Physician assistants can help strengthen Ontario’s long-term care workforce

Dear Minister Fullerton and Deputy Minister Steele,

On behalf of physician assistants (PAs) across our province, we thank you for your tireless dedication to the wellbeing of Ontario’s seniors and your tremendous support of frontline health care professionals throughout the COVID-19 pandemic. Your efforts are greatly appreciated.

Given that your ministry recently asked certain long-term care (LTC) homes to submit detailed plans on how they will stabilize the spread of the virus, ensure the provision of onsite medical coverage, and keep staffing levels up, we are writing to provide information on the PA model of care in LTC.

We would be pleased to discuss this model with your officials and are requesting the opportunity to speak by phone at the earliest opportunity.

The attached briefing note and our recent position statement summarize the PA role and broadly outline the positive impact PAs have on the delivery of care in LTC homes. As you consider our recommendation to expand and further integrate PAs in eldercare, we invite you to read the messages below from PAs working at the frontline of the crisis:

“I am working within a family medicine practice in addition to my involvement within a retirement community and LTC home. Since April 2020, we have had approximately 70 cases of COVID-19 within our residence. I am the sole clinician coming in to assess COVID patients. My physician has been supervising remotely, as they do not want to be exposed to the virus.

I am assessing all these patients, performing NP swabs, and performing follow-up visits as well as communicating with families. For patients who rapidly deteriorate, I have performed palliation and comfort measures within their home to avoid transfer to hospital, as per their wishes and goals of care.

I have personally sat with many of them as their journey ended, as their family could not be present due to current circumstances. Without PA support within my retirement community, the nursing staff and families would be left unsupported and without a doubt patient care would have suffered.”

Joshua Diamante, Physician Assistant
Family Medicine and Long-Term Care

“With the increased demands on my supervising physicians at the local rural hospital to support COVID-19 measures, I am increasingly the physical presence within our long-term care home.

My role has evolved since the start of the pandemic and involves supporting the care of all 200+ residents within the long-term care facility. I often function as the first point of contact for assessments, maintain lines of communication with families regarding goals of care, transition residents to palliative care, help develop protocols related to preventing the spread of COVID-19, and facilitate twice weekly physician rounds through video conferencing.

As a PA in long-term care, I am undoubtedly part of the pandemic health care workforce and it has been a privilege to care for this vulnerable population and their families during this unprecedented time.”

Jessica O’Neil, Physician Assistant
Family Medicine and Long-Term Care

Since the outset of the pandemic, we have seen your ministry act quickly to protect our most vulnerable citizens. With officials projecting that Ontario could be dealing with the effects of COVID-19 for up two years, now is the time to consider new workforce strategies that will effectively strengthen our LTC system over the long term.

Today, CAPA submits our brief in the spirit of collaboration and innovation. We strongly believe that by integrating the PA model of care, your government can improve medical coverage, efficiently use skilled resources, and increase capacity during a surge in COVID-19 cases.

Thank you in advance for your consideration. And, more importantly, on behalf of our members we thank you again for your leadership and compassion during this very difficult period.

Sincerely,

Sahand Ensafi, CCPA
Provincial Director, Ontario

Patrick Nelson
Executive Director

SickKids maximizes frontline PA team in virtual Emergency Department workflow

In a new First View Commentary in the Canadian Journal of Emergency Medicine authors Dr. Daniel Rosenfield, Jordan Levinter, CCPA, et al. outline how Toronto’s SickKids hospital established novel roles for self-isolated physicians and its frontline PA team during COVID-19.

The authors describe how self-isolating physicians work as a “virtual attending” and use the PA team to help with gathering history, performing physical examinations, providing discharge instructions, and more. The article also examines issues around patient selection, communication, and medicolegal risks.

“By implementing creative staffing configurations, leveraging off-site access to EMRs and modern communication tools, these individuals [isolated physicians] can still contribute meaningfully to the operations of the department.”

How the military prepared me to treat COVID-19

William (Bill) Wilson MPAS, CCPA, CD is a Physician Assistant in Internal Medicine. He wrote a Guest Column for the Windsor Star about his experience as a former Canadian Armed Forces medic and PA, and his current work as a PA at the Windsor Regional Hospital. Read his column: How the military prepared me to treat COVID-19.

Physician assistant and Canadian soldier Bill Wilson, taken in Kandahar, Afghanistan, circa April/May 2002. Photo courtesy of Bill Wilson and published in the Windsor Star.

Alberta Health Minister Responds to Calls for PA Regulation

On Friday, May 8 we were thrilled to see Minister of Health Tyler Shandro and UCP MLA Shane Getson discuss physician assistants in the Alberta legislature.

This follows our April 23 letter and briefing note to the Minister recommending an earlier timeline for regulation and identifying how PAs could be better leveraged during the pandemic. We also reminded the government that PA regulation aligns with the McKinnon Report recommendations to maximize the scope of practice of other health care professionals.

New study identifies factors that support and restrict Ontario’s use of PAs

In a new open-access study published in BMC Health Services Research author Dr. Kristen Burrows et al. explore the integration of PAs across multiple health settings and aim to help policy makers understand the role of PAs in complex adaptive systems.

Ontario introduced PAs in 2006 to address wait times, improve access to and continuity of care, and add a flexible resource to the workforce. But misaligned policies around reimbursement and incentives are resulting in diverging interests among physicians and PAs.

“PAs are playing a vital role in the delivery and support of healthcare within a multitude of settings as adaptable and collaborative team members focused on person-centered care. As the PA profession continues to expand into new jurisdictions, findings from this study help fill existing knowledge and practice gaps regarding the role of PAs. Documenting the central role of PAs will continue to inform the design and dissemination of research in order to optimize health care system efficiencies though PA integration.”

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