Monday, January 27, 2014

nurses and doctors in Nova Scotia

A story went by about a looming nurses shortage in Nova Scotia. 45% of the nurses in Nova Scotia are over age 50. which is basically right in the baby boom nurses coming to the end of their careers. Can anything be done about it. that is, could the supply or demographics of the nurses be changed meaningfully in the next few years.

while nurses demographic reflects that of the population, this problem has been made much worse than it could have been due to a terrible policy decision around a generation ago. for a century the hospitals in Nova Scotia had a 2 year nurses residence program where a person would emerge after the 2 years as a fully qualified nurse. in the early 1990s these 2 year hospital nurse programs were force shut by the provincial governments of the day in favor of 4 year university nursing programs.

what a disaster that decision was. so the time to become a nurse was then artificially doubled from 2 years to 4 for no reason. raising the barriers and cost to becoming a nurse chokes off the supply of new nurses. perhaps that was the intent a generation ago? also with the hospital residence scheme a person could finish with minimal debt. so it was a bizarre and nonsensical decision to shut down the 2 year programs. the correct move then and now was to shutter the 4 year university nursing programs and insist that in Nova Scotia it takes only 2 years to become a nurse.


over with the doctors the Lacewood Medical Centre is closing. the owner said he has 20,000 patients and only three family doctors and was losing money. that was actually my clinic although luckily I was a rare visitor. will have to sign up somewhere else I guess. Dr. Power said he's lost Drs and was having trouble recruiting replacements.

let's take Dr. Power at his word that there's a general shortage of Drs in at least some situations. it's been documented about rural Drs certainly being a challenge to recruit. 

so maybe the thing with drs is the same as with nurses. if the time to become a nurse was artificially doubled by fiat from 2 years to 4, then maybe the same has also been true with drs. maybe the 8-12 years we've been told to become a doctor is also artificially inflated for political and certain special interests. if we know it actually takes 2 years to become a nurse then how much more intense should it be to become a doctor? offhand twice as hard sounds about right. so even if it was twice as much then it should be doable in 4 years to become a doctor right out of high school. even 5 years is 2.5 times as long. I wonder in "the past" how long it took to become a doctor.

if the time to qualify "good enough" doctors could be reduced to say 4-5 years direct out of high school then that would fix a lot of problems. the dr only has to be good enough to help grind a 20k patient caseload. writing standard prescriptions, routine situations and treatments, and managing well understood chronic conditions. and it's not like the current doctors are all that special. every day there's stories about misconduct and malpractice and drs being named on suicide notes (after being suspended earlier for misconduct), so I doubt these optimized track educated doctors would be materially worse.

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