Popularity of physician assistants grows as numbers expand throughout healthcare system

Popularity of physician assistants grows as numbers expand throughout healthcare system

Written by Mark Cardwell on November 26, 2015 for CanadianHealthcareNetwork.ca

Dr. Darlene Bilawski and physician assistant Dwayne Lyall. “Hiring a PA allowed me to take on an additional 500 patients,” Dr. Bilawski said.

Two years ago, Dr. Darlene Bilawski followed a friend’s advice and hired a physician assistant for her busy family medicine practice in Barrie, Ont. Now she encourages other doctors to do the same.

“My practice has become a lot more interesting and fun since (PA Dwayne Lyall) started working with me,” Dr. Bilawski told the Medical Post. “He is well-trained and experienced (and) we share patients and discuss cases all day. It’s like having a colleague in my office.”

Forty years after being introduced into Canada through the Canadian Armed Forces, PAs are now one of the fastest-growing professions on the Canadian public healthcare landscape.

First introduced in Manitoba 14 years ago, PAs are also now active in Ontario, New Brunswick and, most recently, in Alberta in 2013. There are currently some 500 PAs practising across Canada, 300 of which are in Ontario. Many are former members of Canada’s military, which churns out some two dozen graduates from its University of Nebraska-recognized PA program based at Canadian Forces Base Borden, near Barrie, Ont.

“We’ve really come a long way in the past few years,” said Deniece O’Leary, Ontario chapter president of the Canadian Association of Physician Assistants.

The latter notably sponsors National Physician Assistant Day, today, Nov. 27, which is intended to raise public awareness about the profession and the impact its integration is having on our public healthcare system.

A PA with the Hamilton Family Heath Team, and a course director for University of Toronto’s PA program (one of two degree-granting programs in Ontario, the other being McMaster University), O’Leary said PAs provide a plethora of services in front-line clinical settings that can reduce wait times and increase access to primary care.

“PAs help to optimize patient care by working alongside physicians and other health professionals,” she said. “In a family practice, for example, PAs can be assessing one patient while the physician is seeing another.”

Though similar in many ways to nurse practitioners, PAs receive medical resident-like training in various specialities—from orthopedics and internal medicine to preventative medicine and acute care—which enables them to collaborate closely with physicians.

Regulated in Manitoba and New Brunswick by the college of physicians and surgeons in those provinces, but unregulated in Ontario and Alberta, where they are allowed to practise by way of delegation under the Medical Act, PAs can’t write prescriptions or fill out forms for CAT scans and other diagnostic tests.

PAs have many of those privileges in the Canadian military, however, where they play an integral role in front-line medical services, notably in the country’s 43 care delivery units(CDUs) where military base populations are rostered.

“They are rock stars, we love them,” Lieutenant-Colonel Anne Bouchard said from Ottawa, where she is a general medical officer and senior staff officer for standards and policy in the Canadian Armed Forces directorate of medical policy.

A former commanding officer of Canada’s medical contingent in Afghanistan, LCol Bouchard said PAs play critical roles in battlefield hospitals, as well as with infantry units in the field. “They are often called on to deal cases that would challenge even the most highly trained and experience emergency care physician,” she said.

Though unaware of the exact numbers of PAs in the military—“One thing I can say is that we don’t have enough of them”—LCol Bouchard said the military is facing recruitment and retention problems as a result of PA integration into the public healthcare system. That has led to the military’s recent decision to stop training PAs within two years, and to transfer training to Canadian universities.

“It’s very time-consuming and costly for us to train them,” said LCol Bouchard. “We’ll let the schools do it, and we’ll hire the graduates, like we do with doctors.”

The military’s loss is the public healthcare system’s gain, said Dr. Bilawski. “Hiring a PA allowed me to take on an additional 500 patients,” she said. “Many of them hadn’t had a family doctor in years.”


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