Thread: Do physician assistants have a role to play in Canada?

Do physician assistants have a role to play in Canada?


By Patrick Sullivan

Physician assistants (PAs) have been part of mainstream medicine in the US for 40 years, but outside the military are all but unknown in Canada. That may be about to change.

At an April meeting in Ottawa, experts from both sides of the border discussed whether there is a broader role for these "physician extenders" to play here. (A longer report on the meeting is available.)

The invitational seminar, the first of its type in Canada, was sponsored by the CMA and Canadian Forces. With the worrisome staff shortages that plague health care in Canada, some observers are wondering whether PAs might offer a potential solution here.

In the US, PAs are specially trained professionals whose work must be supervised by an MD. Unlike nurse practitioners, who have their own scope of practice and are regulated separately from physicians, PAs cannot work independently. They are allowed to prescribe some drugs and order some tests, and many specialize in specific fields, such as orthopedics.

In Canada the Canadian Forces employ 130 PAs and produce 20 to 24 new ones annually. A handful work elsewhere, particularly in isolated locations such as oil rigs. Manitoba, where they are known as clinical assistants, is the only province to regulate them.

In the US, roughly 70,000 PAs are employed and more than 130 two-year PA programs produce thousands of new graduates every year.

Dr. Stan Oleksinski, who represented the CMA Board of Directors at the seminar, said the CMA co-sponsored it because of the lack of knowledge about PAs, who have been part of the association's conjoint accreditation process since 2003.

Oleksinski said the seminar, which proved so popular a waiting list had to be created, was designed "to respond to numerous inquires from physicians, health care facilities and educational institutes."

Captain (Navy) Hans Jung, a physician, noted that PAs have allowed the military to "extend its physician resources," and this is an important factor because the armed forces face a constant shortage of MDs - a problem they share with many Canadian communities. "I think PAs are ideally suited for Canada, especially its underserviced areas," he said.

Dr. Pierre Ozon, a former military physician who serves as medical director of the Canadian Forces PA Training Program, added: "It is apparent that the PA/physician model is based on trust of skills and knowledge, and this trust has its roots in the quality of training. Our CMA-accredited program is as rigorous and challenging as any PA program in the US."

The CF's PA training is open to personnel who have at least 10 years' military experience and a medical assistant/paramedic background; the training takes two years.

Dr. Charles Sun, an emergency physician with the Vancouver Island Health Authority, said "the sky's the limit" in terms of PA employment in Canada, but two potential areas stand out: remote communities and towns that have one or two physicians and face retention problems because of onerous on-call duties.

Dr. Rod Hooker, a PA employed by the Veterans Administration in Dallas, described physician assistants as a cost-effective way to extend physician resources, particularly in areas where primary care is in short supply.

Dr. Patricia Cook, medical director of the PA program at the University of Texas Southwestern Medical Center in Dallas, said the philosophy of the PA profession "is that they are dependent practitioners who work in a collegial relationship with physicians. PAs won't replace a hip, but they will be first assistant as it is being replaced."

Some major issues will have to be resolved before PAs become part of Canada's health care landscape. A key concern is physician legal liability if a PA they are supervising faces a work-related lawsuit.

Dr. Jim Sproule of the Canadian Medical Protective Association warned that physicians must ensure that PAs have their own liability coverage before agreeing to supervise their work. Kent MacDonald, a former Canadian Forces PA who heads the Canadian Academy of Physician Assistants, said inquiries have already been made to insurance underwriters, "but we need a critical mass [of PAs] in Canada to make it affordable."

Cook predicted that this critical mass may develop sooner than expected. "Remember this meeting," she said. "You will be glad to be able to look back and say you were here at the start."


© Canadian Medical Association or its licensors 2005

is there any opportnity for international medical graduates to work in military forces as Physician assistant

Originally Posted by asma

is there any opportnity for international medical graduates to work in military forces as Physician assistant

i realize this is old but if someone later reads it and shows interest...you can actually work as a full doctor in the canadian military...with a bit of additional training, but it's pretty much paid for

I had a lot of respect for those guys when I was in the canadian forces....until one of them diagnoses me a cold (it was rather a nasal polyposis); and until another one diagnoses me a mononucleosis - without having the blood test results - ...it was a dehydration.

They can certainly help, but I think their practice must be seriously supervised. I'm just concerned when some people play doctor without having the academic formation. I have also seen some nurses doing the same...with some bad consequencies.