16 January 2009

AMA vs nurse walk-in clinics

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ABC Online reports that the ACT Branch of the Australian Nursing Federation are concerned that the AMA are trying to undermine public confidence in nurses in an effort to get us to avoid nurse walk-in clinics.

The possibility of nurse walk-in clinics has been raised already by Katy Gallagher, as a way of easing the strain on our busy hospital emergency wards and difficulties getting appointments with GPs.

What do you think? Would you be happy to use a nurse walk-in clinic for some things?

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There are scads of nurses working in the public service too – conditions for nurses are not much good, so it is no wonder they don’t stick around in hospital jobs.

Igglepiggle said :

johnboy said :

There are very few problems in the health system that can’t be laid at the feet of the AMA’s greed.

Not only is the current doctor shortage the result of their efforts to keep the market for their services tight, but now we’re plundering the third world for trained personnel to make up our short falls.

For mine they’ve discredited themselves for a generation.

Actually the current doctor shortage is due to government restrictions on medical school numbers throughout the 1980s. They did all the modelling assuming that all doctors were still old blokes with wives at home to manage their kids and were prepared to wrk 120 hours every week and always on call. Seeing as the gender ratios have been equal since the 70s and no Gen X doctor is prepared to work that way, the modelling was way out. 2001 was the smallest number of graduating doctors in Australia for 40 years. Thats why theres a shortage. The AMA tried to dispute the reduction in numbers at the time (unsuccessfully).

that is a part of it. the numbers of skilled migrant doctors who cannot get accreditation and end up working in other fields is staggering. there has been a couple of cases where regional communities have asked for doctors, and have found one of these migrants working in a fruit picking role, or other unskilled labor, only recognising their medical quals through an accident. These migrants cannot practice medicine in australia, and, if caught unaccredited, can be deported.

bit of a slap in the face of every regional community crying out for a doctor, relying on overworked nurses, who are performing serious triage as there isn’t anyone else to do it…..

maybe the AMA could work on getting help from any quarter, getting it from the nurses who do a stellar job already isn’t so bad.

Nurses do all the work anyway!

I’ve noticed that these days, more doctors than not don’t like to actually touch patients! You have to actually say, ‘can you listen to his chest?’ for them to do this. And instead of looking at symptoms themselves, they want path tests.

While registered nurses are great, there is a shortage of these also, and we are now finding that enrolled (significantly less qualified) nurses are filling the gaps in hospitals. When my elderly dad was at Woden hosp a coupla years ago, we found glaring probs with this – his ward seemed to be mainly looked after by enrolled nurses and the reg nurse seemed always tied up in admin. Broken ankle, right, but he had to try and stay on the ball as he nearly got the wrong meds on more than one occasion, and they didn’t know how to manage his bandaging properly. Next thing, golden staph. Not a good experience.

Nurse clinics in general sound to me like a good idea. Anything that makes community health services more readily available, particularly with our relative shortage of GP’s in the ACT. As for taking the strain off the Emergency Department, the biggest problem is patients who need to be admitted to a bed on a ward somewhere.

The problem in ED is not lack of ED staff, it’s lack of throughput to move patients to other areas of the hospital… even doubling the number of staff wouldn’t help in the slightest if every bed in the place was already occupied!

It will be even more interesting when Gen Y starts working as medicos. I can’t see them sticking out long hospital hours either.

johnboy said :

There are very few problems in the health system that can’t be laid at the feet of the AMA’s greed.

Not only is the current doctor shortage the result of their efforts to keep the market for their services tight, but now we’re plundering the third world for trained personnel to make up our short falls.

For mine they’ve discredited themselves for a generation.

Actually the current doctor shortage is due to government restrictions on medical school numbers throughout the 1980s. They did all the modelling assuming that all doctors were still old blokes with wives at home to manage their kids and were prepared to wrk 120 hours every week and always on call. Seeing as the gender ratios have been equal since the 70s and no Gen X doctor is prepared to work that way, the modelling was way out. 2001 was the smallest number of graduating doctors in Australia for 40 years. Thats why theres a shortage. The AMA tried to dispute the reduction in numbers at the time (unsuccessfully).

Whatsup said :

Nurses are more than qualified to deal with many things. The ANA is just a union trying to protect its members jobs. The health system is broken and needs a different approach, this might just be a successful solution.

I think that they are also concerned with the prevalence of great service from a nursing outfit, it would make GP’s look bad. the AMA wants the world to believe that the doctors that they have are the best, even when they are specialists like anesthesiologists – which currently has a shortage in canberra.

