non-doctors to become surgeons

[sunnyjohn]

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http://www.timesonline.co.uk/article/0,,8122-1540507,00.html

Plans to enable non-doctors to become surgeons were announced yesterday.

Nurses, physiotherapists and operating theatre assistants will all have the opportunity to train to perform minor surgery.

The government launched a consultation on setting up a training programme for surgical care practitioners.

Practitioners have been in place since 1989 - but the aim of the new programme is to encourage more staff to take on the role.

Under supervision of a surgeon, the practitioners would perform minor surgery and run out-patient clinics for care before and after operations, under the proposals.

The department of health said this would boost medical training as many of these routine tasks are performed by junior doctors.

Hugh Phillips, president of the Royal College of Surgeons, said it welcomed surgical care practitioners as members of the extended surgical team.

He said: "The College has enshrined in the curriculum framework for surgical care practitioners, the standards it will expect of those qualifying to practice in this role, and will continue to influence their development. The College would wish to approve those institutions that would offer programmes of education and training".

Health minister Lord Warner said: "The NHS is working hard to give patients faster access to care. By developing the roles of healthcare staff we are able to offer patients skilled practitioners who are able to carry out simple surgical procedures - freeing up doctors to deal with more difficult cases."

But the British Medical Association said it was puzzled as to how the scheme would work - and warned it could place "significant demands" on the time of consultants.

Simon Eccles, chairman of the BMA’s Junior Doctors’ Committee, said patients had a right to know if their operation was not being performed by a doctor.

He said: "We welcome well-thought out measures to expand the clinical team, expand capacity to perform operations, and for nurses to extend their skills into areas such as minor surgery.

"But we are concerned over how these proposals would be implemented. Doctors in training must get as much experience as possible to hone their skills, as they train to be the surgeons of tomorrow."

http://www.staffnurse.com/nursing-news-articles/nurses-can-be-surgeons-1142.html

 

[rn29306]

As a former prehospital and ICU RN, now an anesthesia student who has seen ALOT of bad things go wrong (including terminal "bad outcomes") on "minor surgery cases" I would hope that anyone with 2 synapses still firing in the cranial vault would avoid this like the plague. Why in the world is this even being considered?
This is like staff RNs giving general anesthetics for CS. You have got to be kidding me.

This push by various nursing organizations has got to stop somewhere.
Yeah, I said it.

 

[diabeticfootdr]

Why in the world is this even being considered?

I agree with you. This is a horrible idea. Consider the source: United Kingdom. The reason it is being considered is because there is a shortage of surgeons in England. Since a socialized healthcare system predominates, surgeons are not well paid in the UK. For the years of training required to become a surgeon, it just doesn't "pay off" for many new UK med school graduates.

I spent a few months in England doing research in a diabetes centre. I saw this first hand. Also, you can pick this up from their medical literature. They publish a lot on medical (non-surgical) treatments of ailments that are generally considered surgical problems in the US (ex. osteomyelitis).

LCR

 

[rn29306]

Thanks for the first-hand experience explanation of the ongoings across the big lake. I'll keep this in mind when I'm planning my future travel arrangements.

 

[djquick83]

Non-doctors to become surgeons is like non-teachers to become principals. 😕

 

[rad_one]

Anyone can do surgery, come on. Let's continue this trend into all professions. Non pilots flying planes. Non mechanics fixing your brakes. Just let me know where these people are going to be "operating" (what a joke),so my family and I can avoid the entire facility.

 

[vanessh]

Anyone can do surgery, come on. Let's continue this trend into all professions. Non pilots flying planes. Non mechanics fixing your brakes. Just let me know where these people are going to be "operating" (what a joke),so my family and I can avoid the entire facility.

but i am looking forward to the next field: nurse practitioner neurosurgeons.

the training is as follows: an extra 2 years residency beyond an NP degree with elective credits in "neuro"psychology, "neuro"social work, and "neuro"holistic medicine. followed by 3 yrs residency as scrub tech.

seriously, it really is getting out of hand.

 

[Bandit]

Guys, they are talking about simple out patient proceedures like the ones PAs have been doing for years.

Simple excisions for pathology, FB removals, even saph vein harvesting.
My best friend is a PA that spends his entire day putting in medi ports, central lines and some non-cardiac interventionl radiology.

ALL of these are "surgery"

 

[lawguil]

Guys, they are talking about simple out patient proceedures like the ones PAs have been doing for years.

