Will Physician Extenders Improve Access to Care

Emil H. Schemitsch, M.D., FRCSC
Editor in Chief

Given the ongoing problems with access to care, it makes sense to have orthopaedic surgeons doing the work that they were trained to do. As an arthroplasty surgeon, I myself attend a busy arthritis clinic once a week where I see many patients with the diagnosis of knee arthritis. These patients are potential candidates for total knee replacement. Yet many actually have chondromalacia or minor meniscal pathology. They often have not received the most rudimentary conservative treatment including physiotherapy. A physician extender trained to perform some of the functions currently performed by the orthopaedic surgeon could screen these patients and begin treatment. This would allow me to see those patients who were ready for total knee replacement and thus improve access to this procedure.

The same holds true for the operating room. Much of the time spent by an orthopaedic surgeon in the operating room is devoted to tasks that again dont require the specific training needed to perform total joint replacement. These include patient transfer, positioning, preparation and draping, wound exposure, wound closure, order writing etc. This could all be managed by a physician extender. This would increase access to care by allowing the orthopaedic surgeon to do more of what he or she was trained to do.

But physician extenders really improve access to care? If more patients are seen in the clinic who require total knee or hip replacement, but there is no corresponding increase in resources to manage these patients, then waiting lists may in fact increase. Similarly, if an orthopaedic surgeon is freed up to do the things he or she is trained to do, then he/she will require the resources to make it happen. These resources include OR time, clinic time, anaesthesia and nursing support. Our system can be improved. However it all comes back to the need for appropriate resources. I think physician extenders can play a major role in improving efficiency. But it must be done within the larger context of availability of resources.

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