Nurses are more than qualified to deal with many things. The ANA is just a union trying to protect its members jobs. The health system is broken and needs a different approach, this might just be a successful solution.

oooh I typed that poorly.

peterh said :

you have got it all wrong.

The AMA is the support body. the real culprit is the AMC – Australian Medical Council. This group provides accreditation for doctors to practice medicine in Australia. If you don’t meet their stringent criteria, regardless of the numbers of years that you may have been practicing in another country. And i don’t just mean Asia, this can include Europe, the US and NZ too.

there are many doctors that aren’t members of the AMA. you don’t have to be a member, if you don’t want to. the AMC, on the other hand, is the “union”.

I ahve a friend goign through Meda t ANU – he is from NZ, so can get a HECS place, but will have to go through all sorts of things to get a Medicare number. Even though we’re training him here as if he was an Aussie. And he’d love to work here, but might have to go back to NZ with his Au paid degree to get his first job.

Also there is a new Measles Mumps Rubella shot (MMR) – this is done at school now, but it you were born before about 1980 you probably haven’t had it.

Nurse clinics would be ok for basic coughs and colds and cuts and bruises.

Nurse clinics already exist for babies and toddlers in Canberra, so if it’s good enough for them, why not us. Although appointments take 6 weeks to get at the baby clinics, so nurse clinics may not be any easier to get into than GPs.

For ongoing health issues it is better to see one doctor – they have a proper record of tests you have done etc. Even your immunisations – I just found out everyone is supposed to have a tetanus/diptheria/whooping cough vaccine every 10 years. I haven’t had a vaccine since I was at school.

If we all had the luxury of a family dr, they would know when we last had any shots, and what for.

Captain is right. The Scores to get into courses at unis reflect the popularity of the course, not its difficulty or the lucrative nature of the job it qualifies you to do.

For yeasr, the course with the highest entry TER/UAI cutoff in Canberra was… sports journalism at UCan.

captainwhorebags11:22 am 16 Jan 09

I’d believe this if the scores to get into medicine weren’t still sky high.

Demand to get into a course at the start does not equal graduates at the end.

Perhaps I dreamed this, but apart from greed (never underestimate the power of greed!), isn’t the public liability of doctors fecking enormous? So if you increase the number of doctors, it makes it harder for them to meet those premiums, which then forces the number of doctors back down.

chrispy said :

I agree Johnboy #4
The AMA should be forced to re-name itself as the Doctors Union and stop telling us they are doing things for the benifit of the community. (I don’t have anything against unions)

Doctoring is just like any profession in that you will get doctors who love it and are great at it, then there are other doctors who are bored by it and are crappy at it. The problem is even if you are shit at being a doctor you wouldn’t stop doing it because where else are you going to get such a high paying secure job.

you have got it all wrong.

The AMA is the support body. the real culprit is the AMC – Australian Medical Council. This group provides accreditation for doctors to practice medicine in Australia. If you don’t meet their stringent criteria, regardless of the numbers of years that you may have been practicing in another country. And i don’t just mean Asia, this can include Europe, the US and NZ too.

there are many doctors that aren’t members of the AMA. you don’t have to be a member, if you don’t want to. the AMC, on the other hand, is the “union”.

Anyone who has tried to get in to see a GP recently would be cheering this on. for the vast majority of things ordinary people see drs for, these nurses would as good if not better. The med certs for flu, the initial investigations into minor ailments, teh standard referrals to specialists, the on going drug prescriptions…

Nurses are the ones on the floor, they are the MET (Medical Emergency Teams) that get called when someone is code-ing on a ward (Code-ing i.e flatlining).

Doctors do the surgery, but nurses sustain quality of life post op, and have to deal with a lot more crap than doctors.

I am married to a nurse, so this may seem biased, but she has been swung at many times, punched in the neck, had walking sticks swung at her by old men, kicked in the chest, verbally and physically threatened several times, and at times told she was going to be killed. Now tell me that they get paid enough – pretty obvious why there are not many around.

I think walk in nurse clinics would work a treat here.
It would create a groundswell of nurses wanting to ply their trade in a better environment, and provide less stress on already stretched Er resources.

When i was in Miami, I had to go see a doctor, but instead went to a Minute Clinic instead.

Due to lack of health insurance I had to pay the 50 dollars (I could claim back on travel insurance but would have to pay an excess so no point)

In any case, it took me about 2 minutes to get in, the nurse on duty done all my obs, then ran a quick result swab kit for strep throat, which came up negative. She then done another swab that she sent to the lab to confirm the first swab. She then gave me a script to get filled inside the pharmacy ( Which also sold beer and ice cream??)
A few days later she rang me with the lab results.

