequently.  Secondly, I see the system trying to keep them for in garrison care for some reason or other, which of course conflicts with reason number one.  Third, there are still alot of old medics( now PA's) that still have a BIG problem with nurses and have pull on this - let's face it, the PA lobby is pretty big in the CF and so are alot of the personalities.

There is of course the mentally challenged problem of training them and then posting them to non-clinical positions soon afterwards - a problem shared with the physicians once they become Majors and Base Surgeons and PA's as they become Clinic WO's.  The system seems to be designed to screw the very people they are trying to keep; downside is all that gets screwed are the patients and the system as it eats itself up and vomits the remains out.

Hope I don't sound too cynical - had a rather inconclusive CM meeting the other day and had to get my spleen back under my rib cage.

MM


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## Lima_Oscar (24 Jan 2006)

Armymedic said:
			
		

> Nice try, but I got a one word response why NP's are not the answer:
> 
> Nondeployable.



Just because there is only a handful of Nurse Practitioner in the CF and just because they are non deployable now doesn't mean they cannot and/or will not be deployable in the future.

Furthermore, just because the concept of Nurse Practitioner is new to the CF doesn't mean it'snot a reasonable or bad alternative.  Back when I was a Med A and they say they were going to certify PAs, we thought that idea was pretty crazy too.  Look where we are now. The roles of PAs and NPs are equally valuable to the CF Health System.  If our goal is to provide the best care to serving members, then our approach to care should be holistic and multidisciplinary.  PAs are valuable however their clinical thinking is orientated towards medicine. NPs can bring a collaborative approach to care which is more holistic.

Just my 2 cents.  

Edited for spelling


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## Cdnarmybear (31 Jan 2006)

Speaking of shortages of doctors, I was wondering if anyone else out there has been waiting a long time to see a specialist. After hurting my knee in the fall and getting in to get an MRI in November, I have been refferred to see the military knee specialist at CFB Edmonton. It is now the end of January and still no appointment to see the doctor, let alone get it fixed. After talking with some people on the base here in Wainwright,I was told that it takes a long time to get in to see the specialist out here. Some of them have told me they have waited almost a year after their consult to get their knee problem(s) fixed. Is there a problem with hiring another specialist or two to help out with the workload out here? I can't speak for anyone else out here, but when you're up for promotion or PLQ and are dead in the water because you are waiting to get an injury fixed; things start to suck in a hurry. So if anyone could enlighten me on how things work on this end of the country,I'd appreciate it. I don't remember anyone in Pet having to wait this long to get in to see a specialist, but I could be wrong.


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## Armymedic (31 Jan 2006)

The shortage we are speaking about on this thread is in GDMOs. But sure lets expand.

Waiting 2 months (one of which is Christmas leave) seems reasonable. I believe 3-4 months is the norm. Orthopedics is a busy dept in the CF.
6-12 months would be a long time to see a specialist. That wait time borders on civilian wait times and is unacceptable for our occupational medicine directed system.

You may have access to only one or two orthopedic specialists in Edmonton. If they are military MOs, then they have more to do then just see patients. (military stuff, leave, surgery, conferences, etc).

Due to increasing political pressure to relieve wait times, our use of civilian specialist practitioners may become more difficult.


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