Physician assistants are coming to emergency rooms, but what do they do?
While profession is new to many Canadians, it's been part of military for decades
The provincial government is promising to add physician assistants to emergency departments as part of a long list of planned changes to improve emergency care in Nova Scotia.
But what exactly do they do, and can they help deal with the broader health-care crisis?
The Canadian Association of Physician Assistants describes them as "physician extenders" who work semi-autonomously with a supervising physician to help improve patient access to health care.
Peter Thibeault, the association's provincial director, says physician assistants (PAs) have been working in the Canadian military for decades.
Manitoba was the first province to introduce them to the health-care system back in 1999. Today, they work in five provinces including Nova Scotia, where Thibeault says a small number are already helping patients.
Thibeault spoke with Information Morning Halifax host Portia Clark on Friday from a mining camp in northern Ontario, where he is currently working.
Their conversation has been condensed and edited for clarity and length.
First, remind us what physician assistants do. What's your scope of practice?
A physician assistant's scope of practice is very wide, actually. We can treat everything from a patient who has a common cold, to having a very bad day in the medical world, as we call it. We can do diagnosis, consults, prescribe medications, working along with the health-care team. There are positions for helping out with surgeries, performing minor procedures and doing patient assessments, education…. It's quite vast, what PAs can do.
And what's your relationship with a supervising doctor?
As long as we can reach out via phone, that's fine. You don't have to run every case by the doctor. As long as it's within your scope of practice and a PA feels comfortable, then they can carry on. I'm up here, way up north, as you said, and my supervising physician is 4.5 hours away. So if I have an issue, we can just call him, discuss the whole case and come up with a game plan, either have the patient come and see him or try a different way of treating them, and go from there. It's the same way Canadian military physicians' assistants do it when they're at sea on HMCS ships. The doctor's not there, so if they need a doctor they can do the same thing, make a phone call and get help.
How did you get into this line of work as a physician assistant?
I have 32 years in the military. I joined in 1990 and I progressed through the medical ranks and then met the criteria for a physician assistants program run by the military. (It's no longer run by the military, they gave it up to the universities.) And then I went to the military academy for two years, qualified as one of the first degreed physician assistants in Canada, with my classmates, and I've been a PA since 2009.
You work in Ontario, as you said, but you live in Stewiacke, N.S. You've been saying for a long time that PAs can help our health-care system here. And what are your thoughts about why that hasn't happened until now?
A lot of it is education. A lot of people don't know the value a PA can provide. I know in 2010 there was a big push ... and then I'm not exactly sure why it fell off the rails. But right now, it's the will of the current government and I'm very happy that it is, believe me — and I'm sure all Nova Scotians are. Right now the government wants this, and we're happy to provide PAs and the value PAs can provide to Nova Scotians.
It sounds like more of them will be working in all kinds of places. And there are already some who are in positions in Nova Scotia, is that right?
That is correct. I'm happy to announce that there was the orthopedic pilot project, and there were three PAs that were working in the QEII [in Halifax]. And that pilot project is now done. They saw the value of the PAs and their positions are now permanent. So I'm very happy to hear that. And currently, Nova Scotia has hired three PAs for the Dartmouth General Hospital, and there will be three PAs coming to Bridgewater General Hospital. So there's nine so far. The Canadian Armed Forces is employing their PAs at the Cobequid multi-service centre to continue their education. So if you were to go to there, you're likely going to run into a military physician assistant keeping up his skills.
And where do you see PAs helping in the situation we're in, and not just with emergency departments?
Well that's the key thing. I know everybody's talking about emergency rooms, but PAs can add more value in all aspects of medicine: family practices, walk-in clinics, operating rooms, in those kinds of areas. My own family doctor, his family practice, he would like to have a PA work there so he can see more patients in a more timely manner. Because you don't need to see a doctor for a cold, a physician assistant is more than capable to take care of it. And if there is something more than a cold, they can just reach out to their supervising physician, discuss it and carry on.
Do you see some hurdles to be overcome to get more PAs in place? I mean there's always the recruitment, but other issues as well?
The education piece is the big one. The other thing is that there aren't that many PAs. But when they put out the request or survey for what PAs would like to come to Nova Scotia, there were 64 that answered the survey to come and work in Nova Scotia for not that many positions. So that's very promising. The other thing is that around 3,000 people applied for 69 positions in three universities in Canada. The University of Toronto, McMaster University and the University of Manitoba are the only three Canadian universities that currently offer the PA program. So it would be fabulous if universities in Atlantic Canada that have a medical program would add a PA program.
What do you say to people who may not put their trust in a PA and just want to see a doctor? I don't know if you've run into that circumstance…
I have never run into that, even when I was doing my student rotations. It's just an education piece. If people would like to know what a PA is, all the information you want to know is on the website www.capa-acam.ca. There are PAs all over the world, so it's a valuable resource that's trusted.