Physician Assistants Optimizing Patient Care

1. Physician AssistantsOptimizing Patient Care

2. Presentation Objectives • What is a PA? • Scope of Practice • PAs in Canada • The Impact on the Health Care System • The Value of PAs • Obstacles to Advancement of the Profession

3. What is a PA? • A Physician Assistant is a health care provider who extends the hand of the supervising physician • The profession was developed within the Canadian Forces to provide full spectrum medical care as part of a physician led team • PAs are trained under the medical model

4. What is a PA? • A dependent practitioner who works under the delegation of a supervising licensed physician • Can be entrusted to make certain decisions and to carry out certain actions autonomously • The PA is not intended to supplant or substitute the physician as the principal medical decision-maker • PAs working with the supervising physician can enhance access to quality care for patients

5. Scope of Practice • PAs in Canada have been formally trained and educated to meet the national standard set by CAPA • The National Competency Profile and Scope of Practice was developed in conjunction with the CFPC, CMA, and RCPSC • PACCC administers and maintains the PA certification process

6. What Can a PA Do? Duties Generally Performed by PAs • Medical histories and performing comprehensive physical examinations • Complete admission and discharge procedures for hospital stays • In some cases, refer patients for consultation with specialists • Preventative health counseling • Order and interpret laboratory tests, X-ray, and other diagnostic investigations

7. Duties Generally Performed by PAs • Assist the physician in developing and implementing a patient management plan • Record progress notes in isolated and in-patient care settings • Perform and interpret common laboratory, radiological, ECG, and other routine diagnostic procedures used to identify patho-physiological processes • Prescribe medication in accordance with medical directives and local legislation • Surgical Assist

8. PAs in Canada • There are upwards of 300 Physician Assistants practicing in Canada in both civilian settings and within the Canadian Forces • 4 provinces recognize PAs as a profession • 4 nationally recognized reputable academic institutions offer PA programs • In the US there are almost 85, 000 PAs practicing in health care settings and 156 accredited programs

9. PA Accredited Programs • Canadian Forces Health Services Training Centre • University of Manitoba Physician Assistant Education Program • McMaster University Medical Sciences PA Program • Consortium for PA Education (combination of the University of Toronto/Northern Ontario School of Medicine/Michener Institute for Applied Health Sciences)

10. Benefits to the Health Care System • Today 4.5 million people in Canada do not have a regular medical doctor (“Canadian Community Health Survey”, Statistics Canada) • PAs have been shown to enhance the delivery of care, improve access for patients and reduce wait times • PAs can manage up to 62 % of all patients in emergency care and 75 % of all visits in primary care without referral to physician level care (“Staffing primary care in 1990: physician replacement and cost saving”, Schweitzer & Record)

11. Benefits to the Health Care System • In orthopaedics PAs can increase the volume of primary joint procedures by 42 % a year and decrease wait times for surgeries by 14 weeks (“Experience with physician assistants in a Canadian arthroplasty program”, Bohm et al.) • PAs in Emergency Departments can reduce wait times for patients by 1.9 times and cut the “left without being seen” rates by half ( “Impact on patient flow after the integration of nurse practitioners and physician assistants in Ontario emergency departments”, Ducharme et al. )

12. The Value of PAs • Integrating PAs into health care will increase the level of service for patients and address the challenges that exist within today’s health system • Collaborative approach that reduces the workload placed on the team and the physician • The PA profession is designed to work in a team-based setting which fosters inter-professional collaboration among other health care providers

13. Obstacles to Advancement • Lack of familiarity with the PA role and Scope of Practice • Absence of a funding model(s) • Recruitment and integration of PAs • Liability insurance and coverage for the PA (“Barriers and Benefits to Hiring a Physician Assistant", Taylor et al.)

14. Funding • There is no universal model for funding for PAs • Funding for PAs varies dependent on the setting and location • Typically PAs are funded through the government or directly through the physician

15. Future of the Profession • The benefits to the health system are proven • It is essential to create a funding structure for physicians to employee PAs • Must remove the other barriers to employment • Need to educate stakeholders on the benefits of the profession

16. Conclusion • Physicians are optimistic about the PA profession • The value that PAs bring to the health system is evident • Without the support of local and provincial governments and other key health organizations the profession could become stagnant • We need your support

17. Questions?