The Physician Assistant (PA) profession evolved in the United States during the mid-1960s, in response to a shortage and uneven geographical distribution of doctors. The PA profession alleviated doctors from performing routine technical tasks in hospitals allowing more patients to be served and physicians to focus where their skills would be better utilized. This rapidly evolved to include utilizing PAs in primary care settings. The first trainees were highly skilled military medics who, following Vietnam War service, had no equivalent medical role in civilian life. Programs were developed that build on their qualifications and experience, leading to the establishment of the physician assistant (or physician associate) profession.
These days, PAs continue to be a safe and effective part of the U.S. health system with almost 130,000 practicing PAs and 225 accredited programs. Globally, as of 2017, the PA profession is in over 40 countries[1].[1] Hooker, RS, Cawley JF, Everett CM. Physician Assistants Policy and Practice 4th ed. Page 2. 2017 FA Davis and Company; Philadelphia Advanced Care Professionals performing as primary care clinicians and medical assistants have served the Canadian Armed Forces (CF) since the 1900’s as Sick Berth Attendants or Military Medics. In 1984, the Canadian Armed Forces adopted “Physician Assistant” as the role for senior medics bringing it to the attention of physicians across Canada. In 1991, the Canadian Armed Forces officially changed the name of the Senior Medical Technicians or 6B medic to Physician Assistant. The Canadian Military PA graduates are the first formally trained Canadian PAs. In 1997, Warrant Officer Thomas Ashman and other senior PAs conceived the idea of a National Academy of Canadian PAs. In October 1999 the Canadian Academy of Physician Assistants (now the Canadian Association of Physician Assistants - CAPA) was formed with support of the Canadian Armed Forces. Thomas Ashman was elected founding president. CAPA’s goal was to be a national professional organization that advocated for Physician Assistants and represented its membership across Canada (By PAs for PAs)[1].
In 1999, the Canadian Armed Forces supported the development of CAPA’s goal of self-sufficiency and expansion to public health sectors. In September 2001, CAPA, with assistance from the Canadian Armed Forces Health Services School, developed the Occupational Competency Profile for Canadian Physician Assistants. In June 2003, the Canadian Medical Association recognized Physician Assistants as a unique health professional. This recognition paved the way for a national educational accreditation process to begin. In June 2004, the CMA Conjoint Accreditation Services surveyed and accredited the Canadian Forces Health Services School PA Education Program. In 2005, the first Physician Assistant Entry-to-Practice Certification Examination (PA Cert Exam) established a Canadian standard of quality and professionalism. In 2009, and then subsequently in 2015, updates to the National Competency Profile and Scope of Practice for Canadian physician assistants (now CanMEDS-PA) were published. CanMEDS-PA establishes the standards, professional roles, and competency requirements PA educational programs must achieve with their graduates.
In 2021, and with the experience and feedback gathered from PA program leadership, previous accreditation cycles, and practicing PAs, Canadian PA educators proposed an updated competency framework reflecting competency-based medical education titled: Canadian Physician Assistant Competency Framework 2021 (Canadian EPA-PA). The purposed of this document is to identify the competency-based goals and Entrustable professional activities for Canadian PA education programs. Competency-based education allows for an outcomes-based approach to curriculum delivery that directly assesses learner preparation for clinical practice, patient navigation, and resource application.
In September 2002, the Canadian Armed Forces Physician Assistant Program inaugurated a redesigned 24-month curriculum to align with requirements for accreditation by the Canadian Medical Association (CMA). In 2008, two additional PA education programs at the University of Manitoba and McMaster University began. The PA Consortium (the University of Toronto, Northern Ontario School of Medicine, and the Michener Institute for Education at UHN) launched the third civilian program and fourth Canadian PA program in January 2010. The Canadian Medical Association has accredited all current Canadian PA Education programs[2].
In 1999, Manitoba enacted legislation regulating Physicians Assistants under the title of Clinical Assistants - Certified. In 2009, an amendment made to the Manitoba Medical Act established a separate PA registry and protected the title and practice of Physician Assistant. The province currently (2017) has PAs practicing in 32 different medical and surgical specialties.
In May 2006, the Ministry of Health and Long-Term Care for Ontario (MOHLTC) announced the inclusion of PAs in Ontario’s provincial health care system. The first PAs began to work the as part of the first phase of a pilot project. This was later rolled into the Ontario Demonstration Project in 2007 aimed at evaluating the impact of PAs in the Ontario healthcare system. The province of New Brunswick followed suit in 2009 when the College of Physicians and Surgeons of New Brunswick announced that licensing for PAs under their Medical Act. In January 2010, Regulation 14 established the terms of practice for PAs in the New Brunswick and subsequently in 2014 awarded prescriptive rights.
In December 2010, the Medical Council of the College of Physicians and Surgeons of Alberta (CPSA) passed a bylaw allowing PAs to register as non-members. In 2013, Alberta Health Services at the direction of the Minister of Health launched their successful PA Demonstration Project. Alberta PAs are supporting Rural Primary Care, and Urban Hospital settings including Surgery, Medicine, and Obstetrics. In 2014, the Alberta Minister of Health supported regulating the PA profession in the province under the College of Physicians and Surgeons of Alberta submitting a proposal to the Provincial Cabinet. As of this August 2017, CPSA regulation of PA has not yet been approved.
For a list of historical events related to the Canadian PA profession, read this document.
[1] Chapman, Maurice. THE HISTORY OF THE CANADIAN ACADEMY/ASSOCIATION OF PHYSICIAN ASSISTANTS (CAPA)
1999-2012. 2012 Unpublished CAPSTONE Thesis MPAS Degree University of Nebraska Medical Centre
[2] As of 2017, Canadian Forces Health Services Training Centre – Physician Assistant Program; the University of Manitoba Master of Physician Assistant Studies; the McMaster University Physician Assistant Education Program; d the Consortium of PA Education (University of Toronto, Northern Ontario School of Medicine and The Michener Institute for Education at UHN) Physician Assistant Education Program have achieved Accreditation.