Health-care workers face wrenching decisions on how to care for COVID-19 patients

Doctors and other health-care professionals on the front line of Canada’s battle with COVID-19 are facing some of the most challenging decisions caregivers have to make.

Maureen Taylor, a physician assistant specializing in infectious diseases, is caring for COVID-19 patients at Michael Garron Hospital in Toronto.

The ward is normally dedicated to respiratory and oncology patients, but these days it’s given over to COVID-19 patients who aren’t receiving intensive care — including those who aren’t well enough to benefit from a ventilator or other intensive treatments…read more and listen to this episode of CBC’s White Coat, Black Art.

To fight COVID-19, remove barriers for Ontario’s physician assistants

Dear Minister Elliott and Deputy Minister Angus,

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

We are writing today to propose policy solutions that will allow Ontario to strengthen our health workforce capacity, mitigate the loss of health care professionals to self-isolation, and meet the demand for skilled health care professionals during a surge in COVID-19 cases.

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

The attached briefing note describes our proposals in full, but they include:

  • A temporary order by the CPSO to allow PA oversight and the delegation of acts to be determined at the practice level by supervising physicians, in consultation with hospital medical leadership where necessary, without penalty.
  • The creation of temporary new fee codes or modifiers that would allow physicians to bill at a discounted rate for services and procedures rendered by PAs.

CAPA is not alone in proposing solutions to mobilize the PA workforce during this pandemic. Last month, the state of New York issued an executive order to modify laws governing PAs. Elsewhere in the United States, two other states issued executive orders related to PA oversight and COVID-19, and 14 states had previously updated their laws to relax these requirements in emergencies or disasters.

Here at home, we have seen your Ministry act quickly to address the crisis, from introducing new fee codes to support virtual care to launching efforts to recall retired health care workers back to service. With officials projecting that Ontario could be dealing with the effects of COVID-19 for up two years, now is the time to consider additional policy measures that will effectively strengthen our health system over the long term.

Today, CAPA submits our recommendations in the spirit of collaboration and innovation. We strongly believe that by enacting our proposed measures now, doctors, hospitals, and other health care organizations can improve coverage, efficiently use skilled and flexible 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, commitment, and compassion during this very difficult period.


Leslie St. Jacques, CCPA

Sahand Ensafi, CCPA
Provincial Director, Ontario

Patrick Nelson
Executive Director

c.c.       Mr. Anthony Dale, President and CEO, Ontario Hospital Association

Dr. Sohail Gandhi, President, Ontario Medical Association

Mr. Allan O’Dette, Chief Executive Officer, Ontario Medical Association

Dr. Nancy Whitmore, Registrar and CEO, College of Physicians and Surgeons of Ontario

Dr. Brenda Copps, President, College of Physicians and Surgeons of Ontario

Mr. Patrick Dicerni, Assistant Deputy Minister and General Manager, OHIP

Ms. Rana Shamoon, Director, Health Policy, Office of the Premier of Ontario

Remote Learning Resources and COVID-19 Content from AccessMedicine

In response to the COVID-19 outbreak McGraw-Hill has created new content to help support students, faculty, and residents.

“COVID-19 Central” on AccessMedicine

COVID-19 Central” is hosted on AccessMedicine and free to use (no subscription to the medical platform to access this content).

“COVID-19 Central” will be a source of weekly updated developments and analysis in clinical medicine, public health, and industry and will be aimed at healthcare professionals, trainees, students, and librarians.  It will be open to all, regardless of Access subscription status. It will have daily contributions and resources from across the McGraw-Hill author and specialist professional community. As you may be aware, Dr Anthony Fauci is the leading spokesperson to the US government on COVID-19 and is also one of the editors of Harrisons Principles of Internal Medicine.

Distance Learning by Using AccessMedicine

A distance learning toolkit is available to help support students, faculty, and residents. With face-to-face classes now suspended, the resources listed below will serve as useful guides in making a shift from in-person to virtual classrooms. These may be shared freely with faculty, learners, and staff.