Whilst seeing her, I asked how popular these clinic were in the states and she said she could see anywhere betwen 32 to 40 patients a day – all with quality care.

To say that this system should not be implemented in Australia is absurd. Its just GP’s and their ilk trying to play their cards close to their chest and keep their money their own.

I woukld wholly support and patronise a nurse walk in clinic for anything that was not to do with my long term issues (i.e. would see the nurse clinician for coughs, colds, flu, gastro etc)

If there was any type of support movement, I would join..

I would use a nurse walk-in clinic, as suggested earlier, maybe with a consultant Doctor on hand to give extra advice. All the nurses I have ever met have been the most amazingly caring people in the world. If this would help alleviate the load at hospital casualty, that would be awesome also.

captainwhorebags said :

Lack of doctors may also have something to do with the 5+ years of training, relatively low salary, crap working conditions and poor lifestyle that’s dissuading a lot of people from studying medicine.

And before people jump on the low salary comment, a resident in ED is getting paid around the same as an APS6. The money is in private practice, specialisations and in locum shift work. I’m not saying that 60 – 70k is a bad wage, but you don’t need to study for 5 years, stick your fingers in someones orifice or deal with a very angry meth user in the APS. Okay, maybe ministerial staffers do.

Anyway, back on topic, why not get nurses to do stuff they’re trained for. If you had a walk in clinic with maybe 6 nurses and 1 GP on hand, then they could always get a consult if quickly needed.

I’d believe this if the scores to get into medicine weren’t still sky high.

I agree Johnboy #4
The AMA should be forced to re-name itself as the Doctors Union and stop telling us they are doing things for the benifit of the community. (I don’t have anything against unions)

Doctoring is just like any profession in that you will get doctors who love it and are great at it, then there are other doctors who are bored by it and are crappy at it. The problem is even if you are shit at being a doctor you wouldn’t stop doing it because where else are you going to get such a high paying secure job.

captainwhorebags9:32 am 16 Jan 09

Lack of doctors may also have something to do with the 5+ years of training, relatively low salary, crap working conditions and poor lifestyle that’s dissuading a lot of people from studying medicine.

And before people jump on the low salary comment, a resident in ED is getting paid around the same as an APS6. The money is in private practice, specialisations and in locum shift work. I’m not saying that 60 – 70k is a bad wage, but you don’t need to study for 5 years, stick your fingers in someones orifice or deal with a very angry meth user in the APS. Okay, maybe ministerial staffers do.

Anyway, back on topic, why not get nurses to do stuff they’re trained for. If you had a walk in clinic with maybe 6 nurses and 1 GP on hand, then they could always get a consult if quickly needed.

Trust the doctors’ union to try and guard their patch. Their ongoing fights to prevent nurse practitioners being allowed is another such (nurse practitioners can prescribe, and refer patients for diagnostic tests like x rays). The AMA has helped keep numbers of doctors trained at levels low enough to maintain their salary ranges, so naturally they don’t want to lose ground to anyone else.

Fact is we don’t have enough doctors unless you live in a major city (and not a minor city or anything smaller) or desirable tourist location. so using the skills nurses have is sensible. In some communities, nurses are the only medical practitioners. Nurses, especially these ones with extra qualifications, are a great medical resource adn they shoudl be used.

There are very few problems in the health system that can’t be laid at the feet of the AMA’s greed.

Not only is the current doctor shortage the result of their efforts to keep the market for their services tight, but now we’re plundering the third world for trained personnel to make up our short falls.

For mine they’ve discredited themselves for a generation.

My Brother is a nurse. His advice tends to be, “you don’t need that” or “just put up with it till it goes away”.

Yeah, lots of confidence in a nurse only clinic I have not.

DarkLadyWolfMother9:04 am 16 Jan 09

The majority of Nurses I’ve met seem far more competent than the majority of Doctors I’ve met. So for me, I’d trust a walk in clinic more than the doctor I’ll meet at A&E.

(Had some bad experiences? Me? Nah…..)

Crikey has noted this little spat.

Lets be honest, if you need a doctor, a nurse is going to send you in that direction, but a lot of the time people present at A&E they probably don’t need to be there, but they are concerned enough about their health to be there. I think nurse walk-in clinics in addition to health first and the like is probably a good idea, and where appropriate I and others would probably make good use of them.

The AMA in running a demarcation dispute, I think ends up looking a bit elitist and lost.

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