Simple excisions for pathology, FB removals, even saph vein harvesting.
My best friend is a PA that spends his entire day putting in medi ports, central lines and some non-cardiac interventionl radiology.

ALL of these are "surgery"

Then why don't we just let the PA's keep doing it and stop trying to create a new field that isn't needed!

 

[efs]

Then why don't we just let the PA's keep doing it and stop trying to create a new field that isn't needed!

I think this is the type of plan they are working on. I don't think the UK currently has PA's.

 

[zenman]

I spent a few months in England doing research in a diabetes centre. I saw this first hand. Also, you can pick this up from their medical literature. They publish a lot on medical (non-surgical) treatments of ailments that are generally considered surgical problems in the US (ex. osteomyelitis).

LCR

What were the outcomes for medical treatment vs surgery?

 

[lawguil]

I think this is the type of plan they are working on. I don't think the UK currently has PA's.

Sorry, I get it now. Why would anybody here have a problem with the UK developing what is the equivalent of a PA?

 

[diabeticfootdr]

What were the outcomes for medical treatment vs surgery?

An abstract below:

Diabet Med. 1997 Jun;14(6):487-90

Conservative management of osteomyelitis in the feet of diabetic patients.

Venkatesan P, Lawn S, Macfarlane RM, Fletcher EM, Finch RG, Jeffcoate WJ.

Department of Microbiology, City Hospital, Nottingham, UK.

Experience of conservative management of osteomyelitis in a specialized, multidisciplinary, diabetic foot clinic was reviewed. The records of all patients attending the clinic over a 10-year period were examined retrospectively, and 22 patients with overt osteomyelitis were identified. Median age was 66 (31-87) years. In 12 cases the bone infection was a complication of a pre-existing ulcer; the most prevalent organism cultured from swabs was Staphylococcus aureus. The main site of infection was the first toe. The total duration of antibiotic treatment was 12 weeks (median, range 5-72), and clindamycin was the most commonly used oral agent. Four patients did not respond to initial conservative therapy and proceeded to amputation, while 1 patient responded clinically but had a recurrence of osteomyelitis at the same site 6 years later. In the remaining 17 patients resolution of osteomyelitis was achieved with conservative management over a median period of follow-up of 27 (range 5-73) months. The success of conservative therapy with prolonged courses of oral antibiotics challenges conventional advice that excision of infected bone is essential in the management of osteomyelitis affecting the foot in diabetes.

 

[zenman]

Thanks; interesting.

 

[Docgeorge]

An abstract below:

Diabet Med. 1997 Jun;14(6):487-90

Conservative management of osteomyelitis in the feet of diabetic patients.

Venkatesan P, Lawn S, Macfarlane RM, Fletcher EM, Finch RG, Jeffcoate WJ.

Department of Microbiology, City Hospital, Nottingham, UK.

Experience of conservative management of osteomyelitis in a specialized, multidisciplinary, diabetic foot clinic was reviewed. The records of all patients attending the clinic over a 10-year period were examined retrospectively, and 22 patients with overt osteomyelitis were identified. Median age was 66 (31-87) years. In 12 cases the bone infection was a complication of a pre-existing ulcer; the most prevalent organism cultured from swabs was Staphylococcus aureus. The main site of infection was the first toe. The total duration of antibiotic treatment was 12 weeks (median, range 5-72), and clindamycin was the most commonly used oral agent. Four patients did not respond to initial conservative therapy and proceeded to amputation, while 1 patient responded clinically but had a recurrence of osteomyelitis at the same site 6 years later. In the remaining 17 patients resolution of osteomyelitis was achieved with conservative management over a median period of follow-up of 27 (range 5-73) months. The success of conservative therapy with prolonged courses of oral antibiotics challenges conventional advice that excision of infected bone is essential in the management of osteomyelitis affecting the foot in diabetes.

Dr. Rogers, can you tell me what that means? What are its implications here?

 

[diabeticfootdr]

Dr. Rogers, can you tell me what that means? What are its implications here?

17 of 23 patients responded to oral antibiotics and were "successfully" treated for osteomyelitis (OM) non-surgically.

If you read Waldvogel (who is world reknown for his classification of OM -- he published another article last year in the Lancet on OM), he states that the necrotic bone must at least be debrided. No antibiotics can penetrate bone not getting circulation (necrotic, osteomylitic bone). Therefore, in the US, OM is still considered a surgical problem.

LCR