Nurse practitioner they ain't

One of the latest scandals that I have been meaning to write about is the case of the "medicina integral comunitaria".   They are folks that are about to be unleashed as full doctors in the Venezuelan public health system without the knowledge to take care of the people that go to such hospitals.  But before I get into the subject indulge me a personal reminiscence.

One of my very close friends is a Nurse Practitioner (and a PhD in public health).  She is close enough to have visited me 4 times in Venezuela since I left the States which is quite something if you think of it for a US citizen in an academic career.  I met her while she was supporting her PhD expenses working as a NP and I gained then a considerable respect for that degree, thinking it an essential part of the US medical system, a part sorely missing in either the European system (I think) and certainly in Venezuela.  In brief, had I remained in the US she would have got my power of health to make sure that I would be unplugged if worse came to worse.  That much I trusted her medical knowledge.

When I finally got health insurance in the States, I had the opportunity to meet other NP usually placed in "triage" section where in my opinion they were most effective.  See, a NP with some experience is truly a generalist MD, the good kind of doctors for triage as they tend to look at a patient as a whole, something quite missing in US doctors who tend to be a tad too specialized, at least when one comes from other health systems.  For those not in the US you need to know that a NP is kind of like an MD but limited to general practice, a missing link between the mere nurse and the MD.  In many states Nurse Practitioners can even prescribe restricted drugs and participate in all sorts of medical activities alongside MD.  They can have their own practice and can be very helpful in communities who cannot afford many MD, amen of directing the nursing staff so that MD can go unto their real tasks.  Not that they are not well paid: a good NP can buy a home and a car and save for retirement.  Maybe not a golf retirement like an MD but a decent one nevertheless.

It took all of this digression to make sure you understand that I have no preconceived idea about creating a similar type of degree in Venezuela.  Indeed, NP would be ideal to staff Barrio Adentro modules, as a big triage to send the pueblo of the barrio to the adequate hospital, making even the appropriate appointments as these patients sometimes have no idea how to proceed.  Thus a few years ago when in the bloom of Misiones Chavez announced that people would be trained in a special form of medicine adapted to the needs of the barrios I was not as critical as usual.  But as it is always the case in Venezuela these days, even potentially good initiatives have a way to turn into a disaster, creating more problems than what they are supposed to solve.

The degree created (and never validated by the organizations that are in charge of validating degrees, and thus not "legal") is "medico integral comunitario" which can be loosely translated as "complete community doctor".  The degree is taught only in the universities founded by Chavez since 2003 or taken over by chavismo at those dates.  There is no evaluation of either the teaching staff or the cursus followed or the student evaluation.  Rather important because considering that human lives are at stake, a mere "pass" does not quite make it. In other words there is no way to truly evaluate the kids whose first promotions are about to graduate this year.

Still, if the regime were intent only to staff the Misiones in support positions, we could have accepted such title, expecting that with experience and remedial courses their degree could improve and maybe become, well, NP.  But ideology and Venezuelan vices combined and disaster is about to happen: the regime has changed the law that regulates medicine to make sure that the MIC it will graduate this year will be recognized as full doctors, with all the privileges (and obligations I hope).

This is so wrong and for so many reasons that one must start wonder if there is anyone left with common sense in the government, and evaluation agencies since they waited this late to make all of that scandal.

All the serious reviews I have seen claim that the MIC training is lacking in many aspects, too many aspects if you ask me.  They lack in theoretical training ( apparently many classes were simple videos, coming from Cuba or who knows where).  They lack in practical training as at best they seem to have done some nursing work, and certainly no small outpatient surgery or more advanced procedures that even an NP can do in some states of the US.  In short, the tamer criticism I have seen are suggestions of some "remedial" courses and at least a year of training practice.

But the regime was defiant and had the law voted.  Even more, Chavez himself suggested that their starting salary should be around 9.000 Bs.  Which is more that what experience MD make in the public sector.  My SO was even forced to go a support rally for these MIC from which he sent me the picture above.

So imagine if you will for a minute the following situation: people with deficient training will be sent to hospitals to work under doctors that know their office, that have payed their dues, and that may be making less than what the newbies will be making.  You can imagine the havoc in the making...  Compounded by the fact that already patients are asking to be treated by real doctors and refuse to be seen by the MIC that already are completing their "training".

But in all truth I need to mention a vice of the country which has contributed to this disaster in making: in Venezuela everyone wants a degree, a college degree, even if it is meaningless.  Chavez has tapped in that desire and has been providing plenty of empty degrees for people that today can only find work in the public sector as no one in the private sector will hire a chavista university graduate.  Not even because of the ideological potential of the job applicant but because we know their education is incomplete.  This is what is happening with the MIC where a dangerous mix of ideology and "I wanna be a doctor" is brewing a health catastrophe for the country by graduating thousands of people whose basic anatomy lessons are incomplete.

Because let's not be afraid of words: what the regime is doing with its parallel education of ideological degrees is creating two class of citizens with all the conflicts that will result from that, without ignoring all the damage that these fake degrees will do to the country and its people.

We are going to pay for chavismo for at least a generation.