Canada v. France: Rethinking Role Of Nurses To Meet Healthcare Needs
To meet its current healthcare needs, France looks to the Canadian provinces of Ontario and Quebec which are giving more autonomy to nurses rather than boost the number of doctors.
PARIS — After Ontario, the Canadian province of Quebec has also moved to give specialized nurse practitioners the authority to make autonomous diagnoses and practice certain kinds of therapeutic, even high-risk interventions.
This recognition of nursing's key role and responsibilities is the solution that France must adopt to ensure continuous and smooth healthcare coverage throughout the nation.
Canada"s specialized nurses receive additional training that allows them to do a number of things — from diagnosing illnesses, to prescribing medications and performing therapeutic interventions — that are normally reserved for doctors alone. The illnesses that such nurses are allowed to treat directly include diabetes, hypertension, asthma and chronic bronchiolitis, among others.
This is a far cry from the baby steps that have been taken in France — and tightly restricted always by most healthcare workers unions — to give more autonomy to so-called advanced practice nurses. That's why, without further delay, we need to follow Canada's lead and start offering one- or two-year master's degree programs to train our own specialized nurse practitioners to care for adults, children and seniors, and to work in collaboration with midwives on low-risk pregnancies.
In France, some nurses have taken an additional, year-long course to specialize in prostate care. And in the decade that this option has existed, the results have been wholly positive. Patients don't complain any more than expected when nurses take the lead role in treating them. And it's been good for doctors too, freeing them up to focus on more complex kinds of treatment.
This kind of win-win situation for both nurses and doctors directly calls into question France's plan to increase the total number of doctors by 20%. For one thing, those additional doctors wouldn't arrive on the scene for another 10 years, at the earliest. By then, artificial intelligence and robotics would have already taken up much of the work in various specialties.
In other words, if the 20% plan goes forward, we'll essentially be guaranteeing an abundance of unemployed people without resolving the problem at hand, which are the so-called "medical deserts' in France: areas where there aren't enough qualified people to meet the healthcare needs of residents.
And so here's the other option: Starting next year we begin training several thousand specialized nurse practitioners to go meet those healthcare needs not a decade from now, but in one or two years.
And it's been good for doctors too, freeing them up to focus on more complex kinds of treatment.
There's no time to waste. We need to go further than extending a few discreet privileges to advanced practice nurses and instead embrace real and open professional collaboration between doctors and nurses. The same should go for pharmacists too.
Doctors who oppose this are only shooting themselves in the foot. Canada is already showing us that a rapid transfer of medical responsibilities from doctors to nurses can work. Why wouldn't we at least try to follow the example?
*The author is a member of the National Academy of Medicine and president of the Convention on Health Analysis and Management.