MIDLAND – This letter is a follow-up to David Gravelle’s column in the physician section of last week’s paper.
He says we need two doctors to replace every one doctor retiring. In the traditional health-care model, this is true. Today’s doctor does not take on as many patients. Plus we have an aging population, which leads to more complexity and thus more time per patient.
We are missing out on an important opportunity in north Simcoe – the physician assistant (PA).
PAs are qualified to fulfil many duties that would free up the time of the general practitioner (GP). We are already seeing incredibly reduced wait times in emergency rooms that employ PAs and, in medical offices employing PAs, patients are able to access health care quickly and with greater ease. Read more..
Priya Narula is a Physician Assistant (PA) currently working in Toronto, Ontario at LMC Diabetes and Endocrinology. Her current role as Manager, Medical Services encompasses managing a team of PAs, training medical assistants and being a liaison to all of the endocrinologists across the 9 sites in Ontario, Quebec and Alberta; along with fulfilling her duties as a PA in managing diabetic patients with her supervising physician, Dr. Ronnie Aronson.
Priya is originally from Queens, New York where she completed her PA training from St. John’s University SVCMCNY in 2003. For the next seven years, Priya practiced at an internal medicine/ cardiology solo physician practice. From 2011 to 2012, Priya was at the University of Manitoba as a Clinical Lead. In the summer of 2012, Priya had joined LMC Diabetes & Endocrinology as a diabetes PA under the supervision of Dr. Ronnie Aronson. LMC comprises of 9 sites- 7 in Ontario, 1 in Montreal and 1 in Calgary. The Practice Program at LMC provides the largest group of non-academic endocrinologists in the world and a nationally accredited Diabetes Program. There are 25 endocrinologists with 2 nephrologists plus 24 diabetes educators consisting of registered nurses and registered dietitians. Currently there are a total 4 PAs at the Toronto, Etobicoke, Markham and Thornhill locations who are not employed as part of the pilot project from the Ministry of Health.
Dr. Ronnie Aronson is an Endocrinologist, Research Scientist, founder and Executive Director of LMC Diabetes & Endocrinology – a network of 9 Endocrinology Centres of Excellence in Ontario, Alberta and Quebec. The clinics provide a nationally-accredited Diabetes Education Program, a practice group of >30 specialists in endocrinology & diabetes following 40,000 active patients, and Canada’s largest research network in diabetes. LMC also provides Canada’s only Phase 1 research facility, dedicated to research in diabetes and related metabolic disease.
LMC has been repeatedly nominated as a Best Workplace™ in Canada. Dr. Aronson has been Principal Investigator in over 240 clinical research trials in cardio-metabolic risk factors such as diabetes, obesity, lipid disorders and hypertension. Dr. Aronson serves as a consultant to many of Canada’s largest pharmaceutical and device companies in both drug development and marketing, as well as in health care provider education. What Priya enjoys most about her role is the difference she is making in the lives of patients and the variety she has as a Manager, Medical Services. Her current role not only involves treating patients with diabetes and diabetic disorders but also managing a team of PAs and acting as an educator for other health professionals.
Moms, Babies and PAs
Michele Poirier Amantea, CCPA and Dr. Niki Panich, BSc (Hon), MD, CCFP
Michele Poirier Amantea is a physician assistant (PA) practicing in Calgary Alberta. Her area of specialty is maternity care and obstetrics. Michele is originally from rural Manitoba and has an undergraduate degree in Kinesiology from the University of Calgary. She completed the University of Manitoba Physician Assistant program in 2011. Upon completion of the program, Michele moved back to Alberta where she did contract work in a variety of settings. She also did a lot of ground work to create the first Physician Assistant job in Alberta. Michele was initially hired as an Active Living Coordinator by the Mosaic Primary Care Network (PCN). Soon afterwards, the PCN Executive Director came to learn more about Michele’s PA background and knew there was both a role and a fit for her working with Dr. Niki Panich, PCN Board Member. One year later, the first Physician Assistant job in Alberta was created, working under the supervision of Dr. Panich with the Maternity Care Clinic low risk obstetrics group.
Dr. Panich grew up in Alberta. She did her undergraduate science degree at the University of Alberta and studied medicine at the University of Calgary. She completed a rural family medicine residency based out of the University of Western Ontario in London. Since 2007, she has been practicing family medicine with a strong-focus on low risk obstetrics in Calgary. Dr. Panich and her partner physicians run a full time prenatal clinic and deliver 120-150 babies per month at the Peter Lougheed Centre in northeast Calgary. The patient population is very diverse, often requiring the use of interpreters and translation services, as well as an understanding of different cultures. These important issues necessitate an element of time, a precious piece in the world of medicine.
Adding a Physician Assistant to the practice has helped manage flow of patients, especially post-partum cases in the hospital while the on call physician is in a delivery or assisting the obstetricians in caesarian sections. Michele manages postnatal care and newborn exams as well as prepares patients for hospital discharge. She is able to order appropriate tests for moms and babies in hospital. She also assists with initial prenatal assessments at the MCC clinic. She looks after any prenatal medical issues that need follow up and initiates referrals as required. Michele also plays a role prenatally in seeing patients that are referred to the clinic late or have had little prenatal care and require more time to ensure that the appropriate tests have been done and follow up is organized through to delivery. Most recently, Michele has been working alongside a lactation consultant in a newly established drop-in clinic for moms and babes that focuses on breastfeeding, however, can also be a place for new moms can discuss any issues that have arisen after their discharge from hospital.
