May 1, 2020

Dear Premier Ford and Deputy Premier Elliott,

We are writing today regarding your government’s continued exclusion of physician assistants (PAs) as frontline health care workers who are eligible for temporary pandemic payments.

Your policy is an excellent measure that supports a wide range of health care workers who put their lives at risk every day during COVID-19. But we are disheartened that PAs remain excluded from the list of eligible workers, even following your clarification on April 28 where you rightly added paramedics, respiratory therapists, mental health and addictions workers in hospitals, and public health nurses.

We feel it is important for you to understand the impact of your decision on the morale of frontline PAs who are working under the most challenging circumstances that many have ever faced, just like their MD, RN, NP, and RT colleagues. I encourage you both to read the attached messages from our colleagues that describe in detail what they are doing for Ontarians.

PAs are some of the most flexible health care professionals working in our health system today. Our profession has been quickly mobilized to meet the evolving needs of emergency departments, cancer centres, surgical practices, long-term care residences, and many other clinical settings. And we have no doubt that as the impact of COVID-19 continues to be felt, we will all step up in new ways, whenever we are called upon, for the citizens of Ontario.

During the past month we have seen your government act quickly to address this crisis and we are all grateful for your decisive action and empathy. We are asking you today to do the right thing by making Ontario’s PA workforce eligible for the pandemic support.

We would be pleased to speak to you or your staff at any time. And again, on behalf of our members we thank you for your leadership during this very difficult period.

Sincerely,

Leslie St. Jacques, CCPA
President

Sahand Ensafi, CCPA
Provincial Director, Ontario

Patrick Nelson
Executive Director

Ken Crosby, CCPA
North Bay Regional Health Centre—Critical Care

“I am a working full-time in a Critical Care Unit. I don and doff PPE on a daily basis in assessing and managing patients with suspected COVID-19. The support of PAs has enabled the group of physicians I work with to take on significantly increased roles and responsibilities as part of our hospital’s pandemic plan.”

William Wilson, CCPA
Windsor Regional Hospital—Internal Medicine 

“I work in Windsor on the Metropolitan Campus as a PA in Internal Medicine. Our floor is deemed a hot zone, as we accept patients from ER, ICU and other parts of the hospital. I have been seeing and treating COVID-19 patients since the beginning of the outbreak. Our floor is either for COVID-19 positive or suspected patients with swab results pending and I am in contact with these patients on every shift, exposed just like every other health professional that works on my floor.”

Asma Husainy, CCPA
Etobicoke General Hospital—Infectious Diseases

“I am currently working directly on the frontlines of the COVID-19 pandemic. My supervising physician and I are consulted on the diagnosis and management of COVID-19 patients amidst other infectious disease consults. Our patients vary from newly diagnosed unstable COVID-19 patients in the emergency department requiring admission (including LTC patients from nursing homes with outbreaks), to those requiring ventilation in the ICU.

Amidst managing patients, we are discussing goals of care with families and providing a supportive environment during such difficult times. As guidelines are changing on a daily basis, we are constantly upgrading our knowledge to implement evidence-based medicine and to provide recommendations to all physicians and hospital staff for accurately managing patients.

Despite the risks, I am proud to be a PA during such challenging times and it is always an honour to serve my community, be a source of knowledge, and work as part of the team keeping everyone healthy.”

Maureen Taylor, CCPA
Michael Garron Hospital—Infectious Diseases

“As an Infectious Disease PA, I provide inpatient consults on the majority of patients with COVID-19 at Michael Garron Hospital.  Since March 16, I have seen between four and twelve COVID-19 patients on a daily basis, providing guidance regarding the use of investigational therapies and whether there is any indication for antibiotics for concomitant bacterial infections.

I also help determine the duration of admission and when patients can be considered “resolved”, as this is based on symptom onset date and resolution of symptoms rather than on a negative swab. I help patients interact with family members who cannot visit them in hospital. I answer their anxious questions about their options should they deteriorate, and I facilitate goals of care discussions so that patients understand concepts such as intubation, mechanical ventilation, and Do Not Resuscitate orders.

Although I have not kept track, I estimate I have personally cared for at least 35 patients with COVID-19 with mild, moderate and severe infection. I spend my free evenings enrolling COVID-19 patients for research spearheaded by the Toronto Invasive Bacterial Diseases Network.”

Joshua Diamante, CCPA
Family Medicine and Long-Term Care

“I am currently 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 as 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 hospital transfer, as per their previous 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 of COVID-19. 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.”

Jessica O’Neil, CCPA
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 for their loved ones, 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 caring for this vulnerable population and their families during this unprecedented time.”

Medical Affairs
Hamilton Health Sciences

“Hamilton Health Sciences has enhanced its workforce by developing a COVID-19 Physician Assistant Support Team.  This team is comprised of 12 PAs appointed centrally to the Medical Affairs Department to be deployed to high-risk areas, as needed during the pandemic.

Medical Directives were developed in collaboration with the Chiefs of the Departments of Medicine, Critical Care, and Emergency Medicine.  These Medical Directives enable the fluid transition of PAs across each of these departments.  Given the uncertainty of health care demands during the COVID-19 pandemic, the ability to redeploy medical staff quickly was identified as a key component to adequately meeting patient care needs.  With that guiding principle in mind, the PA Support Team was trained and upskilled in each area and across all sites at HHS. The result is a highly skilled, versatile group of PAs with the ability to shift quickly between areas to deliver care when and where is it needed most.”

The Canadian Association of Physician Assistants issued the following statement after the Ontario government announced a new list of health care workers who are eligible for the COVID-19-related wage boost.

“On Tuesday the Ford government expanded the list of workers eligible for “pandemic pay” to include Paramedics, Respiratory Therapists, and Public Health Nurses, but not Physician Assistants (PAs).

During the worst public health crisis of the past century, we are concerned that this sends the wrong message to PAs working on the front lines every day and we urge the Premier and Minister of Health to reconsider.

As medically trained clinicians, PAs are trusted members of health care teams who work alongside physicians, nurses, and other professions in the same challenging conditions. Since the beginning of the outbreak, PAs have been assessing patients in emergency departments, providing medical care in critical care units, and swabbing patients in testing centres. We have PAs on dedicated COVID-19 hospital wards and being hired to help with the increased number of ICU patients. PAs in long-term care have been caring for older patients with complex needs who are at the highest risk of dying from COVID-19.

The recognition that PAs are medical professionals providing direct, frontline patient care is important to morale, especially when we are putting ourselves at risk to care for others. Like many frontline health care professionals, we are facing great challenges and making significant personal sacrifices to help keep Ontarians safe and healthy.

CAPA is the national voice for PAs and represents the interests of 500 PAs in Ontario. Since the government’s initial announcement on April 25, we have heard from our members who are shocked and disappointed by this oversight. As the voice of PAs, we will continue to advocate strongly for our profession to be appropriately recognized.”

Leslie St. Jacques, CCPA
President

Sahand Ensafi, CCPA
Provincial Director, Ontario

About the Canadian Association of Physician Assistants
The Canadian Association of Physician Assistants is the national voice of Physician Assistants in Canada. We support quality standards and competencies and help establish the profession within the national health care framework. Learn more: capa-acam.ca.