Proletarian Doctors

Medicare reform can only occur when we break the doctors business monopoly and 'their haughty power' over health care. One of the ways is to put doctors on salary.

Another is by creating integrated community medical centers and thus the proletarianization 0f Medicare through the use of salaried Nurse Practitioners and Physician's Assistants. It's an idea Norman Bethune would approve of.

Dr. Sigurdson, who worked with a physician assistant during a fellowship in Atlanta, just completed a master of business administration degree at Saint Mary's University during which he examined the business case for physician assistants.

"We could do things much better here," he said Wednesday.
Dr. Sigurdson said in an average 10-hour day set aside for operating, he only spends about six hours in the operating room and the rest of the time waiting for patients to be moved, the room to be cleaned and so on.

But much of what he does in the operating room could easily be done by a trained physician assistant.

He said it doesn't require a surgeon to prepare and drape a patient for surgery, sew up an incision or dress a wound.

"A (physician assistant) could sew up just as good as I can," Dr. Sigurdson said.

In fact, by his calculations, a surgeon is needed for only about 37 per cent of what happens during an operation. And a physician assistant could handle 51 per cent of the patients he now sees in a clinic.

About 100 patients were booked to see Dr. Sigurdson on Thursday morning. He needs to see patients having or recovering from major procedures like breast reconstruction. But when the appointment is simply to check whether someone who's had a minor procedure is faring well, a physician assistant would do just as well.

Comparing the cost of hiring a physician assistant at about $70,000 per year to a conservative estimate of Dr. Sigurdson's increased productivity, he estimated the province would see a modest cost saving over 10 years.

But when he compared the cost of a physician assistant plus the space and staff to run two operating rooms at once to simply hiring a second surgeon to work in a second room, he found the province could save $1 million in today's dollars.

A full-time surgeon at the QEII is paid an average $432,521 a year under a contract with the province, meaning the doctor would get no extra pay for doing twice as much surgery.

"I'm a young surgeon; I like operating," Dr. Sigurdson said. "And I'd like to operate more. You don't train 14 years to do something and then you only get to do it a day or a day and a half a week. It's frustrating."

He said it's much too late now to hope that increasing the number of doctors trained in Canada can meet the mushrooming demand for care. The country is just now experiencing the leading edge of a huge group of aging baby boomers who will not accept years-long waits for health care.

"To take business concepts and bring them into the public system is a strategy that we really should be thinking very strongly about before we throw the baby out with the bathwater and bring in a parallel private-care system," Dr. Sigurdson said.

Physician assistants work well in the private American system and could easily be incorporated into the public system, he said.

And there are trained physician assistants in Nova Scotia eager to work, he said. Those employed by the military frequently take early retirement and are left with few work options save providing care on oil rigs.

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