Physician AssistantsOptimizing Patient Care

Presentation Objectives• What is a PA?• Scope of Practice• PAs in Canada• The Impact on the Health Care System• The Value of PAs• Obstacles to Advancement of the

Profession

• A Physician Assistant is a health care provider who extends the hand of the supervising physician

• The profession was developed within the Canadian Forces to provide full spectrum medical care as part of a physician led team

• PAs are trained under the medical model

What is a PA?

• A dependent practitioner who works under the delegation of a supervising licensed physician

• Can be entrusted to make certain decisions and to carry out certain actions autonomously

• The PA is not intended to supplant or substitute the physician as the principal medical decision-maker

• PAs working with the supervising physician can enhance access to quality care for patients

What is a PA?

• PAs in Canada have been formally trained and educated to meet the national standard set by CAPA

• The National Competency Profile and Scope of Practice was developed in conjunction with the CFPC, CMA, and RCPSC

• PACCC administers and maintains the PA certification process

Scope of Practice

Duties Generally Performed by PAs• Medical histories and performing comprehensive

physical examinations

• Complete admission and discharge procedures for hospital stays

• In some cases, refer patients for consultation with specialists

• Preventative health counseling

• Order and interpret laboratory tests, X-ray, and other diagnostic investigations

What Can a PA Do?

• Assist the physician in developing and implementing a patient management plan

• Record progress notes in isolated and in-patient care settings

• Perform and interpret common laboratory, radiological, ECG, and other routine diagnostic procedures used to identify patho-physiological processes

• Prescribe medication in accordance with medical directives and local legislation

• Surgical Assist

Duties Generally Performed by PAs

PAs in Canada• There are upwards of 300 Physician Assistants practicing in

Canada in both civilian settings and within the Canadian Forces

• 4 provinces recognize PAs as a profession

• 4 nationally recognized reputable academic institutions offer PA programs

• In the US there are almost 85, 000 PAs practicing in health care settings and 156 accredited programs

PA Accredited Programs• Canadian Forces Health Services Training Centre

• University of Manitoba Physician Assistant Education Program

• McMaster University Medical Sciences PA Program

• Consortium for PA Education (combination of the University of Toronto/Northern Ontario School of Medicine/Michener Institute for Applied Health Sciences)

Benefits to the Health Care System• Today 4.5 million people in Canada do not have a

regular medical doctor (“Canadian Community Health Survey”, Statistics Canada)

• PAs have been shown to enhance the delivery of care, improve access for patients and reduce wait times

• PAs can manage up to 62 % of all patients in emergency care and 75 % of all visits in primary care without referral to physician level care (“Staffing primary care in 1990: physician replacement and cost saving”, Schweitzer & Record)

Benefits to the Health Care System• In orthopaedics PAs can increase the volume of

primary joint procedures by 42 % a year and decrease wait times for surgeries by 14 weeks (“Experience with physician assistants in a Canadian arthroplasty program”, Bohm et al.)

• PAs in Emergency Departments can reduce wait times for patients by 1.9 times and cut the “left without being seen” rates by half ( “Impact on patient flow after the integration of nurse practitioners and physician assistants in Ontario emergency departments”, Ducharme et al. )

The Value of PAs• Integrating PAs into health care will increase the

level of service for patients and address the challenges that exist within today’s health system

• Collaborative approach that reduces the workload placed on the team and the physician

• The PA profession is designed to work in a team-based setting which fosters inter-professional collaboration among other health care providers

Obstacles to Advancement• Lack of familiarity with the PA role and Scope of

Practice

• Absence of a funding model(s)

• Recruitment and integration of PAs

• Liability insurance and coverage for the PA

(“Barriers and Benefits to Hiring a Physician Assistant", Taylor et al.)

Funding• There is no universal model for funding for PAs

• Funding for PAs varies dependent on the setting and location

• Typically PAs are funded through the government or directly through the physician

Future of the Profession• The benefits to the health system are proven

• It is essential to create a funding structure for physicians to employee PAs

• Must remove the other barriers to employment

• Need to educate stakeholders on the benefits of the profession

Conclusion• Physicians are optimistic about the PA profession

• The value that PAs bring to the health system is evident

• Without the support of local and provincial governments and other key health organizations the profession could become stagnant

• We need your support

Questions?