There’s a new profession in Canada’s health care landscape that could help solve many of the problems experts say are heading our way. It’s a story we’re hearing over and over again: as the massive cohort of Baby Boomers age, more people will need health care services just as many current health care workers are retiring—which will put a huge strain on doctors, nurses and other health care providers. Physician assistants could help take some of the pressure off. While the position is not widely implemented yet, it holds promise for the future as a great career for people who want to work in the health care industry without the full commitment of years and dollars involved in a medical doctorate.
Physician assistants are highly trained health care providers who support physicians in all health care settings. The difference between PAs and physicians is that the former works under a doctor’s supervision.
It’s a relatively new position in Canada, but PAs have been successfully implemented in the U.S. health care system for decades. As in the U.S., Canada’s first PAs originated in the military. They are widespread in the Canadian Forces, but are just recently being introduced into our civilian health care system. Manitoba was the first province to introduce PAs in 1999, and Ontario, New Brunswick and Alberta have followed suit.
The Canadian Association for Physician Assistants (CAPA) is working to implement the position across the country through awareness campaigns and stakeholder outreach. “Although it’s starting out slowly, we’re hopeful that eventually PAs will be practising in all provinces across the country,” says Natalie St-Pierre, CAPA communications and marketing manager. “CAPA is working hard with stakeholders and partner groups to try and progress the profession in other provinces. We are hopeful that in a few years time that the profession will be fully integrated throughout Canada.” Right now, there are approximately 300 PAs working in Canada, with 160 students enrolled in programs; CAPA expects this number to grow as the profession advances.
What does a PA do?
“A PA is very similar to a physician in regards to what they do day-to-day, except they have to practise under a physician’s supervision,” says Chris Rhule, president of CAPA and the first civilian PA regulated in Canada. Rhule works in cardiac surgery—one of many options for PAs.
Nancy Aza is an emergency medicine physician assistant and the academic coordinator of the McMaster PA program. “As an ER PA, I work a variety of all shifts in the ER (days, evenings, nights, weekdays and weekends),” she says. “I see patients of all acuity levels, do full assessments on those patients, order tests (bloodwork, imaging, etc.) and interpret those tests. I do a variety of procedures in the ER, from suturing and casting to lumbar punctures to endotracheal intubation. Upon discharge, I provide detailed discharge instructions and arrange necessary follow-ups. Every day and every shift is different for me, which is one reason why I love the emerg!”
St-Pierre says that physicians benefit from the collaboration: “They enjoy working with physician assistants because they’re able to maintain control over their patient population while still improving the care that’s delivered to their patients.”
How does this impact the system?
“So far what we’ve seen here in Manitoba is the ability to decrease wait times to get procedures or to get into appointments, because adding PAs into the mix increases the efficiency of the program or the physician, and allows for them to see patients quicker or even double up because the PA sees some of the patients and the physician sees some,” says Rhule.
“It increases retention of physicians, too, because now they’re not as overworked as they were before. We help share the on-call burden and those kinds of things to make their practice environment much better,” he says. “And we’ve actually been able to recruit specialist physicians and surgeons easier because we have PAs that help them out.”
PAs can also have a huge impact on providing care to rural communities, Rhule says. “You can have a PA working in a rural area, like we have in Manitoba, and the physician may not even be in the same town as them, and so they supervise from a distance,” he says. “That provides the ability to give medical care to a community that otherwise wouldn’t have a physician. It also helps staff in rural ERs and rural hospitals.”
How can I become a PA?
Four schools in Canada currently offer PA training: the Canadian Forces Medical School, the University of Manitoba, McMaster University and the Consortium of PA Education (University of Toronto, Northern Ontario School of Medicine and the Michener Institute of Applied Sciences). All four programs are accredited through the Canadian Medical Association’s Conjoint Accreditation Services.
St-Pierre stresses that it isn’t just an alternative career for those who don’t get into medical school. “It is competitive to get into the program, and really, people that are coming into the program don’t want to be physicians,” she says. “They want to practise medicine but without all of the responsibility included that a physician has.” As the CAPA website puts it, “Physician Assistants want to be Physician Assistants.”
Most of the programs ask for a background in health sciences, though they all have different requirements. McMaster, for example, takes students from a variety of education backgrounds, says St-Pierre.
Education aside, Rhule says communication, decision-making and empathy are three essential skills for aspiring PAs. Aza lists similar skills: “Interprofessional practice is the nature and benefit of our health care system, so a good PA must work well in a team environment and have effective interpersonal communication skills,” she says. “Strong critical-thinking and problem-solving skills are a requirement, as well self-motivation towards continuing medical education and self-improvement, so we can provide the best care possible to our patients.”
If you do manage to get into one of the programs, your employment prospects after graduation are very good. The Ontario and Manitoba governments, for example, have been supportive of the PA profession by creating jobs for new graduates as they’re coming out of school, says St-Pierre. While a job is not guaranteed, “the chances are very high,” she says.
“With the amount of Baby Boomers that are coming into the system, there’s going to be an increased demand on our health system,” says St-Pierre. “And because there is a limited number of physicians, they can’t possibly be expected to take on all of the patients without having some sort of help and assistance.”
What does a physician assistant do?
It varies depending on their agreement with the physician, but some duties can include:
- Conduct patient interviews, histories and physical examinations
- Perform selected diagnostic and therapeutic interventions
- Counsel on preventative health care
- Assist in surgery
- Order and interpret tests
- Write prescriptions
Source: Canadian Association of Physician Assistants