I’m going to jump on in here. So, what is a PA? What do we do? What are we not?
To paraphrase the website for The Canadian Association of Physician Assistants, PA’s are highly trained health care professionals that work in collaboration with a physician or group of physicians as an extender of their capabilities. They provide a high quality of care to patients in a variety of settings and under varying levels of direct and indirect supervision. Their scope of practice is dependant upon their supervising physician’s specialty and comfort levels with the procedures they’re able to perform. In order to receive the post-nominal of CCPA (Canadian Certified Physician Assistant), a national certification exam must be passed and a minimum number of continuing education credits must be logged annually.
PA’s in Canada were originally from the military or trained in civilian programs in the US, where PA’s have been practicing since the Vietnam War…and those original PA’s were largely ex-military medics. The Canadian Armed Forces program at CFB Borden, Ontario, evolved into a two year program, much like our American counterparts’ schooling. This program became the model for 3 other ones at civilian universities. They are at the University of Manitoba, McMaster University and a consortium of the University of Toronto and the Northern Ontario School of Medicine. There are PA’s currently working in Manitoba, Ontario, New Brunswick, Alberta, and in remote mining/drilling camps. PA’s are regulated by the Colleges of Physicians and Surgeons in Manitoba, New Brunswick and Alberta. Military PA’s in Canada are chosen from the Medical Technician trade to become PA’s as a matter of normal career advancement, and generally have a minimum of 8-12 years experience before starting school. Civilian Canadian schools have varying degrees of requirements for type and duration of prior health care experience, whereas most US institutions require a minimum of 1000hrs.
The two years of school are quite gruelling. The first year is basic medical sciences, study of diseases at all life stages, the various major medical specialties, physical examinations entailed with each organ system, occupational and population medicine for the military folks and special population medicine for the civilian programs. Part of our occupational health in the military included basic preventative medicine skills, including kitchen and building/quarters inspections. Second year is full of clinical rotations – family medicine; internal medicine; pediatrics; general, urologic and orthopedic surgery; psychiatry; obstetrics and gynecology; ear/nose/throat medicine and surgery; emergency medicine; trauma medicine and surgery. There is a lot of knowledge to take in all at once – hence the title “Fed By The Fire Hose”…I always felt all I was doing was just studying for the next exam. You open wide, and either hold your ground and drink or get blown away. My class lost 3 people along the way and another failed the final round of exams.
Once I graduated, I wrote my national certification exam and was posted to Victoria BC. While there, I had the opportunity to take my Basic and Advanced Diving Medicine courses offered through the CF School of Operational Medicine in Toronto and worked off and on in the undersea medicine field and primary care at CFB Esquimalt. PA’s also are able to take the Basic Aviation Medicine and Flight Surgeon’s courses as well.
PA’s were embraced by Manitoba roughly 10 years ago to help assist physicians and patients alike to decrease waiting lists for surgeries and in emergency department waiting rooms. Currently, PA’s in Manitoba are practicing in emergency medicine, orthopedic, general, plastic, neurologic, and cardiothoracic surgery, oncology, family medicine, internal medicine and psychiatry. I was originally hired to work as a pilot project in a small town as the main provider in a family medicine clinic and a personal care home with my supervising physician normally about 30 km away – we had direct supervision hours a couple times a month and I did some ER shifts to add to that. My charts were audited and signed off electronically via the electronic medical record shared with our clinics. He’d help with tougher cases and with those that I wasn’t legally allowed to prescribe medications for. I worked there for three years before taking my current position working solely in emergency medicine for the past year.
My job at work is to see patients of all acuity levels in my ER – I’ll interview, examine, order appropriate labs and imaging, initiate treatment. I’ll discuss what’s happening with my attending of the day, and then discharge, admit and refer as needed. This includes prescribing necessary medications within my formulary – I legally cannot sign for hard narcotics for prescriptions leaving the hospital. I can do certain procedures – suturing, casting, removal of foreign bodies, catheters, IV’s and other invasive line insertions, manage airways. When I was in family medicine, I had normal office hours where I saw appointments, managed people’s chronic and acute health issues and looked after the residents of a small personal care home that was attached. If I encountered something unusual or out of my scope, my supervising physician was immediately available by phone or text. As noted earlier, my supervising doc would also come out periodically to see patients outside of my scope for prescriptive authority or for those that needed a second set of eyes.
I suppose lastly I should answer that question of “What are we not?. I’m not a Nurse Practitioner – they are RN’s that have completed extra training, have their own licenses and scopes of practice. While some PA’s may at one time have been RN’s, they aren’t NP’s. Our licenses are tied to a contract of supervision with a physician/physician group. Another frequent question I get is “When are you going to be a doctor?”. I answer never unless I feel really masochistic and decide go to medical school and that my training is actually complete. Lastly, I make a point of introducing myself by my first name and that I’m a PA working with Dr X…I’m not allowed to let people think that I am in fact an MD, and in fact correct people that call me “Doctor”.
Here are links to two Canadian PA websites.
Canadian Association of Physician Assistants
Physician and Clinical Assisants of Manitoba
Will talk with you all later.