Michele really enjoys her role working with young families and new moms both pre- and postnatal. She has great satisfaction in knowing that she is making a difference in the lives of the patients she sees. Most exciting for Michele and Dr. Panich is the growing scope of practice as the team works together to optimize patient care for families as they go through a very exciting time in their lives.
PA/MD Team, Downtown Toronto Doctors a Recipe for Success
Chris LeBouthillier and Dr. James McNally are improving access to care for patients in their downtown Toronto clinic.
Chris and Dr. McNally met when Chris was having his blood work screening tested for PA School. Dr. McNally had not heard of the PA program before meeting Chris and was curious enough to spend some extra time discussing the program. During a follow-up visit, Chris asked Dr. McNally if he would consider taking him on as a student. Dr. McNally agreed and after his successful clerkship, Chris brought up the subject of full-time employment. Having first-hand experience of the benefits that a PA could bring to his practice, Dr. McNally offered Chris full-time employment, to work under his supervision at a new clinic that he was planning to open. Two years later the partnership between these two health professionals could not be better.
Dr. James McNally grew up in Alberta and studied medicine at the University of Alberta. He did an internship in New Zealand. When he returned to Canada in 1980, he settled on Manitoulin Island, Ontario and practiced general rural medicine, based in a 24 bed hospital. In 2001 he moved to Toronto, switching from rural medicine to downtown urban family practice. In 2011, he and his MD partner, Dr. Alya Rahim, started their own family practice clinic and he hired Chris to work with him. Having Chris on staff has enabled Dr. McNally to provide more complex diverse care to his patient population. In addition to Dr. McNally and Dr. Rahim, the clinic has two associate physicians and Dr. Rahim will be hiring her own PA this fall.
Chris originally from Sudbury, Ontario has an undergraduate degree from Laurentian University in Health Promotion. He is also a recent graduate from the McMaster University Physician Assistant program. Upon graduation Chris travelled to Zimbabwe in the summer of 2011 to volunteer at Howard Hospital doing hospitalist medicine and minor surgical procedures. Immediately upon his return he began working with Dr. McNally.
In the Downtown Toronto Doctors clinic, patient satisfaction is high. Patients can be seen same day or the next at all times. Having a PA on hand has enabled the clinic to expand their roster of patients without issue thus increasing the number of individuals that the clinic is able to serve. Patients understand the PA/MD relationship and there is no issue with Chris providing care. In fact there are instances where patients are calling to book appointments with Chris directly. Dr. McNally could not be more pleased with the level of care that Chris is providing. He feels that having a PA helps to provide better patient care through increased appointment availability, shortened wait times, and more flexible management of a larger patient roster. In addition, having a PA to share the workload, helps to prevent burnout and allows each of them to spend more time with complex patients, without worrying that the patient queue is backing up. Chris enjoys his role tremendously and is thankful to be part of a team that has such a high level of respect for his skills and abilities.
After having worked with a PA for almost two years, Dr. McNally states “I think that PAs are destined to become an indispensable part of health care in Ontario.” Dr. McNally is very supportive of the PA role in Canada and often has been the first to approach other physicians to tout the benefits that this health profession can bring to any medical practice. Both Chris and Dr. McNally look forward to a long and prosperous working relationship and improving patient care, one step at a time.
Kim Baril is a Physician Assistant (PA) working in Winnipeg, Manitoba. Kim has been employed for a little over a year at Concordia Hospital. Kim started her PA career in joint replacement surgery and family medicine. Currently 50 percent of her time is dedicated to joint replacement surgery and the other 50 percent is working in family medicine. At Concordia Hospital, she works with a hospitalist who manages the medical issues for the orthopedic surgery patients and physicians in family medicine.
Kim has Bachelor of Arts in Developmental Psychology from the University of Manitoba and a Bachelor of Science in Kinesiology from the University of Winnipeg. Upon graduation, she worked as a research coordinator in joint replacement surgery at the Hip & Knee Institute where her interests shifted from biomedical engineering driven research to clinical interests in medical training. She applied to the PA program at the University of Manitoba and graduated in the fall of 2011.
Kim thoroughly enjoys her current role. The patients are either general family medicine inpatients or orthopedic surgery patients. The orthopedic patients mostly require hip and knee replacements, some shoulder replacements or have upper and lower extremity fractures. The patients range from young, healthy, active patients, to elderly patients and those with multiple comorbidities and long rehabilitation requirements.
What Kim likes most about her position is the tremendous amount of variety working between surgery and family medicine. In her practice she sees both young adults and older geriatric patients in this setting. Kim regularly see patients in their late 90′s and even a 100 year olds who are mobile and relatively independent and who require a keen assessment and more gentle touch with medical management. She enjoys meeting people with so much life experience along with all of their family members who are so dedicated to their care. Kim is fortunate in that she has an extremely supportive medical group who are very motivated about the PA profession and active expansion of this role at Concordia Hospital.
In her practice, Kim routinely meets patients and families who have no idea what a PA is, how they are trained, the history of PAs in Canada, or their scope of practice. The feedback is always positive as patients and families are happy to see someone advocating for them and who are available to discuss updates, medical plans and their concerns. Patients have often asked if they are able to follow up with Kim directly once they are in the community but unfortunately this is not currently within her role.
Kim’s desire is to see the PA profession further advance in Manitoba and across Canada. Initially in Manitoba the PA role was intended specifically for hospital and surgical settings. More recently PAs have been incorporated into other areas such as family medicine. This expansion is already a significant progression for the profession. Kim is proud to be a member of the PA community in Manitoba and has great satisfaction in knowing that she is making a difference in improving access to patient care in her community.