Remarks to B.C.’s Finance Committee on Budget 2021

Below are remarks delivered on June 10, 2020 by Eric Demers, Past-President, to British Columbia’s Select Standing Committee on Finance and Government Services.

Good Morning and thank you, Mr. Chair and Honourable Members, for the chance to speak to you today about our recommendations on the introduction of physician assistants, more commonly known as PAs, in B.C.

I am the Past-President of the Canadian Association of Physician Assistants. We’re the voice of more than 700 PAs who work in public health systems and the Canadian Armed Forces. Here in B.C., we have almost 30 PAs, most of whom serve in the Forces.

Before I tell you what a PA is and the value we can bring to the health system, I want to share part of my story.

I served for 23 years in the Canadian Armed Forces. First, I was a Medical Technician, aka a medic, and later I progressed in my career and my medical training to become a certified PA. I trained to provide medical support to Canadian troops and populations in need. In armed conflicts, disasters, and domestic operations like the Olympics and G8 summits. I spent three years serving on submarines where I was the only PA on board and the lone medical professional providing primary and specialized care to the crew of more than 50 sailors.

I was also deployed to places like Libya, where as a PA I oversaw the health needs for the diplomatic mission and its security. And during my time as a medic I had the honour to deploy many times, including to Afghanistan, and care for our ill and gravely injured.

It has been challenging to be in Victoria and not have the opportunity to care for those in my community, never more so than during this pandemic. And that’s because PAs are not recognized here and cannot work here, despite the obvious need and strong support from Doctors BC, the College of Physicians and Surgeons of British Columbia, the BC Care Providers Association, the BC Rural Health Network, and others.

So instead of contributing in my community during the worst public health crisis we’ve ever seen, I travel across borders, as an essential worker, to deliver healthcare in a remote area.  I’m part of a team that includes B.C. physicians who supervise PAs from afar.

But if I, or any of my colleagues, could work here to our full scope of practice, here is how we could help:

Rural emergency departments in places like Ashcroft could stay open on weekends, instead of the closures we see thanks to doctor shortages. That’s because PAs can help manage departments, with local doctors providing oversight and available for urgent cases.

There would be more flexibility in the type of provider that can be recruited by rural and remote communities, including some First Nations communities. A full-time PA provides important continuity in areas where locum doctors may come and go. And with a broad scope of practice, PAs can help with everything from emergency services, women’s health, mental health, and chronic disease management.

And in long-term care the workforce would be strengthened. Studies show that PAs on staff in long-term care homes help reduce transfers to hospitals, improve patient safety, and save money. And we help eliminate delays in care and perform more procedures in-house.

PAs, like nurse practitioners, are advanced practice professionals. We are educated in the “medical model”, which means our training is similar to that of Canadian doctors. We work autonomously under the supervision of licensed doctors to deliver primary, acute, and specialty care in all types of clinical settings. PAs are trained to assess patients, order and interpret tests, make diagnoses, provide treatment, serve as first assist in surgery, and much more.

Today, B.C. lags behind Ontario, Manitoba, Alberta, New Brunswick, and countries like the United States, United Kingdom, Netherlands, and Germany in terms of integrating PAs in the health care workforce.

In its recommendations to governments, the Conference Board of Canada says: “PAs play a vital role in improving patient outcomes and reducing overall system costs. Canada needs to implement strategic policy and funding changes to the way that health human resources and health services are currently delivered.”

The Conference Board also reports that the Canadian health care system could save over $600 million dollars if the use of PAs increases across the country.

Today, CAPA recommends to the Committee that the provincial government recognize and regulate PAs under the College of Physicians and Surgeons of British Columbia.

We also recommend that the government earmark $6.5 million in funding to hire 50 PAs over the course of the next three years and work with doctors, health system leaders, First Nations, and other stakeholders to identify where the PA model can have the greatest impact on patient care.

And lastly, we recommend that the government explore the creation of a PA education program through UBC that could establish a homegrown pipeline of PAs.

The coronavirus pandemic has swiftly changed our long-held beliefs about how we deliver care in this province. Some say we pushed the telemedicine revolution forward by at least a decade or more.

It’s time to make the same progress in our health care workforce. The PA model can help B.C. provide more care at a lower cost, while helping doctors focus on the complex patients who truly need their expertise.

Budget 2021 is an important opportunity to change the workforce landscape in our province in a way that will benefit generations to come. Thank you.