Hospital walk-in centres seeing 30 odd patients every day

I-filed said :

Did I hear right? I could have sworn the 6 pm ABC news bulletin just then quoted Gallagher saying the new centre was getting “2,000 visits a week”.

Accidentally posted!

Did I hear right? I could have sworn the 6 pm ABC news bulletin just then quoted Gallagher saying the new centre was getting “2,000 visits a week”.

Generally drs are very accepting of ‘their own’ (including medical students) – e.g. unwritten rule that drs do not charge other drs (and medical students, and dr’s families). So a nurse-turned dr or a nurse-turned medical student will be very acceptable to drs.

Well I think drs would be okay with this – I am sure that no one would doubt that nursing experience will enable them to shave off a few years off medical school, also recognising that nurses will be giving up substantial income to embark on such a program of study.
Maybe even more I think – $45K per year scholarship.

JumpingTurkey said :

…..Perhaps a better solution to shortage of drs and recognising some experience that nurses have is to establish a fast track path for experienced nurses to graduate as a doctor – since they already have communication skills, and have experience dealing with patients and have nursing knowledge, why can’t they be admitted into a fully paid (say $35K per year salary) intensive (48 weeks per year) graduate course in Medicine for 2.5 years?….

That’s not a bad idea JT. (but imagine the outcry from the doctor’s unions)

You need to look at how nurses are trained. They are trained to be very good at ‘nursing’ the patients back to health. Their training focuses on improving patient’s health once the diagnosis is clear. Their training focuses on administering medications, taking observations, identifying and managing wounds, etc. They are trained to know when there are deviations from the expected course of recovery of illnesses.

However doctors are trained to be diagnosticians. As I am sure that many of us realise, diagnosis is not straightforward, as there are many many rare conditions that can mimic each other, and it is often not reasonable to subject people to hundreds of tests (many of which are invasive) to rule out all possibilities. Some degree of ‘educated guessing’ is inevitable.

It takes medicos around 10 years to train up as a GP. This involves extensive training in the art of taking a history, examination, and ordering and interpreting of investigations. This also means extensive studies on clinical features and laboratory features of different diseases, as well as studies about medications and their modes of action, common side effects and dosages.

Because of these differences in training and key focus between nurses and doctors, even when nurses undergo further training, and even if they have 20 years experience as nurses, such experience often is not ‘doctor’ experiences or ‘doctor’ training. It is same as asking a kidney specialist who has been around the wards for 30 years that because he has been around the wards long enough that he would know how to do an experienced nurse’s job in effectively nursing people back to health, or administering medications in a safe and efficient manner. 20 years of experience as nurse does not suddenly make them experts in diagnosis – simply because their every day work does not involve diagnosis! Whereas a GP in training will be actively looking at people’s throats, and consulting with their senior colleagues on what it is, and how to treat it, and gain experience by doing that, your every day nurses will not be doing the same.

Even if a nurse undertakes further studies and gains extra experience as nurse practitioners, this is usually limited to the field of their choice. They do not simply gain an all round experience and training that a typical doctor receives by spending time looking at patients from all sorts of different fields – e.g. cardiology for few months, renal medicine for few months, surgery for few months – you get the drift.

The reason for all of this is not to say that doctors are superior to nurses. Simply that their jobs are different. And 20 years experience as a nurse does not make them better than even a junior doctor at diagnosis (the most important part of doctoring) – just as a lawyer with 30 years experience is no better in accounting than a fresh accounting graduate straight from uni. Therefore it is no surprise that these walk in clinics should be limited in scope – they need to be protocol driven in order to protect both the nurse clinicians and the patients. If an illness deviates away from their protocol or what is common then they may not have the core knowledge / diagnostic skills / broad medical knowledge to fall back on to.

Perhaps a better solution to shortage of drs and recognising some experience that nurses have is to establish a fast track path for experienced nurses to graduate as a doctor – since they already have communication skills, and have experience dealing with patients and have nursing knowledge, why can’t they be admitted into a fully paid (say $35K per year salary) intensive (48 weeks per year) graduate course in Medicine for 2.5 years?

You would assume that demand for the clinic is still in the ramp-up phase, and is expected to, let’s say, increase about six to eightfold, within a reasonable period, to get the cost per visit down to something more reasonable, or else after a few months, they intend to scale it back to something matching the demand.

But this is the government, so that’s probably too much to expect, and they’ll have an expensive bunch of nurses under-employed forever.

That’s $220.00 PER VISIT!

Frankly, that’s way too much for the ACT ratepayer to be spending “advising” someone with the sniffles.

How does it stack up against the forecasts?

Are the visitor stats increasing over time?

Maybe it’s just me, but I find the costs for this clinic absolutely staggering. The clinic costs $10 million over 4 years to run, plus $2.175 million in capital costs to get it started.

Averaged over 4 years that’s $3 million a year to treat ambulant patients (i.e, not requiring acute emergency care). Surely it would have been much more cost effective to employ a single GP who could have seen the same volume of patients for a fraction of the cost??

Been on two separate occasions, both in the evening – excellent. Waited 10 mins on on occasion, nil on the other. The nurses were thorough and were able to provide antibiotics there and then for tonsillitis. Had to refer for a kidney infection though – we thought it was a UTI which IS treatable.

These rules and limits are a bit silly and they have to ask 1001 questions first to see if they are allowed to treat you. I expect this is to appease GPs, who probably feel threatened by a nurse prac clinic (and no wonder – it’s top notch, free, and open from 7am to 11pm, unlike my GP).

PS, I believe it’s a Cth (not ACT govt) funded initiative.