  1. Using Access to Support Distance Learning
  2. Guide to Online Resources via AccessMedicine
  3. AccessMedicine video overview of resources for distance learning
  4. AccessMedicine video overview of functionality which can enhance distance learning
  5. AccessMedicine distance learning LibGuide

In addition to these resources, there are also content maps available online. Content maps are documents that take curriculum standards from the various professional healthcare education specialties (i.e., undergraduate medical education, advanced practice nursing, physician assistant, physical therapy, pharmacy, etc. . . ) and match them with resources available to meet those standards from Access sites.

Support For PAs During HESA’s COVID-19 Briefing

Dr. Alan Drummond, a Perth emergency physician and Co-Chair of the Public Affairs Committee for the Canadian Association of Emergency Physicians, is well-known for his advocacy in health care. He speaks passionately about violence in the emergency department, gun control, and the challenges in rural medicine.

He is also a long-time champion of PAs and recently spoke about the need to remove regulatory barriers for both PAs and community paramedics in testimony delivered to the House of Commons Standing Committee on Health (HESA) during its April 7 Briefing on Canada’s Response to the Outbreak of the Coronavirus

When asked about the restructuring of health care and current limitations, Dr. Drummond specifically described PAs as a workforce that is able to help, but facing restrictions that limit our contributions.

You can listen Dr. Drummond’s clip about PAs here, and listen to the full briefing here on ParlVu.

CAPA Letter to PEI Health Minister

Dear Minister Aylward and Deputy Minister Spidel,

I’m writing on behalf of the Canadian Association of Physician Assistants as a follow up to our meetings last fall regarding the integration of physician assistants (PAs) in Prince Edward Island’s health system. At the time, your Government was working towards introducing the PA model at the Queen Elizabeth Hospital Emergency Department and reviewing legislative options to formally integrate the profession.

COVID-19 Policy Implications

We appreciate that the provincial response to COVID-19 is now your top priority, and as you consider measures to address health workforce capacity, the loss of health care providers to quarantine, and the well-documented demand for health care professionals, we encourage you to include PAs in your pandemic planning to realize short and long-term benefits.

In their recent federal recommendations, the Canadian Medical Association called for the elimination of barriers that stop health care workers from delivering care where it is most needed:

“In this time of public health crisis, the federal government must ensure that regulatory barriers do not prevent health care providers from delivering care to patients when and where they need it. Many jurisdictions and regions in Canada are experiencing significant shortages in health care workers.”

CAPA strongly supports this opinion. We believe that provinces should take similar steps to allow “all hands on deck” during this crisis and facilitate the recruitment of PAs over the next year, and potentially sooner.

Regulatory Relief for PAs

A critical measure that can help boost local workforce capacity is your immediate collaboration with the College of Physicians and Surgeons of PEI to authorize physician oversight of PAs in the province.

PAs are “physician extenders” and work as advanced practice clinicians under the supervision of a licensed doctor to provide primary, acute, and specialty care. Manitoba and New Brunswick, where PAs are regulated under provincial physician colleges, provide a roadmap for how physician oversight can effectively function. In the Canadian Armed Forces PAs often operate as senior medical leaders, both domestically and internationally, and the CAF can offer an example of oversight that can be quickly replicated.

By shifting medical tasks to PAs, through substitution or delegation, physicians are freed up for more complex care. The PA model allows for the efficient reorganization of the workforce and, thanks to the versatility of the PA scope of practice, provides one viable solution for improving coverage, efficiently using human resources, and increasing capacity.

Ready To Serve

Right now PAs across Canada are with doctors, nurses, pharmacists, and many others at the frontline of this pandemic. They are helping to manage COVID-19 screening and testing sites, managing isolation areas where respiratory illnesses are screened and treated, and helping manage emergency departments, critical care units, and surgical wards.

During this time when PEI is exploring policy measures to respond to COVID-19, CAPA strongly believes that integrating the PA model is worthy of serious consideration.

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

Thank you for your consideration and for the important work you are doing to protect the health and wellness of Islanders. I look forward to hearing from your office soon.


Patrick Nelson
Executive Director

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