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They are intended to relieve the burden on family doctors, APNs, advanced practice nurses. Does that really help? An inspection.
She is young, a nursing specialist and looks after patients independently in the family doctor’s practice “Im Lenzhof” in Lenzburg (AG). Rahel Hottinger is an Advanced Practice Nurse (APN), a specialist with nursing practice and a master’s degree.
Experts believe that because half of Swiss general practitioners will retire in the next ten years, these APNs could “save” rural general practices in particular. A patent recipe?
“I make home visits to older patients, but also consult in the practice. I also take on emergency appointments,” explains Rahel Hottinger SRF.
I came to the practice as an emergency because no doctor had time.
This morning she is checking on a patient who tore a ligament a few weeks ago. “I came to the practice as an emergency because no doctor had time. “I’m happy that this APN exists,” says the patient.
Legend:
Rahel Hottinger checks a patient. She is happy about the APN offer.
SRF/Ruth Steiner
Hottinger himself has wanted to work as an APN in a family doctor’s office for a long time. In her master’s degree, she received further training specifically in this field.
Your boss, family doctor Marc Meili, is happy. “Without their help, I can see 20 to 25 patients a day. With their help, I can look after five to ten more patients a day.”
Pilot project instead of a permanent solution?
But there is a catch. “APNs are well qualified, we just can’t afford them,” says Isabelle Fuss, co-president of the Aargau Association of General Practitioners and Pediatricians. Billing via the medical tariffs (Tarmed) and the health insurance company does not apply to advanced practice nurses. The pediatrician or family doctor’s practice must pay the specialist itself.
Legend:
How can family doctor practices continue to operate, especially in rural areas?
Keystone/Peter Klaunzer
- One in four doctors was at least 60 years old at the end of 2021.
- At the end of 2021, 25,439 doctors were working in medical practices and outpatient centers in Switzerland, which corresponds to 19,004 full-time positions.
- A good quarter of the doctors were at least 60 years old, according to the latest results from the Federal Statistical Office (BFS).
- In 2021, 44.3 percent of doctors working in medical practices and outpatient centers were women. According to the BFS, the majority of younger people are female.
APNs are currently being paid for by the canton as part of a pilot project in Aargau, for example in the new family doctor’s practice at Muri Hospital. Cost: 1.46 million francs.
There are no other options in Aargau yet. The Aargau government is working on a legal basis that would allow billing via the Tarmed tariff.
Role model from abroad
He knows the APN model from the Anglo-Saxon region, says Lenzburg family doctor Marc Meili. From England. In the USA, nurse practitioners (as academically trained nursing specialists are called here) can even run their own practice and treat patients on an outpatient basis. This is not the case in Europe.
Family doctor Meili says he experienced APN during surgery in the hospital. That convinced him. Meili pays his APN out of his own pocket. “But with a little support, the percentage of their positions could be increased.”
Not a hit yet
APNs are not yet a big relief for general practitioners, say various associations when asked, for example Philippe Luchsinger, President of the national association of general practitioners and pediatricians. “We know that it is mainly larger group practices that employ APNs, or in some cases smaller practices with each other, but it’s certainly not a hit yet.”
Legend:
Half of all family doctors will retire in the next ten years. What then?
Keystone/Gaetan Bally
He doesn’t have figures on how many advanced practice nurses work in Switzerland, but he estimates that 20 to 30 APNs work in general practitioner practices in Switzerland. APNs are not the panacea for the shortage of general practitioners, but: “They help to better distribute the tasks in caring for patients.”
In any case, new care models are required for the large wave of family doctor retirements in the next few years. Advanced practice nurses could be a solution.