And it [IPC] is still not supported from a College regulatory perspective. The regulatory Colleges in terms of how they lay out standard practice guidelines which is their job say that "you shall take a history and you will do this and do that", so doing it in this kind of model, a lot of people who want to be more resistant can fall back on their College Standards say "I have to do this" and so we are caught between this as an organization those College standards and how literally people want to interpret them, and sometimes if it suits them to interpret them really literally, they do.
For me some of the other challenges are not necessarily in this model of care but there are differences between Nurse Practitioner and differences between physicians… sometimes the roles are not clear in this type of care. In particular with NP my understanding is that they consult with physicians if they feel there is no clear plan. That is so unclear… so it is up to that person if they feel it is OK or not and there is a huge misunderstanding by patients, by the public and even by different levels of the hospital as to what a NP is, because there is a lot of confusion and they think they are independent providers and they can basically replace physicians and that to me…it worries me where we are going with this because we have to have ways to ensure that the quality of care is not compromised with defined roles like if you have an RN you know what they can do, with physicians, we know what they can do… we have Colleges watching us. That is lacking with NP, so I have seen NP doing way more than what I feel I can do as a family doctor and so I hope something is going to happen before a bad outcome occurs and someone wakes up and says why are we doing this?
You have some resistance to changing or expanded roles. One example would be OMA's [Ontario Medical Association] resistance to Nurse Practitioners in having them more involved in the provision of care. They were not supportive and resistant to change. And there is resistance to the changing scope of practice for RPNs [Registered Practical Nurses] and some resistance from the RNs [Registered Nurses] and so as long as that continues that becomes an impediment and a barrier to making change, and I think change for the good... getting more people involved and working at a different level.