Tuesday, Nov. 27 marks National Physician Assistant Day in Canada.
This comes about a month after the 2018 Canadian Association of Physician Assistants annual conference was held in Victoria, B.C. from Oct. 18 to 21. Ironically, PAs aren’t actually allowed to practice in B.C.
Joanna Chan, 34, grew up in Vernon but is a practising PA on a large multidisciplinary team at the Children’s Hospital in Ottawa, caring for children with blood cancers and disorders. Though she’d ideally work in Vernon, this isn’t an option. Bureaucratic hurdles prevent PAs from practising within the province despite local doctor shortages, physician burnout, an aging population, and growing rates of chronic disease drive the demand for health care ever higher.
“This isn’t some new, innovative thing. It’s been around for decades in the states and in our military but Canada has just been slow to pick it up which doesn’t make a lot of sense,” said Chan, whose father and brother are both practising physicians in Vernon and whose mother was also a nurse in the community. “There just hasn’t been the political will to put us into the legislation and that’s really the first step in getting us the ability to work in B.C.”
In Canada, PAs are practising in New Brunswick, Alberta, Manitoba, and Ontario. Internationally, they play central roles in health systems in the United States, the United Kingdom, and the Netherlands. All of these jurisdictions are actually investing in the discipline because the evidence shows they improve care in a manner that is patient-centred and cost-effective.
There are about 500 PAs practising in Canada — roughly 300 in Ontario. They have been practising in the U.S. for roughly 50 years and it is one of the fastest-growing segments of the health care workforce with over 100,000 PAs practising in primary care and virtually every medical specialty.
A 2012 study on the utilization of PAs in Ontario found that 71 per cent of physicians working with PAs reported that the PA had a positive impact on patients and 95 per cent of physicians working with PAs said that the PA had increased their own efficiency in providing care.
“Our model has been working well within the military and within Manitoba where I work, so the only thing that I can say is that there’s must be some trepidation or apprehension,” said Trevor Stone, national president of CAPA. “There are multiple other regulated health care professions in the B.C. and they don’t want to initiate another one, which I find contrary to what I think is happening in British Columbia — and other provinces — where there is a shortage of health care provisions across the board.”
Stone, who also grew up in B.C., began his career as a medic in the military but has practised in Manitoba since 2006.
“For the past several decades — for about 40 years — we’ve been part of the military as part of the health care family and in the last 14 we became viably situated within the civilian sector,” he said. “We’re really just an extension of the doctor and a resource in that many doctors have very busy clinics so additional eyes and ears can be very vital in the continuity of care. Many of our patients are familiar with us because they come back on a regular basis and the PAs practice is modelled after the physicians they work for so what we do is tied intrinsically to what our physician does.”
Physician assistants are clinicians educated in the medical school model and practice medicine under the direct supervision of a licensed physician, often within a multidisciplinary health team. They are highly skilled health professionals who can work in any clinical setting to extend a doctor’s reach, complement existing services, and help improve patient access to care.
In 2018, the Conference Board of Canada reported that if PAs could relieve more than 30 per cent of physicians’ time in all practice area, this could represent about $620 million in cost savings for the Canadian health care system. Pressure is mounting against the government, but there have been recent small victories. B.C. Green leader Andrew Weaver has become a vocal champion of physician assistants. At the annual conference of physician assistants in Victoria, he reportedly referred to PAs as a “largely untapped resource” in B.C.
Remaining optimistic, Chan echoes this sentiment.
“We’re trying to improve access to care and efficiency and effectiveness of the care without compromising the quality of care. That’s really important now because we’re so resource-strapped and we’re in a system where demand is going up as our population is aging and people are getting sicker but because of our medical technology, people are also living longer so we have a bigger demand but our budgets are shrinking. There are multiple ways to try to meet that demand and I think PAs are one of the ways that can help,” she said.
Modernizing B.C.’s Health Professions Act would allow PAs to assist in many realms, most notably to help decrease wait times. Since 2015, wait times have increased in B.C. and can also come with serious consequences including increased pain, mental anguish, and poorer medical outcomes.
“I find it really frustrating that there’s no recognition for us on the west coast,” said Stone. “We can make a difference and I think we’re being overlooked and I’m not convinced of the reasons why the B.C. government isn’t changing their attitude and allowing us to be recognized. It’s not like it’ll be like flipping a switch and see masses of us working in B.C. because that’s not realistic at all but we do have a skill set that can lead to improving the health care of British Columbians overall.”
Chan said she believes one reason there isn’t a big push in B.C. to add PAs into the legislation is that of awareness. People aren’t familiar with the work they do or the services they provide. Stone also agreed, adding that there are many students who, like Chan, have graduated from PA programs and are now working outside their home province.
“I love what I do and I love my work at CHEO and have a phenomenal team there but at the end of the day, the end goal for me is to work back here in Vernon,” said Chan. “I do have faith that it will happen eventually but it would be really nice to come home.”
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